People with mental health illnesses often crop up in the media. They appear as the focus in dramatic newspaper headlines and play unforgettable roles in many of our favorite movie classics. But are they treated fairly and accurately? According to mental health advocacy groups, the media often depict characters with mental health issues in ways which create stigma and spread inaccuracies.
This article looks at how mental illnesses and personality disorders are portrayed in the media, both in the past and today. We then look at the impact of media representation – and the language used in media texts – in shaping the public’s perception of mental illness.
Finally, we present links to top mental health organizations and lists of TV shows and movies which have been praised for positive representation of characters with challenging mental health conditions.
Mental Health Issues on our Screens
Although media includes everything from newspapers and radio to social media platforms, the most memorable depictions of mental health issues comes from movies, followed by TV shows.
Before the 1960s, people with mental health problems were rarely represented in the media. When they were, it would normally be in an exaggerated form (giggling hysterically, babbling incoherently, etc.)
The topic of mental health issues covers such a broad area that it is easier to break it down into sub-topics.
Antisocial Personality Disorder
(sociopaths & psychopaths)
When you think about movie psychopaths, who comes to mind? Is it the murderous Norman Bates of the Hitchcock thriller Psycho? How about the sinister Hannibal Lecter of Silence of the Lambs? Then there’s Heath Ledger’s brilliant performance as The Joker in Dark Knight.
All of these characters are the embodiment of one of our primal fears – becoming the focus of interest of a psychopath or sociopath.
1931
One of the first psychopath movies to shock theatergoers was M, a 1931 movie about a child serial killer, Hans Beckert, played by Peter Lorre.
1960
Hitchcock’s Psycho (1960) captivated and horrified audiences with its portrayal of the creepy motel owner Norman Bates.
1971
Malcolm McDowell took sadistic violence to a new level when he played Alex in the 1971 dystopia A Clockwork Orange.
1991
In 1991, Dr Hannibal Lecter became a household name with Anthony Hopkins’ creepy portrayal of the cannibal psychopath.
2008
Batman’s psychopathic nemesis The Joker, was brilliantly played by Heath Ledger in Dark Knight (2008)
2014
in 2014, Rosamund Pike starred as Amy, the arch-manipulator in Gone Girl.
2019
In 2019, Joaquin Phoenix gave us another version of the Joker in the film of the same name.
Are any of these accurate portrayals of real psychopaths – those who would today be diagnosed with antisocial personality disorder (ASPD)?
Psychiatrists Samuel Leistedt and Paul Linkowski watched 400 movies featuring potential psychopath characters. After narrowing the field down to 126, they then formed a larger group of experts to pick out the top three most realistic psychopaths. They came up with Anton Chigurh from No Country for Old Men, Hans Beckert from M and Henry from Henry: Portrait of a Serial Killer.
Among the least realistic psychopaths were Norman Bates and Hannibal Lecter. The researchers said that Bates didn’t count as he was out of touch with reality. Lecter’s ‘elite psychopath’, with his blend of super-intelligence, good taste and love of human flesh was, thankfully, not commonly seen with real psychopaths.
Although antisocial behavior is part of the diagnostic criteria for ASPD, psychopaths are not always violent and rarely kill.
Eating Disorder
1981
In 1981, The Best Little Girl in the World shone a light into the hidden world of eating disorders. Jennifer Jason Leigh played Casey Powell, a teenager forced to compete with her sister for the attention of her parents. Casey develops anorexia and bulimia and ends up hospitalized. Although the film has been criticized for inaccurately portraying eating disorders, the fact that a girl Casey meets in hospital (Carol) dies from her illness does highlight the severity of eating disorders.
1989
The tragic death of singer Karen Carpenter once more saw anorexia make the headlines and the Karen Carpenter Story hit the big screen in 1989
2009
Ten years’ later, an assortment of mental illnesses were represented in the popular film Girl, Interrupted. The movie included Angela Betts as anorexic Janet Webber and Brittany Murphy as Daisy Randone who lives with both bulimia and obsessive-compulsive disorder.
2017
More recently, Lily Collins starred as Ellen in To the Bone, a film charting the struggles of Ellen as she battles anorexia.
Schizophrenia
Schizophrenia is probably one of the most poorly represented mental illnesses in the movies. Films featuring people with schizophrenia often portray them as products of a traumatic childhood, victims of drug abuse and/or prone to violence and serial murder.
For example, the 2002 David Cronenberg movie Spider, blames Dennis Cleg’s schizophrenia on the fact that he witnessed the murder of his father. In reality, trauma is not thought to lead to the development of schizophrenia.
