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In the aftermath of an unconscionable act of random violence, many people are inclined to label the perpetrator "crazy." Although the criminal may have a mental illness, automatically assigning the label "crazy" does a great disservice to people who live with mental illness every day.

In reality, somebody with mental illness is much more likely to be a victim-rather than a perpetrator-of violence. Calling a violent offender "crazy" spreads a dangerous stereotype and belies the complex relationship between criminality and mental illness.

The media teaches us about people with whom we do not routinely interact. This constant flow of data gives us incessant social cues about the nature of other groups of people-including which groups of people should be praised or scorned.

Media portrayals of those with mental illness often skew toward either stigmatization or trivialization. Consequently, all forms of media-including television, film, magazines, newspapers, and social media-have been criticized for disseminating negative stereotypes and inaccurate descriptions of those with mental illness.

What Is Stigmatization?

Stigma involves negative beliefs, attitudes, and behaviors directed toward people based on some distinguishing characteristics. In the case of mental health stigma, it involves the presence of mental health symptoms or a mental health diagnosis.

In other cases, stigma can also involve health conditions, disabilities, gender, race, sexuality, culture, religion, and sexuality.

Stigma happens when some person is viewed as an "other." A person considered an "other" is denied full social acceptance.

The impact of mental health stigma is serious. Evidence suggests that it is linked to worse mental health outcomes because it reduces the likelihood that a person will seek help, receive adequate care, and adhere to their treatment plan.

Stigmatization of Mental Illness By the Media

Stigmatization of mental illness in media is abundant. For example, certain mental health conditions, such as schizophrenia are seen as being so disruptive that people with those conditions must be isolated from society.

The stigmatization of mental illness is so entwined with the media that researchers have used newspaper articles as a proxy metric for stigma in society.

Media accounts tend to focus on the individual with mental illness rather than framing mental illness as a societal issue. Consequently, media consumers are more likely to blame an individual for the illness.

Mental Illness Is Overgeneralized

For instance, common depictions are that all people with depression are suicidal, and all people with schizophrenia hallucinate. In reality, 60% and 80% of people with schizophrenia experience auditory hallucinations. An even smaller number of people experience visual hallucinations.

It's also not uncommon for media portrayals to discount that many people with mental illness don't need to disclose their condition to everyone around them.

Instead, mental illness often goes unrecognized (whether by intention or not). The portrayals in the media tend to present situations where everyone in a character's life knows about their mental illness.

Trivialization of Mental Illness By the Media

The media can also trivialize mental illness, either by promoting mental illness as not being severe or being less severe than it really is.

For instance, many people with eating disorders such as anorexia nervosa feel that their condition is made out to be less severe than it really is. This is in part because people with the condition portrayed in the media often minimize its seriousness and hide the severe consequences of the disease.

The truth is, the death rate for people with anorexia is high. In reality, anorexia has one of the highest mortality rates of any mental health condition. Research suggests the risk of dying is 10 times higher for people who have anorexia nervosa.

The symptoms of mental illness are sometimes portrayed as being beneficial. For example, in the popular television series Monk, the protagonist is a detective with OCD. The fact that he pays close attention to detail helps him solve crimes and advance his career.

People who do not have disabilities can use media channels to mock people who do have disabilities, such as by appropriating mental-illness terminology. For instance, the hashtag OCD (#OCD) is commonly used on Twitter to describe one's attention to cleanliness or organization.

Depictions of Schizophrenia in Film

Probably the most disparaging stigmatizations of mental illness in media lie in the film portrayals of antagonists with mental illness. In particular, when characters with schizophrenia are presented as "homicidal maniacs" in "slasher" or "psycho killer" movies.

In one study, researchers analyzed 41 movies that had been released between 1990 and 2010 for depictions of schizophrenia.

Based on the findings of the analysis, researchers drew several conclusions.

Most of the characters displayed "positive" symptoms of schizophrenia, with delusions being featured most frequently, followed by auditory and visual hallucinations.

The majority of characters displayed violent behavior toward themselves or others.

Nearly one-third of violent characters engaged in homicidal behavior.

About one-fourth of the characters committed suicide.

The cause of schizophrenia was infrequently noted. However, in about one-fourth of the movies it was implied that a traumatic life event for the character had been a significant causative factor.

Of the movies that alluded to or showed mental illness treatment, psychotropic medications were most commonly portrayed.

Why Such Portrayals Are Damaging

These portrayals are not only incorrect but damaging-and for several reasons.

