Film has a strong influence on public attitudes toward mental health, so must be more careful in its depiction, writes John Goodwin

Stigma is an ongoing concern in the field of mental health, with many service users battling negative attitudes on a daily basis. Stigma can prevent people from seeking help for the serious issues that they experience, or cause them to be discriminated against. The general public’s knowledge of mental health issues is poor and beliefs that it holds are often inaccurate, leading to the stigmatisation of those experiencing mental ill-health.

Mental ill-health related stigma has always existed. In ancient times, it was believed that those experiencing mental ill-health were under some sort of supernatural influence – such as demonic possession – or that they had committed a crime against the gods and were being punished. We have advanced as a society, but the beliefs held by a sizeable portion of the general population are not so far removed from the beliefs of our ancestors.

One of the main sources of knowledge for the general public is film and cinema, and unfortunately, mental health issues are often unfairly represented by this medium. In particular, psychosis/psychoses and mental healthcare environments (acute wards etc) are treated with ignorance in film.

Schizophrenia is often poorly misrepresented in film. It is defined by the WHO (2014) as “a severe mental disorder, characterized by profound disruptions in thinking, affecting language, perception, and the sense of self. It often includes psychotic experiences, such as hearing voices or delusions.”

Films are not sensitive in their portrayals of schizophrenia. For example, the film Schizo in 1976 defined it as “a mental disorder, sometimes known as multiple or split-personality. Characterised by loss of touch with environment and alternation between violent and contrasting behaviour patterns”. Madhouse, a 2004 horror film, informs us that “you can never trust a schizo”.

The comedy Me, Myself, and Irene features a character with a condition more akin to dissociative identity disorder but is described as having “advanced delusionary schizophrenia with involuntary narcissistic rage”. Schizophrenia is not associated with split personalities, yet it is being misrepresented in this fashion in film, as well as being seen as an inherently violent condition – another fallacious piece of information. A recent study found that almost 79% of horror films featuring psychosis portrayed characters as stereotypical “homicidal maniacs” .

Mental healthcare environments are also poorly misrepresented in film. The archaic image of the Victorian mental asylum still casts its shadow over modern cinema, and the nurses and doctors who work in these places are often depicted as malevolent and dangerous people, who routinely injure or molest service users in their care.

Batman Begins featured an archaic-looking institute where service users are used in mind-altering experiments. The service users in Insanitarium are also subjected to such experiments, conducted by a malevolent doctor and nurse, and are punished by security guards who use tasers.

The modern interest in the “found footage” film has once again sent the Victorian institute into the forefront, with films such as the Grave Encounters series exploring decrepit, haunted environments. In fact, 53% of horror films set in mental healthcare environments were concerned with supernatural elements , proving that the beliefs held by our ancestors persist in modern society.

Film has the ability to influence and educate us. Considering the public receives a great deal of information concerning mental-ill health from film, and there are is such flagrant misinformation delivered by these films, it is obvious that film is contributing to stigmatisation.

Recently, there has been evidence of films depicting mental ill-health in a more positive and less stigmatising light. Silver Linings Playbook is one of the films which has received attention in the media for its sympathetic portrayal of bipolar disorder. Unfortunately, films such as this are in the minority, with the majority exploiting mental ill-health issues in the interest of creating “easy targets” treated as foolish individuals (in comedy), shock or twist endings (in thrillers) and an atmosphere of fear or disgust (in horror).

As nurses, we have an advocacy duty. This applies to education in relation to mental ill-health issues, and informing the public (be it co-workers, service users and their families, or our own friends and families) about this serious issue. It is important that nurses are involved in positive media campaigns in order to combat the stigma of mental ill-health.

Nurses and other mental health professionals should also be involved in a consultation role within the media, with the aim of portraying characters experiencing mental ill-health and the environments in which they are treated in a more accurate and less stigmatising manner.

All nurses, either working in mentalhealth or in other areas, should be aware of mental ill-health related stigma in film and other media, and look for ways to reduce this where possible.

John Goodwin is a staff nurse at Mercy University Hospital, Cork, and part-time lecturer in UCC

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