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Mental illnesses can be short-term, long-term, or even life-long (Parekh, 2018). When diagnosing a mental illness or an intellectual disorder, medical experts and teachers must always take the patient’s culture, social norms and religion into account, to ensure that they are not diagnosing or perceiving someone based on their own unconscious bias and/or preconceptions (Uono & Hietanen, 2015).

Celebrity Culture and Mental Health

When Britney Spears had a mental breakdown in 2007, she was labelled as crazy and insane by the tabloids. This view slowly started to change between 2000 and 2010 when many stars from the American movie and film industry started speaking out about their mental health, their struggles and their disorders. Some stars worth mentioning here are Robert Downey Jr. and Elton John who spoke out publicly about their drug and alcohol addiction to draw attention to the struggles of people in the spotlight and the pressure that comes with being famous (WebMD, 2020).

Selena Gomez spoke out about her anxiety and depression following her Lupus diagnosis (Gillespie, 2020) and Demi Lovato opened up about her bipolar disorder and drug addiction following a public mental breakdown (Office of Public Affairs, 2017). Lily Collins spoke about her eating disorder following her role in the movie “To the Bone” in 2017, for which she lost weight (Mallenbaum, 2017) and Ariana Grande publicly spoke about her Post Traumatic Stress Disorder (PTSD) and anxiety following the terrorist attack at her concert in Manchester in 2017. Grande furthermore shared a scan of her brain showing the effects of PTSD in a post on Instagram to open up about her struggles and to make the public aware of the effects of PTSD (Young, 2019).

Perceptions of people who live with mental health issues are slowly changing as more public figures open up about their struggles with mental health. In recent years, stars like Lady Gaga, Kim Kardashian West, Kanye West, Zayn Malik and Emma Stone publicly opened up about their PTSD, anxiety and depressions and Daniel Radcliffe spoke about his OCD and alcoholism (Office of Public Affairs, 2017). Despite these changes, it seems like there is still a long way to go towards a fully inclusive culture, as the tabloids still exploit mental health issues for a title story, i.e. Demi Lovato’s mental breakdown in 2018 (Office of Public Affairs, 2017).

Since perceptions are also based on representations in popular culture, let’s take a look at some examples of how mental illnesses and intellectual challenges are portrayed by in Hollywood TV shows and films.

For a long time, Hollywood movies have depicted characters who are living with some form of mental illness or intellectual challenge. Forrest Gump, who is labeled as intellectually disabled with an IQ of 75 but also shows signs of ASD, is just one example. Many Disney and Pixar movies depict characters who show mental and intellectual disorders, e.g. Tigger and Eeyore from Winnie the Pooh (Shea, Gordon, Hawkins, Kawchuk, & Smith, 2000), Sadness from Inside Out and Dory from Finding Dory.

Anxiety in Popular Culture

Characters with anxiety are widely represented in pop culture. Examples include, Elsa in Frozen, Mulan, and Catniss from The Tributes of Panem. In Frozen, Elsa has an accident using her powers when still very young. After this, she is afraid to use her powers again and hides from the public. Eventually, another accident occurs, and she runs away but, in the end, she overcomes her anxiety and returns home and becomes queen. This might be interpreted by young children as an idol and children might adapt this view on anxiety from an early age on (Brooks, 2018).

Many modern interpretations of Disney movies use anxiety as the motive of their main characters actions and behaviours. Throughout the movie, the character normally overcomes their anxieties and becomes the hero or heroine. However, most often anxiety is not something that one can just overcome. Therefore, this representation of anxiety can be potentially problematic as it causes others to think that people with anxiety are not working hard enough on overcoming their anxiety.

Piglet from Winnie the Pooh is a character who struggles with more severe anxiety. Yet, in the case of Piglet, her friends do not try to convince Piglet to overcome the anxiety, but they accept Piglet for who she is. Through Piglet it becomes clear how anxiety can affect our daily lives and how it can influence our actions. Another character who seems to struggle with severe anxiety is the character, Fear, in the movie Inside Out. In this movie, the main character, Riley, has 5 main emotions in her head who control her feelings and actions. These emotions are depicted by animated people, which are Joy, Sadness, Disgust, Fear and Anger.