They Spread Myths About Mental Illness

The portrayals of schizophrenia often focus on symptoms such as visual hallucinations, bizarre delusions, and disorganized speech, and present them as commonplace. In reality, symptoms like decreased motivation, poverty of speech, and flat affect are more common.

They Link Mental Illness to Violence

Several movies have spread the false stereotype that people with schizophrenia are prone to violence and unpredictable behavior. Some films even presented people with schizophrenia as being "possessed."

They Exaggerate Suicide Risk

While suicide is a significant concern for people with schizophrenia, the research on media portrayals of schizophrenia found that this risk is often exaggerated in film and tv representations. In one study, 24% of the characters with schizophrenia committed suicide.

In reality, estimates suggest that between 4% and 13% of people with schizophrenia die by suicide, and approximately 18% to 55% attempt suicide at some point in their lifetime.

They Misrepresent Who Is Affected

Demographics is another aspect of mental illness that is often misrepresented by media portrayals of mental illness.

For example, characters with schizophrenia are frequently depicted as being white males, but schizophrenia disproportionately affects African Americans. It also affects men and women almost equally.

They Spread Myths About Causes of Mental Illness

In a few movies, schizophrenia was depicted as being secondary to traumatic life events or curable by love-both of which are misrepresentations of the condition's causes and treatment.

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What's Accurate In Media Portayals?

Not all the information presented about schizophrenia was found to be incorrect, misleading, or stigmatizing.﻿﻿ For example, in more than half of the movies that researchers analyzed, the use of psychiatric medications was depicted or alluded to.

Even when some movies get it right, the negative media portrayals-especially those that are violent-of people with schizophrenia and other severe forms of mental illness still contribute to stigmatization, stereotyping, discrimination, and social rejection.

Impact of the Media on Mental Health

The impact of mental health stigmatization by the media can contribute to a number of different effects.

Self-stigma: Media portrayals can contribute to self-stigma, which refers to feelings of internalized shame, negative beliefs, and negative attitudes that people have about their own mental health condition.

Incorrect information: Because of media portrayals of mental illness, people often get incorrect ideas about the symptoms of mental health conditions. It can also lead people to develop inaccurate ideas about how mental illness is diagnosed and treated.

Barriers to treatment: Media messages can also create barriers to treatment. Because people internalize stigmatized attitudes about mental illness, they may be less likely to seek out help or treatment when they experience symptoms.

Poor treatment adherence: People are more likely to adhere to their treatment if they have social support and encouragement from others. Negative attitudes toward mental illness and stereotypes portrayed in the media may contribute to worse attitudes about mental health treatments and poorer adherence.

Self-diagnosis: People might also be more likely to self-diagnose themselves based on viral social media posts seen on Tik Tok and Instagram. Such information is often shared by people who are not mental health professionals and is often inaccurate.

What Can Be Done?

We need a better understanding of how these messages are disseminated by the media before we can rectify them. There is limited research looking at how media promotes mental-illness stereotypes, stigmatization, and trivialization.

Nevertheless, certain suggestions have been made on how to improve the depiction of people with mental illness in the media, such as:

Analyzing mass-media production procedures to better understand screenwriters, producers, and journalists' current practices, needs, values, and economic realities (for instance, understanding the balance between being newsworthy or emotionally arousing and verifiable).

Implementing a mental health short course when training journalists.

Including expert input from psychiatrists during a film's production.

Preferring non-individualized descriptions of mental illness and instead focusing on the societal aspects.

Presenting mental illness only when relevant to the story.

Using mental-health terminology with precision, fairness, and expertise.

As individuals who consume copious amounts of mass media and engage with social media, the best thing we can do is stop using words like "crazy" and "deranged" in a derogatory or flippant fashion. We also need to remember that it's best to avoid making a psychiatric diagnosis outside of a clinical setting.

A Word From Verywell

Only a specialist can make a diagnosis of OCD, depression, bipolar disorder, schizophrenia, and other mental health conditions. When we give someone the label of being mentally ill without clinical evidence, we hurt people who live with mental illness on a daily basis.

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How Mental Health Issues Are Damaged by Mass Media

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Get information on how movies, film, and social media often stigmatize and trivialize mental illness.

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How does romanticizing mental health effect young teens

Romanticizing mental illness has negative effects on teens because it delegitimizes claims of mental illness, adds stigma to mental health, and can have harmful effects on unstable minds.

