Critical Report Research Notes

Critical Report Research Notes

Parts written in dull blue are quotations, sourced at the beginning of each article section.

0. Case study notes

Access in the file below.

Case-studies

0. Previous Research

(Representation of Mental Health in Commercial Entertainment Video Games in the context of Stereotypes, Stigma and Gamification.)
  1. (2013). The European Mental Health Action Plan. Çeşme Izmir: World Health Organization, pp. 6-7 
  2. Alexander, L. and Link, B., (2003). ‘The impact of contact on stigmatisation attitudes toward people with mental illness’. Journal of Mental Health 12(3), 271-289. DOI: 10.1080/0963823031000118267  
  3. Angermeyer, M. and Matschinger, H., (1996). ‘The effect of violent attacks by schizophrenic persons on the attitude of the public towards the mentally ill’. Social Science & Medicine, 43(12), pp.1721-1728, DOI: 10.1016/S0277-9536(96)00065-2 
  4. Chung, A. H. and Slater, M. D., (2013). ‘Reducing Stigma and Out-Group Distinctions Through Perspective-Taking in Narratives’. Journal of Communication, 63(5), pp. 894-911, DOI: 10.1111/jcom.12050 
  5. Clement, S., Schauman, O., Graham, T., Maggioni, F., Evans-Lacko, S., Bezborodovs, N., Morgan, C., Rüsch, N., Brown, J. and Thornicroft, G., (2014). ‘What is the impact of mental health-related stigma on help-seeking? A systematic review of quantitative and qualitative studies’. Psychological Medicine, 45(1), pp.11-27. DOI: 10.1017/S0033291714000129. 
  6. Corrigan, P. W., (2000). ‘Mental Health Stigma as Social Attribution: Implications for Research Methods and Attitude Change’. Clinical Psychology: Science and Practice, 7(1), pp.48-67. DOI: 10.1093/clipsy.7.1.48 
  7. Corrigan, P. W., Morris, S. B., Michaels, P. J., Rafacz, J. D., Rüsch, N., (2012) ‘Challenging the public stigma of mental illness: a meta-analysis of outcome studies’. Psychiatric Services, 63(10), pp.963-973. DOI: 10.1176/appi.ps.201100529. PMID: 23032675. 
  8. Couture, S. and Penn, D., (2003). ‘Interpersonal contact and the stigma of mental illness: a review of the literature’. Journal of Mental Health 12(3), pp. 291-305. DOI: 10.1080/09638231000118276 
  9. Ensslin, A. and Goorimoorthee, T., (2018). ‘Transmediating Bildung: Video Games as Life Formation Narratives’, Games and Culture, 15(4), pp. 372-393. DOI: 10.1177/1555412018796948 
  10. Green, M. C. and Brock, T. C., (2000). ‘The role of transportation in the persuasiveness of public narratives’. Journal of Personality and Social Psychology, 79(5), pp.701-721. DOI: 10.1037//0022-3514.79.5.701 
  11. Green, M. C., Brock, T. C. and Kaufman, G. F. (2004). ‘Understanding media enjoyment: the role of transportation into narrative worlds’. Communication Theory 14, 311-327. DOI: 10.1111/j.1468-2885.2004.tb00317.x 
  12. Hickson, T., 2020. On Writing: Mental Illness In Video Games – A Video Essay. [online] Youtube.com. Available at: <https://www.youtube.com/watch?v=SQCb7GiNOrE> [Accessed 10 January 2021]. 
  13. Hyler, S. E., Gabbard, G. O., Schneider, I., (1991) ‘Homicidal maniacs and narcissisfic parasites: stigmatization of mentally ill persons in the movies’. Psychiatr Serv.  42(10), pp. 1044-1048, DOI: 10.1176/ps.42.10.1044
  14. Igartua, J. -J., (2010). ‘Identification with characters and narrative persuasion through fictional feature films’. Communications, 35(4), 347-373, DOI: 10.1515/COMM.2010.019 
  15. Maier, J. A., Gentile, D. A., Vogel, D. L. and Kaplan, S. A., (2014), ‘Media influences on self-stigma of seeking psychological services: The importance of media portrayals and person perception’, Psychology of Popular Media Culture, 3(4), 239-256, DOI: 10.1037/a0034504 
  16. Moyer-Gusé, E., (2008). ‘Toward a Theory of Entertainment Persuasion: Explaining the Persuasive Effects of Entertainment-Education Messages’. Communication Theory, 18(3), pp.407-425. DOI: 10.1111/j.1468-2885.2008.00328.x 
  17. Ritterfeld, U. and Jin, S., (2006). ‘Addressing Media Stigma for People Experiencing Mental Illness Using an Entertainment-Education Strategy’. Journal of Health Psychology, 11(2), pp.247-267. DOI: 10.1177/1359105306061185 
  18. Rubenking, B. and Bracken, C. C., (2015). ‘The Dueling Influences on Stigma toward Mental Illness: Effects of Interpersonal Familiarity and Stigmatizing Mediated Portrayals of Mental Illness on Attitudes’. Studies in Media and Communication, 3(2). DOI: 10.11114/smc.v3i2.1130 
  19. Singorielli, N., (1989), ‘The stigma of mental illness on television’, Journal of Broadcasting and Electronic Media, 33(3), 325-331 DOI: 10.1080/08838158909364085 
  20. Slater, M. D. and Cohen, J., (2017) ‘Identification, TEBOTS, and vicarious wisdom of experience: narrative and the self’. in The Routledge handbook of media use and well-being. (eds) Reinecke, L., and Oliver, M. B., New York, NY: Routledge.  
  21. Slater, M. D. and Rouner, D., (2002). ‘Entertainment-Education and Elaboration Likelihood: Understanding the Processing of Narrative Persuasion’. Communication Theory, 12(2), pp.173-191. DOI: 10.1111/j.1468-2885.2002.tb00265.x 
  22. Stout, P. A., Villegas, J. and Jennings, N. A., (2004), ‘Images of mental illness in the media: Identifying gaps in the research’, Schizophrenia Bulletin, 30, 543-561 DOI: 10.1093/oxfordjournals.schbul.a007099 
  23. Wahl, O. and Yonatan Lefkowits, J., (1989). ‘Impact of a television film on attitudes toward mental illness’. American Journal of Community Psychology, 17(4), pp.521-528, DOI: 10.1007/BF00931176 

