The problem with how the media portrays schizophrenia

The media teaches us about people with whom we do not routinely interact. This constant flow of data gives us incessant social cues about the nature of other groups of people — including which groups of people should be praised or scorned. Media portrayals of those with mental illness often skew towards either stigmatization or trivialization. Consequently, all forms of media — including television, film, magazines, newspapers and social media — have been roundly criticized for disseminating negative stereotypes and inaccurate descriptions of those with any form of mental illness.

Of course, some people with mental health problems commit violent crimes, as do people without mental health problems. When someone is a danger to themselves or others, it is critical that they receive appropriate and timely support. But there is a need to put this into perspective and to recognize the repercussions of negative portrayals of people with mental health problems — most notably schizophrenia.

In 2001, the World Health Organization (WHO) reported that an estimated 25 percent of the worldwide population is affected by a mental or behavioural disorder at some time during their lives. This mental and behavioural health issue is believed to contribute to 12 percent of the worldwide burden of disease and is projected to increase to 15 percent by the year 2020 (Hugo, Boshoff, Traut, Zungu-Dirwayi, & Stein, 2003). In relation to this, it is important to point out the consequences of wrongful portrayals in the media.

People living with schizophrenia are often portrayed as violent and dangerous, their stories sensationalised. A 2012 study found that over 80% of main characters with schizophrenia in films displayed violent behaviour and nearly a third engaged in homicidal behaviour. The independent ‘Inquiry into the “schizophrenia” label’ in 2012 also found that 88% of people living with the diagnosis said they thought the public associated ‘schizophrenia’ with violence.

After looking at the global body of evidence, the Mental Health Foundation found striking evidence on the impact of relationships on our health and wellbeing — comparable to well established risk factors such as smoking. People who are more socially connected to family, friends, or their community are happier, physically healthier and live longer with fewer mental health problems than people who are less well connected.

Living with schizophrenia can often be very frightening and can be enough of a barrier in itself to sustaining relationships without the added stigma and discrimination. None of us are immune to a mental illness and we have a human duty to show solidarity, open-mindedness and compassion for those who are living with mental health problems. People with a diagnosis of schizophrenia die on average 20 years younger than the general population, and around one in ten take their own lives — something you’re not so likely to see represented in the media.

Stigmatization of ‘Schizophrenia’ in the Media

Let’s consider some stigmatization of mental illness disseminated by the media as hypothesized by Myrick and Pavelko in a 2017 article published in the Journal of Health Communication.

First, mental illnesses such as schizophrenia are seen as so disruptive to society than those with such conditions must be isolated from society altogether.

Secondly, media accounts focus on the individual with mental illness rather than framing mental illness as a societal issue. Consequently, media consumers are more likely to blame the individual for the illness.

Thirdly, people with mental illness suffer from overgeneralization in media portrayals; everybody with a specific condition are expected to portray the same characteristics of the disease. For instance, depictions that all people with depression are suicidal, and all people with schizophrenia hallucinate. (In reality, only between 60 and 80 percent of people with schizophrenia experience auditory hallucinations, and a smaller number experience visual hallucinations.)

Fourthly, media portrayals discount the fact that many people with mental illness don’t need to disclose this condition to everyone around them. Instead — whether by intention or not — mental illness often goes unrecognized. Portrayals in the media, however, present situations where everyone knows about a character’s mental illness, and this mental illness is no longer concealed.

Fifth, the media portrays mental illness as being untreatable or unrecoverable.

Most characters displayed positive symptoms of schizophrenia. Delusions were featured most frequently, followed by auditory and visual hallucinations. A majority of characters displayed violent behaviour toward themselves or others, and nearly one-third of violent characters engaged in homicidal behaviour. About one-fourth of characters committed suicide. Causation of schizophrenia was infrequently noted, although about one-fourth of movies implied that a traumatic life event was significant in causation.

Of movies alluding to or showing treatment, psychotropic medications were most commonly portrayed.

