[TW: ableism, sanism, racism, symptoms of various mental illnesses, mention of psychiatric clinics, electroshock therapy, violence, and suicide]
This article was by and large written during a stay in a psychiatric clinic, more precisely in the ward for schizophrenic psychoses. Even though I have some previous experience with the psychiatric system, this special form of writing residency – as I jokingly call it – has significantly shaped my thinking about mental illness and its representation across different media.
As an irony of fate, during my hospitalization, I attended a university seminar on the depiction of psychotherapy in film, where we discussed One Flew Over the Cuckoo’s Nest – a film by Miloš Forman, which directly responds to the anti-psychiatry movement of the 1960s and 1970s and still shapes our collective imagination regarding psychiatric hospitals or mentally ill people. During the course of the seminar, I was repeatedly struck by the unbiased academic ease with which my classmates expressed themselves about the difficult topics that the film opens up (e.g., the ethics of electroshock therapy). What others saw as an abstract topic was deeply personal to me. How can I speak neutrally about psychiatric institutions on campus when every day I sit at a table with people whose illness is so severe that they have decided to undergo electroshock therapy? Or when I myself have to return to the clinic after the seminar?
I know with almost full certainty that any general discussion about mental health will not include my diagnosis. Society perceives schizophrenia differently than anxiety disorder or depression. This hierarchy of mental disorders is also directly reflected in the film and television representation. Thus, we see some disorders depicted more realistically and with more empathy than others.
If I want to see people with my diagnosis in a film, I should settle on a horror movie. Examples incluse a B-movie saga Halloween (where schizophrenia is not directly mentioned but served as an inspiration when writing the script) or the horror found-footage comedy The Visit. But a stigmatizing and inaccurate depiction can also be found in Stanley Kubrick’s film The Shining, where the protagonist, writer Jack Torrance, begins to suffer from violent mood swings and hallucinations until he finally tries to kill his wife and children. On the other hand, people with schizophrenia can be extremely often seen in the true crime genre as feared mass murderers in television programs, despite the fact that research proves that people with serious mental illnesses are more often victims than perpetrators of violence.
All such problematic representations contrast deeply with the fragility of my fellow patients at the clinic. I am therefore wondering what it takes to see schizophrenic psychosis not as an immediate danger but as a state of extreme vulnerability.
Other mental illnesses are portrayed similarly negatively. Dissociative identity disorder in Hitchcock’s Psycho also leads the protagonist to violence. The highly stigmatized borderline personality disorder is often embodied in films through unstable manipulative female characters, as is the case of the comedy-drama Welcome to Me.
But even humorous depictions of mental illnesses can be painful and stigmatizing for those affected. This primarily concerns obsessive-compulsive disorder, which in reality causes a great deal of suffering and difficulties in everyday life, but in films and television, it represents only a kind of peculiar character trait. In addition, obsessive-compulsive disorder is often simplified. In most cases, we will see – often with a comical undertone – compulsions (repetitive performance of certain actions), while obsessions (repeated unwanted ideas), which cause a great degree of anxiety, are rarely present.
Thus, in The Big Bang Theory, Sheldon Cooper must always knock on his neighbour Penny’s door three times in quick succession, or he will not allow his roommates to sit in his place on the couch. In one episode, he complains that he got a sandwich filled in the wrong order because the lettuce leaves are touching the slices of bread. Such a portrayal makes it seem as if OCD is a free choice of the protagonist – his cute little eccentricity. Conversely, we never learn what drives Sheldon to create these rituals.
Detective Monk from the eponymous series embodies another common stereotype associated with this disorder. Even his symptoms – i.e. exaggerated fear of bacteria, anxious maintenance of order and hygiene, and constant fixing of objects to their correct position, represent the source of comedy in the series.
Mental Health in Terms of Intersectionality
We cannot separate the issue of mental health from other forms of marginalization such as skin colour, ethnicity, gender, sexual orientation, social class, and disability. In the following part of the text, I will focus more closely on the intersectionality of the categories of mental health and race. It is impossible not to notice that the vast majority of films dealing with mental illness depict white protagonists. And this is despite the fact that it is scientifically proven that racism directly impacts mental and physical health and that people of colour – especially black communities – in the USA have an increased risk of hospitalization in a psychiatric clinic and suicide.
The marked absence of films focusing on Black mental health, at least in mainstream cinema, is directly related to systematic racism. Throughout history, people of colour have been and still are denied access to (psychiatric) health care. There are also certain cultural tropes associated with this exclusivity of mental health. One of them is the so-called Strong Black Woman who never needs emotional support – on the contrary, she prefers to selflessly take care of her family or community. Although this stereotype has its roots in the African-American civil rights movement, it is often appropriated in the film industry today by white male directors, for example, in The Help, Hidden Figures, or The Color Purple. The positive reception of films with heroines falling into this category – after all, many of them have won Oscars or other film awards – shows us that white society wants to see black women who are able to endure enormous amounts of trauma without becoming mentally ill. However, where does such a perception leave room for vulnerability and sensitivity?
