If Batman ended up in an Arkham Asylum cell, would he be deemed "normal," or would the Gotham facility known for housing the "criminally insane" keep him under lock and key?

In an episode of Batman: The Animated Series called "Dreams in Darkness," the Dark Knight's worst nightmare may have come true when he finds himself being evaluated by psychiatrist Dr. Bartholomew at Arkham Asylum. The doc asserts that Batman is very "ill" and that the one place where "costumed persons with delusional personalities come to find compassionate help" seems like the best place for him. Fighting the onset of paranoid delusions and vivid hallucinations, Batman struggles to reveal the real cause of his insanity: The Scarecrow.

In this episode of The Arkham Sessions, we discuss the experience of being hospitalized for psychiatric reasons, the dangers of labeling people with disorders, and the feelings of dehumanization sometimes perceived by patients in the mental health care system.

The Scarecrow: Genius in the Field of Neuropsychiatry 

In this BTAS episode, medical doctors identified a type of brain abnormality in a patient exposed to Scarecrow's fear gas. His chart stated that he was "hallucinating wildly due to the massive fear reaction of the amygdala (pronounced ah-MIG-dah-la) in his brain." Turns out, the Scarecrow was tapping into the correct brain function: recent studies published more than ten years after this episode aired found direct links between the amygdala and paranoid symptoms in patients with schizophrenia. Gotham's most-feared villain was right all along! Minds blown! Amygdalas blown!


Why Psychiatric Holds? 

All states in the U.S. have laws that permit involuntary psychiatric hospitalization, which refers to non-criminal commitment of a mentally ill person in a facility, as depicted in the BTAS episode "Dreams in Darkness." Persons are typically held in psychiatric holds because they are a danger to themselves, a danger to others, or deemed gravely disabled due to their mental illness. The hold is intended to keep the patient (and others safe), but also allows for appropriate evaluation, testing and care planning. "Dreams in Darkness" raises important questions related to safety: Does keeping Batman locked down at Arkham ensure his safety at the risk of endangering all the citizens of Gotham?


On Being Sane in Insane Places

One of the most startling moments in "Dreams in Darkness" is the dismissal of Batman's plea for his release from Arkham Asylum; despite his insistence that he is psychologically healthy, his mental health provider remains suspicious and interprets his concerns about the Scarecrow as delusions.

"Why don't you believe me?" Batman asks his treating psychiatrist, desperately.

The feeling that one is not heard or trusted is an experience many inpatient individuals may feel. In some cases, just like Batman, patients are pathologized (treated as psychologically abnormal when they are healthy, or being reduced to their diagnostic label in a way that is dehumanizing). In fact, doctors and psychiatrists are more likely to make the error of calling a healthy person sick than to diagnose a sick person as healthy.

The article "On Being Sane in Insane Places" describes the Rosenhan experiment, a famous psychology study from the early 1970's that revealed the over-use and unreliability of labels in the mental health care system. As part of the experiment, healthy participants showed up at mental hospitals pretending to be suffering from hallucinations. Shortly following admission into the facilities, they immediately stopped showing signs of hallucinations. Despite their healthy presentation, they were kept at the facilities for a long period of time (up to 2 months in one case), and were judged by mental health professionals to have impairments that they actually did not have. The original 1973 paper, both fascinating and provocative, can be found here.

At the end of the "Dreams in Darkness," Bruce Wayne reveals his own experience of being "sane in insane places." After having escaped from Arkham, he lays in bed inside a recovery room within the Batcave. As Alfred leaves him to heal, Bruce tells him he finally feels "safe," and what's unsettling about this scene is that he is in place where most of us would feel unsafe: The emptiness of a cave, the floating shadows of bats, the loneliness under the city. It’s as if Bruce is saying he’s living in a crazy world but acknowledges he’s exactly where he needs to be -- and who he needs to be -- in order to feel sane within that world.


More episodes of The Arkham Sessions can be found on iTunes as well as on  Under The Mask. Dr. Drea can be found Twitter at @ArkhamAsylumDoc. Brian can be found at @Bward028. The Arkham Sessions’ official Twitter feed is @ArkhamSessions.

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