TV Creators Tackle Mental Health

Claire Danes

Specificity can be key to portraying serious issues in skeins

Although debates about gun control gained more traction in the wake of shootings at a Newtown, Conn., elementary school in December, the issue of mental illness also re-entered the public conversation. In primetime, mental illness has been in the mix of social issues showrunners address head-on in serious dramas.

“There are still shows that focus simplistically on making ‘crazy’ people violent or comedic,” says Dr. Carole Lieberman, a media psychiatrist who’s also been a consultant on TV shows, including daytime soaps “The Young and the Restless” and “The Bold and the Beautiful.” “Other shows make the effort to go beyond the stereotypes and create characters with specific mental illnesses.”

Lieberman says symptoms don’t appear out of nowhere, and TV shows that explain how they developed — in childhood trauma or through specific adult experiences — paint a more realistic picture.

Former “Homeland” writer Meredith Stiehm says she read popular and medical literature about bipolar disorder, an aspect of the show’s Carrie character (Claire Danes). Stiehm also attended a symposium at Princeton and spoke with Kay Jamison, a Johns Hopkins professor and leading expert on bipolar disorder.

“I feel a lot of responsibility about it,” says Stiehm, who co-wrote “The Vest,” a first-season segment in which Carrie experiences a manic episode. “I ended up doing the research, and I’m pretty interested in it. I know a lot about it — I have it in my family so by default, I became the de facto expert on Carrie’s bipolar disorder.”

Psychiatrist Dr. Eric Hollander of New York’s Montefiore Medical Center praises Homeland for mostly getting its depiction of bipolar right.

“Claire Danes did a terrific job in terms of depicting what it’s like for someone with bipolar disorder in a pretty realistic fashion,” says Hollander, “and showed a pretty broad range of symptoms, from mild hypermania to full psychosis.”

His only criticism was the way the show portrayed electroconvulsive therapy at the end of season one.

“When people have ECT, they’re given a muscle relaxant, so essentially they’re asleep,” he says, “and the only way you can see somebody having an induced convulsive seizure is small movements in their fingers or toes. They wouldn’t appear to be having a full seizure, but I can understand why they did that to dramatize that she was having ECT.”

Hollander also praised NBC’s “Parenthood” for its depiction of an adolescent with autism spectrum disorder, as seen in the character of Max Braverman (Max Burkholder). Parenthood exec producer Jason Katims says he was inspired to include a character with autism because of his own experience with his 16-year-old son, Sawyer, who is on the autism spectrum.

“I didn’t have any kind of noble reasons behind (including the character),” Katims says. “I did it because when I was coming up with the pilot episode of ‘Parenthood,’ I was trying to explore things I felt were relevant today.”

Katims adds that he’s happy more TV shows now identify characters with autism, rather than just present the characteristics of autism without naming the disorder.
“Television in general is getting much more sophisticated,” he says. “It not only allows for you to be more accurate when exploring issues of mental illness, it demands it.”

Carlton Cuse and Kerry Ehrin, exec producers of A&E’s “Psycho” prequel “Bates Motel,” independently asked doctors about the Norman Bates character and what Norman could be suffering from, and both heard the same condition: dissociative identity disorder. The show has yet to diagnose Norman with that degree of specificity — a recent episode featured school authorities expressing concern about Norman’s “emotional instability” — but it could happen “maybe way downstream,” Cuse says.

“It would have to come from a doctor,” he notes, “and it’s so much the story of people who aren’t dealing with doctors, so I don’t know if it would happen. But the way we’re writing it is dissociative identity disorder.”

To balance an accurate portrayal with dramatic license, “Bates Motel” producers break their stories first and then consult with a medical authority.

“If we were doing ‘ER’ or ‘Chicago Hope,’ we would need to be held to some standard of medical veracity,” Cuse says. “This is a fictional show, and I think we’ve given ourselves an enormous amount of license to make the story play. Norman Bates is based on a character in a movie that was taken from a book that was based on a previously existing serial killer, so we’re now four steps removed from that. Right now our concern is about making Norman Bates a compelling character. That’s far more important to us than telling a medical story.”

“That being said,” Ehrin adds, “we do try to have some semblance of reality for the symptoms of the disorder and how it works. It’s not like we’re just making up stuff.”

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  1. jim keiser says:

    “Big pharma and the psychiatric establishment have used their power and money to promote the false thesis that intense human emotions and experiences can be reduced to a biological brain defect. This thesis, which has never satisfied any scientific burden of proof and has never survived even rudimentary tests of validity, has for far too long legitimized stripping a class of people labeled mentally ill of their human rights.”-Greg Benson. Human Rights Advocate

    – ‘Modern psychiatry — with its Diagnostic and Statistical Manuals of non-existing diseases and their coercive cures — is a monument to quackery on a scale undreamed of in the annals of medicine.’ -Thomas Szaz

    -“The problem with psychiatric diagnoses is not that they are meaningless, but that they may be, and often are, swung as semantic blackjacks: cracking the subject’s dignity and respectability destroys him just as effectively as cracking his skull. The difference is that the man who wields a blackjack is recognized by everyone as a thug, but one who wields a psychiatric diagnosis is not.” – Thomas Szasz