1. Mental Illness Representation in Media

How cinema stigmatises mental illness

Arwa Haider, 28th August 2018

– bbc.com/culture/article/20180828-how-cinema-stigmatises-mental-illness

This article discusses the sensational vs sensitive approaches both in large and small budget movies. It mentions and explains the ‘shaky vision’ and ‘insensitivity’ of the industry towards the mental health portrayals. The media nowadays often treat mental illness as a shortcut to creating sensationalised villains and horror settings/ environments. All those elements are still heavily based and ‘fixated’ on old iconic movie scenes that come from a period much different to ours and are simply outdated and spread stigma and wrong stereotypes painting the audiences view of the issue in colours darker than in reality.

Stereotypical depictions

For decades, movies, especially horror and slasher movies, seemed to favour the approach of a cheep way of creating villains by simply making them display mental illness characteristics – Psycho’s Norman Bates, ‘…Halloween’s Michael Myers, Friday the 13th’s Jason Voorhees, A Nightmare on Elm Street’s Freddy Krueger – ‘crazy’ is personified as evil, and often masked or disfigured to ramp up the shock effect…’ (A. Haider, 2018).

“Films such as Psycho (1960) perpetuate the continuing confusion about the relationship between schizophrenia and dissociative identity disorder (formerly multiple personality disorder); Friday the 13th (1980) and A Nightmare On Elm Street (1984) both perpetuate the misconception that people who leave psychiatric hospitals are violent and dangerous; movies such as The Exorcist (1973) suggest to the public that mental illness is the equivalent of possession by the devil; and movies such as One Flew Over the Cuckoo’s Nest (1975) make the case that psychiatric hospitals are simply prisons in which there is little or no regard for patient rights or welfare. These films in part account for the continuing stigma of mental illness.” (D. Wedding, et., all. Movies and Mental Illness: Using Films to Understand Psychopathology, 2009)

Paranormal factors

Portrayals of paranormal factors rendering a character mentally ill, unstable and aggressive are very common and perpetuate a unhealthy and untrue stereotypes as well as spread stigma convincing the audience that all mental illness is connected to aggressive psychosis and that it always ‘…results in extreme, and scary behaviours, as in The Shining’ (A. Haider, 2018)

Article ‘Culture and Hallucinations: Overview and Future Directions’ (Frank Laroi, Tanya Marie Luhrmann and Angela Woods, 2014) disputes that “culture does indeed have a significant impact on the experience, understanding and labelling of hallucinations and… there may be important theoretical and clinical consequences of that observation.”

Madman & Madwoman

‘While ‘madmen’ might be depicted as monsters or anti-heroes (take Bruce Willis and Brad Pitt’s sci-fi asylum meeting in 1995’s 12 Monkeys,  Mel Gibson’s Mad Max or Leonardo DiCaprio’s hallucinations in 2010’s Shutter Island), or heroically misunderstood (The Madness of King George, 1994), cinema poses different problems for its ‘madwomen’. ‘Hysteria’ was archaically regarded as a female affliction. Female ‘madness’, and irrational behaviour, has frequently been hyper-sexualised onscreen – whether it’s impulsive, destructive Beatrice Dalle in the French erotic drama Betty Blue (1986), or the slickly stylised psychosis of Darren Aronofsky’s Black Swan (2010) or Nicholas Winding Refn’s Neon Demon (2016).’ (A. Haider, 2018)

Portrayals of Mental Illness in Film and the Impact on Viewers, Individuals with Mental Illness, and Mental Health Treatment

https://amattleresearch.digitalscholar.rochester.edu/portrayals-of-mental-illness-in-film-and-the-impact-on-viewers-individuals-with-mental-illness-and-mental-health-treatment/

Studies show that…. percent of people considers media their main source of information about many subjects (source), and that their understanding of those subjects can be flawed or inaccurate (source). In terms of mental illness representation, in which case the fight is happening out of sight in most cases, media is the only source of information for most that are not affected or treated for mental illness (source), hence a single inaccurate portrayal will cause many to have misunderstood the issue at hand and henceforth treat it accordingly to the portrayal they had seen, leading to stereotyping and spread of stigma (many sources).  

