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Media misses the mark on mental health conditions

A new report reveals that mental health conditions are rare and dehumanized in film and TV.

As Rocketman flies into theaters this weekend with a central focus on LGBT identity and addiction, it offers unique insight into the experience of living with a mental health condition. It’s also a rare look at the topic: A study out today reveals how few characters across popular film and TV series exhibit mental health conditions and that those who do are routinely dehumanized. 

The report, titled “Mental Health Conditions in Film & TV: Portrayals that Dehumanize and Trivialize Characters,” is the first report from Stacy L. Smith and the USC Annenberg Inclusion Initiative to investigate the topic. The report was conducted in partnership with the American Foundation for Suicide Prevention (AFSP) and funded by The David and Lura Lovell Foundation. The study examined 100 top-grossing films and 50 popular TV series to understand the prevalence and context of mental health conditions in entertainment. Using a purposefully broad definition, the prevalence of mood disorders, anxiety, PTSD, addiction, suicide, autism spectrum disorders, and other conditions was evaluated. Additionally, the elements surrounding these depictions were investigated to understand whether mental health conditions are dehumanized, stigmatized, and/or trivialized in popular media.

The results reveal that fewer than 2% of all film characters and roughly 7% of TV characters experience mental health conditions on screen. In contrast, close to 20% of the U.S. population experiences some form of mental health condition or illness per year. The majority of portrayals of mental health conditions feature straight, white, adult males, which obscures the rates that teens and individuals from underrepresented racial/ethnic backgrounds exhibit mental health conditions. 

“Entertainment is once again completely out of step with reality,” said Smith. “The prevalence of mental health conditions among the audience far outpaces the characters they see on screen. This presents a distorted view of the world for those who live and thrive with mental health conditions but never see their stories represented in popular media.”

One group that is virtually absent from media portrayals of mental health conditions is the LGBT community. There were no LGBT film characters with a mental health condition across the 100 top films of 2016 and only eight TV characters across 50 popular shows in 2016-2017. To supplement the movie findings, an additional 100 films from 2017 were evaluated. Only 1 LGBT character was portrayed with a mental health condition. The lack of LGBT characters shown in this capacity is striking, as the National Association of Mental Illness indicates that mental health conditions are nearly three times more likely to occur among members of the LGBTQ community. 

Portrayals of addiction occurred most often, across both film (29 characters) and TV (31 characters); 15 film and 30 TV characters were shown with anxiety and post-traumatic stress disorders. Eighteen film and 10 TV characters exhibited mood disorders, and a total of 19 characters across film and TV were depicted dying by suicide, or with suicidal attempts or ideation. Disturbances in thinking affected eight film characters and six TV characters. Seven characters in film and three in TV experienced spectrum disorders, while two TV characters and 11 film characters evidenced cognitive impairment. Only two TV characters were shown with eating disorders.

Contextual factors related to portrayals of mental health conditions were also examined, with many characterized by dehumanization and trivialization. Nearly half of film (47%) and 38% of TV characters shown with a mental health condition experienced disparagement. This included verbal or nonverbal rejection, as well as demeaning remarks or behaviors. Words like “crazy,” “freak,” “unstable,” “idiot,” and “psychotic” are examples of terms used to refer to characters with mental health conditions. Humor was a facet of the depiction of half of TV (50%) and 22% of film characters with mental health conditions. Together, these findings reveal that concern is warranted over more than the lack of portrayals — the nature of these depictions is also problematic and features stigmatizing elements related to mental health conditions.

An additional factor explored by the study was the use of violence. Forty-six percent of film characters and 25% of TV characters with a mental health condition were perpetrators of aggression. However, most individuals with treatable mental health conditions do not exhibit violent behavior in real life. Combining mental health and violence may create the perception that individuals living with mental health conditions are “dangerous,” which conflicts with reality.

The report also evaluated how often portrayals of suicide were shown across film and TV. There were 13 instances of suicide, suicidal attempts, or ideation in film and six in TV. Only two portrayals of suicide involved teenage characters, though nearly 1 in 5 American teenagers reportedly experience suicidal thoughts each year. Suicide-related portrayals most often lacked a link to mental health struggles and an opportunity for support or treatment. The study authors note the need for responsible and safe portrayals around suicidal ideation, attempts, and death. 

“There are significant discrepancies in suicide portrayals in film and television — in reality, millions of people actually live through suicidal struggles. The majority of people who experience mental health crises and suicide attempts live through it, find hope and support and don’t go on to die by suicide,” said Dr. Christine Moutier, Chief Medical Officer, AFSP. “Including portrayals of mental health and suicidal experiences in film and television is important in creating a culture that’s smarter around these issues. The real opportunity is in making sure it’s accurate, nuanced and hopeful, and portrays the issues in a way that is safe and responsible for viewers.”

One positive element of portrayals of mental health conditions that researchers encourage content creators to incorporate is treatment and therapy. Only 5% of film and 9% of TV characters were shown in treatment, while 22% of film characters and 62% of TV characters were shown in or mentioned therapy. Depictions of treatment and different kinds of therapies for mental health conditions offer an important message to audiences that effective treatments are available.

“Most Americans understand that mental health is a critically important part of their overall health. And yet, mental health literacy among the general public remains low. To reduce stigma and encourage help-seeking, we must show depictions of characters in film and television both managing or overcoming mental health conditions and suicidal ideation. By showing audiences that people who live with and manage their mental health in an authentic way, we can encourage people, and those who surround them, to be more sophisticated in managing their mental health,” Moutier continued.

Beyond the results, the report includes strategic tools and solutions to help content creators and other entertainment professionals write more-authentic and less-dehumanizing depictions. For example, writers can consider how mental health conditions may be used as a plot device, if portrayals incorporate stigma or humor, and whether treatment or therapy are shown. The report also outlines a program of research for future studies. The authors suggest that investigators should examine content on streaming series and the experiences and knowledge of writers to understand how mental health conditions are shown on other platforms and the ways in which content creators obtain information on mental health conditions.

Ann Lovell, president of the board of trustees for the David and Lura Lovell Foundation, and John Amoroso, the foundation’s executive director, said in a joint statement: “Our Foundation’s roots are in the struggle of a mother’s fight for the rights of her child… so that child could be recognized, treated with dignity, and allowed the opportunity to thrive in this world, just like anyone else. Until Hollywood and other media start doing a better job of representing the truth about mental illness, including the scope of the problem, the reality of treatment options and the potential for positive outcomes, we will continue to struggle. We need to hold the industry accountable to their role in continuing to underrepresent and stigmatize people living with mental illness. The Annenberg Inclusion Initiative’s report is a step in that direction, and we are proud to be a part of this work.”