Welcome back to DIRT FROM THE ROOTS, your monthly blog for discovering new perspectives on interesting, insightful, and obscure topics within the mental health and psychology fields. Continuing from last month, we will look at the influence of the media on how we perceive mental health of both ourselves and others, this time focusing on representation of mental health.
TOPIC OF THE MONTH
MENTAL HEALTH IN MEDIA II: REPRESENTATION
"Anything that's human is mentionable, and anything that is mentionable can be more manageable. When we can talk about our feelings, they become less overwhelming, less upsetting, and less scary."
- Fred Rogers (‘Mister Rogers’)
Continuing from last month, we will here focus on the representation of mental health within modern media. While we are creating greater risk for false assumptions, stereotyping, and misperception, we are dialectically also normalizing, advocating and raising awareness around mental health conditions in ways that have truly never been displayed before at any point of history. Certainly, we should not be using any form of entertainment for hard, clinical advice, but the unique outreach that is made possible overall by the many mediums seen in today’s mental health representation have clearly brought many positive aspects towards progression along with the baggage– something that would not have happened should no representation be offered at all.
Let us first go back to the roots of our cognition machinery and discuss cognitive bias of in-groups and out-groups. It is natural– as natural as the squirrel needing a biased perception of hawks and snakes as dangerous, regardless of actual threat– for humans to need to identify our in-groups, where we feel safe and supported, and out-groups, which inherently then need to be seen as different and often unsafe, dangerous, or threatening in collateral. While this is crucial to our survival, we must also account that many of these biases can become assumptive at best and, well, genocidal at worst. This mechanism serves great purpose, but much like fear, rage, anxiety, and hypervigilance, can become detrimental to self and those around when not properly understood.
I feel it is important to indicate a quasi-disclaimer that all representation assessment done here is based on characters’ displayed traits and are by no means set in stone (not that I would ever consider anyone to be one set-in-stone diagnosis), and the purpose of this month’s blog is to more tangibly and clearly understand what symptoms look like. Any actual humans referenced will be strictly due to their own personal identification of a condition, as it is also notable to mention that diagnosing celebrities or public figures, regardless of credentials, is considered unethical. This being said, there is still much to be gained from accurate portrayals of behaviors as it can be much easier to understand than just reading verbal descriptions.
DEFINING REPRESENTATION & ITS RISKS
Representation, when used in this article, will be referring to the ways by which media deals with, portrays, and defines things such as age, class, race, gender, identity, and in this specific case, mental health. Representation may not seem particularly important, the value can be more difficult to see for those who may align themselves with much of the accepted social norms, but what we may overlook in this perception is that when it comes to a more and more niche or specific set of traits, we are unfortunately even more likely to isolate those specific traits and form a general consensus.
Therefore, we can see how representation can become stigmatizing very quickly around concepts generally lesser discussed within the public, and possibly can see the true power that is held by representation of specific conditions. Let us begin our representation analysis with a very good example in Alfred Hitchcock’s 1960’s slasher movie Psycho. Starting from the very title– much like ‘insanity’ has no symptoms but is rather a legal designation, ‘psychopathy’ is not an actual diagnosis– we can see that we are already forming an association with mental illness as dangerous, scary, and something to look out for. The movie displays the main character’s behaviors as slightly odd in comparison to society at the time, creating a sense of ambiguity in the realm of “unsuspecting danger” when the character ends up being a homicidal murderer. While perhaps the audience only subconsciously connects the two– peculiar behaviors now indicate that someone is dangerous– this is exactly where the damage begins to onset: the conclusion of the movie determines that the character is acting this way due to a “psychotic alter ego” that is completely unhinged and unpredictable.
“But it’s just a movie!” you will say! We certainly know that these productions were made for entertainment, for creative expression, to tell a story with emotions, and in no way to harm those with outside conditions, at least without malicious intent. We see people represented poorly, inaccurately, or hyperbolically often, and therefore there is not much difference in this misrepresentation than for us to see a Lord of the Rings movie and wonder why the series left out our favorite part of the book which changed the entire undertone. This is all absolutely true, but things must be looked at with a caveat when it comes to mental health representation.
