The Representation and Impact of Mental Health in Film: Study Paper Review

One Flew Over The Cuckoo’s Nest

Film as a medium stands as having a position of considerable influence over the perception of topics it chooses to have as subject matter. A frequent concept which generates a variety of attitudes in discussions is mental health, which we can think of as the state of one’s psychological and emotional well being. When discussing how mental health is represented in films, one must observe how it is portrayed to spectators and this portrayal is conducted through the distinct cinematic techniques of characterisation, visuals and narratives. Essentially, the compositional way screenwriters formulate characters who suffer from mental health problems, such as their actions and dialogue, is combined with the optical features of camera angles and costume as advised by the director to orchestrate visions of mental health to audiences.

These audiences will then react to these cinematic portrayals with attitudes towards what they have witnessed in the film’s subject matter. These attitudes towards mental health and disorders occur in direct accordance with the film’s anatomy of mental health as a theme or value. Therefore, the tastefulness and accuracy identified in the representations are what direct spectators’ opinions to either a positive or negative attitude towards mental health and the issues encompassed within it. A significant denominator which assists in these reactions is the issue of stereotypes: a fixed image of a specific concept, of people who suffer from mental disorders. These prescribed images maintain cinema’s position of influence because they are what allegedly validates spectators’ opinions on individuals and events associated with mental health. An example of this is the negative stereotype of someone who has a mental disorder constantly lashing out in violent outbursts, and the frequency of it in narratives is what creates and preserves it as a fixed image. This stereotype as combined with the negative attitudes in which it inevitably generates then goes on to formulate a mass amount of stigma towards mental disorders, which one can think of as branding of disgrace on the topic as a whole. This shame enforced by stereotypes is what causes mental health to stand as a topic which is met with anathema and rejection in dialogue outside of film.

It is this fabrication of stereotypes of mental disorders and their cultural impact that attracts film as an artistic medium for study and academic discussion, in addition to its importance as an approach to issues in our society. The topic of mental health portrayals in film with relation to the stereotypes and stigma surrounding it stood out to me as a research subject. This is due to how empirical research and literature discussing the matter work to analytically observe and communicate the steps in which stereotypes of mental disorders are strategically executed. Furthermore, they present the qualitative data of keywords that are common in representations of mental disorders in film and the reactions they generate, for example, “psycho” or “dangerous”. This is progressed when combined with insight into their direct impact using quantitative data to show the statistics on how frequently specific tropes are shown in film. This efficiently visualises and highlights the extent to which they exist in perceptions. Overall, literature scoping this topic has a strategy in elevating information surrounding portrayals of mental health in film, done so by offering tools of observation in the different forms of empirical data.

The first paper in my selection of empirical research on the representation of mental health in film concerns itself with the qualitative side of the data, such as specific syntax in the mental disorder scope. Damjanovic et al’s. (2009) Psychiatry and Movies is a tool for investigating stereotypical portrayals of mental health in film, introducing the reader to the area by highlighting the cinematic strategies filmmakers use to transfer the psychological outline of the characters [Page 230]. They communicate how film relies on aspects of characterisation, camera angles and lighting as emotional signifiers for spectators, as this is the film’s goal, and these emotions influence perceptions on the subject matter [Page 230]. Thus, Damjanovic et al. is implying that there exists a formula surrounding mental health representation in film, one that is mantled by the characterisation in a film, the emotional responses it evokes and the opinions constructed as the aftermath. To elevate this argument, they reflect on the findings of Weeding and Niemac (2003), who present qualitative data in the form of key terms used to describe the character traits commonly identified in mental health patients, predictably negative ones such as ‘unstable’. Damjanovic et al. use this detection as evidence of the roots in a continuing stigma of mental disorders, a blemish that is validated by cinematic tropes and results in a lack of communication on the matter.

