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Mental Health Representation in Movies and TV Shows

Representation matters. The conversation about mental health has changed a lot over the last couple of decades, yet Hollywood is often hopelessly behind the times. These are the best—and worst—portrayals of mental illness on screen.
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According to the American Psychiatric Association, more than half of people who are struggling with their mental health won’t get help. A major reason for that is the fear of being treated differently by their family, friends, workplaces, and communities. Stigma against mental illness is slowly changing as people have begun talking more openly about their mental health. When movies and TV shows rely on the same old damaging stereotypes, that negative representation reinforces the worst stigma about mental illness.

Hollywood can—and sometimes does—do better. But mental health representation in movies and TV shows has a long way to go.

Note to Our Readers: This article discusses sensitive topics about mental illness and self-harm. If you’re struggling and need help, consider calling SAMHSA’s National Helpline (1-800-662-4357).

Dissociative Identity Disorder

Hollywood Mental Health Representation Grade: F

Psycho (1960)
Paramount Pictures

Dissociative identity disorder is a rare and complicated mental illness. It used to be called multiple personality disorder, and Hollywood screenwriters seem to absolutely love it.

Norman Bates in Psycho is one of the most famous examples. The mentally ill Bates is driven to murder beautiful young women… while dressed as his own (dead) mother. His famous shout of “Mother! Oh God, Mother!” as well as his disturbing cosplay reveal that he believes it’s Mrs. Bates who is actually the murderer. Near the end of the film, Dr. Richman explains that “Norman Bates no longer exists. He only half-existed to begin with. And now, the other half has taken over. Probably for all time.”

So many movies and TV shows have used this trope that it’d be impossible to list them all here. M. Night Shyamalan’s Split (2016) featured a compelling performance by James McAvoy as a burgeoning supervillain with 24 distinct personalities. Identity (2003) starring John Cusack used a similar plot device as ten strangers in an isolated hotel are murdered, one by one, until it is revealed—spoiler alert—that they were all the personalities of one man.

James McAvoy in 'Split'
Universal Pictures

Stories about women with dissociative identity disorders tend to be a little more sympathetic, such as The Three Faces of Eve (1957) and Sybil (1976). While The Three Faces of Eve still depict the mentally ill main character, played by Joanne Woodward, as violent and unstable, it at least offers her a somewhat happy ending when she’s cured with the help of her doctors. In Sybil, Sally Field’s character is accurately shown as being a bigger danger to herself than to anyone else. That movie also ends with her psychiatrists digging into her childhood trauma to cure her. Both films are loosely based on true stories.

Psychiatrists believe that people with dissociative identity disorder develop one or more additional personalities as a coping mechanism during childhood. These people often suffered horrific abuse or trauma, and they are far more likely to be the victims of violence than the perpetrators of it. After Split was released, Dr. Garrett Marie Deckel told CNN that the movie was “going to upset and potentially exacerbate symptoms in thousands of people who are already suffering.”  

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Schizophrenia

Hollywood Mental Health Representation Grade: D+

First, let’s clear one thing up. Schizophrenia is not the same thing as dissociative identity disorder. A person with schizophrenia does not have multiple personalities, but they often experience delusions and hallucinations, as well as unpredictable and sometimes self-destructive behavior. While studies have shown that people with this illness are more likely than the general population to commit violent crimes, some psychiatrists believe that has more to do with comorbid substance abuse than the disorder itself.

On the small screen, Criminal Minds featured a dozen villains with schizophrenia. However, main character Spencer Reid’s mother, Diana (played by Jane Lynch) also suffers from schizophrenia and is institutionalized. Reid cares deeply about his mother, but he also fears becoming like her. It’s a mostly sensitive portrayal, but it also touches on another Hollywood trope of the schizophrenic genius.

In both Shine (1996) and A Beautiful Mind (2001), the main characters are brilliant men whose mental illnesses turn their lives into Oscar bait. Geoffrey Rush’s troubled pianist in Shine, whose talent is overshadowed by his life-long mental illness, is shown as a tragic but sympathetic character. In A Beautiful Mind, Nobel Laureate mathematician John Nash (played by Russell Crowe) is trapped in a web of paranoid delusions that are at first presented as reality in the film. Once we learn that the international conspiracy was nothing more than a hallucination, the movie focuses on Nash’s struggle to accept treatment and manage his illness.

As with the more sympathetic and accurate depictions of dissociative identity disorder, both Shine and A Beautiful Mind were based on true stories.

Obsessive-Compulsive Disorder

Hollywood Mental Health Representation Grade: C-

Obsessive-compulsive disorder (OCD) is one of the most common mental health issues in the world. It affects roughly one in every 50 people—although that number might be higher due to people with undiagnosed OCD that do not seek treatment. It is characterized by a pattern of intrusive thoughts that result in compulsive behaviors such as hand washing, counting, or tapping.

Friends Season 1, Ep 9 The One Where Underdog Gets Away
Warner Bros. Television | NBC | Bright/Kauffman/Crane Productions

OCD almost always equals “neat freak” in movies and TV. Monica Geller from Friends is a prime example. She obsessively cleans her apartment—something that her friends and family find exasperating but funny. The audience is supposed to find it funny, too, given the laugh track that accompanies scenes where she cleans and organizes her home. She’s never diagnosed on the show, and her obsessive rituals are presented as being cute and quirky rather than symptoms of a mental illness.

