Stigma: What Hollywood and the Media Teach Us About Mental Illness

By Richard A. Friedman, The American Prospect. Posted August 5, 2008.

On April 16, 2007, a South Korean student named Seung-Hui Cho shot and killed 32 people and then turned the gun on himself at Virginia Polytechnic Institute in the deadliest shooting rampage in American history. Within hours after the massacre, it was widely reported that the killer had been a loner with a history of bizarre behavior who frightened some of his teachers and fellow students. He apparently had a history of psychiatric illness and had once been hospitalized. This national tragedy was front-page news for weeks, igniting the usual debates about gun control, campus security, and even immigration. Nightly newscasts reported "no known motive" and focused on the gunman's anger, sense of isolation, and preoccupation with violent revenge. No one who read or saw the coverage would learn what a psychotic break looks like, nor that the vast majority of people with mental disorders are not violent. This kind of contextual information is conspicuously missing from major newspapers and TV.

Hollywood has also benefited from a long-standing and lurid fascination with psychiatric illness reflected by such characters as Norman Bates, the psychotic killer in Alfred Hitchcock's Psycho, and Dr. Hannibal Lecter, the cannibalistic psychiatrist in The Silence of the Lambs. Other Hollywood portrayals of mental illness -- oppressive Nurse Ratched?s wards in the screen adaptation of Ken Kesey's One Flew Over the Cuckoo's Nest, or the spurned and psychotic lover, Alex, in Fatal Attraction -- indelibly shaped public consciousness as well. Exaggerated characters like these may help make "average" people feel safer by displacing the threat of violence to a well-defined group.

But the reality is that when it comes to mental illness, there really is no "us versus them." The reason is simple and sobering: An estimated 46 percent of American adults experience some type of diagnosable mental illness or substance-abuse disorder during their lifetime, according to the National Comorbidity Survey Replication, one of the nation's most reliable surveys of mental-health disorders. One percent, one of every 100 adults, suffers from schizophrenia. Close to 17 percent battle major depression in their lives. So one way or another, most of us are affected by the mental health of our friends and relations.

Both the news media and the entertainment industry have a critical role to play in informing public opinion. Together and separately, they can either perpetuate the stigma and misunderstanding surrounding mental illness or they can work to enlighten and educate. Indeed, there is a long tradition of investigative reporting that has had a powerful and positive impact on public policy and thinking about mental health. The intrepid journalist Elizabeth Cochrane (aka Nelly Bly) feigned insanity in 1887 and got herself admitted to the Women's Lunatic Asylum on Blackwell's Island in New York on an undercover assignment for Joseph Pulitzer's newspaper, The New York World. Bly soon discovered that it was easier to get admitted than discharged. After 10 days, she was released from the asylum only after Pulitzer interceded on her behalf. Her undercover exposé of the brutal and inhumane conditions, later published in a book, Ten Days in a Mad-House, led to increased funding for the care of the mentally ill: The New York City Department of Corrections and Charities received an appropriation of $850,000, a 57 percent increase over the previous year.

Decades later, an unlikely group of Americans became advocates for mental-health reforms. During World War II, an estimated 3,000 conscientious objectors to the war worked as attendants at state mental hospitals and institutions for the developmentally disabled. Often sponsored by pacifist religious organizations like the Quakers and Mennonites, these young aides helped fill severe shortages of doctors and other medical personnel called to war duty. Appalled by the conditions -- overcrowding, neglect, and even brutality -- many sought to advocate on their patients? behalf through the press and public officials. In 1946, Life Magazine published a gripping photo essay based partly on the aides' first-hand accounts titled, "Bedlam 1946: Most U.S. Mental Hospitals are a Shame and a Disgrace." Similarly, social historian and journalist Albert Deutsch relied on testimony from the conscientious objectors and others when he published The Shame of the States (1948), a powerful indictment of state-run mental hospitals. Together, these and other exposés of the time increased public awareness of the plight of psychiatric patients, and some reforms were made.

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Richard A. Friedman, M.D., is a psychiatrist and professor at the Weill Cornell Medical College. He is also a behavioral science columnist for The New York Times