Unlike many portrayals we see, we do not have many, if any, real-life comparisons of certain mental health conditions, and therefore it is not an overstatement to assume that however a lesser-seen condition gets presented in media becomes the viewer’s entire schema around the concept. Additionally, we are not portraying a fictional fantasy, the purpose is at least in part to display an accurate representation of the dynamics experienced by a certain individual. While we may see a movie about a killer neighbor, we have all had plenty of neighbors that were not killers and can easily compartmentalize this character as an outlier. If someone had seen the movie Psycho and then met someone with autism who was acting in a peculiar way they did not recognize, the lack of counterexamples may then lead the person to falsely and harmfully assume that they are in danger due to fear derived from poor representation.
PROS AND CONS OF MENTAL HEALTH REPRESENTATION
By comparison to advocacy spreading awareness, representation takes things a few steps further by demonstrating, normalizing, and communicating a concept or construct that someone would probably be unaware of otherwise. Whether this honors, glamorizes, defames, or glorifies, it certainly sends a message– and that perception is truly a double edged sword.
Further, representation may lead us to expect, categorize, and generalize conditions that can again lead to very harmful stereotypes and continue to reinforce an ‘othering’ perspective. Ironically, the fear of addressing lesser-known or less severe symptoms out of misrepresentation risk also prevents us from seeing conditions on a full spectrum and also propagates the idea that conditions present in one specific way. To use myself as an example, I likely would have recognized my ADHD before 19 years old if I had realized that though I did not relate to the troublemaking and hyperactivity seen as the external (and in the 1990s, primarily addressed) ADHD symptoms of Calvin in the famous comic strip Calvin and Hobbes, it was just as valid to assume I possessed the condition considering I strongly related to the internal curiosity, daydreaming, and restlessness that is also constantly displayed by the character.
Another perhaps, fun, angle of representation is how we also seem to drift towards things that we can subconsciously relate to. To continue my own example, Calvin and Hobbes was undoubtedly my favorite thing to read as a child despite not even fully grasping all the vocabulary and context. I felt great connection to the characters, I found the situations relatable, and this is essentially a key ingredient in the latent undertow that determines what makes us really like something. Someone who has depression but never realized may not directly conclude their condition as such after seeing The Sopranos, but likely relates to how most of the characters are sublimating their depression, and at least has a new and potentially more proactive view on their condition, whether correctly identified or not.
Considering stigma and ease of understanding, it is probably easier and more descriptive for that individual to say “I feel a lot like Tony Soprano” than to say “I am identifying as an individual with depression”, and the same positive outcome can be reached regardless of semantics. Another more abstract benefit of representation is that we may “awaken” new perceptions of self, or perhaps work to bridge the gap between aforementioned ‘othering’ situations when we recognize that we do “see a little of ourselves” from a character that is initially perceived as very foreign. A real life example here would be Jerry Seinfeld, who actually has gone on the record saying he identifies as being on the spectrum and simply never considered it before this exact concept led him to connect the dots.
COMMON MISREPRESENTATION TROPES
Here are some examples of common ways that mental health is at risk of being misportrayed.
“I am solely a diagnosis” character-
a character that is entirely defined by their condition or a trait of it, only experiences life through the symptoms of the condition, and does not appear to hold any other roles in life. Example: exclusively showing a bipolar character when they are in either a manic or depressive episode.
“diagnosis is just a character flaw”-
A character’s condition is mocked or used as the butt of a joke without recognition of any disability. Example: an undiagnosed ADHD character is framed as a negligent, stupid and careless slacker that intentionally creates issues for other characters.
“Overgeneralized representation” character-
a character is given a specific diagnosis, but displays many unaddressed comorbid symptoms not seen in theirs. Example: a character with sole diagnosis of social anxiety not only displays overdramatized panic symptoms when in a crowd, but also struggles with OCD and hoarding symptoms that are not addressed as separate issues.
“Mental Superpower” character-
a character uses their development of a trait that is traditionally viewed negatively/apathetically to reach unprecedented heights of functioning. This not only misleads viewers, but can create harmful expectations both internally and externally for individuals with the same condition. Example: a character with savant autism features sees no inhibitions from their struggles with social cues and extreme sensory sensitivities when giving a speech in front of a loud audience because their invention is so brilliant
“Questionably functioning” character-
a character who has either far more inhibitions or far less adversity from symptoms than would be realistically expected. This is particularly problematic as it creates a false perception at best and oppressive stigma at its heights. Example(s): a character with depression is prone to crying fits and lethargy, but has not lost interest in enjoying any other facet of life. A character with agoraphobia is unable to ever leave home and never progresses.
“False correlation” character-
a character is displaying unconnected symptoms due to misinterpretation of condition. Example: a character diagnosed with schizophrenia is shifting between multiple alter personalities, a clear symptom of dissociative identity disorder.
