The media has considerable power and influence over us. Yet
often the presentation of mental illness through the press,
television, radio and on film can be unbalanced. For example,
selective reporting of a few high profile cases has fuelled
distorted stereotypes of individuals with schizophrenia as being
violent. Hollywood films such as Alfred Hitchcock’s ‘Psycho’ (1960)
have probably added to these misunderstandings by suggesting
schizophrenia means having a ‘split’ or dual personality. However,
it is most unusual for people with psychosis to be dangerous, and
the overwhelming majority of murders are committed by those without
any mental illness.
Another popular media stereotype is the black couch, the means
by which the psychiatrist will ‘read minds’ and single-handedly
uncover a person’s deepest secrets. In reality, patients sit in
chairs whilst describing their problems, and psychiatrists
typically work in multidisciplinary teams alongside nurses, social
workers and other professionals. The focus is often upon
pragmatic solutions, using medication, social approaches and a
range of talking treatments (such as cognitive behavioural, family
and dynamic therapies).
By contrast, evidence-based treatments are often portrayed on
screen in a stigmatising way. The 1975 film ‘One Flew Over the
Cuckoo’s Nest’ -starring Jack Nicolson - painted electroconvulsive
therapy (ECT) as a barbaric and impotent tool for social control.
Surveys have revealed that people who have seen this movie are ‘put
off’ ECT and would actively try to dissuade a family member from
receiving it. Yet modern ECT has been shown to be a safe, effective
treatment for severe, life-threatening depressive illness.
Why does mental health often attract such unbalanced media
coverage? To understand this, it is worth remembering the main
goals of those who work in the media - to attract and sell
(always), to entertain (frequently), and to inform or educate
(sometimes). A headline reporting that ‘GPs provide satisfactory
care for depression’ would be unlikely to grip the public’s
attention. This helps to explain the ‘all or nothing’ approach
behind the commonest types of news story: the cover-up or scandal
(eg ‘Care in the Community Fails Millions’), the human-interest
angle (‘My Battle Against Anorexia’), and the scientific
breakthrough (‘New Wonder Drug for Dementia’).
Yet the media can also be a significant force for the good - by
promoting greater awareness and knowledge of mental disorders.
People now talk about ‘depression’ more openly than they did in the
past. Celebrities who use the media to disclose their own mental
health problems can be particularly helpful in reducing stigma. For
example, the actor Stephen Fry has presented several TV programmes
that explore bipolar (manic depressive) disorder. The 2001 film, A
Beautiful Mind (about Nobel-Prize winning Mathematician John Nash),
showed that people battling schizophrenia could be brilliant. And
TV soap operas can sometimes increase their viewers’ knowledge
about important issues,such as the effects of an impulsive overdose
of paracetamol (delayed but serious liver damage). Even media
stories that wrongly label antidepressants as ‘addictive’ still
remind psychiatrists to tell patients not to stop taking their
antidepressant medication suddenly as this may lead to a
New forms of mass media are constantly adding to the ways in
which people receive information about mental disorders. Examples
include handheld computers, mobile phones and the internet. Modern
technologies allow individuals to access treatments with an
evidence base (e.g. computerised cognitive behaviour therapy) as
well as engaging in less regulated areas such as self-help websites
and cyber chat rooms. Unfortunately, like other media sources, not
all the information that is freely available online is reliable,
impartial or of high quality.
Some psychiatrists have become well known through the media.
Anthony Clare (1942-2007) was a respected TV and radio presenter
who conducted probing interviews of well-known figures on his
programme ‘In the Psychiatrist’s Chair’. By contrast, most doctors
are happy to practice clinically outside the media spotlight.
However, they occasionally come under pressure from reporters and
interviewers to offer opinions. The Public Education Department of
the Royal College of Psychiatrists provides advice and training on
dealing with the media. A sensible approach is to make only one or
two points well (rather than many), and not become tempted to stray
outside one’s area of expertise. It is also important for
psychiatrists to respect the confidentiality of any patient under
their care, and to remember that they are entitled to make no
comment at all.
In the half-century since ‘Psycho’ was made, what progress has
been made in combating unhelpful stereotypes about mental health?
Over the past few years, the Royal College of Psychiatrists has led
a number of public education initiatives to improve public
understanding and tolerance of mental disorders. These have
included the Defeat Depression Campaign (‘depression is common,
recognisable and treatable’) and the Changing Minds (anti-stigma)
Campaign (which produced ‘1 in 4’ - a cinema film reflecting how
mental illness can affect anyone). More recently the College’s Fair
Deal Campaign has sought to promote equality in mental health care.
This includes a fair deal in terms of media coverage. In an age
when we are surrounded by images and soundbites, the presentation
of good psychiatric care (as well as the care itself) is an
For those who are considering a career in psychiatry, now has
never been a better time to influence the public face of mental
health. Consider the number of TV dramas, news stories, magazine
articles and novels dedicated to unravelling people’s minds.
Psychiatrists are doctors who deal with how the mind works. They
can harness that public fascination within their daily practice –
to promote tolerance, understanding and innovation. Add to this the
fact that almost everyone knows someone with a mental health
problem, and the resulting ‘headline’ news is that 21st century
psychiatrists are ideally placed to engage with patients, the
public and the media alike.
Dr Paul Blenkiron
Consultant Psychiatrist, Bootham Park Hospital, York
Public Education Officer, Northern & Yorkshire Division, Royal
College of Psychiatrists
Back to student area home page