Psychiatry and the Media

Overview

Mass media are increasingly intertwined with the lives of both adults and children. Whether subtly or overtly, media content (from children's cartoons to television news) affects the public's perceptions of mental illness and mentally ill persons, as well as the expectations patients bring to psychotherapy and other psychiatric treatments, particularly medication management. Media messages can be harmful to health by fanning fears of crime and terrorism, triggering suicide attempts, or modeling violent behavior. But the various forms of mass and targeted media also offer us new and powerful public health, educational, and psychotherapeutic tools.

This chapter addresses several issues: the role of the mass media in stigmatizing mental illness and discouraging help-seeking; the influence of media coverage of suicide; how media (especially television and video games) may affect aggression and violence among youth; the use of “media literacy” principles and new technologies to limit potential harms and increase benefits of media use for children; and how psychiatrists (through planned media campaigns or individual efforts) can use media intelligently to educate the public.

How the Mass Media Affect Public Understanding of Mental Illness

Surveys in the US and elsewhere have found that many people have little understanding of what mental illness looks like (in themselves or in others), what symptoms characterize different illnesses, and what is meant by labels, such as “schizophrenia” and “mania.” Despite some progress in recent years, stigmatizing myths about causality persist. For example, persons with lower levels of education were more likely to blame schizophrenia or depression on a lack of will-power or an immoral lifestyle, and less likely to view medication as an effective treatment. Recent studies across countries suggest that, although public understanding of the biological correlates of mental disorders has increased, this has not increased social acceptance or altered perceptions of dangerousness. However, for affected individuals and their families, having a brain disease may be perceived as less stigmatizing than the “mentally ill” label. Distorted views of the nature and value of psychiatric treatment persist, with some viewing it as more likely to harm than to help.

National surveys (in the US) from 1998 and 2006 show increasing confidence that psychiatric medications can control symptoms, help people cope with stresses, and improve relationships, although a minority of respondents still believed that medications could interfere with everyday activities or harm the body. Despite these positive views, comparatively few respondents were willing to consider taking medication themselves for hypothetical ailments. Roughly half were very or somewhat likely to take prescribed medications for depression, whereas two-thirds might do so for more concrete symptoms (e.g., panic attacks).

The stigma associated with mental illness is a major reason that many sufferers never seek treatment, do not follow treatment recommendations, or drop out of treatment prematurely ( Figure 93-1 ). Children with mental health problems (and their parents) face disdain, blame, and discrimination, in stark contrast to attitudes toward children with “physical” illnesses. Research has shown that inaccurate perceptions by parents and teachers regarding children's mental health problems, and beliefs about treatment (including concerns about stigma that arises from treatment), create major barriers to receiving needed services. Given that over three-quarters of children with mental health needs do not receive treatment, the removal of barriers to care is a critical priority. Furthermore, since the life-time prevalence of psychiatric disorders is about 24%, and over 50% of these conditions begin in childhood, early detection and intervention may well decrease morbidity and mortality.

A number of studies point to mass media content as a major source of stigmatization and misinformation. Among people who have little first-hand experience with mental illness, beliefs about what mentally ill people are like and how they should be treated may be shaped primarily by what is read, seen, or heard in the mass media. Reviews of press coverage across many countries have found that mental illness, particularly schizophrenia, is frequently linked with violence. In one US study on the reporting of mental illness by major newspapers, the focus of 39% of stories was on dangerousness or violence perpetrated by a mentally ill person; such stories also received the most prominent placement. A randomized experiment found that news stories describing a mass shooting by a mentally ill perpetrator increased negative attitudes toward persons with serious mental illness. This increases the desire to avoid persons with mental illnesses.

Another study of US newspapers found that the word “schizophrenic” is commonly used as a metaphor in a way that perpetuates perceptions of that illness as a “split personality” ( Table 93-1 ). Moreover, hostile media reports can increase self-stigma, as well as discrimination, as perceived by people who struggle with mental illness.

Entertainment media can also reinforce harmful images and beliefs. For example, a review of Disney animated films found a surprisingly high number of stigmatizing comments, including “crazy” thoughts, ideas, behaviors, or clothing, with the implication that these traits were irrational and inferior. Children's cartoons often portray “twisted” or “nuts” characters as evil or funny. Even video games feature negative stereotypes. Mental illness is a common theme in movies (including horror films) that are popular with adolescents. These not only present persons with mental illnesses as scary and dangerous but also distort the public's perceptions of mental health professionals and their expectations about the nature and outcome of therapy ( Table 93-2 ). Media portrayals of electroconvulsive therapy (ECT) have been particularly distorted. ECT is routinely portrayed in films as brutal and punishing, and even as a method of torture, with no therapeutic benefit.

