Wednesday 18 June 2014

Mental illness on the screen: Mad, Bad & Dangerous?

We've all seen (or read about) the morbidly fascinating fly-on-the-wall / reality shows featuring mentally ill subjects.  And there have been a raft of mentally "deranged" (because invariably they are "deranged") characters in soap operas, drama series and films.  It makes for compelling viewing: seeing how the insane live, battling their demons, bringing madness into our front rooms.

If we are to change societal perceptions of mental illness, it cannot be done solely through better education of health professionals or even better provision of services (although both these things are vital).  No, it needs to be tackled at the heart of our culture: through books, films, media and, yes, popular TV.  Whether you watched Brookside or not, that first lesbian snog was important in the visibility and acceptance of gay people in the UK.  Likewise, people recovering from or living every day with mental illness need to come out of the shadows, tell their stories with pride and passion, and take their place on the cultural agenda.

So I thought it'd be fun (?) to take a look back over the history of mental illness on the screen, to see how far we have come - and what I'd love to see produced in the future.

First up - a selection of films.  Here, it seems that mental illness is a useful narrative device.  Something to square the circle, or fill in a plot hole or drive a character.  It can usefully instill in the audience profound fear and loathing, in a thriller or horror film.  Or provide a laugh or a distraction in a comedy or drama.  Mentally ill characters seem to fall into the following stereotypes:
- the pathetic / tragic heroine
- the tortured obsessive
- the institutionalised patient
- the psycho
- the split personality.
I could be wrong, but it doesn't seem as if this has changed much over the course of sixty years of film-making:

A Streetcar Named Desire (1951)
This Tennessee William's classic sees Vivien Leigh portray a "tormented" Blanche Debois who loses grip on reality through her alcoholism and delusions of grandeur.  Mental illness here is a vehicle for tortured and damaged figures, objects of our pity.

Psycho (1960)
The portrayal of Norman Bates in this iconic thriller is chilling to the core.  Whatever his psychiatric diagnosis (dissociative identity disorder, maybe?), his actions are cruel and disturbing - with a Freudian twist.  Mental illness here is to be feared.

One Flew Over The Cuckoo's Nest (1975)
The controversy in this Jack Nicholson classic is not so much the portrayal of mental illness, but more the portrayal of institutional treatment, and the dreaded Nurse Ratchett.  The film left its audience in no doubt that "asylums" were inhuman, and should be closed down.  The following decades saw the closure of the remaining large psychiatric institutions - but "care in the community" has been no replacement, given the lack of funding and resources allocated to mental health services.

Fatal Attraction (1987)
In this psychological thriller, Glenn Close plays Alex Forrest - a lady obsessed by her adulterous lover.  It is believed the character has some traits of Borderline Personality Disorder, and perhaps an obsessive condition.  Again, the mental illness is to be feared, the sufferer a monster.

American Beauty (1999)
Is Kevin Spacey's Lester a sufferer of depression, or simply going through an inevitable midlife crisis?  Are we all just victims of a hollow suburban existence?  The portrayal of mental illness here is so nuanced it is almost stylistic.

Fight Club (1999) 
Is this the most glamorous (Brad Pitt, anyone?) depiction of schizophrenia in film to date?  Edward Norton's "Everyman" character inhabits two lives, his own somewhat pallid existence and Tyler Durden's violent, sexual, anti-consumerist, anti-establishment rebel.  It makes for a cult film - but perhaps no realism here.

Me, Myself & Irene (2000) - Dissociative Identity Disorder
Always a tricky one, making a comedy out of an illness.  Here Jim Carrey's physical contortions are put to use depicting "advanced delusional schizophrenia with involuntary narcissistic rage".

Requiem For A Dream (2000)
I remember watching this as a teenager, and being profoundly affected by its themes and graphic portrayal both of mental illness, addiction and their treatments.  In particular, the electroconvulsive therapy used to treat the elderly mother's amphetamine-induced psychosis.  Little did I know that ECT would one day be considered as a potential treatment option for me!  This is a dark film, with little comfort.

