Review of Literature to Examine Representations of Mental Illness in the Media

The following is a literature review completed for Research for Strategic Communication at American University’s School of Communication. The report was compiled for a fictional production company, by a fictional research company.

TABLE OF CONTENTS:

Background
Executive Summary
Depictions of Mental Illness in the Media
From the Media to the Masses
Potential for the Media
Preliminary Proposals for the Structure of the Program
Summary of Literature Review
Sources Cited

I. BACKGROUND

Starting in 2015, Komorebi Productions began preliminary work on a large scale television series about mental illness in American society and the issues facing those affected by it. This purpose of this multi-disciplinary series will be to explain the topic systematically, ethically, and compassionately, using lessons from popular science journalism and media to effectively communicate the causes and effects of mental illness, paired with discussions with people who experience mental disorders. The series will also address the issue historically, tracing the roots of modern treatments, perceptions, and stigma to their sources and working to respectively alter and reduce the latter two.

In late September of 2015, Komorebi Productions selected Bottlegreen & Lowe, a Washington D.C.-based communications firm which specializes in media research and outreach to create a report on the current status of representation for, and public perception of, mental illness within the media. The development team at Komorebi Productions gives equal weight to the goal of developing a program which can educate and engage the public on this issue, and also the imperative of proving that popular media is capable of interacting dynamically and sensitively with the topic of mental illness without indulging in the sensationalism, stereotype or infantilization around which most contemporary depictions are based. This report will provide the producer and writers of the series with the requisite background for their endeavors.

To that end, Bottlegreen & Lowe compiled a review of the literature surrounding portrayals of mental illness in the media, the stigma related to, and often caused by these portrayals, and the effects on the public and those suffering from mental illness. The firm also generated a few extremely preliminary structural proposals for the development team at Komorebi Productions, to be expanded on at a later date. Overall, this report will:

Examine key cases of popular media (film and television) which portray mental illness,
Look at the accuracy of these portrayals,
Study the impact these depictions have on Americans with and without mental illness,
Suggest whether or not popular media can be used as a platform for positive change with regard to the way mental illness is shown,
And if so, what strategies Komorebi Productions should implement in order for them to meet their goals for the series.

The sources examined were compiled or written within the last ten years, and the report examines media that was created since the millennium exclusively because for the purposes of Komorebi Productions, contemporary research was paramount.

The Komorebi Productions team indicated that while the two subjects are closely related and often grouped together, for the purposes of this report, suicide and mental illness should be considered separate topics.

II. EXECUTIVE SUMMARY

In an era of increasing political correctness and unparalleled advocacy for historically marginalized or maligned minorities, the words ‘crazy’ and ‘insane’ are still used casually and denigratingly in common speech (PPA, 2004), discrimination toward the mentally ill is commonplace, and the depictions of those suffering from mental illness have hardly moved beyond 19th century caricatures. Smith (2015) cites Link, Phelan, Bresnahan, Stueve, & Pescosolido (1999) that while awareness of mental illness is higher than ever before, stigmatized attitudes toward the mentally ill have also significantly increased. She points to representations of the mentally ill in the media as a key contributing factor in this rise, and every other source concurs. These negative portrayals “often include the idea that they are violent, incompetent, and at fault for their illness” (Smith, 2015).

Komorebi Productions’ upcoming television series is intended to be a part of the movement to change this stigma and the media representations which propagates and reinforces it. However, in choosing to work within the same platform responsible which has had such a negative effect on the experiences of those affected by mental illness, the production company acknowledges the potential to repeat or reinforce the same stereotypes they desire to undo. In order to accomplish their goal of ethically yet engagingly representing mental illness, Komorebi Productions commissioned research into the current state of media portrayal of mental illness, and how the public has come to understand mental illness through the media.

Literature suggests that mental illness is not only portrayed inaccurately by popular, mainstream media, but also that these depictions focus mostly on violence, reinforce and augment stigma and discrimination toward mental illness. These depictions have extreme negative effects on people affected by mental illness, both on a personal level, but also in the realm of policy, and their ability to become a productive member of society (Stuart, 2006). The public is also negatively impacted because they internalize these false perceptions of the mentally ill, which may eventually prevent them from acknowledging, or seeking help for a problem related to mental health. Smith (2015) cites the World Health Organization’s 2001 report that 20% of the population will suffer from a mental illness each year. The stigma surrounding mental illness, fed by negative portrayals in the media, has kept many, many Americans from obtaining the treatment they need (Smith, 2015). Potential examples of the ramifications of this appear far too frequently in the news.

