Gabbard observed the opposite phenomenon in "As Good as it Gets," the 1997 release that garnered Golden Globe awards for both of its stars, Jack Nicholson and Helen Hunt. While the psychiatrist portrayed in the movie actually exhibited good professional boundaries, he came across as affected and rigid. "It shows the contradiction that what might be good psychiatric practice may not look good to the public in a movie, but ... outrageous psychiatric practice [may] look good [if the therapist] is human, warm and fuzzy," Gabbard said. Nevertheless, the movie was the only one in the history of filmmaking, as far as Gabbard could tell, that suggested medications could be helpful in the treatment of mental illness.

The entertainment industry treats the mentally ill as they do mental health practitioners-poorly. Gabbard, like other sources interviewed for this article, agreed that the portrayals were usually equated with violent or comically affected behavior, but rarely as functional.

Otto F. Wahl, Ph.D., a clinical psychologist and professor of psychology at George Mason University in Fairfax, Va., said the cumulative effect of constant negative depictions of the mentally ill profoundly impacts not only the general public but also those who suffer from mental illnesses. The most significant misrepresentation, he told Psychiatric Times, is the link created by entertainment media between mental illness and violence. The appearance of "psycho killers" in movies, books and children's television programs is at epidemic proportions.

"Wag the Dog," a recently released, award-winning movie starring Dustin Hoffman and Robert DeNiro, for instance, depicts a psychotic, mentally ill soldier who constantly pops antipsychotic medication into his mouth like candy and is then killed while raping a young woman.

"It increases stigma by perpetuating the negative attitudes that people with mental illnesses encounter and fear," Wahl said.

His book, Media Madness: Public Images of Mental Illness, was released again in paperback last October, and his work with the National Stigma Clearinghouse earned him the American Psychiatric Association's Patient Advocacy Award in 1997. "People with mental illnesses are also readers and viewers of those images; they are shamed by them and they're embarrassed by them. They're aware that they are depicted in negative ways and it damages their self-esteem, it damages their confidence, and it increases their likelihood that they won't tell anyone about their illnesses. So they're not going to seek treatment."

Not everyone in the entertainment industry is hardened to the sensibilities of individuals suffering from mental illness and the practitioners who treat them. Someone who walks the tightrope between acceptable satire and insensitive mockery on a daily basis is Jonathan Katz, a standup comic and one of the creators of "Dr. Katz: Professional Therapist."

"I try to be as vigilant as possible because I know that the pain of a mental illness is no different than the pain of a physical illness," Katz said in an interview with Psychiatric Times. "I have had bouts of depression. I have friends who suffer from various forms of mental illness."

An adult-oriented, animated television show, "Dr. Katz" is entering its fifth season on cable's Comedy Central station, carried into 46 million homes nationwide. A self-described combination of "obsessions, compulsions and comedy," it chronicles the lives of psychiatrist Katz-who is as "phobic and obsessive as his patients"-his wayward, adult son, and his "short on interpersonal skills" secretary. The show has spun off a nationally syndicated comic strip seen in over 200 newspapers and a published collection of the cartoons called "Dr. Katz: Hey, I've Got My Own Problems."

Katz conceded that "It's very hard to do comedy without offending someone," but he tries "to be as sensitive as possible to the issues of mental illness."

"This is a segment of society that does not have the same kind of advocacy as other illnesses, Katz said, adding "It still has a stigma attached to it." His show steers clear of disparaging terms such as "wacky" and "fruitcake," and totally avoids mention of serious mental illnesses.

In one episode, however, a "patient" laments, "I've been in therapy now...21 years, and what I would really like to know is when I am going to get better? I'm still agoraphobic, and I still don't know what it means." Mental health advocates often cringe at stereotypical characterizations of ineffectual mental health care, saying that treatment outcomes are often better for mental illnesses than for physical ones.