Category Archives: Awareness

Movies and Mental Illness: What Do We Do About Stigma? (Updated 12.11.13)

iStock_000009307982LargeI’m a great fan of films and really grateful to the film industry for the entertainment they’ve produced. I’m grateful for free speech, letting everyone have their say even if we don’t like what it is they’re saying. But there come’s a point when we have to just take a step back and see the bigger picture.

Mental illness is extremely common. Most people will experience mental illness during their lives. Sometimes this might be very brief and might not impact too greatly on their lives. A person might have a mild acute adjustment reaction which resolves and allows them to move on with their life

Other people might have more severe adjustment reactions. They might have a Bipolar illness with recurrent Depression, chronic Schizophrenia which may be treatment resistant or be developing Dementia with a severe course. Even for these illnesses the course varies considerably between people. Some people with mental illness aren’t able to speak up for themselves. They might have difficulties with cognition including language and just won’t be able to understand what is happening or to hold and communicate views about these issues.

Movie stars are iconic figures. Watching movies has a universal appeal. They make us laugh and cry, make our hearts race and can make us feel good when we come out. With all of this that the movie industry has given us, there are times when it isn’t so good. There are (thankfully rare) times when the films can be harmful for people with mental illness. There are times when the films are so influential that other organisations base entire events on a single film. These events in turn can be harmful.

Here are some films that in my opinion are stigmatising for people with a mental illness.

1. One Flew Over the Cuckoo’s Nest (1975). In this film one of the main characters played by Jack Nicholson goes into an inpatient unit. He gets into conflict with Nurse Ratched and after a course of Electroconvulsive Therapy used as a ‘punishment’ he undergoes a lobotomy to control his behaviour. One of the other characters in the film kills him to stop his suffering. To add to this the film won numerous oscars, BAFTA’s and Golden Globe Awards. Despite the passage of nearly 37 years the film has had a profound cultural influence. I wonder how many people have refused ECT or coming into an inpatient unit because of seeing this film.

2. Halloween (1978). A boy is institutionalised and emerges after many years to go on a killing spree. The film spawns a number of sequels and is classically associated with the use of a chainsaw mask. There is a description here of how the film was made. The premise of the film is that the main character is the most evil boy in the world. From this IMDB review, ‘After being institutionalised for 15 years, Myers breaks out on the night before Halloween…..no one knows, nor wants to find out, what will happen on October 31st 1978 besides Myers’ psychiatrist Dr Loomis‘.

3. Psycho (1960). Norman Bates, dead mother kept in the house, shower, knife and a psychiatrist that talks about a split personality. Psycho can be short for psychopathy and psychotic leading in my opinion to one of the most unfortunate associations in film history for people with mental illness.

4. The Crazies (1973) and the remake. Crazy is a pejorative label for mental illness and the premise of these films is that a toxin makes people mentally ill and dangerous. Unaffected people must defend themselves.

5. The Demented (2013). In this film the afflicated afflicted become zombies and are the focus of the title. Those unaffected must defend themselves. There is a lot of stigma about Dementia with a number of excellent campaigns to raise awareness. The last thing that’s needed is a film with a title like this.

6. American Psycho (2000). The title suffers the same problem as Psycho and makes an unfortunate links with axes. A title change would be sufficient to avoid this association.

If you can think of other titles to add, just include them in the comments section (there might be a delay of a few days before they are added).

Why tackle stigma in the movies – isn’t this taking it too far. Student nurse Katie Sutton has written this article about typical responses to an anti-stigma campaign. I’ve included some of the themes below.

Free speech – there is a right to express views or establish events even if these are not popular

Speech involves a balance between the right to express views and to consider the effects this has on others.

This is not meant to be realistic

Regardless of whether is realistic, for those with little knowledge of mental illness and its treatment this may inadvertently form a part of their education (about mental illness and its treatment).

How are people being made aware that this is unrealistic?

The financial support for mental health awareness campaigns is counterbalanced by the revenues generated and by and financial support for potentially stigmatising film portrayals of mental illness which may be unrealistic.

Its Just a Bit of Fun

There are lots of creative ways to do similar things without targetting people with mental illness

Having fun is incredibly important and can be done with planning. Why plan something that can perpetuate stigma which can cause suffering for others. It is an equation – not just looking at people having fun on one side but also people with something to lose on the other side.

Mental illness is very common. Most people are likely to develop mental illness at one point in their life. If films such as these perpetuate stigma then people having short term gains (i.e. fun) would find that stigma contributes to their experience if they later develop a mental illness.

