Stereotypes of Mental Illness in the Media

Characters with mental health problems in movies are being depicted as more demotic and crueler than at any time in movie history: characters with a mental illness are either evil or simple, with nothing in between. Mental health stereotypes have not changed over a century of cinema. If anything, the comedy is crueler and the deranged psycho killer even more demotic.

These images are contributing to a distorted picture of mental health in the public mind. Almost half of us (49%) have seen people with a mental illness acting violently in films. Similar numbers (44%) believe that people with a mental illness will act violently in real life. Both of these beliefs are, of course, false.

This trend is especially harmful to real men with real mental health problems, because the vast majority of the actors falsely portraying mental illness are men.

The Offenders:

The Dark Knight

The Dark Knight as a low point in depicting mental illness. The violence and humour based is almost entirely on a misunderstanding of schizophrenia, he says. 'Batman describes the Joker as a schizophrenic clown, and when the film's second hero Harvey Dent becomes "Two-Face' and embraces evil, the familiar stereotype of schizophrenia is activated.

One Flew Over the Cuckoo's Nest

But the film best remembered for depicting someone with a mental illness acting strangely or violently remains One Flew Over the Cuckoo's Nest which was released almost 35 years ago - the influence of movie stereotypes on attitudes can last a generation.

Other:
Looney Tunes
Psycho
Dinner With Schmucks

More Realistic Portrayals:

Schizophrenia: Daniel Craig in Some Voices and Russell Crowe in Beautiful Mind
Autism: Dustin Hoffman in Rain Man
Borderline personality disorder: Angelina Jolie in Girl Interrupted
Dissociative identity disorder: Three Faces of Eve

Denying Sadness

I am convinced that stoicism is never the answer to anything, being nothing more than a cruel, callous encouragement to people to devour each other, a powerful ally of sadists and tyrants keen to get people to endure things which should be firmly refused as unendurable. Courage, indeed!

--Les Murray, Killing the Black Dog

Through my countless hours of idle contemplation I became aware of one simple fact. We do not talk about sadness. Anyone who talks about it is seen as whiny and unpleasant to be with. We discourage expressions of sadness with nonsense about Getting a Grip on Yourself. “Emo” is used as a derogatory term. Nobody wants to hear about your dead aunt or mother or brother, and you don’t want to bring it up for the fear of burdening your friends. But has this always been the case? Is it our nature to frown upon talking about sadness? Or maybe this is a socially constructed norm that we all just grown accustomed to, like our obsession with individualism? Somewhere in Abraham Lincoln’s biography I read that in his days showing inner angst was the equivalent of getting a six-pack. So what has changed since then that stigmatized sadness?

There are 50 percent more suicides than homicides in the U.S. Most people get these numbers switched. This is partly because of the mis- and underreporting of suicide by the media, mostly due to coverage leading to copycat suicides. This ignorance prevents the society from addressing the problem of mental illness and perpetuates the stigma associated with mental illness. It seems that people are in denial of all the sadness in the world. They consciously, and often even craftily and pertinaciously, refuse to face the reality that surrounds them. The suicide rates, the prevalence of illness, poverty, and inequality are just a few of the plethora of issues that cause people their lives, and, probably even more importantly, the quality of their lives. But if there is so much suffering in the world, why do we often overlook it? In another book I read that the self-conscious mind makes up only about five percent of our thoughts. If that is true, then that means that 95 percent of our decisions, actions, and behaviors are the result of something wholly out of our control, the subconscious mind. So maybe avoiding sadness is a built-in defense mechanism that protects us against overwhelming thoughts of pain. After all, denial is the first stage in the five stages of grief.

I think our society is in denial of sadness. We avoid the subject of suffering at all costs, and thereby make it taboo. This is because we have not developed coping mechanisms, and simply do not know how to address and deal with the reality of death. We even put make up on the dead to make them seem life-like, as if they are only going into a long sleep. Or maybe we can’t yet accept that suicide is a part of our society. Newspapers underreport suicide for fear of rebuke by family members devastated by guilt and shame. Maybe yet it is anger that we are afraid of. We suppress anger for fear of getting labeled as someone with anger-management issues. We escape and reject pain at all cost. We praise those who go through pain without complaining, because pain is seen as weakness. We say things like "just snap out of it" and "pull yourself by the straps", which are cruel and hurtful, especially to somebody suffering from depression who has no control over his illness. And sadness; well, we brush it underneath our beds because we are too busy being preoccupied with being positive and optimistic all the time. If you talk to a random sample of people in our society, or look at a random sample of profile pictures, you would think we are the happiest people on earth. However, the rates of mental illness and suicide in America are bigger than those in any other industrialized country.

