A man who suffers from schizophrenia goes on a shooting spree in Times Square and later stabs a pregnant physician in the stomach. These are the opening scenes from Wonderland, a drama set in the psychiatric and emergency room units of a New York City hospital. Premiering in 2000, Wonderland was promptly canceled because of dwindling ratings and heavy criticism from mental health groups (though it was brought back in January 2009).
The series portrayed a bleak life for people with mental illness and groups like the National Alliance on Mental Illness (NAMI) criticized its theme of hopelessness.
But images of individuals with mental illness aren’t always so in your face. Subtle stereotypes pervade the news regularly. Just the other day, a local news program in Central Florida reported on a woman setting her son’s dog on fire. The reporter ended the segment by stating that the woman had been depressed recently. Whether it’s a graphic depiction or an insinuating remark, the media often paint a grim and inaccurate picture.
And these pictures can have a big influence on the public. Research has shown that many people get their information about mental illness from the mass media (Wahl, 2004). What they do see can color their perspective, leading them to fear, avoid and discriminate against individuals with mental illness.
These myths don’t just damage public perceptions; they also affect people with mental illness. In fact, the fear of stigma can prevent individuals from seeking treatment. One study even found that workers would rather say they committed a petty crime and spent time in jail than disclose that they stayed at a psychiatric hospital.
Whether it’s a film, news program, newspaper or TV show, the media perpetuates many myths about mental illness. Below is just a sampling of common misconceptions:
People with mental illness are violent. “Studies have found that dangerousness/crime is the most common theme of stories on mental illness,” said Cheryl K. Olson, Sc.D., co-director of the Center for Mental Health and Media at Massachusetts General Hospital Department of Psychiatry. But “research suggests that mentally ill people are more likely to be victims than perpetrators of violence.” Also, recent research found that mental illness alone doesn’t predict violent behavior (Elbogen & Johnson, 2009). Other variables—including substance abuse, history of violence, demographic variables (e.g., sex, age) and the presence of stressors (e.g., unemployment)—also play a role.
They’re unpredictable. A focus group composed of individuals who affect the lives of people with mental illness, such as insurance executives, was asked what they thought about people with mental illness. Nearly half cited unpredictability as a big concern. They feared that individuals might “go berserk” and attack someone.
Contrary to these beliefs, the vast majority of people with mental illness are ordinary individuals who go to work and try to enjoy their lives, said Otto Wahl, Ph.D, professor of psychology at University of Hartford and author of Media Madness: Public Images of Mental Illness.
They don’t get better. Even when portrayals are primarily positive, we rarely see progress. For instance, the lead character in Monk, who has obsessive compulsive disorder (OCD), regularly attends therapy, but has yet to improve, Wahl said. He believes this perpetuates the myth that treatment is ineffective. Still, if you’re seeing a therapist and haven’t experienced much improvement, you might feel the same way. However, this may mean that it’s time to switch therapists. When searching for a therapist, remember it’s best to shop around. Here’s a good guide that can help with the process. You also may want to research the most effective treatments for your condition and check if your prospective therapist uses them.
Even people with more severe disorders, such as schizophrenia, “can be treated effectively and lead integrated lives in the community if we allow them to,” Wahl said.
If the media rarely show people getting better today, you can only imagine the portrayals a decade ago. When he was diagnosed with bipolar disorder, Bill Lichtenstein, founder and director of Lichtenstein Creative Media, spent almost four years before meeting another person with the illness, because “no one talked about it.” In the 1990s, when he got better, Lichtenstein produced Voices of an Illness, the first show to feature everyday people, including a Yale graduate and a Fortune 500 executive, discussing their illness and recovery. And clearly the need was there: After providing NAMI’s number on the show, the organization received 10,000 calls a day.
Depression is caused by a “chemical imbalance.” Thanks to direct-to-consumer drug ads, many think mental illness treatment is simple and requires only a wonder drug to correct a chemical imbalance, Olson said.
Though there’s a plus side — it squashes the idea that mental illness is a “moral failing,” Olson said — this hypothesis hasn’t been substantiated with research (see here and here) and oversimplifies depression’s causes and treatment.