III. DEPICTIONS OF MENTAL ILLNESS IN THE MEDIA

While there is no shortage of news stories involving the mentally ill, fictional television and film gives mental illness a significant amount of coverage as well. Wikipedia offers a far from comprehensive list of over 400 films that heavily feature various varieties of mental illness, ranging from schizophrenia and depression to the full spectrum of personality disorders and PTSD. Within these films, varying degrees of weight are placed on the disorders, with some being of the utmost importance, such as Lars Von Trier’s self-explanatory 2014 film, Nymphomaniac. Television is no different. The last decade has seen shows ranging from “Monk”, which literally bore the tagline of “Obsessive. Compulsive. Detective,” and 2014’s quickly-cancelled “Black Box” about a famous neurologist coping disastrously with manic depressive disorder, to 2011’s “United States of Tara” which examined the life of a artist/housewife with dissociative identity disorder, formerly known as multiple personality disorder.

Primetime shows like these draw their central conflicts and entertainment value from the mental illnesses themselves; these disorders are vividly present in each episode and often form core plot points, both for the seasons or series on the whole, but also within each episode. Many other recent shows use diagnoses as core themes, even if they are not as central to the program. An example of this variation is the BBC’s contemporary update “Sherlock”, in which the title character is repeatedly (self- or otherwise) diagnosed conflictingly as either a ‘psychopath’ or a high-functioning sociopath.

Non-primetime television also features a high incidence of portrayals of mental illness. Brawley (2003) cites Fruth and Padderud (1985) that:

“A systematic analysis of daytime serials on television found that half of them included a character who was mentally ill; 75 percent of the characters who were ill were women; 75 percent were involved in criminal activity of one type or another; and those male characters who were mentally ill were portrayed as dangerous”

In the Wikipedia ‘List of Films Featuring Mental Disorders’ there are almost 100 films alone which feature Antisocial Personality Disorder, which is most often associated with violent behavior. ‘Dexter’ is a particularly well-known example of this, in which the main plot of the show is the title character going about an extremely normal daily life, while using his bloodlust for the good of society as a slightly-tamed serial killer by night. The series does a good job of building sympathy for this character, but the fact remains that America’s fascination with ‘insane,’ emotionless serial killers does a great deal of harm for the mentally ill.

Television and film are almost exclusively for-profit entities, and by their definition necessitate entertainment; these sensational and frightening versions of mental illness are as riveting as they are misleading. Citing numerous crime studies, Smith (2015) explains that “mentally ill individuals are no more likely to commit a crime than another person.” Therefore while in reality there is very little correlation between mental illness and violent crime, 70 percent of mentally ill characters in prime time drama were depicted as violent, and more than 20 percent committed murder (Brawley, 2003). Therefore, if a person with mental illness is shown in the media, they are probably being depicted as a violent, unpredictable source of fear, or as a criminal. This has important and devastating consequences for people living with mental illness. As Oostdyk (2005) notes, “sensationalized stories result in misinformation” which cause “the public to react with fear and anger when faced with making decisions about mental illness in their community.”

Smith (2003) investigates another stereotype in media depictions of the mentally ill which negatively impacts their real life equivalents: that of the societally-irrelevant, isolated loner. She cites a study by Rose (1998) which found that mentally ill characters are filmed in such a way as to emphasize their isolation (using disconcertingly close shots, or ones in which they are always alone) which “creates the stigma that mentally ill individuals are solely defined by their illness” and that “individuals with mental illness are inferior and not important.” Oostdyk (2005) examines a study that found that the more television programming depicting the mentally ill was watched, the more superior people without mental illness felt toward those affected by it. Smith (2015) then links this to a view of the mentally ill within the media as failures, which is extremely disheartening for people struggling to get better in the real world as they deal with these disorders. She ultimately suggests, and finds research to support, the idea that this stereotype propagates a kind of self-fulfilling prophecy “in which those with mental illness think they are supposed to be a failure, and thus give up on themselves and their goals” (Smith, 2015). This self-defeating behavior may be inspired by fictional scenarios, but it has extremely real consequences for the success or failure of a treatment, and therefore quality of life.

However, it is not only the visual and narrative portrayals of the mentally ill that do damage to them and increase stigma, but also the language within the media used to describe them. The PPA’s 2004 report on the portrayal of suicide and mental illness inventories a wide variety of language used to describe mental disorders and those affected by them on television. These words or phrases range from comparatively sensitive, like ‘suffering’, ‘victim’, and ‘afflicted’ to ‘unstable madman’, ‘psychotic killers’ and ‘wacko standoff’ (PPA, 2004). The majority of phrases and words like these are extremely charged and often highly offensive to people with mental illness, and hearing them in the media makes it more likely that the people around them will use such language towards them in real life.

