(Illustration: Dan Evans)
Over 30 years ago, an experiment took place. A group of 146 university students watched One Flew Over the Cuckoo's Nest, in which Jack Nicholson's character ends up in an asylum after faking insanity. "Considerable negative changes in attitude" towards people with mental health problems occurred among those who saw the film.
Considering the majority of the population report that their information about psychotherapy and mental illness comes mostly from what they see on screen, when the media gets mental health wrong it's a concern. There's even evidence to show that people who draw their knowledge from the media are generally more intolerant towards people with mental illnesses, advocating more socially restrictive attitudes and policies, and being less supportive of community treatment.
If you have personal experience with – or decent knowledge of – particular mental illnesses, you'll probably find yourself unable to fully let go and indulge in fiction, instead picking apart performances or plot lines. Plenty of shows do mental health well, such as Netflix's Crazy Ex-Girlfriend with Rebecca Bloom, the tenacious, funny lawyer living with anxiety and mental illness; or Hannah Ashworth from Hollyoaks, whose eating disorder showed the illness as both tedious and dangerous; or the disordered binge eating of C4's My Mad Fat Diary. However, far more have done it badly in the past. Pretty Little Liars, where Hanna got over bulimia "all on her own", the episode of Will and Grace where Grace tries to convince everyone she has Borderline Personality Disorder (bit off), Cassie from Skins and the glamourisation of her eating disorder.
Showing mental health on screen accurately is increasingly seen as something that matters. A 2015 report commissioned by the anti-stigma campaign Time to Change confirmed that TV producers are moving away from dated stereotypes, and last year a significant poll by mental health charity Mind found that a quarter of TV viewers suffering from mental health problems have been prompted to seek help after following mental health storylines. This progress has a lot to do with a select few people – those whose job it is to mitigate against harmful representations on screen.
Senior Media Advisor at Mind, Jenni Regan, watches all the soaps and keeps on top of the TV guide magazines, because they often talk about storylines ahead of time. Part of her job involves watching out for the damaging storylines to prevent them happening again.
"I noticed there were quite a few British dramas last year which had characters with schizophrenia, or something similar, who turned up and killed people," she explains. "In one, a character with schizophrenia was taken into questioning, even though there was no evidence he'd done anything – purely [because] he had this illness and lived in the area. That's appalling, really. We're not there to tell people off; in this case I spoke to the production company and said we should work together in the future to explore this condition."
So what is a good representation of mental health? Jenni says shows should present how and why people became unwell, and how, hopefully, they can get better. Importantly, they should demonstrate that people don't just get ill or better one day; that it's a gradual and fluctuating process both ways.
"Depression is so boring to show. If someone is depressed they don't want to do very much – they want to stay under a duvet, and that's not very dramatic. There is dramatic without the stigmatising knock-on effect, and that's what we're trying to find." – Jenni Regan, Mind
Day to day, Jenni works directly with soaps and dramas. According to her, a lot more research goes into one-off BBC dramas – especially as they usually only have an hour to get an illness right – but soaps are her bread and butter. She talks me through the storyline of Stacey from Eastenders, who suffered from postpartum psychosis, which she says was one of the biggest projects Mind had ever worked on because it was a mental illness depicted onscreen over six months – "practically unheard of in soap history".
"We got together to meet and decide, first of all, what that might look like on screen," says Jenni. "We've worked on storylines involving Stacy for a few years, so we know the character quite well. We threw around ideas and then recruited case studies who came in and spoke to the actress, as well as the script writers, and actually some of the stories you saw on screen in the end were heavily based on people's experiences."
Ideally Jenni will get to see three or four versions of the script, going back and forth with comments between her and the writers, hammering out problematic scenes or dialogue. It's very common to have issues. "In particular, there was a scene where we thought it looked like Stacey was trying to put her child in harm's way. [Postpartum psychosis is] an illness where a lot of people think women must be very dangerous and kill their babies, which is very far from the truth," Jenni explains. "Generally, women might do things that endanger their children, but it wouldn't be something that was intentional damage. Perhaps they're so unwell they neglect their child, but it's very rarely something they're conscious of or trying to do. We managed to get that scene changed completely and ended up with Stacey in danger, but not her child."
It's obvious where the tension lies between advisors like Jenni and production companies – drama is about action, and mental illness doesn't always provide enough of that. "Depression is so boring to show," Jenni offers as an example. "If someone is depressed they don't want to do very much – they want to stay under a duvet, and that's not very dramatic. There is dramatic without the stigmatising knock-on effect. And that's what we're trying to find."
