Monday, February 24, 2020

Ashleigh Adkins - Representation or Bust: Hollywood’s Struggle with Stigmatizing Mental Illnesses

Ashleigh Adkins
Professor Michael Benton
English 102

Representation or Bust: Hollywood’s Struggle with Stigmatizing Mental Illnesses

It could be argued that films are perfectly accessible points of escapism, teeming in idealizations of what one would label as the “American Dream” (which can, and often does, vary from person to person) on a backdrop of perfection and self-perceived realism. Which, at its core, is the very issue Hollywood has in general – there is no ideal America, or a truly perfect life or reality in the world outside of what one person makes of it for themselves, however, an entire industry has been cultivated off of profiting off the desperation of an audience to see something as close to perfect as possible. Or, at the very least, something that can distract them from the news headlines or current political climate long enough to find peace in their existence on this Earth again. That is unless you’re part of a marginalized group – be it racially, sexually (in both orientation or gender identity), or even because of your mental health – and you often find yourself fighting for appropriate representation both on and off-screen. To the defense of the film industry, waves have been made in the way of representation, and the representation of people of color and members of the LGBTQ+ community have come a very long way from where they started.

Unfortunately, on the topic of mental health, it’s far too easy to demonize and stigmatize rather than to produce a narrative that reflects normalcy and honesty about the realities of mental illness and what those who live with them face. Hollywood sticks to the mentality that any representation is good representation so long as it is profitable, and while good representations of mental illnesses are becoming more common, there is still the undercurrent of negativity that surrounds the characters and ultimately still create this idea and notion that those who deal with mental illnesses are dangerous and violent. That the people on screen, in a fictional world and story, are honest representations of the people who live with mental illnesses every day. It’s dangerous to assume that one can watch a film with a depiction of someone living with a mental illness (be it presented properly or not) and discern reality from a fictional retelling. In fact, media often works in subtleties, pushing subconscious preconceptions into our minds throughout our viewing time that stick with us throughout our lives even if we may consciously reject the notions presented (qtd. in Beachum, 19).

The reality around mental illnesses is rooted in statistics that are very often glossed over by the film industry. In fact, according to the National Institute for Mental Health, 18.9% of adults live with a mental illness, 4.5% of them being listed as a severe mental illness. This is with the understanding that there are 46.6 million adults over the age of 18 who live with a mental illness, and an estimated 11.2 million of those are severely mentally ill (NIMH, 2019). While it is not necessary, or even being asked, to include mentally ill people in all forms of media, the number of people affected by them every day should be taken into consideration when looking to do so. The representation proffered to the public is the key detail needing to be closely considered, and a more critical look at one’s own preconceptions of mental illnesses and mental health overall to gauge whether a truly unbiased perspective can be reached in film.

While the most common instances of depictions of mental illnesses in film are inherently bad and rooted in misunderstandings of the illness they are trying to present an overarching negative stereotypes to push a specific narrative that caters towards the benefit of the protagonist (at the expense of the mentally ill antagonist), there are moments in cinematic history that truly do shine with accurate and well-researched depictions of the realities of mental illness and should be taken note of. However, despite displaying the truth behind living with mental illnesses for some, even the more successful depictions continue to fuel the flames of stigmatization that only continue to hinder the acceptance of the general public who live with mental illnesses. Joker is one example that comes to mind, a haunting showcasing of trauma and post-traumatic stress disorder coupled with psychosis and delusions that lend a hand to the strong allusion that Arthur Fleck quite possibly lives with Schizoaffective Disorder. According to the DSM-5, hallmarks of Schizoaffective disorder are symptoms of psychosis, including delusions, hallucinations, disorganized speech, abnormal psychomotor behavior, and negative symptoms along with a major mood episode (American Psychiatric Association, 2013: 106-110). The symptoms must not be attributed to the result of substance use or of a medical condition. Arthur has multiple instances throughout the film displaying each of these symptoms, most notably for the viewer the severity of his delusions when it comes to light that the relationship he had with his neighbor was a figment of his own imagination.