Damjanovic et al. proceed to underline the time period of this contribution to the stigma surrounding mental disorders using Table 1. as shown in the paper [Page 233]. This paper is divided into three sections-Category of Disorder, Classical Movie Example and Recent Movie Example. The categories cover a wide range of specific mental disorders alongside a pre-millennial film which presents the disorder and a post-millennial one that shares it. This effectively communicates a presentation of the themes that have been existing for at least a decade, thus, progressing the previously suggested formula by solidifying how prevalent the negative tropes are represented in a manner of time. As further evidence to support this, Damjanovic et al. combine two individual studies-Wahl (1995) and Hyler et al (1995), with the former focusing on the execution of psychiatric terms and the latter presenting specific stereotypes. Wahl (1995) claims that these tropes as presented in the table are automatically simplified in the process of being used as a narrative trait, meaning there is a lack of elaboration on them for spectators to be educated on and thus, they are reduced to tools for dramatic effect. This is a claim Damjanovic et al. use to elevate their arguments on film representations generating negative perceptions on disorders as it shows a significant factor (an absence of information) that contributes to it, all being significant to film. They then incorporate Hyler et al’s (1995) classification of the common stereotypes mental disorder patients are reduced to as further qualitative data, such as ‘maniac’ and ‘seducer’, which are negatively received by spectators who are conditioned to believe these tropes are accurate. This highlights the fixed images that are the characterisation that exists within the themes presented in Damjanovic et al’s table, further endorsing the claim that stigma is a result of negativity being a key feature in film representation. Overall, Damjanovic et al’s.paper effectively presents introductory ideas to consider when dissecting this topic, as well as steps to the creation and maintenance of negative views on mental disorders. They incorporate their implied formula throughout their findings and reflections to others as a method of elevating their contribution to the portrayal of mental disorders in film.

The second paper in my research project further specified the cinematic tropes that assist in distasteful portrayals of mental disorders by proposing a specific genre that relies on them. Goodwin (2013) presents his ideas on the matter in The Horror of Stigma: Psychosis and Mental Health Care, an examination that comes in two parts on how the horror film genre presents and endorses stigmatising depictions of mental illnesses and the facilities in which they are treated. Part 1 is an accumulation of support for his argument that horror generates negative perceptions of mental disorders by reviewing previous statements as made by Hyler (2003). Statements such as how psychiatry-the study of mental health, is grossly mistreated in the horror genre which produces a rejection of progressing conversations [Page 201]. Goodwin also explores another side of the responses spectators have to this form of portrayals-those who actually suffer from these mental illnesses, and expands from Wahl’s (1999) findings that a factor of offence is prevalent [Page 202]. This offers a significant perspective on the influence these portrayals have as it is personal in that it is coming directly from those who are vulnerable to the shame these representations generate. Characterisation, as mentioned by Damjanovic et al. (2009), plays a role in this and as Goodwin is focusing on horror specifically the characterisation will mainly include serial killers in a code of horror. Goodwin combines dialogue with Wilson et al (2000) to underline how horror filmmakers will poorly use mental illnesses as a foundation for serial killers to fulfil the role of villains to be feared by characters and spectators [Page 204]. Therefore, Goodwin demonstrates a specific area to analyse when observing mental health representation in the horror genre. He presents how this is a classification of film that builds narratives and character profiles using negative portrayals of mental disorders that fail to construct a truthful image of the issue and those directly affected by it.

Goodwin elevates these ideas in the second part of the paper, serving as an investigation into the consistency of negative tropes relating to mental illness being an element to horror narratives. Goodwin bridges between qualitative and quantitative data in his use of scanning film forums with key terminology of “mental patient”/”psychosis” etc. in their plots and characters. This presented to Goodwin a reveal of 55 films released between 2000–2012 (Table 1, Page 226), which included the harmful stereotype of “homicidal maniac” (trope coined by Hyler, 1995 and stated in Damjanovic et al. (2009) ) appearing in 78.78% of the 33 films featuring psychosis (Page 227, Table 3). This illustrates visually the negative representation the horror genre provides for mental disorders. As Goodwin puts it, the genre is painting psychosis and dangerous behaviour with the same brush and therefore is implying that they are associates that cannot be separated (Page 227–228). He elaborates with an addition of the setting of psychiatric care facilities and the cinematic elements of mise-en-scene, as these are the tools which execute the environments. In Table 4. [Page 228], we can see mise-en-scene examples such as ‘flickering lights’ and ‘straight jackets’ alongside the number of films they can be found in, with the former being 57.77% and the latter 64.44%. Goodwin’s findings are then elaborated on using de Carlo (2007), in that the visual images displayed in horror films which use mental health care facilities as a prime location, serve as artistic utensils to reinforce negative images of mental illnesses and places where they are commonly residing for treatment. For example, the flickering lights are used as a tool to create tension and nerve in mood, as these displays of genre-driven mise-en-scene are manipulated to achieve the desired effect of generating fear (page 227). Therefore, Goodwin’s paper conveys how the negative portrayal of mental disorders in (horror) films is elevated by the unappealing representation of the physical environment in which they reside to be observed. He concludes with how a dangerous lack of knowledge has the consequence of souring the attitudes of the general public towards mental disorders (pages 229–230), as they connect facilities where mental disorders are treated with misplaced judgement.