But what could be more sensational, more riveting, than the action before the Eastenders drum roll, the ending of a long-running storyline climax? "Sadly, people always think the only way to finish a mental health storyline is to have them killed or be sectioned," says Jenni. "With sectioning, they'll get dragged away and you don't see them for six months and then they're back, which isn't that realistic and gives the impression that people with mental health problems should just be locked away, which again isn't the case."
With Stacey's storyline, the character was sectioned, but it was positioned as something that would allow her to get the care and support she needed, rather than being a punishment. A successful ending for Jenni was when she worked on the Ian Beale depression storyline a few years ago. "He ended up leaving his life without trying to kill himself or harm others," she says. "What's most realistic for a middle-aged man is to walk away. It happens a lot."
"What historically tended to happen in soaps was there'd be a character who wasn't very well known who'd come in with mental health problems and do something very strange. It was an excuse for someone to behave badly." – Jenni Regan, Mind.
Yet, sometimes suicide is – and should be – talked about, and the events leading up to it shown. Lorna Fraser at Samaritans does the same job as Jenni at Mind. Although she can't name or shame good or bad storylines or scenes, as this would involve talking explicitly about suicide in a triggering way, as well as inadvertently doing the exact same thing in print as she's trying to prevent happening on the screen, she says that if companies come to her there's a very strong willingness to compromise to make the scene work. "There's a significant body of research which shows links between certain types of coverage of suicide and increase in suicide rates, so our work is focused on helping programme makers cover this topic safely to reduce that risk," says Lorna.
Lorna worked on the recent Lee Carter suicidal storyline on Eastenders, which was praised for its sensitivity. "The character had suffered with depression for a long time, and [the producers] got in touch with me and said they wanted to develop a suicide contemplation storyline," she says, highlighting how ideal it was that they brought her in at the very beginning. "It's not good when you're brought in at development stage and have to ask for loads of cuts. We gave a steer from the outset. They continued to work with us over the course of a few months and that involved sharing scripts, giving advice, working with the two main actors involved in the scenes, as well as the writers and researchers."
In the months leading up to this contemplation, viewers had seen Lee struggle with significant life events, like bullying at work and the impact of this on his relationship with his new wife. "What has made this all the more difficult for Lee is that he suffered in silence, pretending things were OK," says Lorna. "The storyline has managed to show the dangers of isolating yourself to any viewers who might be having issues. He reached that lowest point of feeling like he couldn't cope with it. The car park attendant who stops and speaks to Lee also hands him a Samaritans helpline contact card before he leaves and says he should call them if he's struggling again."
Both Jenni and Lorna agree that soaps are now brilliant at depicting mental health issues. "What historically tended to happen in soaps is there'd be a character who wasn't very well known who'd come in with mental health problems and do something very strange. It was an excuse for someone to behave badly," Jenni explains. "Over the years it's become much more about main characters developing mental health problems, which is a lot better way of doing it. It's cutting down the idea of it being us and them."
Now, you're seeing more key characters dealing with their mental health. Coronation Street's grumpy, dopey, sarcastic Steve McDonald, for example. Jenni worked on his long-running depression storyline. "He was a character who was quite funny and likeable, so to have him have depression rather than someone who was a wallflower is a great move for them. In terms of the response, our website crashed after the main episode because people were looking for information on depression. It shows that people do see a character like Steve and think, 'If he can get it, I can get it, and maybe that's what's wrong with me?'"
So where is there room for improvement?
So far, no British soaps or long-running drama excel in showing that, for many people, mental illness doesn't just "get better" – that it's a long-term or recurring factor in their lives. "The fact that Steve McDonald has just lost a child [in Coronation Street]... in real life, that could trigger another depressive episode," says Jenni. "I don't know if they will do that, but that'd be something we'd recommend. Depression doesn't necessarily happen for a month and go away."
Generally, the consensus is that soaps are doing a good job when it comes to reaching and educating people. "Our relationship with the soaps is very well established now," says Lorna. "We'd like to encourage more filmmakers to work with us."
And you can see why: it's difficult to name many big films that manage to depict a mental illness even somewhat accurately. Lars Von Trier's Melancholia is one; Martha Marcy May Marlene is another. But with film and mental health, it's almost as if the bigger the budget, the more offensive the result. That said, consumer sentiment is changing, even if film isn't. For example, mental health advocates hated M. Night Shyamalan's new film Split – in which James McAvoy's character's split personality disorder spawns one persona who becomes something of an evil superpower – and have organised boycotts and protests against it.
Jenni knows people don't want dangerous representations of mental health on screen, because Mind hear the complaints after something comes out in the cinema or is shown on TV – and they get a lot of them. Ultimately, when it comes to mental health and identity, people want to see themselves and the people they care for on screen; more depressed Steve McDonald, less demonic topless James McAvoy.
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