Hyler et. al., (1991) revised classification of the types of mentally ill characters portrayal in media as; ‘aggressive and dangerous homicidal maniac, the eccentric and rebellious free spirit, the enlightened members of society capable of creating a utopia, the nymphomaniac and powerfully seductive female, the overprivileged narcissist, and the dehumanized crazy person’ (check if it is a quote). Additionally two more types are relatively common, the irrational and confused simpleton character often used in comic ways, and the failure or victim who is unresponsive to treatment, unskilled, and unable to contribute to society (Pirkis et al.).

Those depictions add to the overall stigma by depicting mentally ill as needy, feeble and simple-minded for the sole purpose of entertainment and introduction of humorous element into the narrative, trivialising the disorder it ridicules. (Smith et al).

Furthermore many horror movies use asylums as an easy way of creating the atmosphere and the eerie environment accompanying the dark narrative, which perpetrates the popular belief that nowadays procedures, medical opinions and treatments are more similar to the conditions in the middle ages than to nowadays standards. Many movies (One Flew Over the Cuckoo’s Nest 1975, Silence of the Lambs 1991, and Nightmare on Elm Street 3: Dream Warriors 1987) still convey the stereotypes formed in the past (which might have been justifiable before), depicting asylums as prisons, with terrible conditions and scarce actual medical knowledge substituted by extensive experiments without anaesthetic or the patients consent combined with very poor treatment of the patients and dark characters as doctors. This leads to a decrease of a treatment seeking behaviour in mentally ill individuals as the discussed approaches introduce fear and mistrust towards mental health professionals and institutions. In the 2001 study Gabbard concluded that for 400 mental health doctor portrayals that he reviewed, only 3 were sympathetic ones, and even in those cases, the positive portrayal is often overshadowed by inaccurate and unrealistic descriptions of the treatment and the very common, almost instant recovery and lack of medical ethics considerations. Correct in every way portrayals are very rare, as they are not as cinematographically interesting (Pirkis et al.).

“By authentically depicting the nuanced and complex way that mental health conditions intersect individuals’ lives, [film] can introduce audiences to new ways of thinking, ways to ask for help, and ultimately create necessary shifts in our cultural beliefs about mental health” (Smith et al.)

Perciful and Meyer (…) suggest a large percentage of the general audience forming their views based on those previously discussed misleading and misinforming portrayals.

Why We Need Responsible Representation in the Film Industry

Candice Alaska, DEC. 16, 2020

– https://www.nami.org/Blogs/NAMI-Blog/December-2020/Why-We-Need-Responsible-Representation-in-the-Film-Industry

Inaccurate representations of mental illness create barriers to reducing stigma, forcing mental health advocates to work overtime to undo these damaging stereotypes. We need the entertainment industry to start accepting responsibility for the role they have in the mental health movement.

Showing People With Mental Illness As Violent

Many portrayals not only exaggerate a disorder, they commonly also misrepresent it by portraying it with symptoms taken from a completely different illness. This shows how little the people creating those representations actually know and how much they invested in research. ‘In the comedy, “Me, Myself and Irene,” Jim Carrey’s character is supposed to represent a man with schizophrenia, but it is actually a representation of dissociative identity disorder (DID). Not only does it contribute to the common misconception that schizophrenia means having multiple personalities, it portrays one of those personalities as violent, promoting one of the most common stigmas associated with schizophrenia.’ (C. Alaska, 2020). Here again, we have the violence associated with the mental health portrayals in media, the movie ‘Split’, portrays the character as violent, unstable and uncontrollable, further increasing stigma around the dissociative identity disorder. Mental Health Today published in an article that: “After some friends and family of those with DID watched the film, there have been stories and desperate pleas from a person diagnosed being isolated from friends, thrown out of home by family, losing their job at work, and even having their children reported to social services with nothing more than the previously nice neighbours watching this so-called ‘just a film.’”

Mental disorders are often used to ‘add spice’ to the story, but also, often, they are added just for the sake of it, without any connection to the narrative, and so in the Netflix series “Locke and Key” ‘the character’s diagnosis is not mentioned anywhere else in the series and does not add to the character or plot in any meaningful way except to explain his violent tendencies’ (C. Alaska, 2020)

Using “Psychotic” As An Insult

‘Of course, this isn’t the only time that “psychotic” is used as a casual insult in films. In the movie “Suicide Squad,” a crew of dangerous criminals is scathingly referred to as “psychotic, anti-social freaks.” In “Batman Vs. Superman,” Lois Lane tells villain Lex Luthor, “you’re psychotic,” after he reveals his plan to murder Superman. And in “The Dark Knight Rises,” Batman says to of one of the Joker’s accomplices, “He’s a paranoid schizophrenic…What could you expect to learn from someone like him?”’ (C. Alaska, 2020)

Accurate Representation of Mental Illness in Film

Mia Ersher, 2021?

– https://www.latitudementalhealth.com/mental-health-in-the-media/accurate-representations-of-mental-health-in-film

‘The first example I want to discuss is that of a movie which depicts major depressive disorder in a way that many movies have not been brave enough to show prior. The movie The Skeleton Twins (2014), starring Bill Hader and Kristen Wiig, shows the life of two adult twins, who are both struggling with depression. The film, rather than try to simplify depression, displays these characters as complex, and uses their dynamic with each other and the people around them to show a tragic, uncomfortable, and honest depiction of mental illness. I feel that this movie allows for interesting, complex conversation surrounding major depressive disorder, and shows it in a way in which the audience, even if not suffering from depression themselves, can relate to the characters and their dynamics, in some way or another. This kind of portrayal, even if quite painful to watch at times, only allows for more openness about mental illness. It allows for people to be kinder to themselves, and to recognize that these things can happen to people, and they are fixable.’ (M. Ersher, 2021?)

