Abstract
A recent study of New Zealand attitudes to mental illness found, as in other populations [1, [2]] that a clear majority named the media as a significant source of information about mental illness [3]. Of those who claimed media were their main source of information, people who relied on ‘entertainment’ media differed from people who relied on factual media in that they felt better informed and thought that the source was more accurate. These data, like those obtained from Scottish informants [1, [4]], suggest that viewers find characterisations of mental illness within television dramas more compelling than information from factual sources. Reported depictions of mental illness in television dramas are predominantly negative [5, [6], [7], [8]], consistently linking mental disorders with violence, failure and unpredictability. In this paper, we argue that those who are committed to reducing the stigma of mental illness need to recognise both how such depictions are fabricated and why viewers can experience them as more compelling than news or other factual media products.
First, television producers want their programs viewed and believe that this requires them to be entertaining and not to ‘preach’ [9]. To this end, they draw on discursive and technical resources that, they believe, will attract and hold viewers [9] by creating characters and events with which viewers can engage [4]. In this fabrication, what a character says and does contributes to the way they are understood, and this understanding is shaped by the way they are filmed. The meanings attached to appearance, actions and responses of other characters to the appearance and behaviour can be rendered more extreme or moderated through shot selection, setting, sound, lighting, and other technical aspects of the production [10].
In published research, the contribution of appearance and setting to depictions of mental illness has been described rather unsystematically [11, [12]]. We have found no published references to examinations of the contribution of sound in signifying that mental illness, or a character suffering from a mental disorder, is dangerous despite the evaluation [10, p.187] that sound contributes, ‘as much, and possibly more, than image does’ to conveying meaning particularly at the emotional level. Similarly, we could find no published reports that examine the use of lighting and other techniques in constructing and confirming a link between mental illness and dangerousness in prime-time drama.
Second, our argument requires that efforts to reduce the stigma of mental illness must attend to the signification of meaning at least as much as to issues of accuracy. Research on media depictions of mental illnesses has emphasised the inaccuracy of the depictions [6, [7], [13], [14]] while expressing concern that the predominance of unpredictability and dangerousness constitute mental illness as a threat. Mental illness, like other entities, is given meaning through signs that signify its nature, specifying how we should respond to it [15, [16]]. Signs provide interpretive orientations, linking each instance to the entity-in-general and simultaneously affecting how the entity-in-general is understood by association. When a newsreader says that a person with a mental disorder was a ‘time-bomb’, those actions are signified as destructive and potentially avertable. The cue operates by linking the unpredictable bomb to commonsense understandings of mental illness [17, [18]], while concurrently confirming the commonsense association between mental illness and serious crime [13, [14]].
Television production values emphasise pace, or the impression of pace [19], which means that characters must be introduced (signified) to viewers with little pause. This may be achieved through signifiers such as appearance, setting or sound, relying on the widespread availability of commonsense systems of signs (heuristics) [8] or stereotypes [9]. The efficacy of commonsense systems of signs in drama is heightened by the quasi-documentary, ‘fly on-the-wall’ filming [10] where verisimilitude is created by filming on location or in elaborately detailed sets. This fabrication is enhanced by using a single, often hand-held, camera in ways that mimic the conventions of documentary form so we experience ourselves as unnoticed observers of the characters' lives and world [19].
While viewers may be able to identify some of the signifiers used in television drama they typically fail to recognise their reliance on such signified ‘information’ in a subsequent discussion [4] because people have a limited ability to identify the source of what they know [20] and, as discussed below, the production encourages them to adopt everyday approaches to understanding the characters and events. With other researchers [9, [12], [17], [21]], we argue that it is essential to understand this chain of signification so it can be disrupted and the stigma of mental illness reduced.