Index: There are indices for the TAWOP site here and here Twitter: You can follow ‘The Amazing World of Psychiatry’ Twitter by clicking on this link. Podcast: You can listen to this post on Odiogo by clicking on this link (there may be a small delay between publishing of the blog article and the availability of the podcast). It is available for a limited period. TAWOP Channel: You can follow the TAWOP Channel on YouTube by clicking on this link. Responses: If you have any comments, you can leave them below or alternatively e-mail justinmarley17@yahoo.co.uk. Disclaimer: The comments made here represent the opinions of the author and do not represent the profession or any body/organisation. The comments made here are not meant as a source of medical advice and those seeking medical advice are advised to consult with their own doctor. The author is not responsible for the contents of any external sites that are linked to in this blog. Conflicts of Interest: For potential conflicts of interest please see the About section.

Campaigns Against Stigma: Update and A Closer Look at Stigma (Updated 12.11.13)

Jack-O-LanternIn a previous post I wrote about the stigmatisation of mental illness as a theme emerging during Halloween. Here are a few updates.

The story began with a campaign directed at supermarkets selling Halloween costumes with a mental illness theme. The supermarkets quickly apologised and withdrew the costumes.

Although unrelated to Halloween, a tabloid newspaper reported on homicide in people with mental illness. The headline perpetuated a stigmatising association between mental illness and homicide which was quickly challenged by mental health campaigners. I’ve written about this previously here and here. The Lancet article distinguishing fact from myth was particularly helpful in challenging the stigma. Subsequently a petition against the headline has reached 83,773 signatures at the time of writing. The newspaper published a ‘clarification and correction’ of the original story. Paul Jenkins CEO of Rethink, Paul Farmer CEO of Mind and Sue Baker director of ‘Time to Change’ met with staff from the newspaper and summarise the hopeful outcome in this article.

Although it was unrelated to Halloween the stigmatising link was soon reinvoked. Advertisements began for a series of Halloween events – ‘insanitorium’, ‘asylum’, ‘psychosis’ and ‘insanity’. Much of the subsequent discussion and campaigning was directed against the ‘asylum’ maze. Student nurse Katie Sutton did an outstanding job of starting up a petition which at the time of writing has 5503 signatures and went onto radio and television to advertise the petition. The Royal College of Psychiatrists joined forces with Rethink, Mind, Time to Change, The Lancet Psychiatry, The Lancet, Professor Graham Thornicroft, Katie Sutton and @sectioned_ to write a sensitive open letter to Thorpe Park. The response is contained within the above link and states that there are people who hold different views that this is not meant to represent reality and that adults have paid to come to the Park.

Katie Sutton has published an article responding to common retorts to the ongoing campaign and its worth restating here. I’ve also added a few other retorts and suggest some additional responses. (I’ve quoted some of the typical responses and paraphrased KS’s responses).

1. Its been going on for 8 years, why respond now?

KS: The campaigners have only just become aware of it

Additional Responses that I would suggest

Why shouldn’t a response take place at this point?

It is only now that social media platforms and surrounding infrastructure (e.g. charities) can support an effective response

2. ‘It’s just a bit of fun to scare people’

KS: Using simulation of mental illness as a form of entertainment is ethically wrong

KS: There would likely be a different response if people with physical illnesses were targetted in this way

Additional responses that I would suggest

There are lots of creative ways to do similar things without targetting people with mental illness

Having fun is incredibly important and can be done with planning. Why plan something that can perpetuate stigma which can cause suffering for others. It is an equation – not just looking at people having fun on one side but also people with something to lose on the other side.

Mental illness is very common. Most people are likely to develop mental illness at one point in their life. If rides such as these perpetuate stigma then people having short term gains (i.e. fun) would find that stigma contributes to their experience if they later develop a mental illness.

3. ‘Why do you want to ruin Halloween for everyone?’

KS: The target is one of the rides, and the aim is to make the world a better, safer place for everyone.

Additional responses that I would suggest

Halloween is not the target here. It is directed at the entertainment delivered by a small group of organisations which in some cases is just one aspect of the entertainment delivered.

If Halloween continues to be celebrated in this way without challenge such events and potential stigma could continue to increase in the future.

4. People don’t really believe that patients with mental illness are dangerous

KS: responds with studies published by or reported on by the National Mental Health Development Unit, Mental Health Cop and @mentallyjaded.

Additional responses that I would suggest

Stigma occurs in direct and indirect ways. Direct ways are easier to measure – they come out with behaviours towards people with mental illness or attitudes (e.g. expressed in surveys). Indirect stigma is more difficult to detect and involves inaction and avoidance where action and contact are needed e.g. services, communication, support. Events of this nature have the potential to influence people in both of these ways.

There is also something I refer to as self-directed stigma in which people who develop mental illness anticipate how others might perceive them. As a result they act differently to how they might if they didn’t hold this self-directed stigma e.g. they may choose not to come into hospital. Again events of this nature have the potential to influence this.