Phoenix is a phenomenal actor, and there was great care taken by both him and the writing team to give a very real, visceral depiction of severe mental illness in the context of an origin story without applying it strictly to a superhero genre on its own. In fact, Joker could be argued to be more of a case study and origin story rather than any specific visual depiction of the roots of one of the most iconic villains in media history. Arthur is presented as the antagonist, struggling with very obvious mental health issues that take precedence throughout the entire film, while the main antagonist being social constructs and the stigmatizations of the mentally ill that inevitably directly push Arthur to the climatic psychotic break we see towards the end of the movie.

This is partially why Arthur’s extreme acts of violence in the movie come across as so disturbing – an echo of The Joker’s intended violent nature that has been with him and all iterations of his character since his inception in 1940. Even Heath Ledger’s performance of the iconic role in The Dark Knight is firmly placed into a history of violence and psychotic behavior that became the most memorable rendition of the character in modern cinema to date. While Joker focuses on the history of mental illness in Arthur’s personal story, The Dark Knight strays away from the outright associations with any mental illnesses in favor of portraying him as the villain we all know him to be. The Joker is a media icon, often casually diagnosed with schizophrenia, post-traumatic stress disorder, and dissociative identity disorder; none of which have any real substance to the claims, only fueled by misunderstandings of each illness and the willingness of fans to attribute his behaviors to severe mental illnesses rather than anything he does of his own volition (Foulkes, 2017).

In fact, in 2006 a national survey was conducted to gauge the general American public’s perception of the mentally ill and found that 60% of people surveyed at the time believed that those living with Schizophrenia were violent by nature (while 32% believed the same for those living with major depressive disorder). American perceptions of the mentally ill are not reflections of the truth, and most people who live with a mental illness are not violent. In fact, only 18% of people who live with a psychiatric illness alone actually committed acts of violence. In a study conducted on the presence of violence within the mental health community, it was seen that there were larger numbers of those committing violence who suffered from both a psychiatric illness as well as a substance abuse problem, rather than the illness alone. The stigma is still there, though, and it shows when writers use these stereotypes as truths to their fictional characters, rather than looking into far more common cases of mental illnesses that have no history of violence or aggression (Harvard, 2011).

This, in particular, is why Ledger’s characterization is as damaging as it is – there are hints throughout the film that showcase obvious signs of mental strain in one way or another, but nothing is ever confirmed through the story to give any backbone to the assumptions the audience must make based off the performance given. Ledger had even called The Joker a “schizophrenic clown”, further playing into the stigma that severely mentally ill people tend to lend themselves to violence and irrational showcases of their emotions (Foulkes, 2017). In Mental Disorders in Film, Erin Heath discusses the unique appearance Ledger’s Joker took on as opposed to that of his predecessors – sloppy, faded white paint as his base accentuates the running black around his eyes, and the overdrawn red lips used to accentuate his scars seem to emphasize a tired and disheveled appearance. In fact, Heath notes that this use of stylistic makeup choice accentuates the idea of a “mask” used to reinforce his status as mentally ill – a level of indifference in his behavior mixed in with literally painting his illness onto his face to incite fear and chaos into the public. It is a physical presence of an unnamed mental illness that stuck with the audience and the general public. Ledger went on to give the most iconic and memorable performances of The Joker at the cost of an ever-present idea that mental illnesses have to be visual to be real; by refusing to recognize mental illnesses as they are unseen in people, we give in to the harmful narrative that because of films like The Dark Knight and Joker there is a specific look that a mentally ill person must have to be accepted by society as such, and even then it further stigmatizes them with a damaging perception of unkemptness and frazzled appearances (29-32).