As the range of this language indicates, Western society has a long, fraught history of stigma against the mentally ill, which only in the last fifty years has truly, if not completely, departed from the long tradition of institutionalization in horrific or abusive conditions. Even this aspect of mental illness has filmic interpretations, from 1975’s One Flew Over the Cuckoo’s Nest, to 2011’s sadistic Sucker Punch, in which the main character, unjustly institutionalized, slips into ever more fantastical dreams to escape the reality of her impending lobotomy and the near-continuous rape she is subjected to by the guards before the procedure, and, presumably, after. It is worth noting that in these films, as in 2010’s Shutter Island, and many other films that actually take place inside asylums, the main character almost always is sent there by mistake, as a visitor or unjustifiably, but by the end receives the same treatment and hopeless life sentence as everyone else.

Violent, dangerous forms of mental illness do exist, and institutionalization is the best option for some people, yet these films propagate a fear of institutions and the people within them that verges on a phobia of the unclean from caste systems: to touch them, and live among them, is to become them. People who have never experienced mental illness fear it, and therefore the people who are affected by it. This persistent trope of otherness exists in society, and as Brawley (2003) notes, the mass media cannot be held “totally or even primarily responsible” for the crippling discrimination and stigma facing people with mental illness. Still, depictions like these reflect and magnify to a stage of millions that deep-seated fear and mistrust.

Stuart (2006) points out that this leads to stigma and discrimination that “limits help-seeking behavior, medication adherence and illness recovery.” This stigma is also not limited to people without mental illness. Many depictions of the mentally ill in the media convey the idea that “they are not supposed to be a member of society” (Smith, 2015). While this has obvious implications for how people without mental illness treat those who are affected by it, Smith (2015) also examines a kind of self-stigma that can develop among the mentally ill, making them feel that they really are the outcasts they are depicted as. Again, this has disastrous consequences for the success of treatment.

IV. FROM THE MEDIA TO THE MASSES

It is possible to trivialize the depictions of mental illness outlined above as restricted to the realm of fantasy, and therefore having little to do with the concrete reality of real people suffering from mental illness’s experience, or the policies that determine the funding (or lack thereof) for their care and treatment. However, Brawley (2003) notes,

“There can be little doubt that public misconceptions, fueled by distorted media messages, have caused the unnecessary hospitalization of significant numbers of mentally ill people and that others have been added to the growing homeless population nationwide because of a lack of suitable community residences and treatment facilities. The stigmatizing effect of mental illness, which is exacerbated by media images, also results in discrimination in access to employment…”

The media introduces the public to topics which they have not personally encountered in their daily lives, and shapes the way they view those issues that they have witnessed firsthand. Whether people receive their initial encounter with the mentally ill on television, in a movie, or in person, the media’s messages about the experiences matter, and seem to stick. How mass media frames an issue will impact the public discourse around that topic, change community engagement with it, and in turn policy decisions in relation to it (Brawley, 2003).

As Friedman’s 2008 article notes, another serious issue with media representation of mental illness is the perception of the disorders themselves. The media often presents mental illness as “unremitting and untreatable” when many major mental disorders are in fact treatable, with better response rates to treatments than common non-psychiatric medical illnesses (Friedman, 2008).

Finally, non-fiction (news) media also focuses on violence when depicting the mentally ill. News has not been the primary focus of this review of the literature, but it does contribute to the stigma and discrimination people affected by mental illness face. Even when mental health professionals and other experts are involved, as Friendman (2008) notes,

“Media coverage of mental health has relied too heavily on a small cadre of experts, like psychiatrists, psychologists, and policy-makers. The virtual exclusion of the voices of mental-health consumers in the press gives the public the misleading impression that the mentally ill are too disturbed and dysfunctional to speak for themselves”

Therefore another significant change that needs to be made when attempting to depict mental disorders is the involvement of people who have had firsthand experience with those disorders. This has applications not only within the field of news, but should also be considered for fictional programs and films as well, in which people who have faced a particular mental illness work as an expert and consultant on whatever project wants to depict their disorder. From giving the actors a more accurate source to draw from, to inspiring the show-runners or filmmakers to show more respect for the subject, involving people with mental illness in media productions could have long-reaching positive effect, for the success of the project, and also for the success or continuing success of the consultant’s recovery.

V. POTENTIAL FOR THE MEDIA

As outlined above, the image of mental illness and those affected by it in the media is almost overwhelmingly negative, for both the public or for those it pretends to accurately represent. For this reason, many people with mental illness and mental health professionals have their doubts about using the same platform which has done so much damage to try and repair that harm.

“Whether or not the mass media can perform public service and public health functions is a matter of some debate among media scholars” (Brawley, 2003)

However, Brawley (2003) explains that the media is too important an asset to the potential solution of the problems that they contribute to to be ignored, and too essential a component to the world in which we live and devour information to be put aside. There is no alternative. He also notes that there is a strong desire among broadcasters and media professionals to work with mental health professionals to improve the depictions and characterizations of the mentally ill, both for moral reasons, and also for legal and financial ones as well. Fine (2009) discusses the increased use of such mental health professionals as consultants on fictional television series like “United States of Tara”, even though sometimes the show-runners choose entertainment value over commitment to reality.