It isn’t that neurotransmitters are insignificant in contributing to depression; it’s that they’re part of an intricate interplay of causes that includes biology, genetics and the environment. “The more we study the causes of mental illness, the more complex they can seem,” Olson said. Also, “many people with depression are not helped by the first drug they try, and some never find a drug that helps.”
Teens with mental illness are just going through a phase. Movies like the “Heathers” and the “American Pie” series depict alcohol and substance abuse, depression and impulsivity as normal teen behavior, according to Butler and Hyler (2005). The authors also point out that the movie “Thirteen” features substance abuse, sexual promiscuity, an eating disorder and self-injury, but the main character never seeks treatment. Ultimately, these behaviors may be viewed as “a glamorous benchmark to beat.”
All mental health professionals are the same. Movies rarely make distinctions among psychologists, psychiatrists and therapists, further confusing the public about how each practitioner can help. Here’s a detailed look at the distinctions between these professionals.
And they’re evil, foolish or wonderful. Since the 1900s, the movie industry has been crafting its own field of psychiatry, giving the public an inaccurate — and often terrifying — view of mental health professionals. Schneider (1987) categorized this portrayal into three types: Dr. Evil, Dr. Dippy and Dr. Wonderful.
Schneider describes Dr. Evil as “the Dr. Frankenstein of the mind.” He’s vastly disturbed and uses dangerous forms of treatment (e.g., lobotomy, ECT) to manipulate or abuse his patients. Dr. Evil is often seen in horror movies, Olson said. “A surprising number of people, especially teens, get misinformation about psychiatry and hospitals from those films — they’ll lock you up and throw away the key!” Olson described a recent episode of Law and Order: Special Victims Unit where the “greedy and arrogant” psychiatrist who “exploited his patients” turned out to be — gasp! — the killer.
Though he rarely harms anyone, Dr. Dippy “is crazier than his patients,” Olson said, and his treatments range from the impractical to the wacky. Dr. Wonderful — think Robin Williams’ character in Good Will Hunting — is always available, has endless time to talk and is supernaturally skilled. This portrayal, too, has a downside. For one, clinicians can’t live up to this kind of accessibility, Olson said, or to the idea that they’re “supernaturally skilled, almost able to read minds and immediately give accurate profiles of people they haven’t seen,” Wahl said. In fact, to properly diagnose a patient, practitioners conduct a comprehensive evaluation, which often includes using standardized scales, obtaining a mental health history, administering medical tests, where appropriate, and talking with family members (all of which can take several sessions).
Dr. Wonderful also can breach ethical boundaries, making it difficult for people to know what’s ethical and unethical behavior, Wahl said. Williams’ character violates confidentiality by speaking with his buddies about his patient. Plus, “many of these fictional docs lack boundaries between the personal and professional,” Olson said. Films frequently feature psychiatrists sleeping with patients, an egregious violation. Here’s a closer look at the American Psychological Association’s Ethics Code.
TV and Film: The Boring Defense
“People aren’t interested in watching someone with a minor illness go to a self-help group. Just look at ER–they only show the most extreme cases as well,” Robert Berger, Ph.D, the professional consultant for Wonderland, told Psychology Today.
Does showing an accurate portrayal really sacrifice entertainment value? Lichtenstein doesn’t think so. With so many rich, authentic stories of mental illness, having a character stab a pregnant doctor, because that’s the only drama available, “reveals a lazy, uninquisitive mind that doesn’t go below the surface to find where the real story is,” Lichtenstein said. His company produced the highly-acclaimed West 47th Street, which followed four people struggling with serious mental illness at a NYC mental health center for three years. The stories Lichtenstein found were “far more dramatic” than Wonderland’s stereotype-laden series or other films that feature a “limited palette” with violence and antisocial behavior, Lichtenstein said. Using a filmmaking style called cinéma vérité, which excludes interviews and narration, West 47th Street features heartbreak and humor and all the shades of gray in between that accompany real life.
Children and the Media
Adult programs aren’t the only ones that portray mental illness negatively and inaccurately. “Children’s programs have a surprising amount of stigmatizing content,” Olson said. For instance, Gaston in Beauty and the Beast attempts to prove that Belle’s father is crazy and should be locked up, she said.
