Portraying Mental Illness in Story

Mental illness as a term gets thrown around a lot. It’s used by politicians as a scapegoat for problems or a target for funding. It’s sought by individuals to find meaning to their experience, or sometimes a justification for their difficulties. It’s a thing, talked about like any other disease. And yet the term is a lumping of many conditions under a single term, as if all mental illnesses are the same. They are not, but we talk about them that way and “let the experts sort it out.” I get that. At the same time it maintains the mystique and stigma behind mental illness. Because that is what the average person fears – the unknown. By keeping it labeled as one thing, whether that be to ostracize, excuse, or empathize, without educating the public more, we continue to leave it as a large unknown. So the stigma continues.

Media portrayals of mental illness usually fall into one of three categories:

1. Spectacle

2. Educational

3. As a relatable factor to human struggle and suffering

"Crazy" blonde girl.

The first reason clearly stands out as the most popular use of mental illness in the media. I can’t count the number of characters nowadays in movies and TV who are given mental illnesses primarily for the purpose of making them “different” or interesting. This misses the boat though, particularly when added to secondary characters or even worse, villains. The spectacle of the mentally ill involves the “crazy person,” usually meaning dangerous or unpredictable, which can be used for plot turns or as an explanation for the odd character. “He’s just nuts, man.” No one is “just nuts.” We miss the truth when we oversimplify.

Of course spectacle is the purpose of much of film and television. It’s entertainment. It serves its purpose in our lives. Using mental illness to have the “crazy guy” in a group of friends just becomes cliché, though. It isn’t that entertaining, anymore. And in the world of political correctness, it’s offensive.

Any good writer will not hold back from offending now and then, sometime more than that, all for the purpose of telling a good story. I don’t hold back, and others shouldn’t if it truly enhances the story. Adding in a mental illness just to add a character quirk can lessen the story, though. If the intention is to make the person more interesting, but is done only as a spectacle, where it doesn’t serve the larger story, then it hurts rather than helps.

I’m watching “The Bridge” right now, an FX TV show where one of the leads, Sonya Cross, appears to have Aspergers. In examining the story, it isn’t clear at first what the purpose is to the story of her having Aspergers. It isn’t a story about Aspergers. It does contrast well with the “normal guy” of her partner, detective Ruiz, who fits a different cliché of a cop. That may enhance the story as it makes her behavior and his more noticeable (by contrast), but there has not yet been revealed how her having these particular characteristics, with difficulty in social engagement, makes the serial killer stories more powerful. It may raise some obstacles against her pursuing the killer(s) as efficiently as possible, but that more extends the story rather than enhancing it.

Robert Mckee talks about this a bit in his book Story, when he describes the difference between characterization and character. Characterization are the demographics of an individual – their height, weight, job, clothing, background. That isn’t their character, and for the most part that isn’t what makes a story good. Whether it’s an accountant or a lawyer lying to the district attorney doesn’t matter as much as we might think. Character is revealed through the choices people make, with decisions under pressure revealing their deeper nature. Mental illness as a characterization doesn’t enhance a story. If it is left as that, as window dressing, then it’s a missed opportunity.

educational blocks

The second reason, that of educational, isn’t particularly useful in stories, either. I view it as the antithesis of spectacle. In fact, it’s usually boring. Royal Pains did some groundbreaking work from a health advocacy role by portraying a depressed person, and having that person receive ECT. It was shown realistically, with the usual anesthesia and care involved. Much of the episode centered around the stigma and one character fighting to keep the other from receiving ECT. When the ECT session was finally performed, all that was spoken was – “gee, you’re right, it really is a great thing.” It felt boring and didactic. While I appreciate the writers choosing not to further the cliché and inaccurate stereotype of ECT (e.g. Cuckoo’s Nest), it didn’t work as well as it could have as it wasn’t delivered in a way that enhanced the story. It became a story about stigma, which isn’t what the show is really about. Educational approaches require an investment from the viewer, and always risks losing them if it feels like just conveying information, similar to exposition in story. Exposition slows down a story. Education slows the story, and risks losing the audience. Even documentaries have a story structure to them to keep the audience invested.

Educational portrayals follow the rationale that “if we can increase awareness, that will solve the problem.” I disagree. Creating understanding and empathy is more important, and that comes not through the conveying of information, but through feeling a personal connection to another person, even if fictional. It is here that the true benefits of portraying mental health in media lies.

ideas

The third reason is as a relatable factor to human struggle and suffering. Mental illness is not a foreign entity. It is not like cancer, or something that “someone else” gets. Well, sometimes it is. In reality it’s usually a more extreme version of issues everyone struggles with. This is the avenue not only to make a character likable to the audience, but to make the path of that character relatable relevant to the path of the audience. Many people struggle with depression at some point in the life. Even more have lesser bouts of depression that they muddle through. Telling a story about someone with a worse depression could help the viewer, while also just being a compelling story. While psychotic disorders don’t seem relatable, more people than you’d imagine have an episode in their life where they feel like they’re “losing their mind.” These conditions are interesting because they are the extremes of human experience. The keyword is human. Understanding how to take what has been traditionally spectacle, and reveal the authentic human side of it that is relevant to everyone not only makes for good story, but indirectly helps with the stigma. Just as Orange is the New Black didn’t take the approach of a political campaign saying “women are marginalized in media.” Instead they told good stories about women, that made them empathetic and broke the mold on prior clichés.

So I encourage my fellow writers (as I remind myself) to think beyond cliché, spectacle, and even educating when it comes to portraying mental illness in story. Let mental illness be a window into humans, and let that enhance the story as a whole. Otherwise, the portrayal isn’t serving anyone.

Portraying Mental Illness in Story
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Paul Puri

Dr. Puri is a board certified psychiatrist, in private practice in Los Angeles. He practices multiple forms of psychotherapy, including hypnosis, in addition to managing medications. He attended medical school at University of Rochester, and specialty training at University of California, San Diego. He is currently on the Vol Clinical Faculty at UCLA. In his non-clinical time he writes TV pilots, and designs iPhone apps.