    “Psychiatrists employ destructive drugs, intimidation, covert threats, and their decisions on sanity versus insanity are utter garbage, because they’re based on opinion filtered through a maze of pseudoscience unsupported by diagnostic tests.”-unk

    “One day in our collective future, people will shake their heads in utter disbelief that society once saw human experiences like profound hopelessness, altered states, voice hearing, and intense existential pain as “symptoms” of “mental illness.” Those claims will sound as absurd and dehumanizing to them as Psychiatry’s legacy of calling homosexuality a “mental illness” sounds to us, today. I smile as I imagine the day in which the only thing called “insane” by our human family is the medicalization of the human spirit.”-Laura Delano

    GOOD STRATEGY TO REDUCE THE STIGMA OF MENTAL ILLNESS (and other harmful effects):

    -Question the validity of the labels of psychiatry (a/k/a “diagnosis”) promoted through the DSM(Diagnostic and Statistical Manual of Mental Illness), and assert your right to REFUSE psychiatric treatment as well as receive it.

    -Don’t accept any physical/bio-medical oriented psychiatric treatment that hasn’t been preceded by a discovered, or at least discoverable underlying physical trigger or cause in YOUR body, not just a theoretical body, that the treatment targets. Don‘t accept the validity of a theoretical underlying physical condition based only on questionable, often marketing-oriented “junk” science, often intended to promote the use of psychotropic drugs or shock (ECT).

    -IT IS THE USUALLY THE PSYCHIATRIC LABELS (a/k/a “diagnosis”) THAT TEND TO STIGMATIZE PEOPLE, NOT THE SYMPTOMS ASSOCIATED WITH THEM, and tend to justify most psychiatric treatment and the pharmaceutical oriented mental health monopoly of drug (and shock) treatment. The symptoms of these so called “illnesses” or “disorders” are usually problems with emotion, perception, thought, memory, behavior, and life experiences that are very real, but are not typically “diagnosed” (labeled) on the basis of ANY underlying physical conditions.

    -The (“diagnostic”) labeling process in typical psychiatric diagnosis is not a medical diagnosis involving an evaluation and discovery of associated underlying physical conditions. It allows a bio-medical monopoly on human problems, and continued, often unwarranted and unethical profits for the medical and pharmaceutical establishment- at the expense of your over all health and well-being. Don’t allow yourself/others to be labeled in this manner.

    -Psychiatry often demonizes these “mental ills” by suggesting that persons “diagnosed” are an actual or potential danger, or threat to themselves and/or others, with no more evidence than the labeling description and (inadequate) process itself. It is also often asserted that these “illnesses” are incurable, justifying continued treatment (typically a drug oriented form), and offering no alternatives to drug treatment (or shock). This IS the stigma that tends to result in the conclusion (of those “diagnosed”, and others who know the person has been “diagnosed”) that people so diagnosed don’t get better and are “permanently” disabled.

    -AND, unfortunately long term psychiatric patients subjected to drug/shock oriented treatment often do become very physically ill, disabled, and possibly violent or suicidal as the result of the treatment, not as the result of a labeled mental illness, as those promoting psychiatric treatment often suggest. Current drug black box warnings evidence this as well as the facts about the mass shooters’ ‘mental health’ histories

    -Insist on and seek alternatives to the bio-medical, drug oriented model for mental health treatment, and to the DSM oriented system of evaluation. ~Jim Keiser

  2. Lucinda says:

    I don’t understand where phrases like “symptoms don’t come out of nowhere” belong. If it’s a chemical imbalance wouldn’t it seem just like that? As for someone with BP2 and having no outward triggers, I think that is a gross overstatement for where mental illness starts, with some sort of trauma. If we knew where it came from, we could fix it. Since, at best, it is a chemical imbalance we stay in recovery with meds and etc. We don’t get fixed.

    • Yes Lucinda, we stay in recovery by proper medication management, and personal tools designed for our individual well being. I am Bipolar 1. It took me many, many years to come out of denial, that medication was the only way to find recovery. It doesn’t mean I will be free from my mentall health challenge but I will live a quality life and I will be able to cope. You can’t fix mental illness. You can’t cure mental illness. But we can change the way we look at mental illness. That in fact many of us are not ill at all. We are recoverying. We are actually rising up and finding a power struggle with such organizations as NAMI. I know mental illness. I am a mature woman of 49 years old. Many persons with children who have mental illness are my age now. They don’t want to hear what I have to say. And I was a parent of a child with a co-occurring condition. I lost my son to a drug overdose last year at 17 years old. No you can’t fix us but we are getting stronger. And we are rising up!

  3. “Call Me Crazy” is an offensive title for a movie and one that NAMI has clung to as their poster child for actors to represent those of us with a mental health challenge. Two steps bakwards. And the movie was terrible!

    • Susan Cooke-Erskine says:

      I agree that NAMI needs to take more of an active role in stopping the stigma of mental illness. It’s supposed to be what it’s all about and yet, they keep using the word “crazy”. Personally, as a person with mental illness, I find it insulting.

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