Definition of technical terms
We have outlined our argument that the perceived need to capture viewers by providing effective entertainment underpins the use of production techniques that co-opt everyday ways of ‘knowing’, creating fictitious people and situations that are often emotionally compelling, whereas ‘objective’ p r esentations are abstracted from the systems of signifiers in everyday life that producers of television dramas instantiate in their products. Apart from this contrast between embodied and abstracted depictions, media studies [26, [27], [28]] and many viewers recognise that both factual and fictitious media products are constructions. Whether producing news, documentary, soap or drama the content is shaped by the production values and constrained by time and the use of technical resources, even ‘hard’ news or documentary, provide mediated versions of reality.
It follows from our argument that mental health professionals seeking to reduce the stigma of mental illness must develop an understanding of the range of technical and discursive resources enabling depictions of mental illness in prime-time dramas. In another article in this issue [8], we argue that discourse analysis [29, [30]], informed by knowledge of media practices, is the most appropriate procedure to provide such an analysis. This will enable us to both identify the discursive and filmic resources that producers use and obtain an indication of the resources that producers believe their target audience is likely to deploy. This paper does not claim to complete the task but to provide an introduction to and overview of the way in which diverse technical, semiotic and discursive resources were utilised in signifying the dangerousness of a character with mental illness in a single episode of a prime-time drama series.
Method
During 1995–1996, we assembled a sample of 14 prime-time (7–10.30 pm) television dramas with a mental illness storyline from New Zealand free-to-air channels (TV1, TV2 or TV3). A more detailed account of the sample and collection have been provided [8]. All programs were subjected to multiple viewings and detailed analysis of the means by which characters with mental illnesses were created. Of the 10 themes deployed in the construction of characters with a mental illness within the sample, the most common was dangerousness–aggressive [8].
For case study of dangerousness, we wanted a program that was a local product in which dangerousness was central to the storyline without portraying extreme violence. There were four local programs in our sample. In the ‘Blue Heelers’ ‘Friendly Fire’ storyline, the dangerousness was not linked to mental illness. The two ‘Halifax f.p.’ programs, ‘Lies of the Mind’ and ‘Without Consent’ contained some of the most extreme violence in our sample and the former depicted this most graphically. The chosen program, the first episode of ‘Cover Story’, was a local production set in a local context. A ‘dangerous psychiatric patient’ was central to the major storyline of this episode and the dangerousness depicted, as in most items in our sample, was neither extreme nor graphically portrayed.
From systematic, repeated viewings, a synopsis file was created. This included a list of the core, central and relevant minor characters and where the drama was set was created. The psychiatric patient in ‘Cover Story’, Jacqueline Reid, is so classified by her history of hospitalisations, by being under the care of a psychiatrist, and by her need for medication. Her actions and relationships in the storyline were summarised and incorporated into a character profile on which this case study is based. Along with analyses of the deployment of technical resources in important scenes the profile included the available information on her history, medication, diagnosis (labels used and by whom), displayed symptoms, behaviour, and summaries of her social interactions. Transcriptions and detailed descriptions of important scenes within the mental illness storyline were added to the profile.
Intercutting of sequences in the party segment
To convey how this instance of the dangerousness of mental illness is created, three dramatically important segments are referred to in exemplifying the role of the various technical devices and discursive resources. The segments are: (i) the party segment that precedes the opening credits; (ii) the documentary segment, Amanda's program about community care; (iii) the break-in segment where Amanda discovers Jacqueline in her house.
The technical devices (for definitions, see Table 1), that contribute significantly in generating, sustaining and confirming the dangerousness of the psychiatric patient are identified. Each is introduced and briefly illustrated by examples of its deployment in the chosen segments.