Why Accurate Depictions of Mental Illness in the Media are Crucial

Mia Ersher, 2021?

– https://www.latitudementalhealth.com/mental-health-in-the-media/why-accurate-depictions-of-mental-health-are-crucial

‘To recap: self stigma is derived from social stigma. When something is stigmatized in a society or culture, at large, those widespread beliefs are internalized by individuals. This is incredibly harmful because, not only does it cause non-mentally ill individuals to feel negatively towards people with mental illnesses, but it causes people with mental illnesses to feel negatively towards themselves. The fear, rejection, and social ridicule that results from negative portrayals of mental illness cause overwhelming shame and self-loathing, which prevents many people from reaching out for help (Stuart, 2006)’ (M. Ersher, 2021?)

Stigma About Mental Illness Portrayed in the Media

Mia Ersher

– https://www.latitudementalhealth.com/mental-health-in-the-media/stigma-about-mental-health-portrayed-in-the-media

‘In regards to stigma due to misinformation in the media, the examples are pretty much endless. One recent example, though, and one that struck up a lot of controversy, is the movie Joker (2019). In this film, the main character becomes violent in response to his failing mental health. The association of violence with mental illness is incredibly harmful because it can erode support for policies that would help those with mental illness – community integration, for example (Scarf et al., 2020). In a recent study comparing reactions to viewing the films Joker versus Terminator, it was concluded that those who watched Joker were more likely to be prejudiced against those with mental illness (Scarf et al., 2020). Besides this social stigma, this kind of representation can also increase self-stigma, which can severely delay help-seeking for those who may otherwise be open to receiving professional care.’ (M. Ersher)

‘In regards to trivialization, anorexia nervosa is often portrayed as less severe than it really is. In depicting it as a choice, or surface-level characterization, the real consequences are often hidden. But, unfortunately, most peoples’ knowledge of mental health is mostly/only based on what they see in the media. Skins is a raunchy show which follows a group of teens in the UK who all have dysfunctional lives and struggle in different ways. Cassie’s character openly suffers from anorexia, but despite the show being a drama, and her character having major life-threatening issues, the show never really explains why she suffers from mental illness. On top of this, her mental illness is used as nothing more, really, than a defining character quirk which makes her entertaining, reckless, and, according to the other characters on the show, “crazy”. ‘ (M. Ersher)

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

okcoolros, Jan 26, 2021?

– https://rosietibbs-co-uk.medium.com/the-representation-and-impact-of-mental-health-in-film-study-paper-review-caf80229b9a4

Representation (distinct cinematic techniques) -> Stereotype -> Stigma -> Alienation

Damjanovic et al (2009) Psychiatry and Movies – cinematic strategies filmmakers use to depict the background of a character (230 pg.), they suggest the existence of a formula for mental illness representation in film base don the emotional response an element or a mechanic creates and the views created in response by the audience. reflect on Weeding and Niemac (2003) study of the use of demeaning language as a root for the continuing stigma on the subject, which is in turn proved by comparison of similarly themed movies divided by a time period – at least a decade (Damjanovic et al table1).

‘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.’ (okcoolros, 2021?)

‘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.’ (okcoolros, 2021?)

‘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].’ (okcoolros, 2021?)

‘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).’ (okcoolros, 2021?)

‘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) ‘ (okcoolros, 2021?)

Domino (1983)

Psychiatry and Movies

Aleksandar Damjanović, Olivera Vuković, Aleksandar A. Jovanović & Miroslava Jašović-Gašić, 2009

Available from: https://www.researchgate.net/publication/26321216_Psychiatry_and_movies [accessed Jan 06 2022].

‘This paper defines and discusses the most frequent thematic stereotypes seen in movies which are perpetuating stigmatization of mentally ill people. They are: free-spirited rebel, maniac on a killing spree, seducer, enlightened member of society, narcissistic parasite, beastly person (stereotype of animal sort). Psychiatry and cinematography are linked inseparably not only because they creatively complement each other, but also as an opportunity of mutual influences blending into didactical categories and professional driving forces, benefiting both the filmmakers’ and the psychiatrists’ professions.’ (Damjanowic et al, 2009)

SOCIAL IMPACTS OF MOVIES

‘Movies such as “Psycho” (1960) supported and reinforced confusion about the relationship between schizophrenia and dissociative identity disorder (multiple personality disorder). “Friday 13” (1979) as well “Nightmare on Elm Street” (1980) are also movies which accentuate myths about persons discharged from the Psychiatric Ward, who exhibit extremely aggressive and brutal behavior. “The Exorcist” (1973) suggested to the audience that mental illness is equivalent to being possessed by the devil. Movies such as “One Flew Above the Cuckoo’s Nest” (1975) promoted and generated anti-psychiatric sentiment, with mental hospitals simplified and reduced to a jail metaphor where patients were deprived of all human rights, almost as if being in prison. These movies feed even more biases and misconceptions about psychiatry and contribute to the stigmatizing of psychiatric patients.’ (Damjanowic et al, 2009)

PRESENTATION OF PSYCHOLOGICAL PHENOMENA IN MOVIES

depicting a sequence of dreams with multiple levels of superimposition

blurred and foggy images.