How Mass Media Interventions Can Affect Stigma

People who are more familiar with mental illness (e.g., due to personal experience; illness of family, friends, co-workers, or neighbors; or exposure through volunteer or professional work) are less likely to want to distance themselves from people with mental illness, including those with major depression. This also seems to be true after “virtual” exposure to models through educational videos. Drawing on this research, and the research noted previously on the roots of stigma, the goal of many recent educational interventions has been to make the public feel comfortable with mentally ill individuals, and to refute stigmatizing ideas about the causes and treatment of mental illness.

The planning of anti-stigma initiatives has become more sophisticated, with efforts to target key attitudes or behaviors of specific populations. One approach is to reach out through the mass media (using television, radio, films, and the Internet). The World Psychiatric Association's (WPA's) Programme to Reduce Stigma and Discrimination Because of Schizophrenia, begun in 1996, has programs in over 20 countries. The WPA recommends a “social marketing” approach to planning outreach campaigns that includes targeting specific subgroups (e.g., criminal justice personnel), conducting needs assessments to inform the design of media messages, and pre-testing media materials before embarking on expensive campaigns.

The Royal College of Psychiatrists in Great Britain has sponsored several campaigns, including Defeat Depression from 1992 to 1996 and Changing Minds from 1998 to 2003. Pre-post surveys for the latter found encouraging, but small, shifts in attitudes (e.g., regarding perceptions of dangerousness, and whether a mentally ill person “feels different from us” or is to blame for his or her condition); these varied by type of illness. More recently, the comprehensive Time to Change program was linked to significant reductions in levels of discrimination reported by persons using mental health services. Within this program, many prominent figures, including a member of government, came forward with their personal stories about living with mental illness.

Perhaps the most-studied anti-stigma campaign is New Zealand's Like Minds, Like Mine. This research-based campaign includes strategically-placed television, radio, and cinema advertisements (some featuring nationally known and respected people who had experience with mental illness), public relations activities to support the advertising messages (including media interviews and placed articles), and more targeted locally-based education and grassroots activities. National tracking surveys found that awareness of campaign messages was high and that significant changes in attitudes and behavior were evident, as were reports of reduced stigma and discrimination.

It is critical to note that simply teaching facts about mental illness is not sufficient to dispel stigma. A review of studies shows that despite their greater knowledge, psychiatrists and other mental health professionals may hold and perpetuate stigmatizing attitudes toward the seriously mentally ill (e.g., not wanting to live near them, or believing they should not marry or have children). It is also important to monitor anti-stigma efforts for the creation of unintended harmful effects. For example, it was once thought that re-casting mental illnesses as biologically-based “brain diseases” would reduce stigma. Recent research suggests that belief in biogenetic causality can actually increase the desire for social distance from mentally ill persons, especially in the case of schizophrenia. Similarly, comparison of mental illness to chronic illnesses (such as diabetes and allergies), if over-emphasized, could inappropriately discount the effects of mental illness, and create new misperceptions.

Effects of Mass Media on Suicide

A large body of multi-national research demonstrates unequivocally that exposure to media reports of suicide can increase suicide attempts and deaths. Research reviews have found that stories of both fictional and real-life suicides can lead to imitation, but the effect of news stories tends to be greater. Several factors seem to increase the likelihood of imitation; these include stories of celebrities (entertainers or politicians) who commit suicide; extensive, prominent news coverage of the suicide; coverage that glamorizes or sensationalizes the suicide; and detailed descriptions of the suicide method. Imitation is decreased if the negative consequences of suicide (such as disfigurement of the body, a cult-related suicide, or suffering of, and condemnation by, the survivors) are portrayed. Adolescents, and young adults may be par­ticularly prone to imitate suicides that are portrayed in the media, especially when the stories are of victims in their age group.

A 1-year study of over 4,600 newspaper, radio, and television reports related to suicide in Australian media found a larger effect from television stories than either radio or newspapers (contrary to some earlier studies that found newspaper stories more influential). A greater effect was also seen when multiple reports of suicide occurred close together, and when stories addressed completed suicides as opposed to suicide attempts or ideation.

Evidence suggests that changing the content and tone of news coverage of suicide can affect suicide rates. In Vienna, the opening of a new subway system led to an increase in subway suicides that was exacerbated by dramatic media reports. Creation of a suicide prevention media campaign, and guidelines for news reporters, led to a dramatic decrease in attempted and completed subway suicides. New guidelines for media reporting on suicide suggest ways that psychiatrists can help educate the public. When interviewed by reporters, it is important to stress the connection between mental illness (especially depression) and suicide, and to provide information on resources to prevent suicides and to help survivors of suicide. One should avoid weighted language, such as “committed,” “failed,” or “successful” when describing suicide; these words imply criminality or judgment of outcomes, which makes it difficult to put suicide into the content of mental health. It is also important not to associate suicides with simplistic explanations of causation, such as “he was fired from his job or lost his girlfriend, and committed suicide.” One should take care not to be drawn into making comments on a complex clinical situation in which one has not participated. Reports of people who cope positively despite difficult circumstances and suicidal ideation may have a protective effect against suicide.