How Should We Portray Mental Health On Screen?

A look at representation of mental health on screen from the perspective of people who experience mental health conditions themselves.

When I set out to create my own web series, I wanted to thoroughly understand the landscape around how mental health is represented on screen. While the form it takes is a web series, albeit very different from a feature length film being shown on the big screen, it is important to understand how and why mental health is mentioned in all forms of fictional media; from films and TV shows to podcasts and Tik Tok. And most importantly, I wanted to know what those who have experienced mental health conditions themselves thought about the way those conditions are represented in popular entertainment media. 

When we think about representation on screen, we think about the various sides of society that have stories deserving of telling. From old to new, from outside to inside, from a crowded street to an isolated chamber. But not all representations are good representations. And it’s increasingly important to involve those being represented in the creative process early on while the story idea is developing and as the screenplays are being written. Sure, creators are good at observing others and questioning the nature of a person’s situation. But all the secondary research in the world cannot replace the value of speaking directly to those who have authentic lived experiences. 

A common example of what can go wrong when appropriate parties are not consulted until the last minute is Netflix’s 13 Reasons Why. The show has been widely criticized for not involving mental health professionals or offering link outs to mental health resources until very close to the release of the show. 

“13 Reasons Why” (Image Credit: Netflix)

In search of answers from the people at the center of the mental health experience, a survey was conducted with 43 respondents in a randomized sample on reddit*. All respondents had been to therapy for a mental health condition. When asked about the best tone to use when portraying mental health in a fictional TV series, the most commonly used words were normal/normalized and friendly/friendship. Other words/phrases used multiple times included casual, humor/comedy, and just another part of life. Of the respondents who mentioned using a serious tone, all specified not to make it too serious. What’s confusing about these results is that the vast majority of large budget entertainment works portray mental health and therapy as very serious and dramatic. 

When asked about good (positive) representations of mental health they had seen in film/TV, 10 respondents said they hadn’t, and 7 said yes but couldn’t specify. The most commonly mentioned examples were Bojack Horseman (4 respondents) and The Joker (2 respondents). Other answers included A Beautiful Mind, Silver Linings Playbook, Euphoria, Perks of Being A Wallflower, A Streetcar Named Desire, Crazy Ex Girlfriend, Law & Order SVU, Girl Interrupted, Buffy The Vampire Slayer, Serial Experiments Lain, and Mr. Robot.

When asked about bad (negative) representations of mental health they had seen in film/TV, 4 respondents said they hadn’t, and 8 said yes but couldn’t specify. The most commonly mentioned example? 13 Reasons Why with 7 respondents. Behind that were 2 mentions of Split, and a single mention of the Horror genre in general, Welcome Back To Me, Atypical, The Joker, Selma Blair in Hellboy, and The United States of Tara. What I found most interesting about these results was that almost 25% of respondents didn’t recall seeing a good representation of mental health on screen. 

“Bojack Horseman” (Image Credit: Netflix)

In a second iteration of the survey with 31 responses† in which geographical location was also collected, Ozark, Girl Interrupted, Dear Evan Hansen, Sex Education, Inside Out, Crazy Ex-Girlfriend, American Horror Story, Touched with Fire, Shameless, El Camino, Augusta, Gone, The Prodigal Son, A Beautiful Mind, Steven Universe, Atypical, and Reign Over Me were all cited 1-2 times as good representations. Mentions of bad representations included Jim Carrey in Yes Man, 13 Reasons Why (multiple mentions), Craft, Silver Linings Playbook, Split, United States of Tara, Teen Wolf, and Pretty Little Liars.

“Crazy Ex-Girlfriend” (Image Credit: Los Angeles Times)

After conducting these two surveys, I found that additional surveys with more specific and complex language around the words “good” and “bad” are necessary. In her essay “24: Challenging Stereotypes”, Evelyn Alsultany1 discusses the need for looking more deeply at what constitutes a successful or unsuccessful representation and explains that it is more than just “good” or “bad”. While those words can be subjective, it would be impossible to create a portrayal of something considered “good” by all.

Increasing the complexity of how those with mental health conditions are represented on screen and showing both their good and bad moments is of utmost importance. Above all, those with mental conditions (no matter how serious or understated) are human (obviously). Like anyone else, people who experience mental health conditions have redeeming qualities and flaws, and their mental health condition should never be their only character flaw.

While the entertainment industry’s main job is to entertain, the fact that those who have experienced mental health conditions are longing for alternative representations says something about the current landscape. Yes, entertainment is allowed and expected to take creative liberties depending on the format and subject matter, but this longing for alternative representations opens up new opportunities for representations in the content we create around mental health moving forward. 

What’s more, in the era of memes in which people crave relatability, I believe there is a way to fold in nuanced representations without sacrificing the entertainment value of fictional film and television. According to the New York Times, our desire for relatability is what gets us to scroll for hours on social media: “Relatability is the chief psychological lubricant that glides you thoughtlessly down the curated, endless scroll of your feed.”2

While certain elements of a character’s mental health condition may result in dramatized moments, we must also show them experiencing “normal” moments as well that people without a given mental health condition can relate to. Successful representations like this could help decrease the sense of “otherness” that we risk inflaming for people with mental health conditions in an entertainment landscape often portraying those experiencing mental health conditions as overly dramatic and abnormal. 

It’s time to find the time. 

WRITTEN BY
Mariah Marasco
Creator & Director
“The Drive-Thru Therapist” web series 

*Respondent gender breakdown: 53.5% female, 37.2% male, and 9.3% non-binary. Respondent age breakdown: 2.25% under 13 years old, 20.9% 14-17 years old, 32.6% 18-21 years old, 14% 22-25 years old, 14% 26-29 years old, 7% 30-35 years old, 7% 36-40 years old, and 2.25% 41 years or older.

†Respondent gender breakdown: 61.3% female, 28.5% male, 10.2% non-binary. Respondent age breakdown: 0% under 13 years old, 22.6% 14-17 years old, 12.9% 18-21 years old, 29% 22-25 years old, 22.6% 26-29 years old, 6.5% 30-35 years old, 6.5% 36-40 years old, and 0% 41 years or older.

1“24: Challenging Stereotypes”, Evelyn Alsultany

2https://www.nytimes.com/2019/01/08/magazine/the-scourge-of-relatable-in-art-and-politics.html