Eliminating the stigma surrounding mental illness is a daunting prospect, but if the media learns to portray mental illness accurately, it could help to end a persistent pattern of misunderstanding and prejudice that affects millions of mentally ill people. Despite its powers of dissemination, the media is still reinforcing ancient stereotypes. Television presents obsessive case studies about deranged and violent killers while ignoring the experience of mental illness in the general public—an experience that affects one in four Americans, according to the National Institute of Mental Health. Meanwhile, soap operas exploit fictional mental disorders, and Buzzfeed offers us a “bipolar chihuahua.”
Film and premium television, however, are producing some sensitive depictions that may have the power to reverse this negative pattern. In the same way that Philadelphia revolutionized the public perception of AIDS in 1993, film and television may be opening a new era of acceptance for some forms of mental illness. In the past, film has played an active role in exorcising societal demons. But what happens when the demon is so complex and impenetrable, as mental illness is, that the stigma it carries has been a part of human society for thousands of years? How far, then, can the power of a few media depictions go?
Hollywood’s interest in mental illness goes back to the early days of psychotherapy, and of the movies themselves, but it hasn’t always taken a progressive form. Alfred Hitchcock’s 1945 film Spellbound starred Ingrid Bergman as a psychiatrist trying to unravel a tough patient, played by Gregory Peck. Spellbound billed itself as a vehicle for demonstrating the wonders of psychotherapy, but its approach seems outlandish today; it featured an outdated pseudo-Freudian conclusion and a surrealist dream sequence designed by Salvador Dalí.
Other influential films have been red herrings in the development of awareness. The 1975 adaptation of Ken Kesey’s One Flew Over the Cuckoo’s Nest may have helped to change the practice of psychiatry and close down the traditional mental institutions, but it isn’t truly about mental illness; it’s a Beat-era parable about the struggle of the individual within a conformist system. The film uses mental illness as a symbol for the helplessness of the individual, while ignoring the intrinsic value of mental illness as a subject. Beyond the abstract implications of its theme, the film caused a lasting backlash against electroconvulsive therapy—a relatively common recourse for people suffering from treatment-resistant mood disorders today—for its horrific, yet misleading role in destroying Jack Nicholson’s McMurphy.
But slowly, depictions of mental illness began to evolve. In 1980, Robert Redford’s Ordinary People was the first film to bring to a wide audience the devastating effects of suicide and depression on families, and the healing power of therapy. Ordinary People was the first popular film to attempt to portray interiority in a mentally ill character.
Despite its positive impact, Ordinary People did not put an end to misleading portrayals. Since then, depictions of mental illness in popular films and television shows have often been droll and one-dimensional. Tony Shalhoub, for example, played a lovable obsessive-compulsive detective on Monk, which ran from 2002 to 2009. But Monk’s OCD was a gimmick; it inexplicably gave him his powers of deductive reasoning, and almost entirely defined his character. Toni Collette, in the same vein, played a person with dissociative identity disorder on United States of Tara. Tara’s condition was reduced to a plot point and a spectacle. The disorders as depicted in these shows were quirky foibles that turned the characters into oddities—freakshows, there to generate laughs and act out metaphors for the problems of normal people.
Yet this pattern of damaging, identity-determining portrayals may finally be a thing of the past; two recent, highly popular productions have taken a much more positive approach. The Showtime series Homeland and recent film Silver Linings Playbook have produced what many have found to be accurate, sensitive depictions of bipolar illness—a mood disorder that afflicts about four million Americans. Unlike previous portrayals, they provide an immediate window on the disorder that may be inspiring a shift in popular perceptions of mental illness.
In the tradition of Ordinary People, both productions do their best to avoid flat characterizations and address some of the real problems that many bipolar people and their families face: the vagaries of the mental health system; the reasons for resisting treatment; the difficulty of diagnosis; the fact that bipolar disorder has a genetic basis and runs in families; and the emotional cost of mania, depression, and suicide attempts. It’s a dramatic and overwhelming improvement from what we’ve seen before, and a definitive departure from the use of mental illness as a symbol or plot device, or the depiction of it as a harmless quirk. And since Silver Linings Playbook and Homeland have reached an unusually wide audience, their prospects for changing public perceptions of mental illness are as good as any. Silver Linings Playbook earned $132 million at the box office and a number of Academy Awards, and each episode of Homeland attracts about 2 million viewers at airtime.
But neither depiction is flawless, and whether these two isolated depictions can permanently buck the trend of negative portrayals will be a true test of the power of film and television. Both Silver Linings Playbook and Homeland sometimes err where the demands of narrative trump the portrayal of the illness and where the paratactic language of film precludes detail. Silver Linings Playbook may gloss over some details of treatment and overplay the role of love in ameliorating mental illness. Homeland may put too much emphasis on Carrie Mathison (Claire Danes), the CIA analyst protagonist, as a “bipolar hero”—conflating mental illness with a heroic identity and incisive analytical power. At some moments in each, it’s hard to tell where the features of the illness end and the characters begin,though real mood disorders often present the same problem.
These new depictions are undoubtedly a positive development in the media’s approach to mental illness. Yet what is at stake here—a long-overdue end to the mental illness stigma—seems too critically important to leave up to the caprices of Hollywood producers.