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How Media Can Portray Mental Illness Correctly?

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How Media Can Portray Mental Illness Correctly?

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"When portraying mental illness and psychotherapy, the media tends to get it wrong — a lot — which has far-reaching results. Inaccurate depictions fuel stigma and may prevent people from seeking help."
"The realities of a disease like schizophrenia are so harrowing, and its effects on its victims and the people close to them so devastating, that we are eager for deeper meanings and happy endings. But if we sometimes need comforting fantasies about mental illness, we also need movies like Tim McCann's ''Revolution No. 9,'' an unadorned, unsparing chronicle of a young man's descent into a nightmare of delusion, paranoia, and self-destructive behavior."

One of the best portrayals of mental illness in media is Bojack Horseman. The writers did a wonderful job of showing how depression can affect someone. In the show, you see how chaotic and rude and entirely human each and every character is. Bojack, the main character, battles with depression and alcoholism, and instead of the show giving into its comedic nature, it takes the topic very seriously. It is one of the best shows I've seen that portrays mental illness on such a broad scale, it shows depression, anxiety, post-traumatic stress syndrome, love, hate, and multi-dimensional characters.
Media can be a wonderful tool to help remove the stigma against the mentally ill. It can show that not every person who's atypical is someone who's one step away from a murderous rampage and needs to be locked up in a padded cell with a straight jacket. Sadly, some people still think crazy and mentally ill are synonymous, and that's the kind of harmful thinking that specific shows can push if they aren't careful.
Many people could benefit from going to therapy, mentally ill or not, but most are afraid to go because media can depict therapists and those who go to them as nuts. Media can depict therapists as these useless people who can't fix anything, because after seeing therapists like Dr. Phil, who specializes in quick fixes and blanket statements, people end up thinking that therapists who are slowly rebuilding the person up are actually ineffective and pointless.
-Simon

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When portraying mental illness and psychotherapy, the media tends to get it wrong - a lot - which has far-reaching results. Inaccurate depictions fuel stigma and may prevent people from seeking help.

"There are people out there who could benefit from therapy but don't go because they think it's just for 'crazy' people or think all therapists are nuts - because that's what they see in the media," said Ryan Howes, Ph.D, a psychologist, writer and professor in Pasadena, California.

When a tragic or violent act happens, the news media tends to exaggerate mental illness and depict it negatively, according to Jeffrey Sumber, MA, LCPC, a Chicago psychotherapist, author and teacher. "In circumstances such as a school shooting or the Giffords shooting, the person's mental illness is portrayed as something dark and dangerous," he noted.

Therapists don't fare any better. "The mental health field is often portrayed as incompetent in these situations, as if a competent therapist has the ability to cure a personality or thought disorder or as if a therapist can tell the future and know which client will commit violent acts," Sumber said. The reality is that many people reveal dark thoughts, dreams and fantasies in therapy. Doing so helps clients to heal and grow, Sumber said. If therapists reacted fearfully every time, it would squelch these opportunities.

Famous therapists like Dr. Phil and Dr. Drew also perpetuate the many misconceptions surrounding mental illness and how therapy actually works. For instance, they tend to make sweeping statements about everyone struggling with a specific mental illness, Sumber said. Dr. Phil also has created the expectation for quick fixes and short answers to complicated problems, he said.

Shows & Films That Got It Wrong

Most therapists are portrayed as having more problems than their patients, said Howes, who also writes the blog In Therapy. Therapists in shows like "Frasier," Lisa Kudrow's "Web Therapy" and "What About Bob?" are depicted as "highly neurotic, scatterbrained and self-congratulatory."

Yes, therapists have their own issues, but often what we see are warped depictions. "Therapists are real people with as many quirks and hangups as everyone else, but these are distorted caricatures that don't represent the profession as a whole," he said.

Both Sumber and Howes also called out Betty Draper's therapist on "Mad Men." Without her knowledge, Draper's therapist tells her husband everything they talk about in therapy.

Shows & Films That Got It Right

While authentic portrayals of mental illness and psychotherapy are slim pickings, they do occur, even if we just get bits and pieces. Sumber likes the depiction of schizophrenia in "Julien Donkey Boy." "The film was intensely unsettling, disturbing and at times utterly absurd, and yet there are few films that have done the illness as much justice, as well as the dysfunctional family that surrounds the main character," he said.

