Depictions of Mental Illness in Fiction, Part 2

Written By Crystal Shelley

In part one of this post, I reviewed how poor media depictions of mental illness contribute to a cycle of stigma and some of the common ways in which mental illness is depicted poorly in media. In this post, I discuss how treatment for mental illness is stigmatized or shown in harmful tropes, explore ways creators can work toward authentic portrayals, and share what media representations have been praised as being authentic.

A few notes before getting into it:

  • “MI” stands for mental illness. “Fiction” refers to fiction of all types, not just novels. “Creators” refers to content creators like authors and screenwriters.

  • When I talk about accuracy and authenticity, I’m referring to depictions where symptoms are generally in line with the diagnosis and that the representation isn’t reduced to harmful stereotypes or tropes. One depiction cannot capture the experiences of every person who lives with a specific diagnosis and there isn’t necessarily a “right” way to show MI.

Stigma and the treatment of mental illness

Along with the harmful depictions of those who have MI are the problematic ways in which mental health treatment is portrayed. Here are some of the common ones I’ve seen.

  • Implying that MI and/or receiving treatment is a sign of personal weakness or failure. “Cheer up. Just think positive.” “Get over it.” “Try harder.” These phrases are often uttered to those with MI by people who believe that the symptoms are the result of personal weakness or failure. Sheer willpower is all it takes to “snap out of it,” right? This is a harmful narrative that blames those with MI for their disorders. There is also stigma regarding the use of medications and therapy, despite being effective treatments. We don’t blame people with diabetes or high blood pressure for taking meds to regulate their diseases, and we don’t blame people who have just gotten knee surgery for getting physical therapy. But we’re quick to judge those with MI for using medications and therapy (albeit a different kind).

  • Focusing on individual responsibilities rather than societal structures and barriers. This may be more of a commentary on the real world than on portrayals in media, but here it is anyway. When we talk about stigma around those with MI and treatment, we often focus on individual responsibilities. The person with MI has to seek help. The people around them have to support them. Society as a whole has to treat people with MI better instead of fearing them or perpetuating stereotypes. What this does is ignore the societal structures and barriers that are in place for those with MI, and particularly those who are already marginalized in other ways (race, sexual orientation, gender identity, socioeconomic status, etc.). We have to look at access to housing, healthcare (general practice, psychiatric treatment, medications), employment, education, transportation, and countless other systems when we talk about addressing mental health treatment as a whole. The APA has created a presidential task force to address structural racism throughout psychiatry, which is just one step. When depicting the challenges that those with MI have in navigating treatment, it’s important to keep in mind that it’s not just about their willingness to receive help—it’s about society’s willingness to help them.

  • Using love as the ultimate cure for MI. This is a trope that can be harmful and unrealistic. It frames MI as something that can be cured through someone else.

  • Throwing away meds as the ultimate sign of triumph. As said above, medications can be a necessary and therapeutic treatment for MI, yet we often see characters throw away the medicine bottle or flush the pills down the toilet to show that they’re “conquering” their MI. This again frames the use of medication as a personal weakness and that the goal is to not have to use meds anymore. And again, we wouldn’t cheer as someone tossed their insulin or cardiac meds in the trash. Also, for fun, watch “Anti-Depressants Are So Not a Big Deal,” the Emmy-winning song from Crazy Ex-Girlfriend.

  • Depicting all mental health clinicians as the same. Psychiatrists attend med school and can prescribe medications. They often do not provide counseling. Psychologists, licensed clinical social workers, and licensed therapists can diagnose and provide mental health treatment, but they cannot prescribe medications. In fiction, mental health clinicians are frequently lumped together without distinction.

  • Showing a romantic relationship between client and therapist. It’s not uncommon for clients to develop feelings for their therapists, often because of transference. Clinicians are trained to handle these feelings and work through them with the client. When romantic relationships between a client and therapist are depicted in media, it sends the message that this behavior is okay, when in fact, mental health providers are explicitly barred from becoming romantically involved with a client. Here’s a list that ranks fictional TV therapists based on their behavior and treatment of their patients, not necessarily because of romantic relationships but because of boundaries and plausibility.

Doing the work

So, as a creator, what can be done? These are just some ways in which you can work toward more authentic depictions of MI.

  • Research. As is the case for any writer, doing research is essential in creating a more accurate and robust characterization. At a minimum, check to see that the MI you’re describing is actually the one you’re meaning to describe. Time to Change is a UK-based organization whose aim is to reduce stigma around mental illness. They have hundreds of personal stories from people who have various diagnoses and experiences.

  • Talk to people who have experience. If you don’t have personal experience with a particular diagnosis or treatment, talk to those who do. These are highly personal stories, but people are often willing or excited to share their experiences with those who will listen, especially when the goal is to portray their experiences authentically. Another option is to talk with professionals who work closely with individuals who have MI. Hiring a sensitivity reader to critique the authenticity of your work is also a great way to get in-depth feedback on your depictions.

  • Consume media that has been praised for accurate and authentic depictions. I list some examples below. Just because they’re on this list doesn’t mean they’re immune from criticism, but they’ve been brought up as examples that portray certain diagnoses and experiences accurately.

  • Examine the language you use. Ableist language creeps in everywhere, and it’s one of the ways in which those with MI (and disabilities) are stigmatized. Addressing ableist language often involves removing moral judgments to present things more objectively, such as saying “diagnosed with” instead of “suffers from” or saying “died by suicide” instead of “committed suicide.” As always, Conscious Style Guide has curated a wealth of resources, including style guides on how to write about mental illness and articles about various mental health topics.

Recommended media depictions

Here are some media depictions that have been praised for their portrayals of characters who have MI. Many of these come from friends, so I have not personally watched or read all of these. Minor spoilers regarding what they depict.

Books

Shows

Movies

Other

Final thoughts

Accurate depictions of mental illness can play a role in challenging stigma and encouraging conversations about mental health and treatment. By doing the work to show mental illness in a whole, nuanced way, creators can help shape the impressions that readers and viewers have formed. The result can mean shifting the cycle of harmful media portrayals for the better.

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Crystal Shelley

As the owner of Rabbit with a Red Pen, Crystal provides fiction editing and authenticity reading services to authors and publishers. Drawing on her background as a social worker, she unites her love of language and passion for social justice by pushing for writing and representation that’s more dignified, intentional, and just. She is the creator of the Conscious Language Toolkits for Editors and Writers, serves on the board of ACES: The Society for Editing, and is an instructor for the Editorial Freelancers Association. When she's not working with words, she's probably swearing at a video game.

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Depictions of Mental Illness in Fiction, Part 1