Eating disorders in Popular Culture

According to BEAT Eating Disorders (2018) eating disorders are still a taboo topic. For this reason, many suffer in silence and do not dare to share their experiences. The 2017 movie, To the Bone, was a huge step towards starting a more open discussion about eating disorders. In the movie, Lily Collins, who had an eating disorder herself, plays a young woman, Ellen, who battles anorexia. Ellen joins a patient program and moves in with six other young people who live with anorexia, too. The movie was criticized for the way it depicted anorexia, however, in that. It triggered patients suffering from anorexia and glorified the disorder, causing young girls and women to aspire to be like Ellen. Yet the movie is also reviewed positively for opening up a conversation about the topic (Leskiewicz, 2017).

Depression

Depression is often portrayed in movies in an overdramatic and stereotypical way. Often characters living with depression are represented as always sad or depressed, whereas in real life depression is not necessarily a constant state of mind and waxes and wanes depending on sleeping patterns, social surroundings, moods and medications. One example of a very stereotypically depressed character is Eeyore from Winnie the Pooh. Depression is Eeyore’s main character trait and not much else is known about him as his depression overshadows everything else. This is a very one-sided depiction of depression (Shea et. al, 2000).

Another representation of a depressed character is Sadness from the Disney movie Inside Out. In the movie, Sadness personifies the emotion and behaves in a stereotypical way by lying on the ground, losing hope and not fulfilling her tasks. However, in this movie, the stereotypical depiction has a purpose: the movie’s message is that all emotions are equally important and need to be recognized. The character Joy is the personification of happiness and wants to make sure that the main character, Riley is never sad (Clyman, 2015). The stereotypical personification of Sadness in this case has the purpose of showing that deep sadness is also okay to be felt at times and is even crucial to be felt in some cases in order to process events, i.e. moving away from one’s friends. Throughout the movie one can see that Sadness’s depression and the negative association of her is a stereotype itself and is largely connected to the attempt to suppress the feeling. When Sadness is finally allowed to do her job, which she loves, and let Riley feel sad, she becomes less stereotypical and the negative view on sad emotions is no longer so strong (Wermers, 2018).

Depression and other mood disorders are frequently addressed in Hollywood movies. Some movies worth mentioning here are Silver Linings Playbook (2012), Little Miss Sunshine (2006), It’s Kind of a Funny Story (2010), Perks of Being a Wallflower (2012) and most importantly the Netflix series 13 Reasons Why. This show tackles the topics of depression and suicide. The show is based on a book with the same name. The story follows Hannah who was depressed due to sexual harassment, bullying and rape and eventually committed suicide. The show was criticized for its glamorisation and exploitation of teen depression and suicide but the book by Jay Asher (2007) was a New York Times bestseller and won several awards for young adult books for its description of the struggles of high school students, including bullying and sexual harassment (Penguin Group, 2017).

Personality disorders

In today’s popular culture, personality disorders are often portrayed in a negative light. Horror movies like Split, Psycho, Silence of the Lambs, The Shining, American Psycho and the Netflix series, You, and many more use the idea of the mentally ill who become (mass) murderers, disturbed killers, creeps and psychopaths. Often, these characters are depicted as exhibiting a narcissistic personality disorder, an antisocial personality disorder or an attachment disorder in a very stereotypical way. In fact, while it is true that someone with a narcissistic personality disorder is more likely to react with anger to i.e., rejection, they are equally likely to react vulnerably as they fear the abandonment and the fear of the loss of a high self-worth, which their partner often increases (Johnston, 2019).