Little Miss Sunshine (2006)
This film uses comedy brilliantly to bring a human side to mental illness (the uncle in this somewhat unconventional extended family is recovering from a suicide attempt).  

Black Swan (2010)
Natalie Portman plays yet another tortured heroine in the middle of a nervous breakdown: artistic, ethereal, but ultimately mentally ill.

Next up - TV. How has mental illness been portrayed on the small screen?

I'm not a big soap opera viewer, but I believe mental illness has recently been tackled sympathetically in Casualty, on BBC 1.  I'm told that Eastenders provided a realistic portrayal of Bipolar disorder (in character Stacy Slater), but then had the same character go on to commit murder.  This seems to be the programme-maker's temptation: to revert back to Mad, Bad and Dangerous. 

Research commissioned by the Department of Health and reported by Time To Change, on portrayals of mental health in television drama & soaps, found that:
  • * over a 3 month period 74 programmes contained storylines on mental health issues
  • of these there were 33 instances of violence to others and 53 examples of harm to self
  • almost half were sympathetic portrayals, but these often portrayed the characters as tragic victims
  • * the most commonly referred to condition was depression, which was mentioned 19 
  • times, breakdown was mentioned 8 times and bi-polar 7
  • 63% of references to mental health in TV soaps and drama were "pejorative, flippant or unsympathetic"
  • * terms included: "crackpot", "a sad little psycho", "basket case" , "where did you get her from?", "Care in the Community?" and "he was looney tunes"
  • See: 
One of my favourite dramas on TV in recent years has been My Mad Fat Diary, starring the wonderful Sharon Rooney.  It stands out, to me, for tackling self harm, eating disorders, depression and anxiety, and suicidal ideation.  It also shows, in a very touching and tragi-comic way, what it's like to be discharged from psychiatric hospital and to have ongoing group therapy.  Mental illness does not, in any way, define Rae Earl.  In fact, she soon emerges as the 
natural cornerstone of her teenage group of friends.  She has the same issues and experiences as everyone else - but does it all while living with her illness and grieving for her friend who did not recover.

I would love to see more series like MMFD.  Characters like Rae.  Can we see her go on to university?  To enter the world of work?  To start a family?  

Until then, I have to make do with the recent explosion in mental health-related documentaries and reality series.  Since being discharged from hospital myself, I make sure to watch any factual programmes on mental illness. A morbid fascination, if you will! 

Two recent examples stand out:
Bedlam (Channel 4), broadcast 2013, featured various inpatients and wards at the South London and Maudsley hospitals.  It gave me an insight into a wide range of illnesses and symptoms, from intrusive thoughts and extreme anxiety to a brain shutting down for self-preservation (after a traumatic bereavement).
Don't Call Me Crazy (BBC 3) was broadcast earlier this year and featured patients of a teenage psychiatric ward.  Perhaps because they were all so young, I really got the sense that their illnesses could have struck anyone - they were the unlucky ones.  The 1 in 4.

So, other than more series of My Mad Fat Diary, I'd like to see more factual programming on mental illness.  Programmes designed to challenge, rather than perpetuate, the "Mad, Bad and Dangerous" stereotypes.  And I hope that any production team, thinking about making a programme featuring mental illness, would read and follow the Time To Change Media Guidelines, available here: 


  1. Excellent post - we need more factual documentaries and information, not over-dramatisation of mental illness. Thanks for linking up! #PoCoLo

  2. This is such a great post! You've put a lot of effort in to it and it was a really informative read. I too found Rae to be the best depiction of someone I could relate to that I think I have ever seen - I didn't feel embarrassed or like a freak watching her dealing with things I knew all too well, and that isn't a sensation I often get when seeing the "mental" on screen.

    Thank you for this #pocolo

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