Television often presents an exaggeration of real life, but at what point does exaggeration become misinterpreted as reality? Unfortunately, due to depictions of patient-therapist relationships as exaggerated and volatile, viewers have come to perceive mental illness disparagingly and mental illness treatment as ineffective and avoidable.
Multiple studies show a relationship between unfavorable portrayals of mental health in entertainment television and viewers’ negative perceptions of mental illness and its treatment. A 1990 survey in the U.S. reported mass media as the most common source of knowledge in the U.S. (Wahl, 2001). A 1996 study found that participants in focus groups who held negative beliefs referenced fictional movies as their primary source of entertainment (Pirkis et al., 2006). A 2000 study reported that as the exposure to films and television increased, participants’ negative attitudes toward people with mental illness increased. In fact, these negative views increased to the extent that participants viewed those with mental illness as second class citizens deserving little autonomy (Granello, 2000). Moreover, negative representation of mental health and mental health treatment on television and in films affects whether viewers seek or continue receiving treatment (Pirkis et al., 2006). This research occurred decades ago, but the negative representation of therapists and treatment has continued in both reruns of old TV and new television shows.
Contemporary television continues to misrepresent the mental health field. Robin from How I Met Your Mother begins dating her therapist after only a few sessions of unloading personal trauma. Before they begin a romantic relationship, Robin’s therapist shares with Robin his own trauma, ostensibly to make Robin more comfortable (Rhonheimer, 2011). In practice, this would never happen. Not only is it unethical for therapists to pursue romantic relationships with clients, but the therapist’s unloading of his personal experiences makes light of a serious disruption to the social contract between therapist and client.
How I Met Your Mother is not the only contemporary offender. Rebecca in Crazy Ex-Girlfriend sees her therapist on a plane and embarks in an impromptu session right there in public (Bloom, 2016). Frasier in Cheers takes on his friend Sam as a client, whom he knows through Sam’s ex-girlfriend and his own current girlfriend, Diane. When Diane leaves Frasier at the altar, he corners Sam in their therapy session and pulls out a gun (Perlman, 1985). For decades, television writers have used therapy as a tool to make the audience laugh, and in doing so they perpetuate misinformation about the mental health field.
Not only do television therapists fail to maintain proper professional relationships with clients, the shows also promote a dramatic approach to healing. See, for example, the pilot of Crazy Ex-Girlfriend and Black Mirror’s interactive video game-esque episode, Bandersnatch. The public’s negative view of antipsychotic medications can be directly linked to portrayal in television and movies, despite evidence from randomized controlled trials that say otherwise (Jorm, 2000).
How can this be changed? It would be difficult to eliminate the portrayal of therapy in Hollywood altogether, not to mention that no representation, much like bad representation, doesn’t allow viewers to understand the realities of mental illness and therapy. Therefore, television needs to counter negative portrayal with positive, realistic portrayal. Newer shows have started to show mental illness and therapy more accurately. Devi’s therapist in Netflix’s Never Have I Ever speaks in a calm tone, encourages Devi to speak by asking questions, and emphasizes positive experiences in Devi’s life. She sets boundaries and clearly states the ethics of the therapist-client relationship when Devi, only a teenager, mistakenly perceives her therapist as a friend (Kaling, 2020). Should other television shows embrace this kind of representation, not only could there be an increase in understanding of mental health and therapy, but perhaps more viewers would seek treatment for themselves.
To help other television writers, the Mental Health Media Partnership and the Institute for Mental Health have worked with writers, directors, and actors to accurately portray mental illness (Pirkis et al., 2006). Mental health professionals should continue partnering with entertainment media to promote accurate representation of mental health on television. Even though current portrayal of therapy and mental illness seems merely a dramatized version of reality, these portrayals at their core assume therapists as incompetent, ill-intentioned, and judgmental, and those with mental illness as safer and freer away from therapists. If this is how we continue to portray therapy and mental health, viewers will continue to misinterpret, and, more dangerously, avoid seeking treatment to enhance their mental wellbeing.
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