In the series You, the main character, Joe, stalks his love interests, manipulates them into liking him, and acts very violent. He eventually kills one of his love interests when she wants to leave him. This is a very unrealistic representation of someone with a narcissistic personality disorder (Johnston, 2019).

In the movie Split, a dissociative identity disorder seems to be the reason why the character, Kevin, imprisons 3 young girls. From this movie, a very famous meme was created, “That wasn’t me, that was Patricia,” effectively making fun of the disorder.  You, Split, and almost the whole genre of horror movies overdramatizes, exaggerates, stereotypes and exploits personality disorders to illustrate the threatening nature of the characters and to scare the audience.

From a young age on, we are confronted with movie characters who have a narcissistic personality disorder or sociopathy. Some examples include Scar from The Lion King, Governor Ratcliffe from Pocahontas or Hades from Hercules, all of which are depicted as pure evil in Disney movies. Disney often also associates ugly personalities with exaggerated features and ‘ugliness’ on the outside, so viewers know from the first scene on who the villain is. When growing up with such stereotypical depictions of evil, it can be difficult to use critical thinking and spot subtle negative behavior in one’s real life, i.e., by one’s parents, guardians or society in general. Not only do these characterizations hurt people with personality disorders but they are potentially misleading and therefore dangerous for  children and teens. (Garofalo, 2013).

Psychological and neuro-developmental disorders

People with psychological and neurodevelopmental disorders are also frequently represented in the films and television. Characters like Rain Man’s Raymond Babbitt, Forrest Gump or The Good Doctor are only some examples. The movie Rain Man (1988) is today known for being one of the first movies to feature someone with Autism. In the movie, Raymond Babbit is autistic and has the savant syndrome. He lives in a mental institution and has inherited most of his father’s money. His brother, Charlie, has interest in the money and therefore tries to get custody of Raymond. The brothers go on a road-trip together and get to know each other better. Charlie discovers that Raymond is able to calculate really fast and can count cards in the casino and the brothers develop a closer relationship. The character of Raymond represented people with ASD in a stereotypical way. Viewers perceptions of people with ASD frequently included the accompanying savant syndrome (savant is derived from the French word ‘to know’), which only 1 in 10 people with autism show (Treffert, 2009). Yet, this became the mainstream idea of what autism was like, partly because of the movie.

Only in recent years the representation of neurodiverse characters in TV shows is slowly growing. The character of Sheldon Cooper on the show ‘The Big Bang Theory’ is often associated with Asperger’s even though the show never officially stated that Sheldon does indeed have ASD (Applied Behaviour Analysis Programs, 2020).

In a completely different show, Young Shelden, the main character struggles with Asperrger’s as well. Sheldon has become known around the world and his phrase “Bazinga” has become a phenomenon on the Internet.

The Netflix show Atypical represented people with ASD through its main character, Sam. Sam is 18 years old at the beginning of the show and goes to the local high school. The show portrays Sam and his family’s struggles in a light-hearted way. In Season 3, Sam starts college and struggles with the changes this brings to his life. The show draws attention to the fact that 4 in 5 college students with autism do not graduate within 5 years of college (Buechler, 2017). The show was well received by many in the autism community for having actors and writers on the show who themselves have autism (Diament, 2018).

Another neurodevelopmental disorder that is often portrayed in movies is memory loss, due to dementia, retrograde amnesia or anterograde amnesia (where one is not able to remember new memories). In Finding Nemo and Finding Dory, Dory suffers from anterograde amnesia, she constantly forgets how she got to certain places. She forgets conversations and she forgets what she has been doing.

In the Disney Pixar movie Coco, where a young boy, Miguel, embarks on a journey to the Land of the Dead and meets Hector, who wants his daughter, Coco to remember him. However, Coco suffers from dementia and does not remember her father. Through a song, Miguel triggers Coco’s memory of her late father and they sing together. According to Jacobsen, Chételat, Fritz, Joie, Stelzer & Turner (2015), music can in fact often trigger the memories of patients with dementia, often children’s songs trigger memories from patient’s childhood. The representation of dementia in Coco is therefore realistic, according to Jacobsen et. al (2015).

