n the aftermath of an unconscionable act of random violence, many people are inclined to label the perpetrator “crazy.” Although the criminal may have a mental illness, automatically assigning the label “crazy” does a great disservice to people who live with mental illness every day.

In reality, somebody with mental illness is much more likely to be a victim—rather than a perpetrator—of violence.¹ Calling a violent offender “crazy” spreads a dangerous stereotype and belies the complex relationship between criminality and mental illness.

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 toward either stigmatization or trivialization. Consequently, all forms of media—including television, film, magazines, newspapers, and social media—have been criticized for disseminating negative stereotypes and inaccurate descriptions of those with mental illness.

What Is Stigmatization?

Stigma happens when some person is viewed as an “other.” A person who is considered an “other” is denied full social acceptance. Here is how one researcher, Brian Ahmedani, defined stigma in a 2011 paper entitled “Mental Health Stigma: Society, Individuals, and the Profession.”

“The most established definition regarding stigma is written by Erving Goffman (1963) in his seminal work: Stigma: Notes on the Management of Spoiled Identity. Goffman (1963) states that stigma is ‘an attribute that is deeply discrediting’ that reduces someone ‘from a whole and usual person to a tainted, discounted one’ (p. 3). The stigmatized, thus, are perceived as having a ‘spoiled identity’ (Goffman, 1963, p. 3).

In the social work literature, Dudley (2000), working from Goffman’s initial conceptualization, defined stigma as stereotypes or negative views attributed to a person or groups of people when their characteristics or behaviors are viewed as different from or inferior to societal norms.”²

Stigmatization of Mental Illness By the Media

Stigmatization of mental illness in media is abundant. For example, certain mental health conditions such as schizophrenia are seen as being so disruptive that people with those conditions must be isolated from society.

The stigmatization of mental illness is so entwined with the media that researchers have used newspaper articles as a proxy metric for stigma in society.

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

People with mental illness can also suffer from overgeneralization in media portrayals. Every person with a specific mental health condition is expected to display the same characteristics or symptoms.

For instance, common depictions are that all people with depression are suicidal, and all people with schizophrenia hallucinate. In reality, only between 60% and 80% of people with schizophrenia experience auditory hallucinations. An even smaller number of people experience visual.

It’s also not uncommon for media portrayals to discount the fact that many people with mental illness don’t need to disclose their condition to everyone around

Instead, mental illness often goes unrecognized (whether by intention or not). The portrayals in the media tend to present situations where everyone in a character’s life knows about their mental illness.

Perhaps most concerning of all, the media often portrays mental illness as being untreatable or unrecoverable.

Trivialization of Mental Illness By the Media

The media can also trivialize mental illness, either by promoting mental illness as not being severe or being less severe than it really is.

For instance, many people with eating disorders such as anorexia nervosa feel that their condition is made out to be less severe than it really is. This is in part because people with the condition portrayed in the media often minimize its seriousness and hide the severe consequences of the disease.

The truth is, the death rate for people with anorexia is high. In one oft-cited meta-analysis published in JAMA Psychiatry in 2011, researchers analyzed 36 studies representing 17,272 individual patients with eating disorders and found that 755 of them died.³

Mental illness can also be oversimplified by the media. For instance, a person with obsessive-compulsive disorder (OCD) is often depicted as being overly concerned with cleanliness and perfectionism. However, the obsessive thoughts that drive their compulsions are overlooked or absent.

The symptoms of mental illness are sometimes portrayed as being beneficial. For example, in the popular television series Monk, the protagonist is a detective who has OCD. The fact that he pays close attention to detail helps him solve crimes and advance his career.

People who do not have disabilities can use media channels to mock people who do have disabilities, such as by appropriating mental-illness terminology. For instance, the hashtag OCD (#OCD) is commonly used on Twitter to describe one’s attention to cleanliness or organization.

Depictions of Schizophrenia in Film

Probably the most disparaging stigmatizations of mental illness in media lie in the film portrayals of antagonists with mental illness. In particular, when characters with schizophrenia are presented as “homicidal maniacs” in “slasher” or “psycho killer” movies.

