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The Royal College of Psychiatrists Improving the lives of people with mental illness

Psychiatry in the media

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 discontinuation reaction.

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 important challenge.

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

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