Psychiatry and Mental Illness: Are They Mass Media Targets?

Psychoanalysis-contagious disease originating Vienna circa 1900-now extinct in Europe but occasional outbreaks among rich Americans. - 3001: The Final Odyssey, by Arthur C. Clarke

Nothing is sacred in America's pop culture. So when it embraces any topic, we've grown used to the relentless distortion that occurs, one that transforms reality into an odd combination of fact and fantasy. For those suffering from mental illnesses and the practitioners who treat them, the implications of a steady onslaught of often negative and inaccurate portrayals of mental illness in all forms of entertainment media are dire.

Battling the societal stigma that enshrouds brain diseases is difficult, and the ability to overcome centuries-old biases is often thwarted by the stereotypical representations of mentally ill individuals, as well as psychiatrists, psychologists and other therapists. The issue is nothing new, but the latest spate of movies, books and TV shows that involve mental health issues renews concerns that rather than progression there is a backslide into prejudice that militates against understanding.

Often the slights are not intentional, according to Jean Arnold, chair of the National Stigma Clearinghouse, a New York City-based hub of information for "stigmabusters" nationwide. In her experience, the creators of entertainment don't understand the harm they do when they include stereotypical depiction of mental illness.

"These people don't really mean to harm the mentally ill," Arnold said. "They do it inadvertently because they think that [using stereotypes] is the easiest route to take. But they're willing to change. They're not intending to be offensive once they're sensitized," Arnold said. She added that the entire mental health community needs to be more outspoken and willing to take on the entertainment industry when it steps out of line.

The publicity surrounding Woody Allen's latest release, "Deconstructing Harry," however, suggests that sometimes the motives for negative portrayals may be driven by "not-so-hidden" agendas. In the film, Kirstie Alley plays the role of a psychiatrist, one whose boundary breaches and neurotic emotional state are typical of the way psychiatrists are often portrayed in the media.

In a Dec. 11, 1997 USA Today article, Alley told the interviewer, "I don't like psychiatry. And I don't believe it works. And I believe psychiatrists are neurotic or psychotic, for the most part. I wanted to play her that way, and Woody just totally let me do it. I said, 'I want to be taking Prozac or drugs during the session with her patient.' I wanted to show that this woman is so twerked out that she has to take drugs, too. She takes her own medicine. So he said, 'Yeah! That's a good idea.' "

Efforts to reach Allen through his publicist to discuss his portrayal of mental health-related subjects in his movies were unsuccessful. But in the same USA Today article, he was quoted as saying, "I didn't give her even one direction. I never had to. Her instincts were right on from the start."

Alley is a member of the Church of Scientology and the international spokesperson for Narconon, the church's program for drug and alcohol abusers. The church, through various affiliated groups, has publicly denounced psychiatry and psychiatric care.

Allen, meanwhile, has become the unwilling national icon for critics of mental health benefits parity, whose use of the term "Woody Allen Syndrome" connotes endless, pointless and often useless therapy, the cost of which will allegedly bankrupt the health care system.

Impressions created by members of the entertainment media, whether intentional or not, have a profound impact on the public, according to Glen Gabbard, M.D., author of the book Psychiatry and the Cinema. Originally published in 1987, an updated edition is scheduled for release next year by the American Psychiatric Press.

"Movies, to the American public are like what Greek drama was to ancient Athenians. They shape our culture and they shape our attitudes," said Gabbard, the Callaway Distinguished Professor at the Menninger Clinic in Topeka, Kansas. "Ever since McLuhan, we know how influential the electronic media is in shaping the culture."

Whether in the depiction of psychiatrists or mental illness, the history of cinema has not been kind, according to Gabbard, who can reel off the names of movies and their release dates with the ease of a seasoned film buff. Except for a "golden age" between 1957 and 1963, when 22 movies were produced featuring idealized portrayals of therapists, and a few exceptions in other years, neither psychiatrists nor the mentally ill have fared well.

