Mental health-related stigma in movies: A call for action to the cinema industry

Cinema represents one of the most popular and widespread art forms in modern human history. It is capable of reaching and entertaining people of all ages, backgrounds, cultures, educations, and ethnicities in a well-liked and accessible way (Damjanović et al., 2009).

Whilst cinema can function as pure entertainment, it also holds the power and the responsibility to convey positive and educational messages that are ecological, inclusive, gender equal, anti-racist, anti-discriminatory, and culturally sensitive (Murphy et al., 2015). However, in its function of a faithful description of current society, cinema can often take on, in a more or less unintended way, stigmatizing models, which influence all areas of life, not sparing mental health (Hyler et al., 1991). Therefore, cinema risks reproducing psychiatric disorders in a too grossly and superficial manner, with models of social jeopardy or judging, far from the respect needed for a medical condition, such as mental illness. Mental health has been struggling for decades to free itself from stigmatizing and discriminatory labels and representations (Sartorius, 2007; Thornicroft et al., 2022).

Cinema can play a significant role in advancing or hindering that journey. However, more often than not, cinema has played a negative role in portraying people with mental illness, being usually connotated by negative characteristics, and represented as not reliable or not-empathic (Carter, 2015; Damjanović et al., 2009; Hyler et al., 1991). People with mental health issues are often described as overly dramatic, homicidal maniacs, manipulative, or narcissistic not-empathic individuals, unwilling to seek help in most cases. Importantly, the words used to describe mental disorders are often discriminatory and labeling, and are accompanied by name-calling and stigmatizing behaviors. There are various factors that may play a role in maintaining these practices. These include widespread misinformation regarding psychiatry, the simplicity of reproducing pervasive stereotypes, fear of change and novelty in the cinema industry, and sensationalism.

In this context, 13 early career psychiatrists from 11 countries from different cultures and continents aimed to explore and address the important cultural power of cinema to an academic description that reduces the stigma associated with mental health in all its appearances.

To this end, we have summarized some examples and provided recommendations that could help tackle mental health-related stigma and discrimination in cinema (Table 1).

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Table 1.

Recommendations to fight mental health-related stigma and discrimination in cinema.

To encourage a realistic and empathetic representation of patients suffering from severe psychiatric disorders and the challenges they face in everyday life.

To show a realistic view of treatments, including electroconvulsive treatment, representing an accurate, non-stigmatizing, and optimistic view of mental illnesses and mental health professionals to enhance mental health literacy.

Not to show mental diseases as distant issues, existing only in specific communities or affecting only certain people, but rather they should be acknowledged as a common condition that can exist across societies and with a relevant impact on all communities.

To increase the realistic and concrete description of mental health conditions, patients, hospitals, and mental health providers to favor a normalization process.

To describe psychological, pharmacological, and somatic treatments as medical interventions as they are, with different safety, tolerability, and efficacy profiles, but all based on stringent evidence-based scientific validation processes.

To increase the involvement of associations of mental health professionals and patients in the film industry, especially in the phase of conceptualizing and finalizing a script.

The film industry should aim to bring mental health closer to modern society, ideally playing an educational role, but at least avoiding stigmatization and discrimination.

Examples include showing real mental health hospitals and depicting the wards as safe places where people receive the care and the support they need rather than as frightening asylums with harsh restraints and long periods of isolation. Similarly, taking psychiatric medications should be shown as a positive action with reasonable side effects, and psychiatrists should be portrayed as the active, talented, and empathic physicians that they are. This may require scriptwriters and directors to have sufficient exposure to mental health facilities before conceptualizing and finalizing a script, or the involvement of a multidisciplinary team with ethicists and mental health professionals. Moreover, the script drafting process should involve different stakeholders (e.g., patients’, caregivers’, and mental health professionals’ associations). In addition, general issues such as the role of psychiatrists in society, medical ethics, professionalism, and stigma could also be usefully highlighted for consideration and debate (Akram et al., 2009). Overall, cinema should aim at informing and developing empathy towards mental health.

Echoing the literature (Conrad et al., 2014; Quinn et al., 2011), we agree on the high educational and advocacy potential that cinema can have, a potential that remains largely untapped worldwide. Indeed, movies may serve as therapeutic tools to aid discussion about patients’ fears and misconceptions, and work to amend these issues in a supportive environment. Movies may be used to introduce and inform patients and their families about specific disorders, create therapeutic alliances, help patients reframe issues, give patients role models, offer hope, bring out emotions, help patients prioritize their needs, and facilitate communication.

Despite the great efforts made to reduce the stigma associated with mental illness, many expressions of society, including art, still appear steeped in old stereotypes that weigh on the inclusion of patients suffering from psychiatric illness, their caregivers, and mental care providers. Cinema still presents many clichés and stereotypes that struggle to change and often undermine the efforts made for the social reintegration of patients with severe mental disorders. Cinema has dominated the art industry and thus has a massive effect on the general population. So, we call on cinema to rally alongside mental health professionals to deal with mental health with respect and accuracy, avoiding prejudices and stereotypes that slow down the social inclusion process of patients suffering from mental health disorders.

The present article did not require ethical approval from local institutional ethical committees.