Mental Health Stigmatization Spread by Mass Media

Misrepresentations are spread by film, television, and social media

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In the aftermath of an unconscionable act of random violence, many people are inclined to label the perpetrator “crazy.” Although the criminal may have mental illness, automatically assigning the label “crazy” does a great disservice to people who live with mental illness every day.

In reality, somebody with mental illness is much more likely to be a victim—rather than a perpetrator—of violence. Calling a violent offender “crazy” spreads a dangerous stereotype and belies the complex relationship between criminality and mental illness.

The media teaches us about people with whom we do not routinely interact. This constant flow of data gives us incessant social cues about the nature of other groups of people—including which groups of people should be praised or scorned.

Media portrayals of those with mental illness often skew toward either stigmatization or trivialization. Consequently, all forms of media—including television, film, magazines, newspapers, and social media—have been roundly criticized for disseminating negative stereotypes and inaccurate descriptions of those with mental illness.

What Is Stigmatization?

Stigma happens when some person is viewed as an “other.” This other is denied full social acceptance.

Here is how stigma is defined by Ahmedani in a 2011 article titled “Mental Health Stigma: Society, Individuals, and the Profession”:

The most established definition regarding stigma is written by Erving Goffman (1963) in his seminal work: Stigma: Notes on the Management of Spoiled Identity. Goffman (1963) states that stigma is “an attribute that is deeply discrediting” that reduces someone “from a whole and usual person to a tainted, discounted one” (p. 3). The stigmatized, thus, are perceived as having a “spoiled identity” (Goffman, 1963, p. 3). In the social work literature, Dudley (2000), working from Goffman’s initial conceptualization, defined stigma as stereotypes or negative views attributed to a person or groups of people when their characteristics or behaviors are viewed as different from or inferior to societal norms.

Of note, stigmatization is so entwined with the media that researchers have used newspaper articles as a proxy metric for stigma in society.

Stigmatization in the Media

Let’s consider some stigmatizations of mental illness disseminated by the media as hypothesized by Myrick and Pavelko in a 2017 article published in the Journal of Health Communication.

First, mental illnesses such as schizophrenia are seen as so disruptive to society that those with such conditions must be isolated from society altogether.

Second, media accounts focus on the individual with mental illness rather than framing mental illness as a societal issue. Consequently, media consumers are more likely to blame the individual for the illness.

Third, people with mental illness suffer from overgeneralization in media portrayals; everybody with a specific condition is expected to portray the same characteristics of the disease. For instance, depictions that all people with depression are suicidal, and all people with schizophrenia hallucinate. (In reality, only between 60 and 80 percent of people with schizophrenia experience auditory hallucinations, and a smaller number experience visual hallucinations.)

Fourth, media portrayals discount the fact that many people with mental illness don’t need to disclose this condition to everyone around them. Instead—whether by intention or not—mental illness often goes unrecognized. Portrayals in the media, however, present situations where everyone knows about a character’s mental illness, and this mental illness is no longer concealed.

Fifth, the media portrays mental illness as being untreatable or unrecoverable.

Trivialization

“Trivialization suggests the opposite in the case of mediated representations of mental illness: a downplaying of the notability or negativity of these conditions,” write Myrick and Pavelko.

Here are some possible ways that trivialization can rear its head in the media.

First, the media promotes mental illness as either not being severe or being less severe than it really is. For instance, many people with anorexia feel like their condition is made out to be less severe than it really is—in part, because people with the condition who are portrayed in the media minimize its serious and hide severe consequences.

In reality the death rate of anorexia is the highest death rate of any eating disorder. In an oft-cited meta-analysis published in JAMA Psychiatry in 2011, Arcelus and colleagues analyzed 36 studies representing 17,272 individual patients with eating disorders and found that 755 died.

Second, mental illness is oversimplified in the media. For instance, people with OCD are depicted as being overly concerned with cleanliness and perfectionism. However, the obsessive thoughts that drive these compulsions are overlooked.

Third, the symptoms of mental illness are portrayed in the media as beneficial. For example, in the television series Monk, the protagonist is a detective who has OCD and pays close attention to detail, which helps him solve crime and advance his career.

Alternatively, there’s the “super-cripple” misrepresentation. According to Myrick and Pavelko: “Akin to a mental ailment being perceived as an advantage, individuals with physical ailments have also been associated with the ‘super cripple’ label, a stereotype that attributes magical, superhuman traits to people with disabilities.”

Fourth, using media channels, people without disabilities mock people with disabilities by appropriating mental-illness terminology. For instance, the hashtag OCD (#OCD) is commonly used on Twitter to describe attention to cleanliness or organization.

Schizophrenia in Film

Probably the most disparaging stigmatizations of mental illness in media lie in the film portrayals of antagonists with mental illness. In particular, characters with schizophrenia are presented as “homicidal maniacs” in “slasher” or “psycho killer” movies. Such portrayals disseminate misinformation about the symptoms, causes, and treatment of people with schizophrenia and other forms of severe mental illness. Of note, popular movies have been shown to exert potent influences on attitude formation.