We make the topic of sadness taboo, making it impossible for someone to discuss feeling a healthy dose of sadness with anyone else. We perpetuate these fears by social norms, such as everyone telling us that being sad is somehow a weakness and that we should be calling 5150 if someone even mentions the word suicide. We what message are we sending them other than “under no circumstances talk about sadness or people will think you are crazy.” So people never do, and one day they are gone without even saying goodbye, and you wonder how can it be. So talk, talk, talk about sadness, suicide, depression, about your inevitable death, which could come at any moment and under any circumstances, and about feelings of sadness and melancholy. Because by sharing sadness with your friends, you are letting them know that when they are going through hard times they are not alone.

Depressed and at Cal

I never really thought about mental illness until the start of my sophomore year when my psychotherapist diagnosed me with major depression. I saw the Prozac commercials on TV and the posters around campus, titled “Look for the Signs of Depression”, but I never suspected that it would happen to me— much less that it would force me to withdraw from school and admit myself into a hospital.

One day I was disturbed by the eccentricity of my thoughts, so I decided to call and make an appointment to see a counselor at the Tang center. As I found out, I had six free sessions, as all Cal students do even if they do not have insurance, which gave me some comfort. However I was very apprehensive about my first appointment—I am not all too comfortable with spilling all of my personal problems to a complete stranger. So in an attempt to regain some potential loss of control, I wrote a list of all of the questions that I would ask my counselor during our first appointment, such as “What are your religious views?” and “Why did you decide to become a counselor?”

The first counselor I saw at the Tang center was Dr. H, a non-intimidating, energetic man. When I sat at the chair in his office, and after he asked me, “so what brings you here,” my defenses somehow dropped, and thus my treatment began and continues until today, although with a different counselor. While sharing the experience of my first counselor visit with my friend over the phone, he asked me, “so how did it go?” To which I replied, in jest, “he said I was crazy”. He responded, “come on man, this is serious”. It is. As I later found out, one in ten students are treated for depression in the U.S. in any given year and many more are affected by it through knowing somebody who suffers from it.

            Despite seeing a counselor, watching my diet and exercising, I was feeling progressively worse, and even though I was attending my classes, I was failing them. This led me to withdraw from all of my classes by the end of every semester that year. So, Dr. H recommended me to take antidepressants, to which I initially was extremely opposed (“I am not down to take drugs”, I told him during our first meeting. I was against any sort of pharmaceutical intervention because my cultural background taught me that I was the one who should resolve all my difficulties and the belief that such medication is "unnatural"). However, the symptoms kept exacerbating, so I finally gave in and saw a psychiatrist, Dr. M, who prescribed me my first antidepressant, Paxil. I put all of my hope into these pills, and—thanks almost exclusively to the placebo effect—I started feeling better almost immediately. But this amelioration was ephemeral, and my health soon regressed.

When the summer came, and I went home to San Diego, thinking, "if I couldn’t get better at Berkeley, I will get better here". After all, the sun is supposed to be good for people with depression, right? When I stepped into my home in San Diego, I remember crying from relief. But as the end of summer drew nearer, things weren’t looking any better, especially because around that time I was going through withdrawal while trying to wean myself off of Paxil, which was only making me drowsy. So I withdrew from Berkeley and admitted myself into a hospital for “Cognitive Therapy Intensive Outpatient Program”.

This six-week, twenty-day program consisted of lectures and group therapy. The purpose of the lectures was to help us re-learn the rudimentary life skills, such as making decisions and being assertive. Group therapy was where everybody had a chance to talk about his or her issues and receive feedback from the rest of the group. Of course, the issues in these groups revolved around the most familiar topics of conflict, intimacy, and loss.