The director may create a situation where the viewer is not capable of distinguishing what is really happening and what is the subconscious imagination of the characters.

Mental processes, such as thoughts, memories, imagination and feelings are not visible, but film editing language and techniques of the camera, such as slow disappearance/fading of images may suggest these invisible processes.

symbolism


The next symbol, used very often in movies, is the mirror… this usually represents self-reflection, self-revelation, soul searching, figuring out oneself, self-exploration journey, new identity to be born or changed or even narcissistic obsession with oneself….symbolize self-distortion, self-consciousness and a negative perception of self

MISCONCEPTIONS AND STEREOTYPICAL THEMES IN MOVIES

Table 1 still applicable old stereotypes

Otto Wahl – Media Madness 1995 – book

Hyler et al. (1995) – tropes explained with movie examples

The Horror of Stigma: Psychosis and Mental Health Care Environments in Twenty-First-Century Horror Film (Part I)

John Goodwin, 2013

Media and mental health

Kalpana Srivastava, Suprakash Chaudhury,1 P. S. Bhat, and Swaleha Mujawar, 2018

Available from: https://www.industrialpsychiatry.org/text.asp?2018/27/1/1/243325

Srivastava K, Chaudhury S, Bhat P S, Mujawar S. Media and mental health. Ind Psychiatry J 2018;27:1-5

‘Social learning theory suggests that learning is achieved not only through direct experience but also through observation. People acquire knowledge about behaviours as well as social conventions such as rules of conduct from television. Television teaches or reinforces social conventions about how to treat persons with psychiatric disorders. (Bandura A. 1992)’ (Srivastava K. et al, 2018)

The protective media effects are termed the Papageno effect, as opposed to the harmful Werther effect (Niederkrotenthaler T, Stack S, 2017)

Etzersdorfer E, Sonneck G. Preventing suicide by influencing mass-media reporting. The Viennese experience 1980–1996. Arch Suicide Res. 1998;4:67–74. [Google Scholar]

Portrayals of Mental Health in Film

Declan Barnes, Oct 10, 2016

– https://exepose.com/2016/10/10/portrayals-of-mental-health-in-film/

Media and The Portrayal of Mental Illness Disorders

Anonymous, 2020

– https://integrativelifecenter.com/wellness-blog/media-and-the-portrayal-of-mental-illness-disorders/

Use Person-Centered Language: Instead of using a mental illness or disorder as a defining characteristic, shift your language to be person-centered. Instead of referring to a person as an addict or a schizophrenic, use language like “a person living with addiction/schizophrenia”. 

Do not use Derogatory Language such as crazy, insane, deranged, etc. 

If comfortable doing so, initiate a conversation with those around you who continue to use such language. Oftentimes, people don’t realize that stigmatizing language creates a barrier for those who are living with mental illness. This stigmatization of disorders often results in a delay or avoidance of treatment by those who are living with them. 

Discuss Subject Matter: This is particularly important if you have children in your household. When watching questionable material, offer immediate advice, ask questions, and leave some time for healthy reflection of the material. By opening up this channel of communication with your child, or other household members, you can help equip them with the tools – such as empathy and knowledge – to help them navigate material that may otherwise encourage negative stereotypes.

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  25. 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
  26. 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
  27. 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
  28. Weeding D & Niemec R: The clinical use of films in psychotherapy. Journal of Clinical Psychology, 59, 2003; 207–15.
  29. Further Research
  30. Normalizing Mental Illness and Neurodiversity in Entertainment Media: Quieting the Madness’
  31. Corrigan PW, Watson AC (2002). “The paradox of self-stigma and mental illness”. Clinical Psychology: Science and Practice. 9 (9): 35–53. doi:10.1093/clipsy.9.1.35.
  32. Campbell A (2012-10-09). “Media Portrayal of Depression: We’ve Still Got a Long Way to Go”. Huffingtonpost.co.uk. Retrieved 2014-03-04.
  33. Domino, George (1983-08-01). “Impact of the Film, “One Flew over the Cuckoo’s Nest,” on Attitudes towards Mental Illness”. Psychological Reports. 53 (1): 179–182. doi:10.2466/pr0.1983.53.1.179. ISSN 0033-2941.
  34. Wilson C, Nairn R, Coverdale J, Panapa A (May 2000). “How mental illness is portrayed in children’s television. A prospective study”. The British Journal of Psychiatry. 176: 440–3. doi:10.1192/bjp.176.5.440. PMID 10912219.
  35. Carter, Michael C.; Cingel, Drew P.; Lauricella, Alexis R.; Wartella, Ellen (2021-12-01). “13 Reasons Why, Perceived Norms, and Reports of Mental Health-Related Behavior Change among Adolescent and Young Adult Viewers in Four Global Regions”. Communication Research. 48 (8): 1110–1132. doi:10.1177/0093650220930462. ISSN 0093-6502.
  36. Scarf, Damian; Zimmerman, Hannah; Winter, Taylor; Boden, Hannah; Graham, Sarah; Riordan, Benjamin C.; Hunter, John A. (2020-04-24). “Association of Viewing the Films Joker or Terminator: Dark Fate With Prejudice Toward Individuals With Mental Illness”. JAMA Network Open. 3 (4): e203423. doi:10.1001/jamanetworkopen.2020.3423. ISSN 2574-3805. PMC 7182795. PMID 32329769.
  37. Etzersdorfer E, Sonneck G. Preventing suicide by influencing mass-media reporting. The Viennese experience 1980–1996. Arch Suicide Res. 1998;4:67–74. [Google Scholar] 
  38. http://www.inquiriesjournal.com/articles/1474/exaggerations-and-stereotypes-of-schizophrenia-in-contemporary-films
  39. https://www.icanotes.com/2018/04/11/ways-mental-illness-is-commonly-misrepresented-in-the-media/
  40. Hyler, S. (2003, June 1). Stigma continues in Hollywood. Psychiatric Times. Retrieved October 21, 2013, from http://www.psychiatrictimes.com/articles/stigma-continues-hollywood.