Methods
Appearance
Jacqueline, the patient, is introduced to viewers attending a bizarre party for which she wears a costume consisting of a black top and trousers, and a long, flowing, black cape with purple feathers around the neck. Her short black hair is spiky, framing an unnaturally pale face against heavy black eye make-up and dark, blood-red lipstick. At the door, ‘bouncers’ dressed in plate armour, horned head pieces, and masks are silhouetted against the red interior beside the slit-like entrance. Inside, dancers' c o s t u m e s include horns, hats, capes, glasses, wings, shaved heads, animal heads, teeth and fur, and body suits with lights attached. Despite attending the party, Jacqueline (the patient) does not participate but searches for someone with whom she argues when they meet. Aspects of her appearance echo vampires and other horror characters, night-time activity, dark colours, pallor, and the socially detached movement among the living imply a dangerousness that is confirmed with her murderous assault on Amanda at the end of the segment. The producers later confirm this reading through Amanda's explicit use of the vampire conventions in her documentary on community care.
Amanda's role as the normal foil for Jacqueline's (the patient) strangeness is most clearly signalled through appearance. Their physical similarities; height, age, build, and short, dark hair, provide a foundation for the differences between them that mark Jacqueline's strangeness. Amanda dresses with style and flair while Jacqueline appears in a motley array of op-shop garments and appears ill at ease. Amanda's hair is styled and tidy whereas Jacqueline's tends to the dishevelled and spiky [12]. When introduced to the viewer, Amanda is wearing a tailored black trouser suit, white blouse, full-length black coat, earrings, handbag and briefcase: a confident business woman. Despite changes required by the plot, her confident competence shows little change through the episode.
Music and sound effects
In the party scenes, throbbing dance music with a heavy bass beat controls the dancing and the camera cutting. Background laughter and muffled talk can be heard throughout, adding to the noise and sense of confusion. When Jacqueline (the patient) stands for-lornly in the road after leaving the party, sounds of rain and thunder are underscored by an eerie, synthesised melody that increases in volume and tempo as Amanda's car approaches. The collision is accompanied by loud discordant notes to which an irregular drum rhythm and threatening bass are added over the original sustained melody. These sounds sustain and build tension as Jacqueline's depiction moves from merely strange through abnormal to confirmed dangerousness.
The sounds in the party segment (heavy rain and thunder together with aspects of the music) draw upon horror film conventions. In Amanda's documentary, eerie music and sound effects (cymbals, werewolf baying, maniacal laughter) explicitly link the vampire images to the patient, strongly signifying her as dangerous and predatory. Because most television drama is saturated with sounds, their absence focuses viewer attention. In the break-in segment, Amanda's realisation that Jacqueline, her attacker, is in the house is conveyed in total silence, using an expressive close-up (Table 1) of her face.
Sound is also used to link different scenes, as in the documentary segment where the baying werewolf on the screen is echoed by a barking dog as scene shifts to capture Jacqueline's last reactions to the documentary. In segment 1, the unities of time and space for the two women are signalled by sounds common to the two storylines, specifically thunder claps as they leave the office and the party, and thunder and rain as their trajectories converge to the collision.
Language
In Amanda's documentary about community care of those with a mental illness, she talks of the patient as a vampire; ‘nightmare’, ‘blood-drinking’, ‘horror’, and as a beast, ‘creature of fantasy’, ‘fangs’, ‘bite can be chillingly real’, who is released to ‘roam our streets’. This signifies a more predatory dangerousness than references to bombs or accidents would achieve. The phrase ‘roam our streets’ explicitly separates the patient from the community who ‘own’ the streets, an ‘us and them’ that underlies Amanda's documentary and the depiction in this episode. In the party segment, Jacqueline (the patient) is not heard to speak until she is attacking Amanda. Deprived of the meanings typically provided through dialogue, the viewer must interpret images that suggest strangeness, abnormality and a dangerousness that is confirmed by her first words: ‘You're dead. You're not real.’, shouted as she attacks.
Lighting
This includes intensity, colour tone, clarity. Many of the dramatically critical scenes, including the chosen segments, are set at night, or in dark places like the stormwater tunnels. The blue tone of film shot in such circumstances can be enhanced, as in Amanda's documentary, to give the darkness a cold, unfeeling quality. In the party sequence, light contributes to the chaos; the scene is lit by flashing white, red, yellow and blue lights that fragment the scene. The illumination changes continuously, and as smoke blurs details of gyrating body parts, there is little clarity. The only recognisable image is the patient's face as she searches, isolating her strangely within the event. Amanda is first seen in the familiar steady, office illumination that viewers can easily relate to.
