Portraying mental illness on the small screen

Fictional characters with experience of mental illness are often one-dimensional, frequently disappointing and regularly offensive.

If we were to take these portrayals as gospel, it would be impossible to imagine a person affected by mental health problems who wasn’t either helpless and pitiable, or stark-raving mad.

Let’s not forget violent too. Thanks to director Alfred Hitchcock, the character of Norman Bates in Psycho could be, for many people, the quintessential crazed killer. Remember that scene? Bates, in a woman’s dressing gown, creeping towards the shower curtain. The curtain is wrenched aside, there’s a bloodcurdling scream, frenzied arm strokes and splattered blood. A deranged man with mother issues and a penchant for cross-dressing. A ‘psycho’, through and through.

Stigmatising portrayals of mental illness have been done on a grand scale on the big screen, but they can be equally damaging on the more intimate, and arguably more accessible, medium of television. Both serve to reinforce many of the stereotypes associated with mental illness and are barriers to social inclusion, acting against the work of Like Minds, Like Mine, Time to Change, Mindframe, Bring Change 2 Mind, and many more anti-stigma organisations.

Character portrayals are improving

However, headway has been made with TV producers in New Zealand, across the Tasman and particularly in the UK, which has seen more realistic portrayals of characters living with mental illness and enjoying fulfilling lives. Like Minds looks at how portrayals of characters experiencing mental distress have improved over time, what the research tells us about the effect TV has on public opinion, and ways to continue the gains made.

Research shows power of TV

A number of studies in Australia and elsewhere in the world have shown a strong link between the portrayals of people with mental illness on the small screen, and public attitudes to people with lived experience of mental illness.

A 2005 report by mental health organisation SANE Australia looked at consumers’ impressions and responses to TV and movie depictions of mental illness and suicide. The majority of people who participated in Make it Real! believed that inaccurate and stigmatising portrayals of people with mental health problems were far more common than informed representations, and that the examples had a lasting impact.

This included reinforcing stereotypes and negative labels, and increasing the self-stigma for people living with mental illness.

“I don’t know much about it [the portrayal of mental illness in TV dramas],” said one respondent. “Just what I see on TV, and they’re always psycho killers.” Another said: “They only care about creating a big drama to get ratings up, not how this affects us”.

In the same year, a University of Melbourne study reviewed the research literature around fictional film and television portrayals of mental illness. This found that the portrayal of mental illness is “extensive and, predominantly, perpetuating myths and stereotypes”.

The report says: “People with mental illness are most commonly shown as being violent and aggressive, but they are also frequently depicted as eccentrics, seductresses (in the case of women), self-obsessives, objects for scientific observation, simpletons and/ or failures.” The study also found that, perhaps contrary to popular opinion, entertainment media may have a greater influence on community attitudes towards mental illness than news media.

However, not all of the findings from the research mentioned were negative.

On the positive side, participants in Make it Real praised the portrayal of selected characters in the Australian TV shows, Neighbours and Stingers. “Stingers was good because it showed [a character] dealing with bipolar over a long period of time, not just a once-off,” said one participant. Another said the portrayal of Boyd from Neighbours was “pretty cool” – “he was such a popular guy, so normal, and he got so much support from his friends and family”.

Some success over the ditch

Australian mental health initiative, Mindframe, was established in 2000 to provide information to various groups on how to responsibly and authentically report on or portray issues around suicide and mental illness.

Amy Visser, of the Hunter Institute of Mental Health, which manages Mindframe, says television drama plays an important role in influencing people’s attitudes. “There is a demonstrated link between negative portrayals of mental illness in the mass media and negative beliefs among people in the community,” says Amy. “In short, this can lead to stigma and discrimination towards people living with a mental illness. It’s not so much the instance of these portrayals as the way in which they are presented that can influence outcomes for people who are vulnerable, and community understanding generally.”

In 2007, Mindframe turned its attention to fictional portrayals of mental illness, with the launch of its stage and screen project. “From the very beginning, we’ve had positive engagement with people working in television, film and theatre,” says Amy. “The Hunter Institute of Mental Health partnered with the Australian Writers’ Guild and also engaged individual consumers from the SANE Australia speakers’ bureau, all with the aim of informing the project and making it accessible to the entertainment industry and the mental health sector.”