After establishing a clear presentation on the exact tropes that generate these negative portrayals of mental health in film, the literature I found during my research also contributed specification on how the influence of opinions found in spectators proceeds. Lauren Beachman conducted an analysis and explanation on this matter in her 2010 paper The Psychopathology of Cinema: How Mental Illness and Psychotherapy are Portrayed in Film. Throughout the paper, she argues for observation on narratives and characterisation through a scope concerning mental disorders, as this is something that affects one in four Americans [NIMH, 2009, Page 1]. Beachman stresses that all portrayals of mental disorders should be inspected thoroughly, regardless of whether they are “exaggerated” or “realistic”, a consideration that is hardly ever absent as stereotypes of people with mental illnesses continue to involve a sense of danger which results in reducing individuals to exaggerated versions of their diagnoses [Page 4]. Beachman proceeds to underline this issue of fact and fiction within media and culture, and so reflects Anderson’s (2003) statement on how these two binaries can be complementary in endorsing film visuals in their directing of public perception”. She advances this perspective by mentioning how these portrayals are mannered to initiate emotional responses [Page 8], thus conveying a cause for why narratives use extreme dramatisation in their portrayals of issues. Therefore, Beachman is addressing the conflict between cinematic dramatisation and realism when it comes to representations of mental disorders, an issue that is stemmed from a need to create specific emotions in audiences.

In an attempt to visually solidify this claim, Beachman incorporates the study conducted by Domino (1983). In this examination, students were surveyed about both their knowledge and attitudes on Electroconvulsive Therapy, with Beachman offering a definition given by Enns, Reiss and Chan in 2010 as a procedure that involves brief electrical stimulus to induce cerebral seizures [Page 10]. Beachman stresses Macfarquhar and Thompson’s (2008) argument that catalysed the study that those who receive their facts about ECT do so through films, with the most common being Forman’s 1975 One Flew Over the Cuckoo’s Nest [Page 10]. The students were then surveyed on the subject again three months after seeing Forman’s film, to which Domino discovered 85 students who saw the film presented a higher amount of negative attitudes towards the procedure compared to before. Beachman states her agreement with Macfarquhar and Thompson (2008) on how this is a result of the brutality and pain that resides within the portrayals of mental disorders and their treatment [Page 10]. Beachman concludes with how this proves how the manners in which a film chooses to discuss psychiatric treatments has a great influence on how audiences will perceive them. Stigma is a result of dramatic and brutal portrayals serving as a breeding ground for negative representation and attitudes. The higher the levels of brutality in the portrayals of ECT, the stronger the criticism the procedure receives.

Influence of mental disorder portrayals can be analysed as it proceeds in the film realm in addition to that of the spectator, meaning that it can be observed with attention to how mental illnesses can affect the characters that are suffering from them. Shu-Ting (2019) elaborates on this concept with a study on von Trier’s 2009 psychological horror Antichrist, as supported by Fuchs’ (2001) paper Melancholia as a Desynchronization Towards a Psychopathology of Interpersonal Time. Shu-Ting focuses on the cinematic element of time progressing in a narrative, building from Fuchs’ contributions to how temporal differences are frequent in narratives surrounding mental disorders, to suggest herself that individuals who suffer from depression have a separate awareness of time compared to those who do not [Page 110]. This transcends from the reality of our world to the fictional one of films and experienced by the central character in Antichrist who, as Shu-Ting stresses, is a psychologist [Page 110], thus psychology serves as a crucial aspect of his lifestyle. Shu-Ting proceeds to highlight how von Trier’s characters rely on harmony between their psychological state and the physical habitat they reside in for a chance of stamina to engage in activities [Page 112]. This conveys what is at risk for characters who suffer from mental illnesses in film, as they are dependent on their psychological wellbeing being intact with their environment for necessary activities. As the characters in Antichrist are suffering from the grief that is the source of their depression, they are submitted to an alternate temporal experience [Page 112], demonstrated by the temporal editing of the film lacking in an anchor of reality and diverting into a surrealist style Thus, Shu-Ting offers a broader scope on the representations of mental disorders in film that has not been considered in previous papers shown, by specifying the cinematic technique of time in editing that can be dictated to construct the existence of those in the film to present a more intimate perspective on how their disorders affect them.

In a fitting display, the final paper in my research provided a solution to the misinformation and judgement that infiltrates mental health portrayals in cinema. In a 2018 article published on NursingTimes, a contributing group of writers outlined how the Mental Health Movie Monthly are providing a solution to this problem using screenings held at Robert Gordon University. The screenings consist of films which offer mental health as a subject matter, in a positive or negative matter, as a way of generating an open debate among the audience. The reason for this is given as how a film exists as a medium that has power in building up awareness of mental wellbeing and how it promotes specific portrayals of the issue must be analysed and discussed with sophistication. The article emphasises how the open discussion of the audience’s responses constructs a sharing of experiences and understandings that has the potential to remove the stigma, as defined by the article using the contributions given by Corrigan and Kleinlein (2005). They outline how stigma is created as a blend of three elements-Stereotype, prejudice and discrimination, all concepts that have been dissected in the previous papers. It is communicated in the article how the screenings and discussions dismantle the stigma of mental health representations in film, as qualitative data is given in frequent phrases used in the audience’s feedback, such as making “difficult topics” more accessible for “positive discussions’’. This article is therefore successful in highlighting elements that create stigma which thus shows audiences what to look out for during viewings, in addition to illustrating how film can be used as a tool for education and rewriting what we think of mental disorders as shown in film.