Psychological and neuro-developmental disorders are also addressed in Winnie the Pooh: Owl shows the struggles of dyslexia and tries to cover up his issues with reading. Tigger shows many symptoms of ADHD, yet it is never specifically stated that the character has ADHD. Tigger is very hyperactive, always jumping, impulsive and shows risk-taking behaviour (Shea et. al, 2000). Even though Tigger sometimes puts his friends in danger, his friends still treat him like a friend and accept him for who he is. This is a very powerful message about neurodiversity; we should accept people for who they are and not think they need to be healed from or cured of something.

The film A Beautiful Mind, tells the story John Nash, a famous mathematician who has schizophrenia. Since this movie is a biographical drama based on the life of John Nash, it represents Nash’s schizophrenia more accurately than many films and draws attention to the struggles of people and their families living with schizophrenia. (Howard, 2001).

Substance abuse disorders

Winnie the Pooh has an addiction to honey. Honey is the only thing that really makes him happy and he spends most of his life looking for it (Shea et. al, 2000). He shows no desire to stop consuming unhealthy amounts of sugar and he suffers from the physical consequences of his constant overdosing on sugar. This shows how addiction often manifests itself and how it creates a vicious cycle out from which it is hard to break out. Our brains become wired to crave the substance and it becomes increasingly difficult to stop consuming it because we think it will make us feel better (Parekh, 2017).

A German book which focuses on substance abuse is: Christiane F.: Wir Kinder vom Bahnhof Zoo (Translation: We Children from Zoo Station). This biography tells the life story of Christiane F., a young girl who became addicted to heroin when she was 13 years old after trying multiple other drugs. In order to finance her addiction, she became a prostitute, together with her boyfriend. Later on, her best friend died of an overdose at 14. The book is based on real events and described the drug scene of West-Berlin in the 70s. It represents the dangers and struggles of substance abuse disorders as Christiane describes her hepatitis, jaundice, multiple cold turkeys and eventually the deaths of multiple acquaintances and friends (Hermann & Rieck, 1979).

Trauma-related disorders

People suffering from trauma are increasingly and frequently represented in modern movies. Almost every movie uses a traumatic experience as a tool to justify the actions of certain characters, whether it is in war movies, (i.e., American Sniper, Deer Hunter, Iron Man, Batman), dramatic movies (i.e. Extremely Loud and Incredibly Close or Perks of Being a Wallflower) and even Disney movies (i.e. Rapunzel, Beauty and The Beast, Lion King or Mary Poppins). In each of these movies, something traumatic happens at the beginning, most often it happens to the main character. Throughout the movie, the main character struggles from the trauma and eventually overcomes it. In The Lion King, Simba is traumatized by the death of his father and he runs away, thinking that he was responsible. For years, he tries to overcome the guilt before his friends show him that it was Scar who caused the death. After this, Simba overcomes his trauma and returns to his kingdom and becomes king. Similar to the representation of anxiety, this causes a wrong perception of the possibly life-long struggle people with trauma face.

In The Perks of Being a Wallflower, a high school student, Charlie, suffers from depression and trauma due to the sexual abuse by his aunt when he was 7 years old. Charlie has no memories of this and suffers from flashbacks, which start after the suicide of his best friend. Throughout the movie, his mental health fluctuates, in certain scenes, Charlie is highly depressed, in others he seems to be doing better. At the end of the movie, Charlie becomes aware of what happened to him in his childhood, and he begins his journey towards recovery. This movie shows how trauma in early childhood can sometimes be repressed, when a child cannot comprehend the trauma the brain sometimes represses the memories. The Perks of Being a Wallflower depicts this accurately. Furthermore, Charlie does not seem to experience a “miracle healing” in the movie, which other movies often use to show how the main character is suddenly healed from their trauma (Bowman & McGuire, 2014).