In the past 30 years, Gabbard said, only three movies have portrayed therapists sympathetically-"I Never Promised You a Rose Garden" (1977); "Ordinary People" (1980): and "Good Will Hunting" (1997). In the latter film, although Robin Williams portrays a sensitive, understanding therapist struggling to help a gifted, but troubled, youth, the depiction of what Gabbard called "outrageous and preposterous therapy" detracted from the overall positive images in the film. "Therapy is seen as helpful and maybe some people will go to therapy because they see it as being helpful," Gabbard said. "What they expect when they get there is going to be a problem."

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.

But Katz said he has never received any complaints about the show's content, and he would be "upset" if he felt he was contributing to stigma or to people hesitating to obtain care. "I'm actually a believer in therapy. I've had good experiences with it myself," he said.

At one point last year, Katz and his creation "Dr. Katz" were slated to be part of a citywide antidiscrimination campaign sponsored by New York City's Department of Mental Health, Mental Retardation and Alcoholism Services. But the $250,000 media blitz aimed at dispelling the stigma of mental illness stalled last June when the department and the advertising agency hired to run the campaign parted ways.

Suzan Mullin, the department's director of public education and community affairs, who is now responsible for the campaign, said they expect to hire a new public relations firm, and a roll-out is now scheduled for late this spring. The emphasis of the antistigma campaign will be redirected toward employment opportunities and the availability of mental health services. She said the decision not to go forward with using "Dr. Katz" centered around peoples' lack of familiarity with the image and their inability to relate to it.

Smiling Through Tears, a recently published book by Pamela Freyd, Ph.D., and Eleanor Goldstein addresses the recovered memories controversy using a combination of cartoons and text. Freyd, an education researcher, is the executive director of the Philadelphia-based False Memory Syndrome Foundation, while Goldstein is the author of a previous works on the same subject, including Confabulations, Creating False Memories-Destroying Families and True Stories of False Memories.

In this latest work the authors use cartoons that lampoon mental health-related topics, therapy and therapists to buttress their view that "through the use of mind-altering techniques therapists have contributed to the devastating damage inflicted upon tens of thousands of families." Both Freyd and Goldstein, however, told Psychiatric Times that their book was never intended to disparage appropriate therapy and competent mental health practitioners.

"We would never be against psychotherapy per se," said Freyd. "Indeed, psychotherapy, therapy in general, and all of psychiatry is tremendously important to our society. People should have confidence when they turn to it."

Nevertheless, she conceded the book may not have made sufficiently clear that appropriate treatment is available, too. "In terms of guidelines for what one could expect or what are the things to look for in good or bad mental health care, that is not something that we included in this book, because it wasn't something that we felt was necessary for the story that we were telling," she said. "Perhaps that was an oversight."

Another recently published book, "Freudian Slips," by cartoonist Sidney Harris, also presents a satirical portrayal of therapy and therapists. The book is a collection of his works over the past two decades, and the comics originally appeared in magazines such as The New Yorker, Playboy, Science and National Lampoon. At one point, Harris said that his work even appeared in the APA's Psychiatric News.

He doesn't believe his form of humor adds to any stigma of the mentally ill and denies that he "is advocating anything." Harris tends to create cartoons about subjects that interest him, and he cautions against hypersensitivity that would prevent people from appreciating the humor in his work.

Meanwhile, the mental health community continues to gear up its efforts to combat stigma. The National Alliance for the Mentally Ill already has an antidiscrimination campaign underway, and the National Mental Health Association and the APA have made efforts to turn the media around to a more sympathetic and accurate point of view.

But according to Menninger's Gabbard, although the media has sometimes realized its potential to educate the public about mental health, fictitious portrayals won't get significantly better as long as stereotypes of the mentally ill and the practitioners who treat them continue to entertain the American public. "As long as the box office is the bottom line, accurate depiction of mental illness and psychiatry will never be seen."