Intercutting
In the party segment (no.1), as shown in Table 2, the psychiatric patient (Jacqueline) and Amanda have separate storylines set on a converging course that is signalled by the intercutting (Table 1). Through the segment the sequence durations in each storyline decrease, creating a sense of pace [19] and signalling the inevitability of collision. To the end of sequence 10, Jacqueline (the patient) has been presented as strange and abnormal, a possible source of danger (although viewers cannot readily anticipate the form it might take) and this builds suspense that is explosively released by her attack on Amanda.
Jump-cutting
Jump-cutting (Table 1) is demonstrated in the brief, disconnected shots of coloured flashing lights, spinning silver ball, and fragments of people dancing, in the party sequences. Many of the shots are low-angle, distorting the proportions of dancers, and their shadows further rendering the party bizarre. The cuts occur to the beat of the music, creating a dazzling background against which Jacqueline's (the patient) face is the only recognisable image. Jump-cuts predominate in sequences 1 and 3 (Table 2), creating a world that is distorted, disrupted and unstable.
Point-of-view shots
Point-of-view (POV; Table 1) or subjective shots present the scene as through a character's eyes and may act to enhance empathy with them. In the break-in segment, the destruction in the kitchen is seen from Amanda's POV as the camera pans across open drawers and equipment strewn over the floor. As she moves cautiously into the hall, the camera switches between her POV and shots in which she is observed. The latter are ambiguous; they could be from the intruder's POV, which would mean that she is being observed and might be attacked. By inviting the viewer to connect empathetically with Amanda, the sequence increases the likelihood that the viewer will feel similarly threatened by the intruder, Jacqueline.
Horror conventions
Horror films, as a genre, have a characteristic style of sound, image and thematic content that producers of ‘Cover Story’ draw on in segments 1 and 2. Most obviously, there are the vampire motifs of appearance, language and the attack on Amanda's throat. There is the nighttime setting, weather and sound effects of eerie music, werewolves, and maniacal laughter. These elements coalesce in the low angle shot of Jacqueline (the patient) running from the party (segment 1, sequence 5), her cape flowing against the rain and thunder mimicking many vampire exits. In horror films, the protagonist is a dangerous predator and, by referencing these elements, the producers add an actively threatening quality to her strangeness. The intercutting in segment 1 places Amanda in the role of prey the necessary foil for the predator.
Intertextuality
Intertextuality is the way in which a text draws upon meanings already formulated in existing texts that form part of the viewer's discursive resources [22, [23]] for generating its meanings [31]. For this episode of ‘Cover Story’, the horror conventions are the most visible example of this practice. Depicting Jacqueline (the patient) as alternating between passively unconfident and dangerously aggressive creates references to similar portrayals of mental illness like the mild-mannered Norman Bates of ‘Psycho’(1960), who becomes a knife-wielding maniac [11]. Amanda's normality is similarly fleshed out by viewers resourcing other portrayals of competent, active professional women like ‘Murphy Brown’ or Jane Halifax (‘Halifax f.p.’).
Discussion
We have identified nine production elements deployed in signifying the psychiatric patient, Jacqueline Reid, as dangerous. The analysis describes multiple, mostly consistent signs in various sensory and cognitive domains that generate this instance of the linkage between mental illness and violence. We have argued that viewers must engage with these systems of signs if they are to make sense of the story, although we have only been able to sketch how the role of Jacqueline's dangerousness is integrated into the plot. While describing the devices separately for ease of understanding, we have sought to emphasise that it is the perceptually seamless interplay among them that is critical in generating the dramatically effective presentation of mental illness.
