"Your portrayal of mental illness affects stigma"
September 2, 2014 8:37 AM   Subscribe

When it comes to mental illness you must absolutely pay meticulous attention to detail. Misconceptions and preconceptions are the reason funding is inadequate, why people who suffer from mental illness do not wish to come forward, why people with gender dysphoria suffer minority stress, why the mentally ill are targets of physical and verbal violence.
Mental Illness: a prome for speculative fiction creators.
For reasons I won’t go into I could not give the talk I was scheduled to at the Nine Worlds London Geekfest . Instead, I’ve decided to do a series of posts on the same topic.
  1. Why should I care?
  2. What is mental illness?
  3. How to assess mental illness
  4. Mini case study: Buffy
  5. Electro-convulsive therapy
  6. Suicide and the Sandman
  7. Hush and the freakshow
posted by MartinWisse (13 comments total) 38 users marked this as a favorite

 
Looks interesting -- but by prome, do you mean primer?
posted by Drexen at 9:08 AM on September 2, 2014 [2 favorites]


Interesting. I've got a couple characters in my work-in-progress that have issues. This could prove to be invaluable. Thanks.
posted by Ber at 9:48 AM on September 2, 2014


Regarding Part 4:

The author makes a lot of points regarding the medical accuracy of the events of a hallucination. The more I think about it, the less I like the implications of that part - he mentions that she's actually spent two weeks in treatment, which I guess is supposed to imply that she'd therefore know what it's supposed to be like?

I feel like there's an assumption there, that having been in a mental hospital at all automatically becomes a core part of your identity, and will loom large in your mind forevermore. I don't think the two weeks I spent in a mental hospital would have prepared me to accurately hallucinate it six years later. That's six years of other stuff on my mind, and I'm not even someone who kills monsters on the regular.
posted by reprise the theme song and roll the credits at 10:10 AM on September 2, 2014 [3 favorites]


Looks interesting -- but by prome, do you mean primer?

"Proem" was probably intended.
posted by grobstein at 10:36 AM on September 2, 2014 [2 favorites]



I was a consumer health librarian for several years (and currently provide library services to inpatient mental patients in a state hospital). I know that unless it affects them personally, people aren't likely to seek out any kind health of information, period, unless they are actual health professionals (and sometimes not even then). They absorb information as it washes over them in the media that they consume, and in the case of mental illness, this information is not always true or helpful to those who suffer; it can perpetuate myths that hurt the mentally ill and their families.

Presenting this information proactively, instead of waiting for creative professionals to become enlightened when they seek information because it has become an issue in their families/lives, is essential to helping end the stigma of mental illness. And this author has presented good information in a proactive way. Bravo.

I feel that an expanded version of this article should be required reading for anyone with creative responsibilities in media/fiction/nonfiction, including everyone from advertising professionals to graphic artists to storytellers to screenwriters to poets to copywriters! When I say expanded I mean it would need more varied examples, a non-UK focus (though it doesn't bother me here in the US particularly), and a section describing the main categories of mental illness and examples of disorders. But I think just as it is, it has the potential to really educate a lot of people about what mental illness is and isn't.
posted by gillyflower at 10:56 AM on September 2, 2014


. . . I don't think this is very good.

The hope of laying out a kind of doctrine for how to deal with mental illness in fiction is undercut by the over-broad, under-theorized scope of the term "mental illness." This is illustrated in section 2. There are no general principles to hand then. We must resort to the call for "verisimilitude."

The examples of failures in portraying mental illness are extremely unconvincing. Discussing the "case study" of Buffy season 6 # 17, the author asks, "Can a single dose of toxin cause this kind of elaborate belief system? Unlikely." Who cares? A demon injected Buffy with this poison; to expect it to conform to what a real poison is likely (likely) to accomplish is bizarre. Furthermore, the fact that it fails to so conform says nothing important about the portrayal of mental illness on Buffy. It doesn't contribute to the stigma of mental illness, it doesn't misinform about any real-world condition. This is nitpicking that at best distracts from the point these posts are supposed to be making.