            Following the hospital, more treatment of meeting with my therapist followed as well as being put on a new antidepressant, Effexor XR, and then on Welbutrin. In addition, I was taking classes at UC San Diego and a community college to satisfy my UC Berkeley requirements, with the full intention of returning as soon as my health allowed. What was I doing in my spare time? Trying to escape my misery through watching TV shows, hanging out with friends, learning to meditate, volunteering, and making some pocket money through tutoring—everything a non-depressed me would do, only without enthusiasm.

            One spring day, I walked outside to go to my car and noticed that something was different, slightly yet distinctly so—that unnameable tide that obliterated any enjoyable response to the living world was gone. For the first time in many months I felt pleasure—I could feel the sun’s warmth on my shoulders, I noticed the greenness of the grass, and I smelled the freshness in the air. That was the day my depression was gone, and tears of relief filled my face. Now it was time to face the life’s responsibilities and return to Berkeley, where I am currently continuing my study and reflecting on these past days.

The Stigma Within Us

During my sophomore year as an undergraduate student at UC Berkeley I was diagnosed with depression. What my therapist meant was that I had clinical depression, or major depressive disorder (MDD)—the mental illness that is characterized by an inability to enjoy life; including eating, exercise, social interaction or sex; feelings of worthlessness, isolation, and hopelessness. That's what I had. I felt hopeless, worthless, and utterly alone—feelings I never had before to that intensity—and I felt ashamed for feeling this way.

My mind brought up feelings from the deep recesses of my mind—the dark, secluded corners that are inaccessible and even dangerous for our conscious minds to see. I had feelings that I never had before—for which there are no names—and I did not even suspect that these feelings were possible. As I said before, I did not enjoy life, had frequent crying spells, and felt guilty about it. Everyone around me seemed so happy, and I did not want to be a burden on my friends and family, so I did not tell anyone that I had depression. This state was wholly alien to me, and I knew I was in uncharted waters, and yet I was afraid to ask for help. I just ignored it and hoped for it to go away. Had mental illness and depression been an open subject, where everyone knew what it is and how to treat it, I might not have felt the way I did and would have reached out for help sooner.

It all started at the end of my freshman year at Cal. I lost my motivation to do homework, I could not pay attention in class, and I stopped attending my classes altogether. Any work just felt so meaningless. Although I remember that I did reach out to two of my friends, who took the time to chat with me. But even though it felt good to relate what I was feeling to another human being, my friends did not suspect that anything was seriously wrong. But how could they, at a time when mental illness is such a sensitive topic that virtually nobody talks about it and the media avoids it? It was hard for me to acknowledge that what I was experiencing was anxiety and depression. I did not even consider that I was in the early stages of depression, but sensing that something was wrong, I scheduled to see a counselor at the Counseling and Psychological Services (CPS) at the University Health Services. But even after I was diagnosed I denied this fact for a very long time.

After I reached my six-session semester limit, my therapist, who also worked at other Universities, told me—explaining the high demand for counseling at the University—that depression is an “epidemic” at Cal. This is no surprise, considering that I led the typical freshman lifestyle: I ate whatever and whenever I pleased, I didn’t exercise, I pulled all-nighters almost weekly, and I was under the stresses of adjusting to new academic demands and a new setting, while being away from home for the first time. Considering that one of my classes was the size of my whole high school, Cal can be an overwhelming, alienating place. Therefore, like many students do when they first come to Cal, I had difficulty adjusting and feeling a sense of belonging.

Although people may feel grief, stress, and sad due to life's changes, not everyone becomes clinically depressed. The lifetime prevalence of major depressive episode is 17% in the US (or 1 in 6), and 1 in 15 have it at any given year, with varying severity. The term "depression" is highly misunderstood because it is ambiguous. When people say they are depressed they usually refer to having low mood or a bad day. However, in a major depressive episode, low mood is but one of dozens debilitating symptoms. Depression may also refer to an umbrella term for any or all of the mood disorders (Major depressive disorder, Dysthymia, Bipolar disorder, and substance induced mood disorders). There is usually no clear cause of MDD—such neat logic and compartmentalization are not how the human mind and depression work. Surely, my genes, poor lifestyle and perpetual stress contributed to me having depression, but the exact pathways remain a mystery in the medical field. Almost one in seven college students nationwide have been diagnosed with depression in their lifetime. Depression is also the leading cause of disability worldwide, and yet the subject remains taboo! A moment's reflection would reveal that this is an outrage. How many people with depression do you know?.. My guess is not many. So if depression is an “epidemic” on campuses across the U.S., and especially at Cal, why do so few people know about it and why did I feel so stigmatized?