In Santa Sagre (1989), Felix develops the illness due to his debauched lifestyle including hard drug use. Although drug abuse is thought to be linked to psychotic episodes, there is no evidence to suggest schizophrenia is caused in this way and most schizophrenics do not take drugs at all.
The prevalence of people with schizophrenia as serial killers (e.g. Fisher King, Mr Brooks, Nightbreed, etc.) is also at odds with reality.
One of the most positively received representations of schizophrenia in the movies is the portrayal of mathematician John Nash in A Beautiful Mind. Even then, some critics have argued that the film gives the false impression that all people living with schizophrenia have a genius within them.
OTHER MENTAL ILLNESSES
Other mental illnesses which have been depicted in the movies and on TV include obsessive-compulsive disorder (OCD). As already mentioned, OCD is featured in Girl, Interrupted but it is also portrayed in Matchstick Men (2003) with con man Roy Waller, played by Nicholas Cage, afflicted by the condition (as well as Tourette’s Syndrome).
The lead character of the TV detective show Monk, San Francisco sleuth Adrian Monk, also lives with the condition.
Silver Linings Playbook (2012), one of the most popular modern films about mental illness, chooses to focus on bipolar disorder. Bradley Cooper’s character Pat Solitano loses his wife and job through his illness and the film depicts the wide range of emotions experienced by those living with bipolar disorder.
Depression is covered in a number of ways in the movies. A more light-hearted take on the illness is found in It’s Kind of a Funny Story (2010) and The Skeleton Twins (2014). The tragic consequences of depression are portrayed in movies such as Sylvia (2003), about the life of poet Sylvia Plath, and Interiors (1978) which shows how depression can tear families apart. Melancholia (2011) explores depression and catastrophe.
Mental Health Representation in the Newspapers
In 2017, the British Journal of Psychiatry published the results of a study into how people with mental health issues were represented in print media. The research was carried out in response to pressure from mental health advocacy groups. It focused on how media representation of mental health had impacted on newspaper reporting over a period of four months in 2014.
Nine newspapers were included in the study and the press coverage of physical illnesses were used for comparison. The study found that:
- News in negative tone: 50.5%
- News in neutral tone: 27.5%
- News in positive tone: 22%
200
articles on mental
health disorders
- News in negative tone: 50.5%
- News in neutral tone: 27.5%
- News in positive tone: 22%
763
articles on physical
health disorders
200
articles on mental health
disorders
763
articles on physical
health disorders
13.5%
Personality disorders, undefined mental illnesses and post-traumatic stress disorder (PTSD) made up 13.5% of the diagnoses where articles involved violence.
1.5%
Despite the regular association of schizophrenia with violence in the movies, only 1.5% of the newspaper articles reviewed featured violence from someone with this diagnosis.
None of the articles relating to people with eating disorders or dementia were linked to violence.
When compared with a similar study carried out 15 years’ earlier, negative reporting of mental health issues was down from 64% and the link between mental ill health and violence was also less likely to be featured. Treatment and rehabilitation was more likely to be mentioned and the voices of people living with mental health conditions were more often heard too, suggesting that newspaper representation of mental health issues is heading in the right direction.
Nevertheless, the disproportionate association between mental ill health and violence endures. This is partly because newspaper editors (and by implication, the public at large) favor stories which are sensational in nature (hence the adage, ‘if it bleeds, it leads.’) Where people with mental health problems are involved as perpetrators, there is a reinforcement of the aggressive, dangerous and unpredictable traits that are already associated with mentally ill people in the public consciousness. In many cases, violent offenders reported in the newspapers and on TV news reports are described in terms which suggest they are mentally ill (e.g. ‘crazed maniac,’ ‘murderous madman,’ etc.) However, in a large proportion of these cases, the perpetrator is not mentally ill at all.
Making a full recovery from mental health problems is more common than people may think.
This harmful stereotype is allowed to flourish when alternative views and accurate statistics are hidden. Since media coverage involves an active process of selection, editors can choose to construct a positive or balanced representation of people with mental illnesses if they want to challenge this stereotype. For example, they could publish quotations from qualified healthcare professionals explaining how most mentally ill people are non-violent and more likely to be a victim than a perpetrator of an attack. They could also publish more stories focusing on those who have successfully recovered from mental health problems.