Brawley (2003) also touches on the success of utilizing the prestige of public figures to promote more accurate depictions of mental illness, such as the work of President Jimmy Carter and his wife on behalf of Emory University’s Rosalyn Carter Center. There are also institutions like Mediascope, which promotes constructive media depictions of health and social issues (Brawley, 2003). Also as Fine (2009) notes, there are now many watchdog organizations which focus exclusively and attentively on media portrayals of mental illness, and “don’t hesitate to complain when a depiction veers toward stereotypical or is overly negative.”

However, fictional television and film do have the capacity to act as their own hair of the dog, and correct many of the stereotypes they propagate. Even some of the programs and films outlined above work at building sympathy through understanding, and as Stuart (2003) notes, in the hands of mental health professionals, films like 2001’s A Beautiful Mind can engender positive public discussion “designed to promote greater understanding of mental illness and greater compassion for the mentally ill.”

Moreover, as Stuart (2003) also observes, the time is right to shift

“…Attention away from any further cataloging of media representations of mental illness to the more challenging prospect of how to use the media to improve the life chances and recovery possibilities for the one in four people who live with a mental disorder”

There is no shortage of films or television that interact (usually badly) with mental illness, but there is also no shortage of academics and academic papers trying to further inventory that ever-growing list. Resisting the urge to catalogue these atrocities, great and small, is a difficult task, as this review of the literature proves. However, it can be hoped that the other list, of contemporary media which treats mental illness with sensitivity and respect, and has the capacity to impart this perspective to viewers, will grow as well. This list, brief though it may be, does exist, and Komorebi Productions’ new project can certainly find a prominent place on it.

VI. PRELIMINARY PROPOSALS FOR THE STRUCTURE OF THE PROGRAM

Bottlegreen & Lowe

A. Collaboration with mental health professionals

B. Letting the mentally ill speak for themselves

C. Endorsing and propagating positive representations

D. Not depicting the mentally ill as incurable, hopeless, or as alienated from society

E. Utilizing prestige from key public figures

VII. SUMMARY OF LITERATURE REVIEW

Literature suggests that mental illnesses are frequently used by the media as plot devices, sensationalism, or shock value.
The majority of these representations of mental illness depict people suffering from mental illness as violent, unstable, dangerous or murderous.
While documented stigma and discrimination toward mental illness has existed for a very long time (if not always) within Western civilization, and therefore American society, the media has propagated these and more deeply entrenched them in viewers.
These depictions of mental illness have a direct, negative impact on the real people dealing with mental illness, mental health professionals, and the families of the mentally ill.
The stigma produced by media representations also have crippling effects on people affected by mental illness because they impact people’s willingness to seek or complete treatment, and also contribute to the discrimination they face.
This stigma also impacts policy makers, both in their personal priorities and perceptions, and also because of the comparatively small advocacy surrounding improved rights, conditions and access to insurance or life insurance for the mentally ill
There is potential for the media to work as a positive platform for change if mental health professionals and people with mental disorders are used as consultants, and the producers of the media treat their subject with respect and work to gain an understanding of the history of the topic.

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VIII. SOURCES CITED

Brawley, E.A. & Brawley, E.E.M. (2003). The Media Role in Marginalizing the Mentally Ill: Taking Corrective Action. Portularia, 3, 285-297.
Fine Maron, D. (2009, January 25). Can Hollywood Get Mental Illness Portrayals Right? Retrieved September 15, 2015, from http://www.newsweek.com/can-hollywood-get-mental-illness-portrayals-right-78421

Friedman, R. (2008, June 20). Media and Madness. Retrieved September 15, 2015, from http://prospect.org/article/media-and-madness

List of films featuring mental disorders. (n.d.). In Wikipedia. Retrieved September 15, 2015, from https://en.wikipedia.org/wiki/List_of_films_featuring_mental_disorders.

Oostdyk, A.M. (2005). Portrayal of Mental Illness on Television: A Review of the Literature (Master’s thesis). University of Pittsburgh Graduate School of Public Health. 1-42.

The Prevention Promotion and Advocacy (PPA) Network Committee and Anti-Stigma/Discrimination Working Group. (2004). Technical Report of a Province-Wide Survey Into the Portrayal of Suicide and Mental Illness. Retrieved September 15, 2015, from http://www.novascotia.ca/dhw/mental-health/documents/media_guidelines_report_ns_jan04.pdf

Smith, B. (2015). Mental Illness Stigma in the Media. Undergraduate Review: A Journal of Undergraduate Student Research, 16(10), 1-14.

Stuart, H. (2006). Media Portrayal of Mental Illness and its Treatments: What Effect Does it Have on People with Mental Illness?. CNS Drugs, 20(2), 99-106.

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