In a 2012 article titled the “Portrayals of Schizophrenia by Entertainment Media: A Content Analysis of Contemporary Movies,” Owen analyzed 41 movies released between 1990 and 2010 for depictions of schizophrenia and found the following:

Most characters displayed positive symptoms of schizophrenia. Delusions were featured most frequently, followed by auditory and visual hallucinations. A majority of characters displayed violent behavior toward themselves or others, and nearly one-third of violent characters engaged in homicidal behavior. About one-fourth of characters committed suicide. Causation of schizophrenia was infrequently noted, although about one-fourth of movies implied that a traumatic life event was significant in causation. Of movies alluding to or showing treatment, psychotropic medications were most commonly portrayed.

These portrayals were wrong and damaging for several reasons, including the following:

  1. Portrayals of schizophrenia in recent movies often focused on the positive symptoms of the disease, such as visual hallucinations, bizarre delusions, and disorganized speech. These symptoms were presented as commonplace when, in fact, negative symptoms, such as poverty of speech, decreased motivation, and flat affect, are more common.
  2. Several movies spread the false stereotype that people with schizophrenia are prone to violence and unpredictable behavior. Moreover, some movies presented people with schizophrenia as being “possessed.” These violent stereotypes poison viewers and engender harsh negative attitudes toward mental illness.
  3. In these movies, 24 percent of the characters with schizophrenia committed suicide, which is misleading because in reality only between 10 percent and 16 percent of people with schizophrenia commit suicide during the course of a lifetime.
  4. Characters with schizophrenia were usually depicted as white males. In reality, schizophrenia disproportionately affects African Americans. Furthermore, schizophrenia affects men and women almost equally.
  5. In a few movies, schizophrenia is depicted as secondary to traumatic life events or curable by love, which are both misrepresentations of the disease.

On the bright side, Owen found that not all the information presented about schizophrenia in modern film was stigmatizing. For example, in more than half of the movies analyzed, use of psychiatric medications was depicted or alluded to. Furthermore, nearly half the characters with schizophrenia were depicted as poor, which jells with the epidemiological data that suggest people of higher socioeconomic means are less likely to experience schizophrenia.

Ultimately, negative portrayals—especially violent negative portrayals—of people with schizophrenia and other severe types of mental illness in the media contribute to stigmatization, stereotyping, discrimination, and social rejection.

What Can Be Done

In their 2017 study, Myrick and Pavelko found that television, movies, and social media are the most frequent sources of portrayals of mental illness that stigmatize and trivialize. However, as noted by the authors: “Given the power of media to quickly and widely spread inaccurate portrayals, a deeper understanding of their similarities, differences, and interactive effects is called for.”

We still need to better understand how these messages are disseminated by the media before we can act to rectify them. Currently, there is limited research examining how the media promotes mental-illness stereotypes, stigmatization, and trivialization. Nevertheless, certain suggestions regarding how to improve the depiction of those with mental illness in the media have been made.

  1. Analyze mass-media production procedures to better understand the current practices, needs, values, and economic realities of screenwriters, producers, and journalists. For instance, understanding the balance between being newsworthy or emotionally arousing and verifiable.
  2. Present mental illness only when relevant to the story.
  3. Prefer non-individualized descriptions of mental illness and instead focus on the societal aspects.
  4. Include expert input from psychiatrists during production.
  5. Implement a mental health short course when training journalists.
  6. Use mental-health terminology with precision, fairness, and expertise.

As individuals who consume copious amounts of mass media and engage on social media routinely, the best thing that we can do is to stop using words like “crazy” and “deranged” in a derogatory or flippant fashion. Moreover, it’s best not to make psychiatric diagnoses outside of a clinical setting. Only a specialist can make a diagnosis of OCD, depression, bipolar disorder, schizophrenia, and so forth. By labeling without proof, we hurt those who really live with mental illness on a daily basis.

Sources:

Arcelus J, Mitchell AJ, Wales J, Nielsen S. Mortality Rates in Patients With Anorexia Nervosa and Other Eating Disorders: A Meta-analysis of 36 Studies. Arch Gen Psychiatry. 2011;68(7):724–731.

Myrick JG, Pavelko RL. Examining Differences in Audience Recall and Reaction Between Mediated Portrayals of Mental Illness as Trivializing Versus Stigmatizing. Journal of Health Communication. 2017.

Owen PR. Portrayals of Schizophrenia by Entertainment Media: A Content Analysis of Contemporary Movies. Psychiatric Services. 2012; 63:655-659.

Stout PA, et al. Images of Mental Illness in the Media: Identifying Gaps in the Research. Schizophrenia Bulletin. 2004;30:543-561.

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