The contribution of appearance and language to the signification of mental illness as dangerous is unsurprising. Wahl [12] comments on these signifiers in a rather unsystematic manner and Philo [4] refers to both devices in his discussion of viewers' responses to a ‘Coronation Street’ storyline based on erotomania. The use of horror conventions in this program provides a clear example of intertextuality. It has been argued [30, [31]] that intertextuality is central to our ability to respond to sign systems but researchers analysing depictions of mental illness have only hinted its importance, for example Wahl's ‘mad murderer’ stereotype [12, [4]]. While the contribution and interplay of the other devices might be obvious to a producer, they are presented here in some detail as an introduction, for mental health professionals, to the processes of signifying emotional meanings.
This storyline is built on the polarities of normal–strange, normal–abnormal and normal–dangerous. Amanda, the successful journalist and core cast member, functions as the normal protagonist. Jacqueline, the psychiatric patient, unproductive, lacking any visible social connections, currently being treated for her mental disorder in the community, enacts the other poles. As described, editing techniques place their actions in close conjunction emphasising different aspects of the contrasts between them. Throughout the episode, this ‘compare and contrast’ amplifies differences between the women, generating dramatic tensions.
The major storyline requires the possibility of violence, here linked explicitly with mental illness, to build and sustain dramatic tension. Jacqueline (the patient) looks unusual, behaves strangely, and attacks without provocation but viewers are given only the generic label of ‘chronic mental illness’. No information about her symptoms is provided, so attention is focused entirely on her actions, which are both explained by and define her disorder. This presentation, emphasising the dangerous and abnormal over more positive actions and qualities displayed by real people with mental disorders, increases fear and distrust fuelling the stigma. A further consequence of depicting the illness in this generic manner is to invite the viewer to generalise from this depiction to other persons with mental illness. Such generalisation of the depiction and its significations is enhanced to the extent that viewers have had to draw on prior understandings of mental illness to engage with the story.
There are significant limitations to our reported findings. First, this article attempts to convey, through words alone, how associations between mental illness and dangerousness are produced in an episode of a particular prime-time drama. The difficulty of capturing the detail present in a single frame, multiplied by the interrelationships created within and across sequences by lighting, music and sound, appearance and setting of characters has meant this report is both very detailed and rather sketchy. In concentrating on the details of the construction of signification, it is easy to overlook the contribution of intertextuality which enhances the power of the visual, auditory and verbal signs as instanced by the use of the vampire image in the episode analysed.
Second, we acknowledge that the balance between the production elements will differ in films or other dramas, as they did across items in our sample of television dramas. Further studies are warranted to provide more complete delineation of the use of these resources in television depictions linking mental illness and dangerousness. These must be complemented by studies of how viewers engage with particular programs, as in Philo [4], to confirm the impact of the effects described. If psychiatrists or other mental health professionals are to contribute effectively to changing these depictions of mental illness, they will need to have an appreciation of the role of such sign systems in the construction of those depictions and how viewers engage with them.
Finally, it is not claimed that the nine production elements we describe are the only production elements used in depicting a person with a mental illness as dangerous but that they are the primary contributors to this depiction. We recognise that other researchers might well highlight other aspects of the episode, but believe that they would not contradict our central findings that, through these devices, viewers are alerted to the character's potential to harm in ways that are systematically linked to her mental illness.
This research is novel and important because it has systematically separated out technical devices deployed by television producers in signifying a character with mental illness as dangerous. In showing how this dangerousness is constructed, the basis of such stereotyped portrayals and their attendant contribution to the existing stigma can be better understood. That these portrayals are negative, exaggerated and do not reflect the reality of most people who suffer a serious mental disorder is a major concern that has drawn various responses from mental health professionals. Those working to reduce the stigma of mental illness need to understand how this threatening blemish is signified in dramatic portrayals if they are to achieve their goal.
Footnotes
Acknowledgements
This study was supported by a summer studentship from the Faculty of Medicine and Health Science, The University of Auckland, to Claire Wilson.