Going back to the study quoted above, it can be seen that fewer health professionals were quoted in relation to mental health issues than physical ones. This indicates a need for reporters to more actively involve sources for professional insight and for mental health professionals to make their voices more clearly heard. 13% of articles helped to raise awareness of or provide advice for the mental illness mentioned in the article compared to 17.2% for physical illnesses.
The Importance of Positive Media Representation
Why does it matter how mental illness is portrayed in the movies? Surely we can all pull apart fact from fiction, can’t we?
Not necessarily. According to social learning theory, we use a range of influences to educate ourselves about the world we live in.
If we have a relatively typical upbringing, our strongest influences will come from our primary social groups. These include our family and friendship groups.
Our next strongest influence should come from our secondary social groups. These include our schools, the government and faith groups.
Any gaps in our knowledge and understanding of the world will then come from a third group which includes the mass media. A lot of research has been done in this area and it is now proven without doubt that the mass media influences everyone who is exposed to it to varying degrees.
Family and Friendship groups
Our schools, the government and faith groups
mass
media
Where there is a lack of influence from primary and secondary groups, mass media can become the single most influential force on an individual. It has been shown that young people can find it particularly difficult to separate out fact from fiction when they spend a lot of time in front of the TV. However, even adults’ opinions and attitudes can be strongly influenced by media representation if they lack the counterbalance of personal experience and a quality education.
For many people, the only exposure they have to mental health issues is via TV shows and movies. While films often distort or exaggerate the symptoms of mental illness for dramatic effect, even the most realistic documentary will shape the representation of the subjects they are treating.
To get an accurate picture of how media representation influences the public, we need to take into account all forms of media. This includes movies, TV shows, radio shows, magazines, newspapers and advertising. Increasingly today, social media is becoming a powerful influence on public perception and attitude.
The way a person, group or subject matter is treated in the media will depend upon the ideology of the media producer and the reason for the media’s creation. This can be at odds with the facts.
For example, movies are designed to make money by attracting a specific audience. To attract an audience who enjoy horror flicks, it is the producer’s job to present characters that create fear and revulsion and not to accurately represent the nuances of mental illness.
With newspaper reports, the publication will normally be aligned to a particular political position. The reports are likely to have a political agenda. For example, if a political group wants to criticize the federal government’s handling of national security, they may want to give the impression of a city running wild with dangerous criminals. By focusing on a story where a person with mental illness has carried out a homicide, they will both attract general readers and reinforce their political position.
Advertisers will be mainly focused on proving that their product or service will solve a particular pain point. They will portray the subjects of their advertisements in a way that meets that motivation. For example, a drugs company may depict a scenario where someone with anxiety is immediately calmed by taking their product.
Making a full recovery from mental health problems is more common than people may think.
Social media works through personalizing an individual’s relationship with content providers. A typical social media feed will contain a blend of content from both commercial and social sources. The algorithms of social media platforms are often designed to filter content based on a user’s past viewing history and chosen preferences.
In the absence of moderating influences, this can lead to the reinforcement of existing beliefs. The ease by which biased and inaccurate content can be created, published and distributed via social media has led to an explosion of potentially dangerous ‘fake news.’
To fully understand the way people with mental illnesses are represented in the media, we need to know how media texts are constructed.
Mediation and inclusive language
The process of selecting material for and constructing a piece of media is known as mediation. The process of media representation is explained fully in another of our articles regarding the media portrayal of LGBTQ+ people.
The language used in constructing media, both written text and the anchorage (tag-lines, headlines, captions, etc.) has a powerful effect on public perception. In recent years there has been a drive to use language that includes marginalized groups rather than alienates them.
Examples of non-inclusive language include referring to people with mental health conditions as crazy, lunatics, madmen, mental cases, nutters, psychos or schizos. It also includes defining people by their illness (e.g. schizophrenics, alcoholics, etc.) and assuming that they are victims of their condition (e.g. afflicted by depression, a victim of self-harm, etc.)
Trivializing mental illnesses through imprecise language usage (e.g. ‘I’m so OCD’ or ‘I went schizo on him’) also excludes people with genuine mental illnesses who feel misunderstood and ridiculed.
Inclusive language extends beyond labeling people. For example, a ‘mental institution’ distances people hospitalized by their mental illness from patients with physical ailments. The term ‘happy pills’ trivializes mental illness and its treatment.
The Importance of Positive Media Representation
The influence of the media in public attitudes is now an undisputed fact. Where people do not have direct day-to-day contact with people with mental health issues, their perception will be colored by media representations of mental health issues. These media representations include movies, TV shows and newspaper reports.
