Movies are the most engaging form of “mass communication”. Primarily people watch film or television for entertainment, without the intention of being influenced or learning anything in particular. Despite this, television is the medium with the greatest socialization effect, teaching us what is acceptable or taboo in our culture. Movies and television series covering almost every aspect of medical practice have been produced at one time or another. And for those who don’t have first-hand experience in a certain area or scenario, film and television can be their sole source of knowledge for this. For this essay, focus will be placed on the portrayal of mental health by this medium, exploring the societal impacts it can have. Questions will be asked regarding the possible impacts depiction in movies and television series can have on help-seeking behavior, where the myths and stereotypes of mental illness originated and the effect they have and whether on-screen portrayals can help to challenge the stigma associated with mental health.
A common complaint among viewers and mental health organizations is the insinuation that mental health conditions are untreatable and unrecoverable. One of the latest examples of this is the Netflix drama “13 Reasons Why”, which aired this year and tells the story of Hannah, a teenage girl who killed herself. One major criticism of the series was the lack of an example of successful help-seeking. Hannah was contemplating suicide and sought help on only one occasion, going to her school counselor, who unfortunately sent her away, failing to grasp her true mental state. Several of the other characters failed to communicate their struggles, silence being a major theme throughout the story, which in turn led to further suffering.
People should never consider that it’s ‘too late’ or they’re ‘too far gone’ for help or that they’ll seek help once and if it fails then they’ll give up as there’s no hope. This notion is extremely detrimental and implies that help is unattainable. With a narrative full of desperation and suicide painted as Hannah’s only option, little light was shone on how help-seeking can lead to recovery, survival and essentially prevent what the show is primarily about.
Others may argue that despite being marketed as a drama and not an educational resource, the show and others like it hugely raise public awareness of suicidal thoughts and in highlighting it as a real issue that lots of people face, sets up a conversation. This is evident by the data reports of online search terms in the days following the shows release. There was a 26% rise in the phrase “how to commit suicide” and an 18% rise in the term “commit suicide”, but thankfully the term “suicide hotline” also rose by 12%.
There can be little doubt that the show generated a lot of much needed suicide awareness with there being5668 deaths from suicide in UK alone in 2016 and that figure doesn’t include attempts or suicidal thoughts. Suicide is the leading cause of death among young people aged 20-34 years in the UK and it is considerably higher in men as they are less likely to seek help or communicate their feelings with others. In addition, more than 90% of suicides and suicide attempts are associated with a mental health condition, the highest rates amongst those with depression. This highlights another criticism of “13 Reasons Why”, as the show never actually talks about mental illness or depression, those words are never mentioned. Alternatively, suicide is depicted almost as a type of weapon for revenge. It is already hard to come to terms with the possibility that you might be suffering from a mental illness and the conditions themselves are tricky enough for health professionals to diagnose without interference from poorly written storylines and character portrayals skewing the publics ideas about mental health behaviors.
The popular Australian soap Home & Away included a plot line which involved a teacher who accidently killed another character when setting fire to the school when she intended to murder a different character. The individual was labelled as “crazy” and a “psycho”, but again, there was no actual diagnosis of any mental health disorder. Like “13 Reasons Why”, the lack of clarity of the mental illness, highly insinuating things and using language that is undermining and offensive to describe mental health imply that someone with a mental health problem should be feared and mistrusted, whereas, in fact people with severe mental illnesses are more likely to be victims, as illustrated by the high rates of suicide outlined earlier, than perpetrators of violent crimes. Most violent crimes and homicides are committed by those who do not have mental health problems9and therefore mental health disorders should not be used as ‘scape-goats’ as an explanation for violent acts.
Film and television can exert substantial power on popular beliefs. This is extremely evident in the ill-informed association between schizophrenia and violence, which according to research by Glazgow Media Group, can be directly linked to media representation. This generates ill-informed anxiety amongst the public and can lead to an increase in stigmatization, so further movement away from these over simplistic stereotypes in film and television would be a welcomed development.
The beauty of the silver screen is its ability to leave lasting images in our mind. Vivid images from a BBC Sherlock episode where Homes’ nemesis Moriaty is thrashing about, his limbs bound by a straight-jacket, play over in the brain following viewing. With the film “One Flew Over the Cuckoo’s Nest”, set in a psychiatric institution which was basically impossible to escape from, memories of characters being treated as ‘in-mates’ rather than patients are what remain. Not only are depictions such as these vastly out of character and setting, acting as a barrier to help-seeking, with people fearing that this is the un-balanced and outdated approach they’ll receive should they seek treatment, but it also reinforces the negative stereotypes associated with mental health patients. Mental health professionals aren’t spared from disparaging depictions either, from bullying nurses in “One Flew Over the Cuckoo’s Nest” to a manipulative murdering psychologist in the popular teenage TV show “Skins”, a rather unwelcoming picture is created for mental illness and healthcare.
Other recent examples include the films “American Psycho” and “Split”.The fact that the story-line for “American Psycho” never actually resolved whether the protagonist was physically committing the horrific murders or if they existed solely in his mind sends the message that sufferers of psychosis could potentially be homicidal maniacs. In “Split”, the main character has dissociative identity disorder (DID) and is simultaneously portrayed as an unhinged kidnapper. People with DID may suffer from an extreme inability to recall key personal information and highly distinct memory variations, which fluctuate with the person's split personality, but cases of ‘arch evil’ behaviour are non-existent.