Monk stars Tony Shalhoub as a brilliant detective whose OCD manifests as an extreme fear of germs and a need for highly ritualized routines. While his illness is often played for laughs, it does get a few things right. Shalhoub’s portrayal is often nuanced, especially when he expresses his frustration with the illness that dominates his life.

For better representation of OCD, we’ll need to head over to another comedy: Scrubs. The character Kevin Casey (played by Michael J. Fox) is a surgeon whose OCD is nearly debilitating. He’s shown washing his hands for hours after the stress of his new job makes his illness harder to manage. Fox is such a talented actor that he makes the scene into a meaningful dramatic moment instead of a cheap laugh.

Dr. Casey is legitimately tormented by his illness. OCD is not just being a bit tidier than your friends, and Hollywood needs to do better in representing this common mental illness.

Bipolar Disorder

Hollywood Mental Health Representation Grade: C

Like OCD, Bipolar disorder is both common and misunderstood. About 2.6% of the US population lives with this illness. In this mental illness, a person will experience periods of depression and mania. An increasing number of celebrities have made their bipolar diagnoses public, which has helped reduce stigma. Those celebrities include Carrie Fisher, Linda Hamilton, Catherine Zeta-Jones, Demi Lovato, and Mariah Carey.

Jennifer Lawrence and Bradley Cooper standing side by side and preparing to dance
The Weinstein Company/Mirage Enterprises

The award-winning movie Silver Linings Playbook (2012)stars Bradley Cooper as Pat, a man with bipolar disorder who has recently been released from a mental health facility. He falls in love with Tiffany (Jennifer Lawrence), a mentally ill widow. They are both self-destructive, and many people have praised the movie for its portrayal of manic episodes. On the other hand, the movie also shows Pat refusing to take his medication and implies that the characters’ love for each other saved them.

As with most depictions of bipolar disorder, Silver Linings Playbook shows Pat’s manic episodes rather than his depressive ones. This can make it more difficult for people with this disorder to feel like their illness is being represented onscreen. That being said, if anyone watches Silver Linings Playbook and feels seen by the film in return, then that’s worthwhile. Other movies and TV shows that do at least a halfway decent job with bipolar representation include Homeland, Euphoria, Degrassi: The Next Generation,

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Depression

Hollywood Mental Health Representation Grade: B-

Moves and TV shows often feature depressed characters who believe that their medication is the real problem, not their mental illness. This has to stop. For many people suffering from depression, medication (along with therapy) is a life-saving treatment. Framing mental health meds as something that robs people of their personalities or prevents them from experiencing joy isn’t just inaccurate. It’s irresponsible.

With that rant out of the way, let’s look at the best and worst depictions of this incredibly common mental illness.

Garden State shows a depressed man (Zach Braff) falling in love with a “manic pixie dream girl” (Natalie Portman). Thanks to her zany attitude, he’s able to find a new lease on life and decide to go off his meds. If nothing else, suddenly stopping medication can lead to withdrawal and increased side effects. Not great. Let’s see if we can find something better.

Still image from '13 Reasons Why'
Netflix

13 Reasons Why (2017) received an avalanche of critical praise after it premiered, but mental health advocates were concerned that it glamorized suicide. It also treated Hannah Baker’s trauma and death as something that happened to the main character, Clay Jensen, and treated her suicide as a puzzle to be solved. Researchers found that following the release of the series, Google searches about suicide—including how to commit it—spiked by up to 44%.

Going back to It’s a Wonderful Life (1946), depression and suicide are seen as the result of a traumatic event rather than a mental illness. If, like George Bailey, we could just see how wonderful our lives actually are, then we wouldn’t feel depressed anymore.

Diane in 'BoJack Horseman'
Netflix

Weirdly enough, we have to look to cartoons to find some of the best representations of depression. BoJack Horseman shows the long-term impact of relying on substance abuse instead of actual treatment for mental illness. While the title character pretty much constantly spirals deeper into depression and self-destructive behavior throughout the show, a few of the people in his orbit manage to do a better job of caring for themselves. The character of Diane Nguyen (voiced by Alison Brie) eventually realizes that her relationship with BoJack is toxic for both of them, and—with the help of a loving partner—seeks medical treatment. Her journey isn’t easy, and she’s not magically cured by love, success, or even feelings of happiness.

The Pixar movie Inside Out does an outstanding job of showing what depression is like. We spend the movie inside eleven-year-old Riley’s head—literally—with her emotions Joy, Fear, Anger, Disgust, and Sadness. What’s remarkable in this movie is that both Joy and Sadness go AWOL from Riley’s head, leaving Anger, Fear, and Disgust behind to run things.

Bing Bong from Inside Out
Walt Disney Pictures | Pixar Animation Studios

Depression is often depicted as overwhelming sadness, but it’s more accurate to describe it as numbness or detachment. That’s one of the reasons why trying to be happy all the time—and especially being told to “just cheer up”—is unhelpful for a person dealing with depression. Not only is Inside Out a wonderful way to help kids understand their own complex emotions, but it’s one of the best and most accurate representations of mental health in all of Hollywood.