The combination of direct and indirect stigma as well as self-directed stigma can act in concert to result in general and more specific inequalities for people with mental illness. If events such as this contribute to stigma then it may influence such inequalities.

5. There are other similar attractions

KS: There are distinctions between other rides and the one considered

Additional responses that I would suggest

The attractions must be considered individually.

This is even more reason to challenge this. If Halloween continues to be celebrated in this way without challenge, such events and potential stigma could continue to increase in the future.

6. Its not meant to be a realistic experience

Open Letter response: Events such as these are creating culture.

Additional responses that I would suggest

Regardless of whether is realistic, for those with little knowledge of mental illness and its treatment this may inadvertently form a part of their education (about mental illness and its treatment).

How are people being made aware that this is unrealistic?

The financial support for mental health awareness campaigns is counterbalanced by the revenues generated and by and financial support for potentially stigmatising events and media portrayals of mental illness which may be unrealistic.

7. Its based on a horror film not real life

KS: The origin of the theme does not matter and there is artistic license

Additional responses that I would suggest

Let’s take a closer look at the films

8. You haven’t experienced it how can you know its stigmatising?

KS: All that is needed is a misrepresentation of mental illness

Additional responses that I would suggest

There is enough material about the maze available including footage and reviews in addition to the material about the theme to draw conclusions about stigmatisation.

9. The actors aren’t being described as patients

KS: The context is clear

Additional responses that I would suggest

The Asylum is culturally associated with people with mentally mental illness. Where are alternative associations being made in this case?

10. This is political correctness taken to an extreme

KS: The response by the supermarkets suggests that this is not

Additional responses that I would suggest

This is free speech.

Why is there pressure against people pointing out stigmatisation – does this happen with the reverse i.e. that its just a bit of fun

11. There are people with mental illness who do not object to this

KS: There is still a need in society to represent people with mental illness who do object to this.

Additional responses that I would suggest

Society helps people to express their views – although there is not a consensus the scale of response in petitions and other forums suggests that significant numbers of people object to this.

12. There are bigger things to worry about

KS: Stigma works on many levels and affects mentally ill people as well as services delivering care to them.

Additional responses that I would suggest

For people working in mental health or people with mental illness or having friends or family with mental illness these can be very important issues.

As mentally mental illness is very common it has the potential to be important to everyone.

13. Free speech – there is a right to express views or establish events even if these are not popular

Responses that I would suggest

Speech involves a balance between the right to express views and to consider the effects this has on others. The campaigns and petitions here have involved a dialogue. The core aspects of these campaigns/petitions have been conducted in a civilised way which allows others to make up their minds.

Index: There are indices for the TAWOP site here and here Twitter: You can follow ‘The Amazing World of Psychiatry’ Twitter by clicking on this link. Podcast: You can listen to this post on Odiogo by clicking on this link (there may be a small delay between publishing of the blog article and the availability of the podcast). It is available for a limited period. TAWOP Channel: You can follow the TAWOP Channel on YouTube by clicking on this link. Responses: If you have any comments, you can leave them below or alternatively e-mail justinmarley17@yahoo.co.uk. Disclaimer: The comments made here represent the opinions of the author and do not represent the profession or any body/organisation. The comments made here are not meant as a source of medical advice and those seeking medical advice are advised to consult with their own doctor. The author is not responsible for the contents of any external sites that are linked to in this blog. Conflicts of Interest: For potential conflicts of interest please see the About section.

The Royal College of Psychiatrists Writes Open Letter to Challenge Stigma (Updated 25.10.13)

awarenessThe Royal College of Psychiatrists along with journal editors, other charities and blog/twitter mental health campaigner @sectioned_ have joined forces to write an open letter to Thorpe Park about ‘The Asylum’ maze. This is a profound letter which explicitly outlines the reasons why the maze is stigmatising. The letter addresses injustices including those that happened in older Asylums and how this relates to perceptions of the Asylum maze.

Care of the mentally ill in the UK and elsewhere has been transformed for the better and so too have the approaches to challenging stigma.

Index: There are indices for the TAWOP site here and here Twitter: You can follow ‘The Amazing World of Psychiatry’ Twitter by clicking on this link. Podcast: You can listen to this post on Odiogo by clicking on this link (there may be a small delay between publishing of the blog article and the availability of the podcast). It is available for a limited period. TAWOP Channel: You can follow the TAWOP Channel on YouTube by clicking on this link. Responses: If you have any comments, you can leave them below or alternatively e-mail justinmarley17@yahoo.co.uk. Disclaimer: The comments made here represent the opinions of the author and do not represent the profession or any body/organisation. The comments made here are not meant as a source of medical advice and those seeking medical advice are advised to consult with their own doctor. The author is not responsible for the contents of any external sites that are linked to in this blog. Conflicts of Interest: For potential conflicts of interest please see the About section.