The portrayal of psychiatry in popular culture: Harmful or helpful?

‘Does psychiatry have any credibility left at all?’ opens a 2013 Guardian opinion piece by Will Self, portraying psychiatrists as failed doctors, drug peddlers and snake oil salesmen.

The portrayal of psychiatry in popular culture is harmful and has been for decades. It stems from the wide dissemination of reports of early psychiatric practice, including harrowing institutionalisation, and a prominent and well-funded anti-psychiatry movement.

The negative image has been perpetuated through instruments of popular culture – the entertainment media, the news media and word of mouth. Some of the earliest glimpses into the world of psychiatry through fictional accounts have become memes – cultural analogues of genes – that have been accepted as fact and transmitted over time from one generation to another.

An example of this is the motion picture adaption of Ken Kesey’s 1962 novel, One Flew Over the Cuckoo’s Nest, which remains one of the most acclaimed films of all time. The simplistic approach towards mental illness taken in this film, in particular its portrayal of electroconvulsive therapy (ECT), influenced the beliefs of baby boomers who subsequently influenced the beliefs of their children. ECT remains a symbol of ‘all that’s bad’ in psychiatry.

This is supported by the scientific literature. In a review of ECT use in 52 movies, 21 television programmes and two animated programmes up until the present day, ECT is consistently depicted inaccurately. It is incorrectly performed, shown as a memory-erasing, painful and damaging treatment, and is used as a metaphor for repression and control (Sienaert, 2016).

Other memes have their origins in popular media – ideas germinated from myths, misunderstandings or malicious agendas. Some of these common beliefs, produced and perpetuated by popular media, include that people with mental illness are unpredictable and violent, are the product of poor parenting and are treated by incompetent quacks with undisclosed agendas. These themes, along with exaggerated stereotypes of the mentally unwell, can be seen in a number of contemporary films and television dramas.

A content analysis of American television dramas found that characters portrayed as being mentally unwell were up to 10 times more likely to be shown performing acts of violence, having a poor quality of life and having a negative impact on society when compared to those without mental illness (Diefenbach and West, 2007). These sensationalised and distorted accounts of mental illness reinforce the aforementioned pre-existing beliefs.

These fictional television programmes and movies have influenced social media content, with the majority of YouTube clips portraying psychiatry negatively (51%) compared with neutrally (29%) or positively (20%) (Gordon et al., 2015).

There is a brighter situation with non-fiction media. Analysis of Australian non-fiction media, including newspaper, television and radio sources, has found that reporting of mental illness focused less on themes of crime and violence than may have been expected, with the majority of news and current affairs items having a positive ‘recovery focused’ or neutral angle (Henson et al., 2009).

The portrayal of mentally unwell individuals in the news has improved over the past two decades, but what about the portrayal of psychiatrists?

Robust evidence is lacking, but indirect evidence of the general perception of psychiatrists is informative. A 2013 report from the Swinburne National Technology and Society Monitor found that there was a statistically significant difference in the level of public trust in medical specialists and general practitioners (GPs) (3.9 and 3.63 out of 5, respectively) compared with psychologists and psychiatrists (2.93 and 2.84, respectively) (Bruce and Critchley, 2013).

The medical community is not immune to the influence of popular culture. Among medical students, psychiatry is considered one of the less prestigious specialties and is ranked low with respect to future career choice. The negative portrayal of psychiatry in popular culture also affects rates of stigma around mental illness within the profession.

With respect to medication, it is known that media reporting has significant influence on Australians’ use of medication. In October 2013, an episode aired on the ABC science journalism programme Catalyst that was critical of statins. This programme resulted in tens of thousands of Australians ceasing their statin use. In light of this, one can safely hypothesise that the cumulative and continuing negative coverage of psychotropic medication must have at least moderate negative impact on medication adherence.

Such is the seriousness of the harmful portrayal of psychiatry from popular culture that the World Psychiatric Association has felt compelled to publish explicit guidance for psychiatrists and their representative bodies on strategies to combat stigmatisation of psychiatry and psychiatrists.

Alas, there is hope. The narrative is beginning to change. Adolescents tend to have a relatively sophisticated understanding of mental illness, often influenced by prior contact with family and friends who have experienced mental illness. Also, improved appreciation of the commonality of mental illness and increased recognition and acceptance, promoted by events like ‘RUOK? Day’, are leading to a better understanding of people with mental illness and psychiatric illness in general. Additionally, educational content created by non-profit organisations is providing accurate information about psychiatry, and this information may be reducing prejudice.

Individual advocacy by health professionals is key. The first action is to reflect on and address what negative images of psychiatry that health professionals contribute to themselves. Adroit use of the media by psychiatrists can improve the conversation around mental illness and psychiatry, but care must be taken to ensure that psychiatrists do not contribute to the problem through carelessness in their media interactions.

The imbalance in the current portrayal of psychiatry demands that psychiatrists correct the record and explain that art does not always imitate life; the media do not always report accurately; and ‘truthiness’ (Truthiness [noun]: the quality of seeming or being felt to be true [coined by US satirist Stephen Colbert]) is not always truth. Psychiatrists must advocate a balanced view of their specialty, including acknowledgement of its tarred history, and a balanced view of their patients.

The harmful portrayal of psychiatry continues to permeate throughout popular culture. Some of these portrayals still dominate entertainment media and mental illness may remain a scapegoat for unimaginative screenwriters for some years to come. However, Australians and New Zealanders are increasingly aware that black and white depictions of mental illness are false representations of complex psychology. More accurate reporting by news media is helping this recognition.

There appears to be a meandering path towards progress with the portrayal of psychiatry. This progress is the result of collective actions of dedicated individuals, despite active opposition, and will only continue with concerted effort.

Rather than lament the slow rate of progress, psychiatrists may draw inspiration from the words of a past luminary of popular culture. In 1858, the famed Scottish philosopher Thomas Carlyle wrote, ‘our grand business undoubtedly is, not to see what lies dimly at a distance, but to do what lies clearly at hand’.

When popular culture is wrong, it is the profession that must be right.