To a large extent, the stigma is due to our misunderstanding of mental illness. Partly because its severity is inaccessible to someone who has not experienced it, and partly because this topic is avoided in conversation and the media. Media only mentions mental illness (if at all) when it reaches the extreme, such as in the cases of a school shooting or a suicide. This gives the public an image of the mentally ill as being a threat to society who should be locked away in an asylum. Even mentioning—much less admitting to having—a mental illness leads most people to discomfort and avoidance.

So now, the real question is: how do we get rid of the stigma of mental illness that plagues so many students on our campus? How do we accept that depression is a real illness as reality and stop the deplorable shame and unnecessary suffering? How do we recognize that mental illness necessitates the same care as cancer or diabetes or an injury does? Only through talking openly about depression and mental illness, we've got to take any opportunity to talk about it. So let’s start right away and talk to just one person—friend or stranger—about mental illness today.

Darkness Visible: A Memoir of Madness, by William Styron

A beautiful book... almost plain-spoken, and all the more profound for it. Describes depression very accurately and gives a just account of its innumerable intricacies—all the more impressive, since it’s a short book. Reading this book was the greatest solace in my loneliness, where no one can relate. The focus, the honesty, the disarming lyricism, the sensitivity, that constant rueful sadness, even humor—and, yes, redemption. There isn’t any attempt to glamorize or romanticize depression—Styron even reflects on centuries of artists who seem to be inexplicably blighted by the disease. A mix of personal defeats, friends, the writing life—and how one’s existence is just permeated with the darkness. Oh, there’s just so many things I want to share, to discuss—I want to point to a page and say, “Yes, that’s true,” and then to another, “He’s right.” Depression is sometimes termed "the invisible illness", because it is not apparent—nor is its severity accessible—to an outside observer.

William Styron (1925 – 2006), Darkness Visible: A Memoir of Madness

[A] fascinating aspect of depression’s pathology . . . This concerns not the familiar threshold of pain but a parallel phenomenon, and that is the probable inability of the psyche to absorb pain beyond predictable limits of time. There is a region in the experience of pain where the certainty of alleviation often permits super human endurance. We learn to live with pain in varying degrees daily, or over longer periods of time, and we are more often than not mercifully free of it. When we endure severe discomfort of a physical nature our conditioning has taught us since childhood to make accommodations to the pain’s demands- to accept it, whether pluckily or whimpering and complaining, according to our personal degree of stoicism, but in any case to accept it. Except in intractable terminal pain, there is almost always some form of relief; we look forward to the alleviation, whether it be through sleep or tylenol or self-hypnosis or a change of posture or, most often, through the body’s capacity for healing itself, and we embrace this eventual respite as the natural reward we receive for having been, temporarily, such good sports and doughty sufferers, such optimistic cheerleaders for life at heart.

In depression this faith in deliverance, in ultimate restoration, is absent. The pain is unrelenting, and what makes the condition intolerable is the foreknowledge that no remedy will come- not in a day, an hour, a month, or a minute. If there is mild relief, one knows that it is only temporary; more pain will follow. It is hopelessness even more than pain that crushes the soul. So the decision-making of daily life involves not, as in normal affairs, shifting from one annoying situation to another less annoying- or from discomfort to relative comfort, or from boredom to activity- but moving from pain to pain. One does not abandon, even briefly, one’s bed of nails, but is attached to it wherever one goes. And this results in a striking experience- one which I have called, borrowing military terminology, the situation of the walking wounded. For in virtually any other serious sickness, a patient who felt similar devastation would by lying flat in bed, possibly sedated and hooked up to the tubes and wires of life-support systems, but at the very least in a posture of repose and in an isolated setting. His invalidism would be necessary, unquestioned and honorably attained. However, the sufferer from depression has no such option and therefore finds himself, like a walking casualty of war, thrust into the most intolerable social and family situations. There he must, despite the anguish devouring his brain, present a face approximating the one that is associated with ordinary events and companionship. He must try to utter small talk, and be responsive to questions, and knowingly nod and frown and, God help him, even smile. But it is a fierce trial attempting to speak a few simple words.

Thank you, Mr. Styron. You saved my life, and you are deeply missed.