To bring forth a conclusion on the empirical literature presented as so, one can identify the common feature they share in demonstrating how film overlooks its influence on wide range outlooks on mental health. Majority of the papers exemplify an accurate display of data which endorses claims that characters and narratives perpetuate a pessimistic ideology on mental disorders when there is an absence of sympathy towards mental disorders. Whilst Shu-Ting’s paper lacked in this value of quantitative or qualitative data, which provided obstacles in underlying a distinct conclusion in an empirical sense, it did study its chosen films with an innovative perspective by dissecting the experiences of figures within the narrative. Beachman’s contribution demonstrated a defining image of how portrayals dictate opinions in audiences with Domino’s experiment which she progressed with her own perspective. Goodwin’s provided a condensed area to study this topic and so highlighted specific strategies the film engages in to construct its representations, with the reasoning of dramatic effect consistently emphasised. The Nursingtimes’ article established a sense of full cycle to the matter by conveying a way to combat it, with careful selection of material that shows how educated discussion is key to a switch in the representation of mental health that can work against the tropes analysed in the previous papers.

Word Count: 3,048

References

Anderson, M. (2003). ‘One flew over the psychiatric unit’: Mental illness and the media. Journal of Psychiatric and Mental Health Nursing , 10, 297–306)

Beachman “The Psychopathy of Cinema: How Mental Illness and Psychotherapy are Portrayed in Cinema”,, Grand Valley State University, ScholarWorks@GVSU, 2010

Corrigan and Kleinlein, The impact of mental illness stigma. In: Corrigan PW (ed) On the Stigma of Mental Illness: Practical Strategies for Research and Social Change. Washington, DC: American Psychological Association. 2005

Damjanović, Vuković, Jovanović & Jašović-Gašić ‘PSYCHIATRY AND MOVIES’ Institute of Psychiatry, Clinical Center of Serbia, Serbia, Psychiatria Danubina, 2009; Vol. 21, №2, pp 230–235, © Medicinska naklada — Zagreb, Croatia

de Carlo, K. (2007). Ogres and angels in the madhouse. Mental health nursing identities in film.International Journal of Mental Health Nursing, 16, 338–348.

Enns, M.W., Reiss, J.P., Chan, P. (2010). Electroconvulsive therapy. Canadian Journal of Psychiatry, 55 (6), 1–11

Fuchs’ “Psychopathology of Interpersonal Time” to Lars von Trier’s films Antichrist and Melancholia, vol. 34, 2001, pp. 179–186

Goodwin “The Horror of Stigma: Psychosis and Mental Health Care Environments in Twenty-First-Century Horror FIlms Part 1 and Part 2”, Perspectives in Psychiatric Care, ISSN 0031–5990, 2013

NT Contributor, Nursing Times Innovations, “Using Film Screenings to Raise Public Awareness of Mental Health”, 2018

Hyler, S, Gabard O & Schneider I: Homicidal maniacs and narcissistic parasites: stigmatization of mentally ill persons in the movies. Hospital and Community Psychiatry 1991; 1044–48

Hyler, S. (2003). Stigma continues in Hollywood. Psychiatric Times. Retrieved October 21, 2013, from http://www .psychiatrictimes.com/articles/stigma-continues-hollywood

Shu-Ting KAO, Depression and Desynchronization of Temporal Relation in Lars von Trier’s Antichrist and Melancholia, A Melancholic Exploration of Humanity (The Solitude of Man) pp. 109–122, 2019

Wahl O: Media madness. Public images of mental illness. New Brunsvick, NJ: Rutgers University Press, 1995.

Weeding D & Niemec R: The clinical use of films in psychotherapy. Journal of Clinical Psychology, 59, 2003; 207–15.

Wilson, C., Nairn, R., Coverdale, J., & Panapa, A. (2000). How mental illness is portrayed in children’s television: A prospective study. British Journal of Psychiatry, 176, 440–443

Get the Medium app

A button that says 'Download on the App Store', and if clicked it will lead you to the iOS App store
A button that says 'Get it on, Google Play', and if clicked it will lead you to the Google Play store