Where media texts are contaminated by exaggeration, distortion, sensationalism and non-inclusive language, the general public will, to a greater or lesser degree, accept a warped, usually negative, picture of people with mental illnesses.
As the British Journal of Psychiatry puts it: “widespread negative portrayals have reinforced the continued stigmatization and lack of acceptance among those with psychiatric diagnoses, possibly increasing social distance and contributing to morbidity and distress.”
Examples of negative coverage might include a headline like ‘mentally ill man in frenzied knife attack,’ or ‘voices told schizophrenic woman to hurt child.’
Distorted media representations, including the use of sensationalist language, can even have the effect of dehumanizing people with mental ill health. They might be portrayed as monsters or animals rather than humans in need of help.
The public’s warped view of people with mental health problems leads to those human beings being rejected by society, denying them the opportunities for success that those without a diagnosed mental health condition can take. It has been proven that being on the receiving end of negative media representations can lead to low self-esteem, a reduction in help-seeking behavior, non-compliance with medication and slower rates of recovery.
“Widespread negative portrayals have reinforced the continued stigmatization and lack of acceptance among those with psychiatric diagnoses, possibly increasing social distance and contributing to morbidity and distress.”
There is another worrying implication of mentally ill people being routinely depicted as dangerous and unstable. This message can be internalized in a process known as ‘projective identification.’ This leads to the mentally ill person accepting the distortion and living up to it. Where graphic details of specific crimes have made the news, this can spark copycat crimes, further adding to the impression that all mentally ill people are dangerous. Copycat killers can even draw inspiration from fictional crimes and characters. For example, the shooter who killed 12 people at the Aurora movie theater in Colorado in 2012 was thought to have been inspired by the Joker in Dark Knight.
There are other negative effects of inaccurate media representation of mental illness. For example, a mistaken belief that recovery from mental health is rare has implications at public policy level. After all, if there is little chance of a positive outcome, why would hospitals and federal agencies provide funds for recovery and rehab programs?
Movies featuring mentally ill characters often end with the person being institutionalized or committing suicide, feeding into the belief that it is futile to try and rescue and rehabilitate such people.
On the other hand, portraying a mental illness as responding too well to treatment (e.g. in some movies featuring anorexia or depression) can lead families to underestimate the seriousness of the condition. Those living with the conditions may feel that their issues are being trivialized.
Movies and TV shows have also been criticized for their representation of mental health professionals. Psychiatrists in particular are often portrayed as unstable and even depraved while the mental health system is depicted as cold and inhuman with its iconography of padded white cells, straitjackets and forced injections.
It is easy to understand why many people with mental illnesses would feel uneasy about trusting mental health professionals with their care.
Mental Health and the Media: Some More Statistics
Mental health issues are incredibly common and half of us are likely to experience one or more mental health problems in our lifetime. In fact, in any given year, one in five people will be living with a diagnosable mental health disorder.
That is a lot of people who face being stigmatized. For example, surveys have shown that one person in three believes that those with mental health issues are more likely to be violent than the general public (and 61% admit to being particularly afraid of former convicts with mental health issues).
In reality, there is no evidence to back up these fears. Just as with the general population, only a very small minority of people with mental health issues are perpetrators of violent attacks. This was borne out by the 1998 MacArthur Violence Risk Assessment Study which followed the activity of 1,136 people with mental health diagnoses. More recently, the National Confidential Inquiry into Suicide and Homicide found that between 2001 and 2011, 19% of homicides were carried out by someone with evidence of some kind of mental problem within the past 12 months. That figure rose to 30% when looking at suicide rates, suggesting that mental ill health is more likely to lead to violence against the self rather than against others.
Mental health conditions can also be represented in a distorted way. Schizophrenia is a prime example. Portraits of Schizophrenia by Entertainment Media: A Content Analysis analyzed 41 movies from between 1990 and 2010. It found that the active symptoms of the illness (e.g. delusions and hallucinations) were portrayed far more commonly in movies and TV shows than the passive (dull affect, lack of motivation, etc.) Delusions are the most commonly active symptom followed by hallucinations. While 20 to 40% of people with schizophrenia never hear voices, this symptom is almost always present in characters with this illness.
As mentioned above, almost all characters with schizophrenia were found to be violent with a third homicidal. Although schizophrenia does have a high mortality rate (10 to 16%), a quarter of characters with schizophrenia took their own lives. One quarter became ill due to childhood trauma – something which is not linked to schizophrenia in real life. Most of the characters featured were male whereas in society, schizophrenia is equally distributed between men and women.
