Mental Illness Is All Over TV — Here's Why That's Not Always a Good Thing

Featured on Instyle. Author: Jessica A Gold, MD, MS

Lately it seems like everyone has been talking about mental health, so it's not surprising that our favorite TV shows are taking on topics pertaining to the psyche more and more, too.

This is Us beautifully and fairly portrays binge eating disorder, alcoholism, and panic disorder. Shameless features a mother and son who both have bipolar disorder, and it thoughtfully represents their challenges. The last season ofHandmaid’s Tale showed a variety of responses to trauma, sexual assault, and peri- and postpartum mood disorders. Representation like this on television is a great way to destigmatize mental illness — but that only works if the representation is fair and accurate. Unfortunately mental health storylines are much more likely to be fear-mongering and wildly wrong. As a psychiatrist, this both piques my interest and upends my work-life balance. Whether I’m watching everyone’s favorite medical drama or “reality” TV, it’s impossible not to switch into physician mode, angry on behalf of all of my patients and the many viewers who are being misled.

Here’s why: We learn about ourselves and our world through entertainment. You may think getting information about mental illness from mindless TV is like taking health tips from a Kardashian (and, okay that's fair). But one study published in 2016 in the journal Social Work in Mental Health found that a quarter of college students reported TV and film as their primary source of education on mental illness. In 2014, 25 percent of young adults in Californiasaid they would be unwilling to move next door to someone with mental illness. Perhaps this is because they’re used to seeing such people portrayed as violent loose cannons (instead of, say, just like their current next-door neighbor). 

What we see on TV can influence our behavior, too. Following the release of the first season of 13 Reasons Why, internet searches for “how to commit suicide” jumped 26% higher than what would normally have been expected at the time, and some teen deaths were labeled “copycats.” Searches for “suicide prevention” and “suicide hotline number” also rose by 23% and 21% respectively, according to research into Google data. Hopefully that means the show helped at least some people reach out who wouldn’t have otherwise, but that also further proves how important it is to get these portrayals right.

Consider the inverse: If your drinking problem doesn’t look like a Real Housewives drinking problem, you might think it’s fine, and carry on without seeking needed help. And when shows like our beloved Bravo franchises get mental illness wrong, they seem to be getting it really wrong. Here are a couple examples from this past year that had me screaming at my TV. With any luck, the new fall slate will do better.

(13 Reasons Why: Season 2, Episode 13)

The plotline: Tyler is a student who is bullied in high school. In the Season 2 finale, he is sexually assaulted by a group of other boys in the school. Afterward, he decides to go to the school dance and “make them pay” using a stockpile of weapons.

The problem: By linking a very violent scene of bullying and trauma to a person’s motivations for attempting a school shooting, this episode suggests that “revenge” shooting is a viable or at least justifiable option. It also suggests that psychological conditions can lead to violence (such as PTSD, which we can assume he would be experiencing, though it isn't outright mentioned on the show). This link, between mental illness and violence, is a dangerous and frankly overused cliche. “A good deal of the demonization of people with mental disorders stems from a marked overestimation of their risk of violence,” says Paul Applebaum, MD, a professor of psychiatry, medicine, and law at Columbia University​​​​​​​. “Media portrayals of violence involving mental disorders reinforces the false view that we should be afraid of our neighbors who need our help and understanding, and should not have to the face the consequences of our fear.” Especially in a country in which gun violence occurs all too often, and perpetrators' mental illness is often the go-to blamed entity, TV portrayals need to be mindful not to add to this stigma.

(Orange Is the New Black, Season 6, Episode 1)

The Plotline: Following the prison riot at the conclusion of Season 5, this season opens with Suzanne "Crazy Eyes" Warren watching what appears to be a hallucinated television set. Flipping imaginary channels, Suzanne sees her peers in different shows (Red is a Clown, Piper is on Jeopardy, Nikki is a comic dog). Some of the dialog is grounded in real events (for example, Daya’s exchange with guards who are beating her is reimagined as a dance routine). After about eight minutes of this, we learn that Suzanne is off her medication. We later see her hallucinate her mother as a calm participant in a meeting with investigators, and then she envisions the entire prison ward doing the "Cha-Cha Slide." What fun.

The problem: This is not at all what hallucinations look like in a person suffering from mental illness, and this portrayal leads to further stigmatization and misunderstanding of disease. While we are unsure what Suzanne's diagnosis is exactly, according to Rona Hu, M.D. a clinical associate professor at Stanford University, "Hallucinations are auditory much more often than visual. It's understandable that a TV show or movie, being a visual medium, would prefer to depict visual hallucinations, but I've often thought an accurate and well-done depiction of what auditory hallucinations are like would go a long way in helping people be more compassionate about serious mental illness." Dr. Krystal adds, "Most people experiencing chronic hallucinations develop ways to hide this fact from the people around them. Most commonly, they seem a little distracted." For Suzanne to clap along to the musical number, and point and laugh at what she's seeing, seems to be not just an unlikely and uncommon scenario, but an unrealistic one.

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