TV programmes that have taken on-board Mindframe’s guidelines and anti-stigma messages include Home and Away, Neighbours, All Saints and

“We consulted with the Neighbours story department on developing a character with bipolar disorder, in collaboration with SANE Australia and a person with lived experience,” says Amy. “We also consulted with production team members for Dance Academy on a storyline involving the issue of eating disorders, linking in with the Butterfly Foundation for direct information and follow-up support. “In each case, the most important factor has been linking creatives with real-life stories, either by face-to-face contact with people with lived experience, or through the many other story sources we provide.” While old stereotypes are being challenged more often, negative depictions of characters with mental illness are still all too common on Australian television screens.

“There are still many myths and misconceptions being perpetuated in the name of ‘drama’. Mental illness is often easy fodder for creating characters with bizarre and eccentric behaviours and the conflict that ensues, with little explanation as to if, how or why someone living with an illness would behave this way. However, increasingly these clichés are being challenged as writers seek out new and exciting stories.”

The English experience

In the UK, positive portrayals of mental illness on screen are not as unusual as they once were. Anti-stigma programme Time to Change has commended a number of local television shows for their handling of stories featuring people experiencing mental illness.

The Spring 2013 issue of the organisation’s Speak Out magazine delves into some of its most successful work with Eastenders and Emmerdale – two long-running UK soaps, which also air in New Zealand.

Jenni Regan, who runs Time to Change’s Media Advisory Service, says Eastenders approached them in 2012 for help with a depression storyline for Ian Beale, a major character on the show. She advised the writers that symptoms should build up over several months and, rather than the story reaching the usual dramatic violent ending, having the character simply walk away from his life was a much more realistic peak.

Eastenders also had guidance from Kevin Shepherd, a Time to Change media volunteer who has lived experience. He worked with scriptwriters by sharing his own insights on how Ian may feel or react. Jenni script-checked the results and provided feedback around Ian’s symptoms, treatment options and the way he interacted with others. “It was a unique opportunity to show millions of people the reality of living with a mental health problem,” Jenni says. “Our role with this storyline means that we have been able to ensure as much accuracy as possible.”

Emmerdale character Zac Dingle also experienced a mental health crisis in 2012. The show’s writing team was blessed with a writer, Bill Lyons, who was keen to get it right and had done quite a bit of the initial research himself, and a producer who wanted to keep the story as true to life as possible. They, like Eastenders, also worked with a Time to Change media volunteer, Lol Butterfield, who advised on the storyline.

Lol shared his experiences of depression and, as a qualified mental health nurse, could look at the plot from both angles. Emmerdale researcher Fiona McAllister says Lol was invaluable because of “his openness about his own experience”, which “really fed into the script and informed the excellent performance”.

“Showing a patriarchal figure like Zac Dingle going through a period of mental distress is a really tough call, and we’re still showing the reality of his long-term recovery. I think it was dramatically brilliant and also did its bit challenging stigma.”

Emmerdale scooped a 2012 Mind Media Award for their storyline, while actor Adam Woodyatt, who played EastEnder’s Ian Beale, was nominated for an award for his portrayal of depression.

Path opens for consultation

Back in New Zealand, Kiwi soap Shortland Street beams into thousands of lounges each week and is nearcompulsory television viewing for many Kiwis. Like Minds, Like Mine National Contract Manager Katrina Mathers has been watching the show since it started and has generally been impressed with its portrayal of minority groups and sensitive social issues. So, when the storylines started to stereotype and stigmatise characters living with mental illness, she was disappointed and compelled to act. “There seemed to be a tendency to fall back on mental illness as an excuse for episodes of violence,” explains Katrina. “One of the characters, Bree, had previously been placed in care following an attempt to kill her sister.