Hollywood's reinforcement of the ‘mad and bad’ mental illness stereotype only provides a cumulative effect to the stories that commonly appear in tabloid news headlines declaring the perpetrators of violent acts ‘mentally ill’. Questions arise as to the effect this is having on viewer’s perception of mental health. One study focussing on the film “One Flew Over the Cuckoo’s Nest”, showed a substantial negative impact on viewer’s attitudes after watching. Whist this study was published back in 1983, mental illness is still stigmatised today and a more recent study showed that following watching a fictional film, viewers had more negative emotional reactions towards schizophrenia patients than those who watched an educational documentary. Consideration could be placed on conducting a new study looking at the relationship between mental health, media and society and more importantly use it as an opportunity to find solutions to counteract the myths and miss-information the public may be garnering through film and television.
Mental illness is almost ubiquitous within the horror genre. Norman Bates, Hannibal Lecter, Patrick Bateman, all depicted as deranged psychopaths or crazed killers wreaking havoc on society, their mental illnesses exploited and skewed to provide a shock factor and for entertainment as opposed to for accuracy. Creators are free to construct narratives in ways that will be most beneficial for them both financially and in gaining professional recognition. However, these unrealistic but more thrilling depictions for consumers may be the most harmful and stigmatizing towards those who suffer with mental illnesses.
Films could also have a self-stigmatizing effect. There are many Woody Allen films, such as “Annie Hall” and “Lovesick”, that play with the stereotype of mental health patients being self-centered attention-seekers. If the character’s narcissistic behavior is the focus of the film then real patients could think their issues to be trivial and feel more uncomfortable with voicing their concerns, not wanting to be seen as ‘needy’.
Nevertheless, movies, with their audience reaching millions worldwide, can play a key role in the battle against mental health stigma. Netflix recently released the film “To The Bone,” which centres on a young woman’s struggle with anorexia and follows her through treatment. Following the release of the initial trailer there was concern that it was glamorizing eating disorders and the graphic images of extreme thinness displayed could be triggering for those who suffer with or are at risk of the illness. A petition13stating the movie should be withdrawn from Netflix for these very reasons reached over 1000 signatures. But once the full film had been released there were many positive aspects that could be considered. The film takes the illness seriously and addresses the complexity of the disorder, sophisticatedly avoiding the trap of anorexia being the result of merely wanting to be pretty and skinny. Lily Collins, the actress in the main role, spoke out about her own past struggles with anorexia. The whole cast also created a Public Service Announcement14that streamed on YouTube for World Eating Disorders Action Day highlighting some important facts about eating disorders. The diversity of characters in the treatment centre shown in the film (a young man, a young black woman) is a positive step away from preconceived notions of what eating disorders look like and who they effect. This is important as stereotyping eating disorders puts us at risk of not identifying people who don’t fit this frame and might be suffering in silence. This is evident in the results of a survey15carried out by Time to Change which explored viewer’s opinions on the portrayal of mental health in TV and dramas and found that “54% of respondents cited an improved understanding of mental health problems, 48% reported that it helped change their opinion of the kind of people who can develop these problems and 31% said it actively inspired them to start a conversation with friends, family or colleagues about the mental health issues explored in the storyline.”
Other films, such as “A Beautiful Mind”, do well to draw attention to the positive contributions from sufferers of mental illness, further combatting the attached stigma. Even more recently, the films “Take Shelter” and “Mad to Be Normal”, capture more of a realistic sense of mental illness and delve into issues such as the cost of medications. Having more accurate storylines with relatable characters who face understandable issues promotes an openness regarding discussing mental health. For many people, your teacher, neighbour, friend or family member, it’s part of their everyday life, which is why sincerity is vital in tackling the attached stigma.
There is little doubt that the substantial popularity of the films and television shows highlighted in this essay, along with others, have led to an increased interest and awareness of the various mental health issues that they addressed and if done right, a reduction in the stigma and potentially an increase in help-seeking behavior as opposed to discrimination could result. However, although conversation on the topics is good, where does this lead to? There can’t be a full stop here, this isn’t where the conversation ends. With more awareness comes a greater responsibility of not only film makers to be more truthful in their depictions of sufferers, recovery processes and options for help, but also for the health service to promote preventative measures, provide the support depicted and therefore expected by the public for those who now think they may need it. This may be even more pertinent when shows, such as “13 Reasons Why”, introduce viewers to new ideas about mental illness in a way that deters from prevention.
In the future, more can be done in addition to the traditional strategies already in place to help reduce stigma and increase levels of hope surrounding recovery from mental illness. Community-based film festivals could be a possible avenue to explore. Recent research on a national mental health and arts film festival demonstrated a positive relationship between arts and mental health. There was seen to be an increase in positive attitude, including more optimism about the potential to recover. Films and television have the power to break down both the physical and metaphorical walls that separate us. Patient and therapist consultations, the struggles of daily life, the joy of recovery, are things behind closed doors that the public don’t get the opportunity to see. By placing it in front of us, albeit fictional, it creates shared meaning, audiences engage with characters on an emotional level and connect with those around them with an openness they previously lacked.