These portrayals disseminate misinformation about the symptoms, causes, and treatment of schizophrenia as well as other forms of severe mental illness. What’s more, research has shown that popular movies have been shown to exert potent influences on attitude formation.

In a 2012 paper, “Portrayals of Schizophrenia by Entertainment Media: A Content Analysis of Contemporary Movies,” researchers analyzed 41 movies that had been released between 1990 and 2010 for depictions of schizophrenia.¹

Based on the findings of the analysis, researchers drew several conclusions.

• Most of the characters displayed “positive” symptoms of schizophrenia, with delusions being featured most frequently, followed by auditory and visual hallucinations.
• The majority of characters displayed violent behavior toward themselves or others.
• Nearly one-third of violent characters engaged in homicidal behavior.
• About one-fourth of the characters committed suicide.
• The cause of schizophrenia was infrequently noted. However, in about one-fourth of the movies it was implied that a traumatic life event for the character had been a significant causative factor.
• Of the movies that alluded to or showed mental illness treatment, the most commonly portrayed were psychotropic medications.

These portrayals are not only incorrect but damaging—and for several reasons. The portrayals of schizophrenia often focus on symptoms such as visual hallucinations, bizarre delusions, and disorganized speech, and presented them as commonplace.

In reality, symptoms like decreased motivation, poverty of speech, and flat affect are more common.

Several movies have spread the false stereotype that people with schizophrenia are prone to violence and unpredictable behavior. Some films even presented people with schizophrenia as being “possessed.”

These violent stereotypes influence viewers and engender harsh negative attitudes toward people with mental illness.

24% of the characters with schizophrenia committed suicide. In fact, between 10% and 16% of people with schizophrenia commit suicide in the course of a lifetime.

Demographics is another aspect of mental illness that is often misrepresented by media portrayals of mental illness.

For example, characters with schizophrenia are frequently depicted as being white males, but schizophrenia disproportionately affects African Americans. It also affects men and women almost equally.

In a few movies, schizophrenia was depicted as being secondary to traumatic life events or curable by love—both of which are misrepresentations of the condition’s causes and treatment.

Positive Representation

Not all the information presented about schizophrenia was found to be incorrect, misleading, or stigmatizing.¹ For example, in more than half of the movies that researchers analyzed, the use of psychiatric medications was depicted or alluded to.

Nearly half the characters with schizophrenia were depicted as being poor, which aligns with epidemiological data suggesting that schizophrenia is diagnosed less frequently in people of higher socioeconomic standing.

Even when some movies get it right, the negative media portrayals—especially those that are violent—of people with schizophrenia and other severe forms of mental illness still contribute to stigmatization, stereotyping, discrimination, and social rejection.

What Can Be Done?

We need a better understanding of how these messages are disseminated by the media before we can rectify them. There is limited research looking at how media promotes mental-illness stereotypes, stigmatization, and trivialization.

Nevertheless, certain suggestions have been made on how to improve the depiction of people with mental illness in the media, such as:

• Analyzing mass-media production procedures to better understand the current practices, needs, values, and economic realities of screenwriters, producers, and journalists (for instance, understanding the balance between being newsworthy or emotionally arousing and verifiable).
• Implementing a mental health short course when training journalists.
• Including expert input from psychiatrists during a film’s production.
• Preferring non-individualized descriptions of mental illness and instead focusing on the societal aspects.
• Presenting mental illness only when relevant to the story.
• Using mental-health terminology with precision, fairness, and expertise.

As individuals who consume copious amounts of mass media and engage with social media, the best thing that we can do is to stop using words like “crazy” and “deranged” in a derogatory or flippant fashion. We also need to remember that it’s best to avoid making a psychiatric diagnosis outside of a clinical setting.

Only a specialist can make a diagnosis of OCD, depression, bipolar disorder, schizophrenia, and other mental health conditions. When we give someone the label of being mentally ill without clinical evidence, we hurt people who live with mental illness on a daily basis.

By Naveed Saleh, MD, MS