Then it is pointed out that the nurses should not have injected Buffy with a tranquilizer in the bicep -- they should have found a better site for the injection.

Okay, so what?

Not every inaccuracy in the portrayal of something relating to mental illness matters at all. We don't expect a self-consciously cheesy fantasy drama like Buffy to be accurate in every respect. It's not even a medical show. And almost none of the complaints about the show are consequential. I would like mental health professionals to know better than Buffy, but I don't accept that everyone whose writing touches on mental illness has to have the knowledge of a professional (remember here that "up to 1 in 4 people can be affected by mental illness").

And it's not important. Just because mental illness is an important subject over all doesn't mean that every factual inaccuracy in fictional portrayals of mental illness is important. Most of them are inconsequential. A middle-school principal could come on here and grouse about the inaccurate portrayal of school administration on Buffy and that would be dumb, too.

This writer seems to know a fair amount about mental illness and treatment protocols (seems to -- they have no qualifications as far as I can tell; as usual on the Internet I am asked to believe them because they sound confident). But they are wrong to assume that anyone with less knowledge (or different opinions or training) is unacceptably ignorant.

Everyone wants to think that their little corner of world knowledge is indispensable and should be mandatory for everyone. It rarely is. And the wizards behind these education programs rarely know as much as they think.
posted by grobstein at 11:06 AM on September 2, 2014 [10 favorites]


It's just so obviously a nice undertaking to educate people about mental illness, but the work is shoddy.

It's also one-sided. I found the section on electro-convulsive therapy especially disappointing. It's true that ECT has been rehabilitated within psychiatry, and is considered a very good therapy for some otherwise very hard cases. And that's great.

But our author would have us think that this invalidates the use of ECT as a source of horror in fiction. It does not. Some quick points:

1) Even if modern ECT protocols are relatively safe, older ones could be more dangerous. So if a Batman villain gets ECT and it looks unpleasant, that doesn't have to be an inaccuracy(!) -- it might just be that that person is receiving different care than they would in a perfect modern psychiatric hospital.
2) Getting a powerful psychiatric treatment that you don't need (or don't think you need) is horrifying, even if there are patients who badly need it. ECT can be medically justified but you shouldn't line up around the block for it. Even strong proponents will admit it fucks with your head -- for example, it often causes memory loss (hopefully temporary).
3) There is a live debate over ECT and long-term memory loss and cognitive impairment. The author doesn't even mention this, giving us instead the panglossian picture that ECT is great. A fairer portrayal might characterize ECT as a drastic treatment that can nonetheless be appropriate for drastic cases.

The author's reform program just rests on thin reeds. I feel like the impulse to come up with standards of propriety for media is slightly out of hand here -- in a way that illustrates problems with the impulse. If we are too eager to come up with rules for writing, candidates like these ones will emerge -- thin, covertly opinionated, pointing at irrelevancies (that bicep!) to justify their reach. And if we are not friendly to attempts to criticize these would-be standards, then we will come to be ruled by ones that wouldn't stand up in a stiff breeze.
posted by grobstein at 11:24 AM on September 2, 2014 [3 favorites]


If anyone wants to read actual published research regarding portrayals of mental illness in fictional media and the effects on mental illness stigma (and self-stigma/treatment-seeking behaviors of those will mental illnesses), it's out there. I can direct you to it. Why this author hasn't cited any of it is beyond me.
posted by Young Kullervo at 12:47 PM on September 2, 2014 [5 favorites]


Young Kullervo -- yes! Please post it here?
posted by Westringia F. at 12:52 PM on September 2, 2014 [5 favorites]


Most fictional diagnosis could fall into the "not otherwise specified" category. It's only one person, they need not be part of any statistical cluster.
posted by StickyCarpet at 1:25 PM on September 2, 2014 [1 favorite]


I have to admit, as someone with now fairly extensive experience getting to know a lot of people with schizophrenia very deeply, I've been struck anew by how profoundly even people who interact with people with thought disorders both inadvertently and willfully misunderstand both the limitations these individuals sometimes have, their strengths, and how the different symptoms work and interact.