2. Horror – Visuals and Mental Illness

The Horror of Stigma: Psychosis and Mental Health Care
Environments in Twenty-First-Century Horror Film (Part I)

John Goodwin, 2013

depictions of mental illness and institutions in media, misrepresentations, associations between two unrelated disorders

Damjanovic´,et al 2009

‘…the look of the film was manipulated, through expressive use of skewed angles and shadow, to create a haunting and threatening environment.’ (Goodwin, 2013a)

‘Films can affect audiences deeply, so much so that the phenomena of cinematic neurosis” have been reported, where the viewer may develop anxiety, dissociation, or even psychosis after viewing a film (Ballon & Leszcz, 2007). Not all responses are as potent; however, the way in which film affects us is irrefutable. This affect is teased by various technical aspects, be it the lighting, sound, or the way in which a scene is shot (Wilson, Nairn, Coverdale, & Panapa, 1999).’ (Goodwin, 2013a)

‘Using the mise-en-scene to create “symbols” helps evoke certain feelings (depending on the genre) (Damjanovic´ et al., 2009). Barker (1996) notes that metaphors/symbols allow for messages to bypass the logical side of the brain and reach its more receptive side. Films can be highly symbolic and so have the ability to affect our emotions and opinions on a subconscious level.’ (Goodwin, 2013a)

‘Dark or chiaroscuro lighting, point of-view (POV) shots, makeup, and other effects all combine to evoke fear, shock, or even revulsion.‘ (Goodwin, 2013a)

‘Filmmakers depend on the audience’s familiarity with rules established by the horror films of the past (Smith, 2001).’ (Goodwin, 2013a)

‘However, the heinous acts committed by killers and monsters prevent us from identifying with them, and allow us to instead identify with the victims of the suffering (Briefel, 2005). In this fashion, our emotional responses become synchronized with the emotional responses of horror cinema’s victims (Carroll, 1987).’ ‘If we, as an audience, synchronize our emotions with these victims, then it stands to reason that we will view these people/places in a negative and frightful context.’ (Goodwin, 2013a)

‘A recent stigma-based survey revealed that a third of people would not be interested in being friends with someone who had mental health difficulties; a fifth believed mental health difficulties are associated with lower intelligence; 62% would not hire someone with a history of mental illness; and 42% believed seeking help to treat mental ill health is a sign of weakness (Breaking News, 2012).’ (Goodwin, 2013a)

reducing help seeking behaviours, historical background

‘In fact, films depend on these views being held by audiences, and use them to capture our attention by exploiting our fears (Morrison, 2009).’ (Goodwin, 2013a)

Remake – ‘This confirms that the media is not fully progressing with regard to its presentation of mental health issues, merely presenting it in a more modern form.’ (Goodwin, 2013a)

‘…in the Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition, Text Revision (Carroll, 1999). Authenticity is often compromised in cinema for the sake of a good story and to sustain the audience’s emotional investment.’ (Goodwin, 2013a)

the gaze theory (Mulvey, 1975? Visual Pleasure and Narrative Conema), Manlove (2007)

‘Various horror films encourage our identification with the protagonist/s (possibly later victim/s) but a familiar convention in the horror film is a POV shot from the killer’s perspective (Cherry, 2009).’ (Goodwin, 2013a)

‘…the killer’s POV may be so shocking that the viewer is forced out of any feeling of identification with them from the initial POV shot…’ (Goodwin, 2013a)

‘Blocking of the gaze is another convention frequently used in horror films in order to hide things from the audience/spectator, only to reveal them for the purpose of a scary moment.’ (Goodwin, 2013a)

‘POV shots from the killer’s perspective often make use of shaky/handheld camera work, or use objects in the foreground to frame them, suggesting they are concealing themselves (Cherry, 2009).’ (Goodwin, 2013a)

Movie and Further research suggestions

‘This is achieved through the use of symbols and metaphors that access our subconscious, and through artistic manipulation of the mise-en-scene.’ (Goodwin, 2013a)

‘The mise-en-scene often forces us to identify with the victims of these “otherly” psychotic murderers, producing an “us and them” effect.’ (Goodwin, 2013a)

‘Inaccuracies related to certain conditions are also presented as “truths” in horror films, which are then held as “facts.”’ (Goodwin, 2013a)

‘The mise-en-scene encourages these images; familiar horror tropes (i.e., chiaroscuro lighting) evoke responses from audiences such as fear, shock, and revulsion, encouraging a view of a place which is not used for treatment, but for violence.’ (Goodwin, 2013a)

The Horror of Stigma: Psychosis and Mental Health Care
Environments in Twenty-First-Century Horror Film (Part II)

