Titicut Follies (1967)

Film Review by Harry Karlinsky, MD, MSc, FRCPC

USA, 1967 Director: Frederick Wiseman

Titicut Follies is perhaps best known as the only American film ever restricted from full public exhibition for reasons other than obscenity, immorality or national security.[1]

Conceived and directed in the 1960s by Frederick Wiseman, a young lawyer turned film director, this 84-minute black and white documentary is a frank and relentless depiction of conditions in the Massachusetts Correctional Institution at Bridgewater, a prison hospital for the mentally ill.

The film’s title is appropriated from the institution’s annual staff-patient vaudeville show, promoted as Titicut Follies within the institution and with the word Titicut stemming from the original Native American name for that part of the country.

Though scenes from the vaudeville show begin and end the documentary, it is in between that the viewer sees the real folly – the indignity and abuse endured by the patients at the institution.

Although Wiseman originally received encouragement and permission from the hospital’s administration to make the documentary, the exhibition of the film was almost immediately challenged in the courts, initially by guards in the facility and then by the Commonwealth of Massachusetts, its commissioner of corrections, and the superintendent of Bridgewater.

The most significant explicit concern of those objecting to the film was the contention that the film violated the rights of the patients at Bridgewater because they were allegedly filmed without their consent.

However, it is hard to imagine that the self-interest of the plaintiffs wasn’t at least equally involved in precipitating the court challenges, an attempt to cover-up the embarrassing, inhumane conditions depicted in the film – mass strip searches, taunted patients, and the indifferent, callous professional interactions with the patients.

One unforgettable scene has a physician’s cigarette hovering over an emaciated patient as naso-gastric tube feeding is cavalierly implemented.

Whether valid consent from the participants was obtained was a legitimate concern. It was Wiseman’s contention that the appropriate permission was obtained from all of the patients portrayed in the film or their legal guardian – the hospital’s superintendant.

There were also conflicting opinions between Wiseman and the institution’s administration over the verbal agreements reached regarding who had the ultimate control over the film’s final content.

The initial court decision was that the right to distribute and show the film was protected by the First Amendment to the American Constitution.

Following an appeal, a subsequent court decision found the movie violated patient rights to privacy and precluded all public screenings. That decision was in turn appealed by Wiseman and, in 1969, the Massachusetts Supreme Judicial Court ruled that the film could be screened but only to a very circumscribed audience – “legislators, judges, lawyers, sociologists, social workers, doctors, psychiatrists, students in these or related films, and organizations dealing with the social problems of custodial care and mental infirmity.”

It wasn’t until 1991 that the ban was finally overturned and the unique (and remarkably elitist!) restrictions were lifted. Those interested in viewing the film can now order the DVD directly from its distributor Zipporah Films, Inc. at www.zipporah.com/films/22.

More than 40 years since its original release, the legacy of Titicut Follies continues to be debated.

At a minimum, it remains a pivotal illustration within the film and legal community of the potential dilemmas in making a documentary, particularly well-meaning exposés involving mistreated individuals who may or may not be competent to provide informed consent.

What is least controversial is the role of Titicut Follies in establishing Wiseman as an elite independent filmmaker. His body of work now reaches almost 40 full-length films and has primarily revolved around the social exploration of various American public institutions, such as High School, State Legislature, and Juvenile Court.

Throughout his career Wiseman has remained a steadfast practitioner of a distinct style of filmmaking that relies on non-narrative observation. Although often described as a ‘direct cinema’ pioneer, Wiseman appears to prefer the term ‘reality fictions’ to describe his work, emphasizing his films go far beyond impassive observation and involve the active manipulation of source material.

The less certain legacy of Titicut Follies is whether it has had a lasting impact on psychiatric care and institutional reform. Changes and improvements at Massachusetts Correctional Institution-Bridgewater did indeed occur within a few years of the film’s release, including a wholesale move to a modern facility.

However Wiseman himself is pessimistic about whether Titicut Follies effected any fundamental transformations, later self-mocking his “naïve and pretentious view that there was some kind of one-to-one connection between a film and social change.”[2]

To anti-psychiatry critics, such as Thomas Szasz, inhumane psychiatric conditions are still all too prevalent, with Titicut Follies being simply a “forgotten story of a case of psychiatric censorship”.[3]

As mused by Szasz, perhaps if Titicut Follies had not been banned for so many years it is conceivable that more significant social reform may have occurred.

1. Anderson C, Benson T.W. Documentary Dilemmas: Frederick Wiseman’s Titicut Follies. Carbondale and Edwardsville: Southern Illinois University Press, 1991.

2. Poppy N. Frederick Wiseman. Salon.com, January 30, 2002.

3. Szasz T. The Titicut Follies: the forgotten story of a case of psychiatric censorship. History of Psychiatry 18(1):123-125, 2007.