Stigma Continues in Hollywood

Representations of this stereotype are found in film characters such as R.P. McMurphy in One Flew Over the Cuckoo's Nest (1975), as well as in many of the patients (peripheral characters) in films such as The Dream Team (1989) and The Couch Trip (1988). One of the more memorable recent film characters is Melvin Udall (played by Jack Nicholson) in As Good as It Gets (1997). He has the Hollywood variety of obsessive-compulsive disorder, or perhaps obsessive-compulsive personality disorder. In any event, he dispenses homilies to the other characters while receiving some from the nurturing Carol Connelly (played by Helen Hunt). I imagine that this portrayal of individuals with OCD did not endear the filmmakers to real people with OCD, who may resent the protagonist being portrayed as egocentric, rude, obnoxious and destructive.

Another stereotype to appear in a number of recent films is that of "Specially Gifted Mental Patient." This a person with an identifiable mental illness who happens to possess special powers that are either related to the mental illness or serve to compensate for the disorder. The character of Raymond Babbitt (played by Dustin Hoffman) in Rain Man (1988) presents a Hollywood portrayal of some sort of pervasive developmental disorder or autistic disorder. His autistic persona is accompanied by his prodigious powers of memory and calculation of sufficient capacity to break the bank playing blackjack in Las Vegas. The character is a form of idiot savant who combines the disability with the compensating special powers.

In K-Pax (2001), the character of Prot/Robert Porter (played by Kevin Spacey) appears from nowhere (perhaps from outer space) in Grand Central Station, where he is taken immediately into custody and transferred to Manhattan Psychiatric Institute. He claims that he is from the planet K-Pax and proceeds to impress an assembled group of physicists with his remarkable knowledge of physics and astronomy. Along the way he assists several of the other patients in the ward in overcoming their mental disorders more effectively than the well-meaning psychiatrist. In A Beautiful Mind (2001), Russell Crowe acts out the life of John Nash, the man who won a Nobel Prize, despite being afflicted by terrifying psychotic experiences. Similarly, the David Helfgott character (played by Geoffrey Rush) in Shine (1996) is a world-class pianist who is told that his mental problems are due to his submitting to the rigors of learning to play piano concerti by Rachmaninoff.

The idea that individuals with mental disorders are actually gifted (or at least compensated for their disorders) with special powers suggests that they can fend for themselves provided that they have the appropriate handlers (think of Tom Cruise's character in Rain Man) to steer them toward harnessing their powers. That their special gift is linked to their illness suggests that treatment of the disorder will destroy the gift (and power) that accompanies it. Many of our patients who might identify with such characters may be led to believe that they would be better off discontinuing their medication and forgoing treatment for their mental disorders, lest they, too, have to give up their "gift" as would happen if they take medication to control their symptoms.

It might be tempting to write off these depictions of mentally ill people as merely harmless Hollywood distortions, but as advertising executives thoroughly understand, media images insidiously work their way into the collective unconscious of society and influence the way we all regard the world around us. Although none of the images described can be said to have arisen de novo, the question of whether society's perceptions of the stereotypical representations came first cannot be resolved without empirical research. Regardless of which came first, it is important to recognize the effect that cumulative viewing of such images may exert.

There are several strategies that might be useful in combating the effects of the negative stereotypes presented by Hollywood that stigmatize our patients. A letter-writing campaign to producers of films or television shows that depict stereotypes and to editors of newspapers and periodicals that advertise offensive films may be effective. The campaign launched against the television show Wonderland illustrates the effectiveness of this technique. This series appeared briefly on ABC in 2000 and attempted to depict life in a psychiatric emergency room, based on Bellevue Hospital in New York City. Whatever the merits of the plot, characters or production values, many viewers representing patients with mental illnesses and their advocacy groups voiced their offense. After only two episodes the show was taken off the air.

Other remedies include: public information campaigns such as the Mental Health Awareness week that has been observed for the past several years; encouraging public testimonials by respected celebrities who have experienced mental illness such as Patty Duke, Mike Wallace and William Styron; encouraging recognition of accurate depictions of patients with mental disorders that portray the suffering of the patients and their families; and enhancing communication between mental health professionals and clinicians in other medical fields.

Since the publication of our original paper on stigma (Hosp Community Psychiatry 1991;42[10]:1044-1048), the Internet has come to play an increasing important role in communication and imparting information. A recent Internet search has revealed many Web sites dedicated to overcoming the stigma of mental illness (Table).

In addition, more sympathetic portrayals of individuals with mental disorder have appeared. One example is the Maggie character (played by Sally Fields), who suffers from bipolar disorder, on the NBC TV show ER. The manner in which she is portrayed and the effect on her family testifies to the fact that a character can be made interesting and engaging without resorting to over-the-top negative stereotyping.