John Goodwin, 2013

‘FINDINGS: Homicidal maniacs are the most common stereotypes. Misinformation is often communicated. Familiar horror tropes are used to stigmatize MHCEs’ (Goodwin, 2013a)

‘A very common symbol used in film is that of the mirror (Damjanovic´ et al., 2009) or even glass, and this is often used as a symbol to show the audience that a character’s mental state has become fragile.’ (Goodwin, 2013a)

‘…the importance of glass/mirror used to imply fragmentation or fragility.’ ‘About 66.67% feature glass/mirrors used to imply fragmentation or fragility;…'(Goodwin, 2013a)

‘Lighting is an element of the mise-en-scene often used in horror films to provoke a fearful response (Cherry, 2009), and a recurring image within these films is flickering lights.’ (Goodwin, 2013a)

Statistics on stereotypical portrayal base don Hyler’s tropes

‘…Flickering lights appear in 57.77% of the 45 films…’ ‘…About 53.33% of the 45 films feature environments that are either haunted or deal with supernatural elements, adding to their nightmarish view…’ ‘…40% of the films feature seclusion/locked rooms;…’ ‘…ECT and psychosurgery feature in 28.88% and 24.44% of the 45 films, respectively…’ (Goodwin, 2013a)

‘The essence of cinema is editing. It’s the combination of what can be extraordinary images of people during emotional moments, or images in a general sense, put together in a kind of alchemy.

— Francis Ford Coppola

Visual analysis

2. Bibliography

  1. The Horror of Stigma: Psychosis and Mental Health Care Environments in Twenty-First-Century Horror Film (Part I) & (Part II) John Goodwin, 2013
  2. Damjanovic´, A., Vukovic´, O., Jovanovic´, A., & Jašovic´-Gašic´, M. (2009). Psychiatry and movies. Psychiatria Danubina, 21(2), 230–235.
  3. Corrigan, P.W., Roe, D., & Tsang, H.W. H. (2011). Challenging the stigma of mental illness: Lessons for therapists and advocates. West Sussex, UK: John Wiley & Sons, Ltd.
  4. Corrigan, P.W., & Watson, A. C. (2007). How children stigmatize people with mental illness. International Journal of Social Psychiatry, 53, 526–546. doi:10.1177/0020764007078359
  5. Hyler, S. E. (1988). DSM-III at the cinema: Madness in the movies. Comprehensive Psychiatry, 29, 195–206.
  6. Hyler, S. E., Gabbard, G. O., & Schneider, I. (1991). Homicidal maniacs and narcissistic parasites: Stigmatization of mentally ill persons in the movies. Hospital and Community Psychiatry, 42(10), 1044–1048.