She was reintroduced to the show, but it soon became clear this was only to provide a culprit for an unsolved murder. “There also seemed to be a tendency to ship people off when they had mental health issues. The character, Dayna, ‘disappeared’ into care the moment she was diagnosed with bipolar disorder. For months on end, nobody even talked about her. It implied that when a person has a diagnosis of mental illness, you can wash your hands of them and hand them over to authorities. This completely goes against our ‘be there, stay involved’ message.

Judi Clements, Chief Executive of the Mental Health Foundation (MHF), sent a letter to the Shortland Street writers, voicing these concerns and suggesting ways the organisation could help inform more positive storylines.

A reply was received soon after from the show’s producer, Simon Bennett, who suggested a meeting to discuss better ways of portraying people experiencing mental illness. Simon says the “credibility and authority of the MHF” was enough for him. “If the MHF thinks that there are problems with what we’re doing, we respect that,” he says. “In making the show, we don’t try to be irresponsible and we have a responsibility not to misrepresent things or perpetuate stereotypes that could be damaging. “We are very aware that our viewership is wide and influential, so we try to get the medical aspect of what we’re doing right. We have a nurse advisor, but she doesn’t specialise in mental health. That’s why it’s been great to have the MHF to call on.”

Katrina, and others from the MHF who attended the meeting, says it was productive and “positive all round”. “I was encouraged that they seemed to be so open to our suggestion that we could help them develop more positive storylines,” says Katrina. “It was great to see they had gathered the entire writing team too – I thought we’d just be meeting with a couple of people. The writing team seemed genuinely interested in what we had to say and surprised and moved by some of the things we told them.”

Since then, a positive working relationship has been established between the MHF and Shortland Street, which has seen more positive storylines develop for Dayna. “They aren’t mentioning her diagnosis anymore, which I think is great,” says Katrina.

“Before she just seemed to be ‘the bipolar girl’, but now she’s just Dayna. I think they’re doing really well.”

Working with television – the way forward?

Dr Fincina Hopgood, Sessional Lecturer, School of Culture and Communications at the University of Melbourne, sees the future success of fictional TV characters lying in their ability to engender empathy in their audiences.

Earlier this year she convened a symposium in Melbourne called Try Walking in My Shoes: Empathy and Portrayals of Mental Illness on Screen to discuss how mental illness is represented in film and television and what the implications are for mental health awareness in the community. “The idea for the symposium grew out of my PhD research project and that of a colleague, Patricia Di Risio,” she says.

“We wanted to explore the emotion of empathy and how this can be elicited through film and television – and had the support of The Dax Centre and ARC Centre of Excellence for the History of Emotions.”

Fincina says discussion about this issue was important because “cinema and television can be quite influential in shaping people’s attitudes”. “While most of us know that films and TV shows are not ‘real life’, their emotional appeal means a negative portrayal of a character with mental illness can have a greater impact on social attitudes than a well-informed newspaper article or an anti-stigma campaign.

“It’s also important for people with lived experience [of mental illness] to see themselves on screen, to feel validated by having their stories told, rather than feeling invisible, as if they don’t exist, or, worse, being demonised. “What matters is the intention of the filmmakers and producers in creating a character with mental illness – is it for sensational effect? Is it just lazy scriptwriting – eg. when a crime happens, pull out the stereotype of the psycho killer? Or is it to create a character with depth and complexity that audiences can relate to?

“The critical and commercial success of TV shows like United States of Tara, Homeland and The Bridge show that filmmakers and TV producers are looking for different stories, more complex characters, and are willing to ‘take risks’ by having their main character living with a mental illness – and those perceived ‘risks’ are clearly paying off.

“Armed with accurate information and valuable research material about mental health, writers can now create more complex, authentic characters that go beyond stereotypes and clichés.”

The shift towards developing empathetic characters on TV lies in the flexibility TV has to establish and deepen connections with the audience over several episodes. Fincina thinks the key to destigmatisation lies in developing characters and storylines that "tap into our potential to empathise with another human being". “It allows audiences to go on a shared emotional journey and makes the experience of living with a mental illness accessible and relatable,” she says.

“Whether filmmakers/producers consult with mental health organisations or talk to people with a lived experience, that research will pay off in producing a film or TV show that is compelling and resonates with audiences.”