Psychiatry in the Media – How TV and Film Result in Untended Consequences

Despite the public's fascination with psychiatry as portrayed in countless television programs and movies, the creators of these works of entertainment are too often (and to the detriment of the viewers), focused on creativity and narrative rather than accuracy.

This, as decades of studies conclude, adds to the negative perception of those struggling with mental illness and encourages institutionalization over treatment and therapy.

More troubling perhaps is the relationship between the stigma of mental illness and mental health disorders and media aimed at young audiences. Two separate studies found instances of negative or fearful attitudes toward characters labelled as “crazy,” “loony,” or “mad” in Disney animated features such as Dumbo, Beauty and the Beast, and 32 other animated films.

As a member of the mental healthcare community, these findings are startling. After all, it is highly unlikely that a person’s stigma toward those suffering from a mental illness develops post-puberty, with the foundations of bias likely occurring during early childhood. In this blog, I hope to help explain the relationship between popular media and the public’s perception of mental illness and clinical therapy as a whole.

Common Myths About Mental Illness as Depicted in the Media

Whether it’s a movie, TV show, online article, or a news program, much of the media we consume propagates many common myths about the mentally ill and those who work in the field.

“The mentally ill are inherently violent as a result of their illness”

Crime and danger are the most common theme throughout stories involving mental illness. As Professor of Clinical Psychiatry at Columbia University Dr. Michael Stone suggests, only 5-7% of violent crimes are committed by mentally ill or psychotic people.  

“If you’re schizophrenic, the risk of you doing a violent crime is four to six times higher than it would be in the general population,” Dr. Stone says. “That means that 94 or 96 percent of people who are diagnosed schizophrenic are not committing a violent crime.”  

In news media, Dr. Stone argues that coverage of tragic or violent events stems from a lack of necessary nuance and understanding of mental illness in order to report accurately and fairly. This leads to cognitive biases and fear of the mentally ill, leading to circumstances not unlike a person crossing to the other side of the street in order to avoid walking past an African-American teenager in public - a baseless concern.

“Mentally ill people are unpredictable and untrustworthy” 

Unfortunately, the first examples that come to mind when discussing depictions of mental illness in film and television are often the worst representations.

In The Silence of the Lambs, an FBI trainee seeks the counsel of an unspeakably dangerous former psychiatrist who was imprisoned for murder and cannibalism. While most cite Anthony Hopkin’s portrayal of Dr. Hannibal Lecter among cinema’s best villains, the character’s popularity may have mired public perceptions of the mentally ill in negativity for decades. Lecter is an extreme case and the character’s diagnoses have been popular fare for amateur and certified psychiatrists for years, but his portrayal as a calculating, manipulative, and even seductive individual helps to solidify the myth of mental illness as an unpredictable and frightening diagnosis in the minds of the general public.  

“Mentally ill people don’t get better” 

Even in instances where portrayals of those struggling with mental illness are positive and hopeful, the treatments they seek and participate in do not work or are largely ineffective in helping them in their daily lives. For instance, Tony Shalhoub’s character in Monk struggles with obsessive compulsive disorder (OCD), but his condition does not appear to improve with therapy. In fact, many episodes center around the idea that the eponymous character finds professional success as a result of his condition, even if that means sacrificing his non-work life.

It is true, however, that people who seek therapy for mental illnesses may not find the right therapist for several years - or ever. That’s why it’s very important to “shop around” for a provider that specializes in treating your specific condition or is knowledgeable about treatments you’ve found to be effective.

“Depression and anxiety disorders are caused by chemical imbalances”

Contrary to popular belief (and rampant television ads for pharmaceuticals), many people believe that mental illness treatments are a simple “wonder drug” away from a cure. While this does squash the myth of mental illness being a “moral failing,” as Cheryl K. Olson, co-director of the Center for Mental Health and Media at Massachusetts General Hospital Department of Psychiatry, suggests, this hypothesis hasn’t been backed up by clinical research and often oversimplifies the causes and treatments of depression.

Depression is a complex and difficult illness to treat, leaving many without answers for the duration of their lives. While neurotransmitters are important to consider while treating depression, it’s also true that biology, genetics, and a person’s environment all contribute in intricate, often unseen ways. A one-size-fits-all pharmaceutical solution does not exist and likely never will, but a careful dose of antidepressant medication as prescribed by your doctor may help.

“He/she/they are simply going through a phase” 

In films such as American Pie, Heathers, and countless others, alcohol, substance abuse, depression, and impulsive behavior is represented as commonplace and very normal for teenagers and young adults. A 2005 study by doctors Jeremy Butler and Steven Hyler cite the film Thirteen as a key example of a main character undergoing episodes of substance abuse, sexual promiscuity, eating disorders, and even self-harm - all without seeking treatment. Depictions such as these run the risk of glamorizing mental illnesses and anxiety disorders.

“Shrinks are all the same”

Film and television programs rarely - if ever - take time to explain the differences between psychologists, psychiatrists, and other therapists, leaving the viewer to draw their own conclusions and judgments about the industry through the lens of a fictional representation. A detailed guide to the differences between these professionals is available here.

“Therapists are evil and manipulative”

While the aforementioned Dr. Lecter is cinema’s most identifiable psychiatrist-turned-murderer, the depictions of psychiatrists as evil, foolish, or manipulative are rooted in the earliest days of the medium.

Commonplace in the horror genre are disturbed doctors who use their education as a tool for torture and experimental treatments, often at the expense of their patients’ lives. Even a recent episode of Law and Order: SVU contained an episode in which a psychiatrist exploited his patients and was ultimately discovered to be the killer.

On the other end of the spectrum, some television shows have depicted those working in the mental health field as playing fast and loose with their ethical responsibilities, sleeping with patients, developing relationships outside their offices, and even speaking with friends about a patient’s confidential information (as is the case in the otherwise acclaimed Good Will Hunting).  

Positive Representations of Mental Illness Treatment in Film and TV

Thankfully, not all representations of psychiatry and mental illness in film and television are negative. In fact, some have helped humanize the mentally ill in the eyes of the public and may have moved the metaphorical needle as far as mainstream acceptance of therapy and clinical psychiatry are concerned. Here are a few positive examples to consider. 

The Sopranos

Perhaps the most notable and wide-reaching example of respectable representations of mental illness in the history of television, HBO’s hugely popular series The Sopranos centers around a mob boss dealing with severe panic attacks and anxiety disorders. Over the course of the series, Tony Soprano experiences the challenges, frustrations, and breakthroughs that are common in therapy. Furthermore, his relationship with his therapist is tested multiple times, but ethical boundaries are not breached. As the show progresses, Soprano begins to accept his treatment and his symptoms lessen, giving way to more complex and deeper psychological issues that he must tackle. While the show certainly takes liberties with the standard doctor-patient relationship to enhance dramatic impact, the writers’ ability to humanize a deeply troubled individual and allow the audience to feel empathetic to his personal struggles despite his starkly criminal morality is a remarkable accomplishment.

Ordinary People

In Robert Redford’s Ordinary People, a couple and their young son deal with the loss of their oldest child in a dramatic, but realistic manner. An accurate portrayal of a family undergoing post-traumatic stress disorder and depression during the grieving process, the Oscar-winning film also tackles the barriers of communication that can hold back individual family members from making progress in their emotional and psychological recovery. Finally, Ordinary People also succeeds in accurately demonstrating the relationship between the patient and their therapist, showing that results are not immediate.

In Treatment