While schizophrenia is represented as more dangerous than it is, people with eating disorders face the opposite problem. Anorexia nervosa, for example, has the highest mortality rate of any psychiatric illness. In a meta study published in a journal for the American Medical Association (JAMA), 755 out of 17,272 people with eating disorders sadly died from their illness. Yet in the media, many characters, particularly the main subject, pull through. This risks society trivializing the issue while people struggling with their eating will feel misunderstood.
Mental Health Media Resources
To help media organizations represent people with mental health issues positively, various organizations have produced media guides. These often include glossaries of inclusive language.
Here is a list of organizations that have published helpful online media resources:
Mental Health America (MHA)
America’s leading community-based nonprofit dedicated to addressing the needs of those with mental illnesses and promoting mental wellbeing.
National Institute of Mental Health (NIMH)
The lead federal agency for conducting research on mental disorders.
National Alliance on Mental Illness (NAMI)
Provides advocacy, support, education and public awareness to help support people living with mental illness
American Foundation for Suicide Prevention (AFSP)
Focused on saving lives and bringing hope to people affected by suicide.
Child Mind Institute
An independent nonprofit dedicated to supporting children with mental illness and learning disorders and their families.
Treatment Advocacy Center
Dedicated to removing barriers to the effective treatment of severe mental illness.
Brain and Behavior Research Foundation
Committed to relieving the suffering caused by mental illness by awarding grants for scientific research.
Anxiety and Depression Association of America (ADAA)
Focused on saving lives and bringing hope to people affected by suicide.
The Trevor Project
Providing crisis interventions and suicide prevention support for young people from the LGBTQ community.
Depression and Bipolar Support Alliance (DBSA)
Provides help and support for people living with mood disorders.
Active Minds
Committed to changing the current approach to dealing with mental health issues in young Americans.
Project Semicolon
Aims to reduce the incidence of suicide through resources, information and support.
The Jed Foundation (JED)
A nonprofit focused on protecting the mental health of teens and young adults and preventing suicide.
Rethink Mental Illness
Services, information and advice for people living with mental health issues and their families.
Mental Health Media Resources
Here is a list of TV shows and films which sensitively represent people with mental health issues:
Popular TV Shows
Will Arnett voices an anthropomorphic horse in this Netflix animated series. The series is praised for its portrayal of depression and substance addiction.
Lawyer Rebecca Bunch (Rachel Bloom) pursues an old flame to California. Bunch experiences depression, anxiety and psychosis and is eventually diagnosed with borderline personality disorder.
A popular Netflix show from the Marvel franchise. Deals with serious mental health issues including PTSD
Stand-up comedian Maria Bamford plays herself in a loosely biographical series about her journey to rebuild her life following therapy for bipolar disorder.
An Army veteran and single mother attempts to bring up her family while dealing with PTSD.
Themes around coming out as gay and attempting suicide are covered in this charming Australian series.
Anxiety, grief, addiction and trauma are realistically portrayed in this American family comedy series.
The effects of depression on relationships are among the themes explored in this American comedy drama.
More TV shows worth watching
More TV shows worth watching:
Popular Films
Russell Crowe plays the part of John Nash, a brilliant mathematician who develops symptoms of schizophrenia.
After the death of their parents, Benny moves in with his mentally ill sister Joon in this romantic comedy.
Based on Susanna Kaysen’s memoirs of her stay in a mental institution. Characters portray a range of mental illnesses from anorexia and OCD to schizophrenia and antisocial personality disorder.
The mental strain of moving home is portrayed by animated characters in this Pixar comedy film.
Lars von Trier’s moving portrayal of depression and the reaction of the psyche to disaster.
Jack Nicholson plays Randle McMurphy, who feigns mental illness and ends up committed to a mental institution.
After undergoing treatment for bipolar disorder, Pat Solitano Jr. (Bradley Cooper) embarks on a mission to reconcile with his ex-wife.
More TV shows worth watching:
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Key Questions
- How has the media depicted mental health issues on our screens?
- What famous movies depict characters with Antisocial Personality Disorder?
- Who were the most realistic psychopaths played by actors?
- How accurately has the movie industry represented Schizophrenia?
- How has mental health been represented in the newspapers?
- How important is mental health being accurately portrayed in the media?
- How much influence does mass media have on us?
- How has social media affected our perception of information?
- What are mediation and inclusive language?
- How have negative depictions of mental health in the media affected people with actual disorders?
- What are some helpful mental health media resources?
- What are some popular TV shows that represent mental health issues?