When Wahl and colleagues examined the content of children’s TV programs (Wahl, Hanrahan, Karl, Lasher & Swaye, 2007), they found that many used slang or disparaging language (e.g., “crazy,” “nuts,” “mad”). Characters with mental illness were typically depicted “as aggressive and threatening” and other characters feared, disrespected or avoided them. His earlier research also showed that children view mental illness as less desirable than other health conditions (Wahl, 2002).
Wahl offered several suggestions for caregivers to help kids go beyond these images:
- Recognize that others can spread misconceptions, including you.
- Examine your own biases so you don’t unknowingly hand them to your kids.
- Gain an accurate understanding of mental illness.
- Be sensitive in how you talk about and behave toward people with mental illness. For instance, avoid using disparaging language.
- Cultivate critical thinking skills. Instead of saying, “You shouldn’t say that,” talk to your kids about what they see and hear. Ask them: “What would you say if you had a mental illness? Why do you think people with mental illness are portrayed like that? Do you know anyone with a mental illness who isn’t like that?”
Become a Critical Consumer
It can be tough to distinguish between accurate and inaccurate information yourself. Here’s a list of strategies:
- Consider the content producer’s motives. “Are they trying to sell you something, or do they have a vested interest in a particular point of view?” Olson said.
- View the news as something “out of the ordinary,” Olson said. Research has found that a violent crime by a person with mental illness is more likely to get the front page than a crime committed by a person without mental illness, Wahl said. Just as we hear more often about plane crashes than car crashes, we hear more about people with a mental illness being violent, Olson said. When a person with a mental illness is involved, it elicits a kneejerk reaction: The person’s disorder automatically becomes the lead of the story, Lichtenstein said. “Few stories address other aspects of mental illness, or show everyday people who happen to be dealing with a mental illness,” Olson said.
It isn’t that newspaper stories are inaccurate; a person with a mental illness might have committed a crime, Wahl said. But people need to avoid making generalizations and understand that the news that’s presented to us is selected. “Everybody’s lives aren’t dominated by fires or crime,” he added.
- Scrutinize studies. If you’re hearing about a new, “breakthrough” study, Olson suggested paying attention to: “who was studied, how many people, for how long and what results were actually measured.” For context, also consider other studies’ findings. The media “very often report a single finding that hasn’t been validated by other studies,” Wahl said.
- Visit reputable websites, such as: Psych Central, NAMI, Substance Abuse and Mental Health Services Administration, Mental Health America, or organizations for specific types of mental illnesses like the Depression and Bipolar Support Alliance and the Anxiety Disorders Association of America.
- Seek a variety of sources. If you need information on the economy, it’s doubtful that you’d turn to just one source, Lichtenstein said.
- Check out first-person accounts. Information from individuals with mental illness and their families tends to be more authentic in terms of experience, though it doesn’t mean it’s more fair, accurate or trustworthy, Lichtenstein said.
Finally, remember that the media aren’t the only source of stereotypes and stigma. Prejudice can come even from well-intentioned individuals, people with mental illness, their families or mental health professionals, Wahl said. “We don’t want people to focus only on the media as scapegoats. Yes, we need to recognize that they’re a leading purveyor since they reach so many households, but we have to look at ourselves, as well.”
Resources and Further Reading
Butler, J.R., & Hyler, S.E. (2005). Hollywood portrayals of child and adolescent mental health treatment: Implications for clinical practice. Child and Adolescent Psychiatric Clinics of North America, 14, 509-522.
Elbogen, E.B., & Johnson, S.C. (2009). The intricate link between violence and mental disorder: Results from the national epidemiological survey on alcohol and related conditions. Archives of General Psychiatry, 66, 152-161.
Schnieder, I. (1987). The theory and practice of movie psychiatry. American Journal of Psychiatry, 144, 996-1002.
Wahl, O.F. (2002). Children’s views of mental illness: A review of the literature. Psychiatric Rehabilitation Journal, 6, 134–158.
Wahl, O.F., (2004). Stop the presses. Journalistic treatment of mental illness. In L.D. Friedman (Ed.) Cultural Sutures. Medicine and Media (pp. 55-69). Durkheim, NC: Duke University Press.
Wahl, O.F., Hanrahan, E., Karl, K., Lasher, E., & Swaye, J. (2007). The depiction of mental illnesses in children’s television programs. Journal of Community Psychology, 35, 121-133.
Psych Central’s list of Anti-Stigma Sources
Fact sheets, articles and research from SAMHSA