Howes believes that Paul Giamatti in "Sideways" and Zach Braff in "Garden State" provide a good look at depression. Reality shows such as "Obsessed" and "Hoarders" give viewers accurate snippets of cognitive-behavioral therapy, he said. Still, he'd like to see other therapies explored. "It may be easier to find sound bites for CBT, but many people in dynamic therapy experience profound, lasting change, and that might make for interesting viewing."

While it's overly dramatic, HBO's "In Treatment" is the best portrayal of therapy, according to both Sumber and Howes. "I love the way the show brings us into the intimate process between client and counselor and how we get the opportunity to follow the ups and downs, shifts and stuck places over a number of sessions," Sumber said.

Judd Hirsch in "Ordinary People," Robin Williams in "Good Will Hunting" and Lorraine Bracco in "The Sopranos" offer some truthful elements, according to Howes. Sumber also likes Williams's portrayal "because it showed how deeply he became connected to the process of his client and the struggle to remain neutral."

His favorite portrayal is Bruce Willis in "The Sixth Sense." "Willis did a great job demonstrating the methodical, note-taking, conscientious side of the therapist behind the door."

"I even think some of what we saw in the comedic roles from Bob Newhart ('The Bob Newhart Show'), Allan Arbus (Dr. Sidney Freedman on 'M*A*S*H') and Jonathan Katz ('Dr. Katz, Professional Therapist') occasionally show up in the room," Howes added.

Taking the Media with a Grain of Salt

The media's job is entertainment, not education, Howes said. "What we see on TV or in the movies is therefore several times more dramatic, dangerous, condensed, frightening and/or bizarre than reality," he said.

A screenwriter's job, he noted, is to create larger-than-life stories that capture viewers, are artistic representations and drive ticket sales. "It's not up to them to provide us with a balanced and nuanced education." (On the other hand, it is the news media's job to provide accurate information.)

Just compare an episode of Law & Order or a John Grisham film to your jury duty experience, Howes said. "That's about the same distance you'll find between TV therapy and actual therapy."

Also, keep in mind that even when you do get an accurate portrayal, it's just one character's struggle and life. "The reality is that no two people are alike and that mental health exists on a multi-axis spectrum where many different factors intersect to paint a unique picture of each situation and each individual," Sumber said.

Whatever the portrayal, the key is to take the media with a grain of salt, Sumber said. And get your facts from reputable resources.

The Media and Mental Illness: The Good, the Bad and the Ridiculous

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"National and international research clearly indicates the very real impact and risk to harmful
suicide exposure leading to increased risk and possible suicide contagion," Headspace's manager of school support Kristen Douglas told The Huffington Post Australia. "It's not like car crashes or cancer; irresponsible reporting of suicide can lead to further death[s]. We need to talk more about youth suicide, but there's a way of doing that and a way we can raise those concerns and have a range of awareness."

Douglas said she's already heard from people triggered by the show. "It has been raised with us, the content has created a lot of distress in recent weeks," she said. "People have disclosed their own distress, and that they're being triggered. It's great that people are talking about being in distress but this is also magnifying those vulnerabilities."

Multiple organizations, including Mindframe and Press Council, warn against sharing any details on how or where a suicide may be completed.

In addition, the Recommendations for Reporting on Suicide warn against blaming a suicide on any one thing, since there are typically multiple causes, reports. In the show, the protagonist largely blames her peers and school counselor, which could encourage misconceptions about what leads to suicide and could make those who have lost someone to suicide blame themselves. Plus, mental illness usually precedes suicide, but it's not discussed in 13 Reasons Why.

Another potential issue with the series is that the protagonist is still around to narrate it, which could undermine the finality of suicide, Suicide Awareness Voices of Education's (SAVE) executive director Dan Reidenberg told The Post. "Young people are not that great at separating fiction from reality," he said. "That gets even harder to do when you're struggling with [suicidal] thoughts."

That's why SAVE and the Jed Foundation created talking points for parents to discuss the show with their kids. According to these guidelines, we should make it clear to anyone at risk that it's entirely possible to overcome suicidal thoughts. They also recommend reaching out if you feel triggered by the show. Talk to a loved one or a mental health professional; or contact Crisis Text Line by texting "START" to 741741 or calling 1-800-273-TALK (8255).

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"National and international research clearly indicates the very real impact and risk to harmfulsuicide exposure leading to increased risk and possible suicide contagion," Headspace's manager of school support Kristen Douglas told The Huffington Post Australia . "It's not like car crashes or cancer; irresponsible reporting of suicide can lead to further death[s].