I have a tiny window into it myself, but the advantage of, for example, knowing a dozen or more people with delusions and having a subset of them willing to discuss what they are thinking and perceiving and a larger set react to them in front of me. I also have experience with people who don't have delusions, but who have dysfunctional beliefs that negatively affect their lives.

The usual example I use of a delusion is "squirrels tell me things" (this actually has its roots is a discussion I and a gentleman had about his beliefs, and was the example he gave as to how goofy he sometimes found his delusions in his more lucid moments; his reality was closer to "the squirrels are monitoring me" though) but in reality the delusions often are congruent with a person's personality and life experiences - that is, the people whose delusions tend to be persecutory have usually perceived themselves as outsiders and "dangerous"; the people who have delusions that tie into limitations meant to keep them safe tend to have experienced traumas related to safety and rules; duty driven people have duty driven delusions; etc...

When used in media, however, the delusions tend to be what the plot requires, or something "bizarre" that is not necessarily rooted in the character themselves. Similarly with other mental illnesses - they tend to be used as vivid stand-ins for "scary" or "tragic" without any regard for them as people because they are a means of showing how bad evil characters are and how good good characters are.

The other time I see the stigma used the most is in discrediting other people. And it is true, if someone is delusional, taking what they say at face value will lead to a higher incidence of errors as what they say and what reality appears to reflect are often at odds. However, people often discredit everyone someone says even if it isn't, for example, in an area where they tend to be delusional. I work with one highly delusional person who always knows when things are open; I doubted him once and had to apologize when he was so right (I'd assumed he was having a fear based delusion, but I was wrong). Once you get to know someone and can figure out the forms their delusions usually take, it's pretty easy to tell when someone is reporting things accurately and when they're not.

"You're crazy" and "stop being delusional" are both trotted out as dismissals in debates and arguments, however, and it really makes me want to smash heads. Firstly, differences in beliefs and perceptions are rarely delusionally based, and secondly it's a lazy way to tells someone they're wrong without having to explain why. Drives me up a wall.
posted by Deoridhe at 1:51 PM on September 2, 2014 [3 favorites]


Speaking as a spec-fic editor (I work at both Escape Pod and the Drabblecast), the things that bug me (and will generally cause me to reject stories out of hand, in case anyone reading this is also intending to submit stories) are less the nitpicky medically accurate details of hospital care and are more toward the specific pitfalls of speculative fiction, like Deoridhe's mention of delusions/hallucinations being completely disconnected from the character having them because the plot requires the hallucinatory aliens be real at the end, or - and this is the big one at the Drabblecast in particular - the mental-illness-specific form of the Wikipedia Story.

That is, the author has read about a mental illness (like, say, Alien Hand Syndrome) and had decided to write a story about it. These usually end up as not actually speculative fiction at all (i.e. the author writes the story from the perspective of the person with delusions, including their inaccurate perceptions) with the "twist" at the end of the delusion actually being true in some way. I generally find these to be bad writing on the face of things (since the plot and characters tend to be thin in favor of descriptions lifted from Wikipedia) and also usually pretty disrespectful toward just about everyone involved.

More broadly, using "being crazy" as a narrative get-out-of-corners-free card or portraying mental health workers as inherently evil and stifling (and oy do we get a lot of both of those, too) is still a problem, at least from my limited perspective. I just don't think this particular article is doing a great job at counteracting that; it's long and meandering and keeps (to me) kind of missing the point.
posted by Scattercat at 4:37 PM on September 2, 2014 [5 favorites]


I think the author is a psychiatrist btw. Wasn't immediately apparent to me.
posted by grobstein at 7:18 PM on September 2, 2014 [1 favorite]


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