These portrayals were wrong and damaging for several reasons, including the following:

1. Portrayals of schizophrenia in recent movies often focused on the positive symptoms of the disease, such as visual hallucinations, bizarre delusions, and disorganized speech. These symptoms were presented as commonplace when, in fact, negative symptoms, such as poverty of speech, decreased motivation, and flat affect, are more common.
2. Several movies spread the false stereotype that people with schizophrenia are prone to violence and unpredictable behaviour. Moreover, some movies presented people with schizophrenia as being “possessed.” These violent stereotypes poison viewers and engender harsh negative attitudes toward mental illness.
3. In these movies, 24 percent of the characters with schizophrenia committed suicide, which is misleading because in reality only between 10 percent and 16 percent of people with schizophrenia commit suicide during the course of a lifetime.
4. Characters with schizophrenia were usually depicted as white males. In reality, schizophrenia disproportionately affects African Americans. Furthermore, schizophrenia affects men and women almost equally.

In a few movies, schizophrenia is depicted as secondary to traumatic life events or curable by love, which are both misrepresentations of the disease. Ultimately, negative portrayals — especially violent negative portrayals — of people with schizophrenia and other severe types of mental illness in the media contribute to stigmatization, stereotyping, discrimination, and social rejection.

Social stigma is structural in society and can create barriers for persons with a mental or behavioural disorder. Structural means that stigma is a belief held by a large faction of society in which persons with the stigmatized condition are less equal or are part of an inferior group. In this context, stigma is embedded in the social framework to create inferiority. This belief system may result in unequal access to treatment services or the creation of policies that disproportionately and differentially affect the population. Social stigma can also cause disparities in access to basic services and needs such as renting an apartment.

Stigma development in most social psychology research focuses on social identity resulting from cognitive, behavioural, and affective processes (Yang, Kleinman, Link, Phelan, Lee, & Good, 2007). Researchers in social psychology often suggest that there are three specific models of public stigmatization. These include socio-cultural, motivational, and social cognitive models (Crocker & Lutsky, 1986;Corrigan, 1998; Corrigan, et al, 2001). The socio-cultural model suggests that stigma develops to justify social injustices (Crocker & Lutsky, 1986). For instance, this may occur as a way for society to identify and label individuals with mental and behavioural illnesses as unequal. Second, the motivational model focuses on the basic psychological needs of individuals (Crocker & Lutsky, 1986). One example of this model may be that since persons with mental and behavioural disorders are often in lower socio-economic groups, they are inferior. Finally, the social cognitive model attempts to make sense of basic society using a cognitive framework (Corrigan, 1998), such that a person with a mental disorder would be labelled in one category and differentiated from non-ill persons.

What to do:

• Use mental health terminology with precision, fairness, and expertise
• Implement a mental health short course when training journalists
• Include expert input from psychiatrists during production
• Prefer non individualized descriptions of mental illness and instead focus on the societal aspects
• Present mental illness only when relevant to the story

Movies like A Beautiful Mind, Through a Glass Darkly, Sybil etc. tell great stories inspired by mental illness that foster understanding rather than stigmatization. As individuals who consume copious amounts of mass media and engage on social media routinely, the best thing that we can do is to stop using words like “crazy” and “deranged” in a derogatory or flippant fashion. Moreover, it’s best not to make psychiatric diagnoses outside of a clinical setting. By labelling without proof, we hurt those who really live with mental illness on a daily basis.

Conclusions

Mental health conditions are pervasive around the world. In addition, the burden of these conditions is expected to grow over the next 20 years (Mathers & Loncar, 2006). Unfortunately, few individuals receive the psychiatric treatment they need, as individuals often do not seek services and frequently do not remain in care once they begin. The WHO (2001) has suggested that stigma is one of the largest barriers to treatment engagement, even though treatment has shown to be effective, even in low income countries (Patel, et al, 2007).

-Hajara Hussaini Ashara

Contributor, MANI