Films openly dealing with Black mental health, on the other hand, are often criticized from within the community for focusing too much on the traumatic experiences of the main characters. Mental illness in them is almost always caused by negative experiences associated with racism. Such films often remain trapped in the heroine’s painful past – at the expense of showing the current state and the possibility of therapy or other methods of treatment.
The Illness Should Mainly Inspire
Compared to physical illnesses, we still look at the topic of mental health somewhat abstractly – as if we do not perceive that mental illnesses cause not only emotional/psychological pain, but also varying degrees of disability, which affects the ability to perform certain activities, for example, functioning at work or school or maintaining social relationships.
A good example of how mental illness can affect both personal and professional life is the 2001 Hollywood film Beautiful Mind, which depicts the life story of a mathematician and Nobel Prize winner for economics John Nash. During his studies, he developed the game theory in a significant way but later he began to show symptoms of paranoid schizophrenia. The scientist subsequently underwent various forms of therapy and on campus, he was perceived as a prototype of a crazy academic scribbling strange mathematical calculations on blackboards. It took many years for Nash to return to the shared reality and regain his former glory.
The film builds on the uncertainty of the viewer – so to speak, we see what Nash sees or thinks under the influence of his illness, without knowing what is real at that moment. However, the multi-layered nature of the psychotic experience is reduced merely to the visual level. Such a depiction, on the one hand, offers a quick (but rather flat) identification with Nash’s suffering, on the other hand, it points out the inability of classic narrative film to faithfully interpret such complex phenomena as visual hallucinations, hearing voices, or delusions. All of Nash’s symptoms are rendered into hyper-realistic scenes and characters, although hallucinations generally have a different ontological status than shared reality. Despite the fact that Nash mainly talks about hearing voices in several interviews (his imaginary roommate Charles was actually a voice and not a visual hallucination), the film handles the sound component very stereotypically and does not employ it at all to approximate auditory hallucinations. The unique psychotic experience is assimilated to be comprehensible mainly to an “abled-minded” audience.
If we look at Beautiful Mind through the lens of Disability Studies, we could label the main character as the so-called “Super Cripple”, i.e. a person who overcomes a (psychosocial) disability and becomes successful despite his diagnosis. An important aspect of such a reading is that it is a so-called non-disabled gaze, where disability is a source of fear and fascination for healthy people at the same time. It is no coincidence that the film focuses much more on the individual struggle with schizophrenia than, for example, on the socially constructed discrimination of the protagonist based on his illness. In addition, Nash’s disability and his subsequent overcoming should inspire a healthy viewer to perform in a sense: if a person with such a severe mental illness can do it, I can do it too.
About Us Without us
At the end of this text, I want to address the epistemic inequality that arises if people with a given diagnosis do not participate in the creation of films about mental illnesses. In addition to the glaringly stigmatizing depictions that I mentioned at the beginning of the text, there is a category of films that at first glance look acceptable. Films whose hidden ableism and sanism (discrimination against people on the basis of mental illness and/or neurodivergence) will only be exposed upon closer inspection.
One such film is the romantic coming-of-age drama Words on Bathroom Walls (2020). Here, we follow American high school student Adam, who experiences a psychotic episode during chemistry class and is expelled from school after being released from the hospital. In the new environment of the Catholic school, Adam learns to live with his illness, but the film does not focus only on listing the symptoms. In addition to visual and auditory hallucinations, Adam has to deal with issues that probably every teenager experiences – conflicts with parents, grades, or falling in love.
Although the film does not depict any of the harmful stereotypes mentioned above, the members of the most affected group i.e., people living with schizophrenia (or schizoaffective disorder), nevertheless pointed out its problematic nature.
Laura from the YouTube channel Living Well with Schizophrenia in her aptly named video Words on Bathroom Walls – Why You Should Skip It criticized the unrealistic nature of film portrayals of schizophrenia, for example, the absence of the so-called negative symptoms, the content of Adam’s hallucinations and the extremely rapid effect of antipsychotic drugs. The author’s freedom of expression is at odds with the responsibility for the correct depiction of a disorder that most often emerges at a young age.
In the Schizophrenia and the City podcast, mental health activists Michelle Hammer and Cecilia McGough drew attention to problematic aspects of the film’s production and distribution. People with lived experience were not involved in the creation process in any way. The film’s director, Thor Freudenthal, said in an interview with Hammer that he acquired the information solely from books and conversations with a friend who cares for a person with schizophrenia. As McGough rightly notes, it is impossible to truly help a community of marginalized people without that community being involved in the helping process. Freudenthal defended himself against criticism by saying that he simply could not find any group of people with schizophrenia. However, upon the film’s distribution, the creators very quickly reached out to various activist groups to promote the film – among others, the organization Students with Psychosis, which was founded by McGough.
Given the positive reception of the film by the general public, we have to wonder whose voice matters in the mental health debate and who we are really listening to. Is it enough for us if the protagonist with a serious mental illness is not a murderer or a criminal? Are we ready to perceive more subtle and profound forms of discrimination? And finally: will we allow people with mental illnesses – including the most severe and stigmatized – to create their own stories?