2. Further Reading

  1. Aja, A. (2008). Mirrors [Motion picture]. USA/Romania/ Germany: Regency Enterprises, New Regency Pictures, Luna Pictures, ASAF, Castel Film Romania.
  2. Anderson, B. (2001). Session 9 [Motion picture]. USA: USA Films, Scout Productions, October Films.
  3. Byrne, P. (2000). Stigma of mental illness and ways of diminishing it. Advances in Psychiatric Treatment, 6, 65–72
  4. Carroll, N. (1987). The nature of horror. Journal of Aesthetics and Art Criticism, 46(1), 51–59.
  5. Carroll, N. (1999). Horror and humour. Journal of Aesthetics and Art Criticism, 57(2), 145–160.
  6. Cherry, B. (2009). Horror. Oxon, UK: Routledge.
  7. Deane, F. P. (2004). Psychologists’ use of motion pictures in clinical practice. Professional Psychology: Research and Practice, 35(5), 535–541.
  8. 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. doi:10.1111/j.1447-0349.2007.00488.x
  9. Fearing, F. (1947). Psychology and the films. Hollywood Quarterly, 1, 118–121.
  10. Pirkis, J.,Warwick Blood, R., Francis, C., & McCallum, K. (2006). On-screen portrayals of mental illness: Extent, nature, and impacts. Journal of Health Communication, 11, 523–541.
  11. Gabbard, G. (2001). Psychotherapy in Hollywood cinema. Australasian Psychiatry, 9(4), 365–369.
  12. Gabbard, G. O., & Gabbard, K. (1999). Psychiatry and the cinema. Washington, DC: American Psychiatric Press, Inc.
  13. Gharaibeh, N. M. (2005). The psychiatrist’s image in commercially available American movies. Acta Psychiatrica Scandinavia, 111, 316–319.
  14. https://www.filminquiry.com/beginners-guide-psychological-horror/
  15. McAllister, M. (2008). Looking below the surface: Developing critical literacy skills to reduce the stigma of mental disorders. Journal of Nursing Education, 47(9), 426–430.
  16. Sampietro, H. M. (2010). Mental illness and violence in the media. An illicit association? Quaderns de Psicología, 12(1), 109–120.
  17. Schneider, I. (1977). Images of the mind: Psychiatry in commercial film. American Journal of Psychiatry, 134, 613–619.
  18. Schneider, I. (1987). The theory and practice of movie psychiatry. American Journal of Psychiatry, 144(8), 996–1002. In Pirkis, J., Warwick Blood, R., Francis, C., & McCallum, K. (2006). On-screen portrayals of mental illness: Extent, nature, and impacts. Journal of Health Communication, 11, 523–541.
  19. Trott-Paden, B. J. (2002). A study of the portrayal of mental health professionals in films from 1991 through 2000. Carlos Albizu University. In Pirkis, J.,Warwick Blood, R., Francis, C., & McCallum, K. (2006). On-screen portrayals of mental illness: Extent, nature, and impacts. Journal of Health Communication, 11, 523–541
  20. Wahl, O. F. (1999). Mental health consumers’ experience of stigma. Schizophrenia Bulletin, 25(3), 467–478.
  21. Wahl, O., Wood, A., Zaveri, P., Drapalski, A., & Mann, B. (2003). Mental illness depiction in children’s films. Journal of Community Psychology, 31(6), 553–560.
  22. Wayne, M. (2005). Spectres and capitalism/spectacle and the horror film. In G. King (Ed.), The spectacle of the reel: From Hollywood to reality TV and beyond (pp. 201–212). Bristol, UK: Intellect Books.
  23. Wedding, D., Boyd, M. A., & Niemiec, R. M. (2005). Movies and mental illness: Using films to understand psychopathology (2nd ed.). Ashland, OH: Hogrefe and Huber.
  24. Wedding, D., Boyd, M. A., & Niemiec, R. M. (2010). Movies and mental illness: Using films to understand psychopathology (3rd ed.). Ashland, OH: Hogrefe and Huber.
  25. Wedding, D., & Niemiec, R. M. (2003). The clinical use of films in psychotherapy. Journal of Clinical Psychology, 59(2), 207–215.
  26. Wee, V. (2011). Visual aesthetics and ways of seeing: Comparing Ringu and The Ring. Cinema Journal, 50(2), 41–60.
  27. Ballon, B., & Leszcz, M. (2007). Horror films: Tales to master terror or shapers of trauma? American Journal of Psychotherapy, 61(2), 211–230.
  28. Barker, P. (1996). Psychotherapeutic metaphors: A guide to theory and practice. Philadelphia: Brunner/Mazel.
  29. Baun, K. (2009). Stigma matters: The media’s impact on public perceptions of mental illness. Ottawa Life Magazine, February, 31–33.
  30. Bordwell, D., & Thompson, K. (2003). Film art: An introduction (7th ed.). New York: McGraw-Hill.
  31. Carroll, N. (1987). The nature of horror. Journal of Aesthetics and Art Criticism, 46(1), 51–59.
  32. Carroll, N. (1999). Horror and humour. Journal of Aesthetics and Art Criticism, 57(2), 145–160.
  33. Cherry, B. (2009). Horror. Oxon, UK: Routledge.
  34. Domino, G. (1983). Impact of the film, One Flew Over the Cuckoo’s Nest, on attitudes towards mental illness. Psychological Reports, 53, 179–182.
  35. Hyler, S. (2003). Stigma continues in Hollywood. Psychiatric Times. Retrieved October 21, 2013, from http://www .psychiatrictimes.com/articles/stigma-continues-hollywood
  36. Hyler, S. E., Gabbard, G. O., & Schneider, I. (1991). Homicidal maniacs and narcissistic parasites: Stigmatization of mentally ill persons in the movies. Hospital and Community Psychiatry, 42(10), 1044–1048
  37. Manlove, C. T. (2007). Visual “drive” and cinematic narrative: Reading gaze theory in Lacan, Hitchcock, and Mulvey. Cinema Journal, 46(3), 83–108.
  38. Newman, K. (2011). Nightmare movies: Horror on screen since the 1960s (2nd ed.). London: Bloomsbury Publishing Plc.
  39. Philo, G. (1994). Media representations of mental health/illness: Audience reception study. Glasgow: Glasgow University Media Group.
  40. Wilson, C., Nairn, R., Coverdale, J., & Panapa, A. (1999). Psychiatry and the media. Mental illness depictions in prime-time drama: Identifying the discursive resources. Australian and New Zealand Journal of Psychiatry, 33, 232–239.
  41. Philo, G. (1996). The media and public belief. In G. Philo (Ed.), Media and mental distress (pp. 82–104). New York: Addison Wesley Longman.
  42. Philo, G., Henderson, L., & McLaughlin, G. (1993). Mass media representations of mental health/illness. Glasgow: Glasgow University Media Group.
  43. Poseck, B.V. (2006). Insanity and cinema: Keys to understand a complicated affair. Journal of Medicine and Movies, 2, 80–88.
  44. Wahl, O. F. (1992). Mass media images of mental illness: A review of the literature. Journal of Community Psychology, 20, 599–605.
  45. Wahl, O. F. (1999). Mental health consumers’ experience of stigma. Schizophrenia Bulletin, 25(3), 467–478.
  46. Wahl, O. F., & Lefkowits, J. Y. (1989). Impact of a television film on attitudes toward mental illness. American Journal of Community Psychology, 17(4), 521–528.
  47. Wahl, O. F., & Roth, R. (1982). Television images of mental illness: Results of a metropolitan Washington media watch. Journal of Broadcasting, 26, 599–605
  48. Walter, G., McDonald, A., Rey, J. M., & Rosen, A. (2002). Medical student knowledge and attitudes regarding ECT prior to and after viewing ECT scenes from movies. Journal of ECT, 18(1), 43–46.
  49. Wedding, D., Boyd, M. A., & Niemiec, R. M. (2010). Movies and mental illness: Using films to understand psychopathology (3rd ed.). Ashland, OH: Hogrefe and Huber.

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