“The cured” character-
and perhaps most detrimental, a character who has a chronic mental illness or disorder that is magically cured by meeting the right person, finding the right place, or having the right attitude around the condition. While this is not to say these factors can’t help a condition drastically, it’s best to say these factors will make other effective coping mechanisms easier but are not the coping mechanism themselves. Example: a character is detrimentally neurotic and paranoid until meeting an open-minded free spirit whose presence “fixes” all anxiety issues, the character is implied to be “cured” so long as they stay around their magical partner. A clinically depressed character instantly becomes an optimistic person after one “magic bullet” treatment.
EXAMPLES OF MENTAL HEALTH REPRESENTATION
EFFECTIVE USAGE OF MENTAL HEALTH REPRESENTATION
Legitimate Accounts-
while there have been some beautifully written fictional characters that powerfully represent conditions, and you can argue that most characters have at least one trait that could be positively seen as generalizable or at least specific to certain subtypes of a condition, nothing will beat the real deal. The most impactful and important information I ever gained on any condition when studying to become a mental health professional always came directly from individuals who managed that condition every day of their life. Particularly in cases of rare and under researched conditions (notably dissociative identity disorder, being born intersex, rare genetic conditions, and the like), documentaries interviewing real individuals were the only helpful sources I ever found to learn more on these conditions.
Balanced characters with conditions as addition rather than definition-
a comparable situation parallel can be seen through recent development of LGBTQIA+ characters here: while old representation had more (if not entire) emphasis on tropes associated with gay culture and presented the character being driven almost entirely via the root of their sexual orientation, newer representations will base the character off another plot angle, and incorporate aspects of life that an LGBTQIA+ individual might commonly experience rather than encompass the entire character in that identity. Though probably not directly intentional, we do actually see this with anxiety, depression, ADHD and substance use often– but mostly because these are conditions with a high number of people showing lower end presentation of features. A good general example here would be Johnny Depp’s character in the aptly titled movie What’s Eating Gilbert Grape; The film does not center on the main character’s condition– in fact, does not even designate he has one– but rather how he is realistically affected by the trauma of managing the mental health issues of his immediate family around him.
Hiring actors with conditions they are portraying—
while obviously there is a complication in this as certain conditions would create hard barriers to acting due to symptoms, there are plenty of situations (autism, bipolar, anxiety, ADHD, CP, Tourette’s, etc) where a perfectly capable actor who possesses the condition is overlooked. It is shocking how often we hear actors discussing how roles that they can relate to in real life are much more compelling, yet do not seem to view this for conditions that can be even more hard to relate to at a baseline. A final consideration could be seen reflected in ‘personality’ actors— or actors who are usually cast in specific roles which they naturally play well– and how this can unintentionally work as representation. Jim Carey is a great example of someone known for and cast into roles that play off his specific eccentric, high energy persona— perhaps not surprising to find that the actor identifies as ADHD and also struggles with major depressive issues connected to it. While we may not view this situation directly, we also now have a peripheral awareness that even though this individual displays high energy exuberance, he also counters the stereotype by showing the full emotional range seen in the condition rather than just the expected ones.
CONCLUSION
The value of representation overall is generally seen in the subconscious; while we may not consciously feel any type of way about what we are seeing on a screen, we will eventually associate patterns– just like in any other facet of life!-- that contribute to the formation of our schemas. Sometimes this is logical– someone very intelligent is likely to be seen in critical thinking or computational situations, someone who has magnetic charisma and gregariousness does well at parties, etc. Due to the nature of these ideas making rational sense, the same thought pathways are also vulnerable to generalizing assumptions and stereotypes in this realm.
So while representation of violent schizophrenia may not lead one to assume violence as an all-encompassing trait of the condition, it does fasttrack harmful bias around any association between violence and a schizophrenia diagnosis to be seen as accurate due to lack of alternative and more representative portrayals. If it surprises you to hear that in reality 90% of people with schizophrenia will never show a violent symptom, we are then seeing a real-time example of how representation can become harmfully misleading.
Ultimately, representation has been a very valuable tool towards progress; it just must be seen with a keen eye of assessment rather than taken at face value.
WHAT’S COOKING FOR NEXT MONTH
MENTAL HEALTH AND MUSIC
Next week we will take a look at the interplay between mental health and music, touching on a range between how music can influence the awareness and understanding of our own mental health as well as the actual application of music therapy.
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