The Joker was created to be a villain, sculpted over the years into an iconic image of psychotic behavior and unthinkable acts of violence. He is fictional, but to an audience who is unaware of the realities of mental illnesses, he is inherently rooted in truths that scare and disturb them. The Joker is a sensationalized representation of a psychopath with no real direction as far as his actual diagnosis is concerned, though still created to be a villain because of the illnesses he is casually associated with. Arthur Fleck is a truly rare instance of raw honesty behind the realities of mental illnesses, especially the social stigma and the mental health crisis in America that failed him in more ways than one. There was truth to the things any audience saw as they watched his story play out, however it still pushed the narrative that severely mentally ill people are dangerous – almost justifying the things that happen to him by having his psychotic break be a direct result of the treatment he received.

On the other hand, A Beautiful Mind portrays John Nash’s experience in living with schizophrenia, based on the book of the same name written by Sylvia Nassar. While not necessarily being the most faithful retelling of Nash’s life, A Beautiful Mind is triumphant in its presentation of schizophrenia as well as the devastation it can have on one’s psyche. In particular, the choice to visualize moments of delusion so fully pull the viewer into a false sense of understanding without truly realizing what is going on. Tactics like this are incredibly unique and effective ways to give someone in the audience a brief glimpse into how delusions make those affected by them feel – lost in a different reality, unaware of the truth to the world around them. It’s a humbling presentation that the National Alliance on Mental Illness’s own Richard C. Birkel, Ph.D. said that “A Beautiful Mind is a breakthrough of historic proportions. It’s authentic.” NAMI’s Xavier Amador mentions what benefits could come from the film, specifically citing a better understanding of how people living with schizophrenia may have a hard time reaching out for help, and also the effectiveness of cognitive therapy as a coping strategy (NAMI, 2002).

There is a certain amount of honesty in the film that comes with schizophrenia, specifically Nash’s struggles with medication and the effects they had on his daily functions. While medication is often suggested to treat mental illnesses (specifically ones that drive into the severe levels) it very often negatively impacts the cognitive processing of the person taking them – while medication controls the symptoms of the illness, they often treat the symptoms at the cost of one’s ability to emote. Nash even mentioned medication affected his ability to work and make any progress in his field, and while he suffered relapses into schizophrenic episodes during times where he went unmedicated, he ultimately opted to pursue treatment without the aid of any medicines (The Ohio State University). This, along with Nash’s initial reluctance to get help, are both common themes mentally ill persons see themselves facing regardless of the condition. It’s not something that Others them, rather, it humanizes and normalizes their concerns in a way that an audience can perceive it with better insight.

The realities around mental illnesses are ones often glossed over by Hollywood in favor of a written portrayal of harsh lies and misrepresentations that give way to an easy scapegoat for evilness. It’s too easy to pen misdeeds and cruelty on a marginalized group, specifically one that already has a poor reputation among the general public of already fitting the bill by the very nature of their illnesses. While films like A Beautiful Mind give truths to mental illnesses that often find themselves to be demonized in the media, instances such as Joker are more common than not and are the causation for further stigmatization of the mentally ill. Representation in itself is important, and it’s good that Hollywood is starting to be more conscious about the way they depict characterizations of the mentally ill. However, simply being better about how a character’s illness is written is not enough – Hollywood has to make an active effort to change the narrative surrounding the characters as well. When discussing the topic of mental health and film, there needs to be a dialogue about positive representations and stories. Normalization needs to be at the forefront of the minds of future authors and directors. An understanding between the mental health community and actors looking for guidance for their performances must be met. Truthfully only time and further education will tell if Hollywood can make amends to the community it has directly harmed. Perhaps at some point down the line, we will see fewer Arthur Flecks and more John Nashes.


Heath, Erin. Mental Disorders in Popular Film. The Rowman & Littlefield Publishing Group Inc., 2019.

American Psychiatric Association. DSM-5. American Psychiatric Association, 2013.

Beachum, Lauren. “The Psychopathology of Cinema: How Mental Illness and Psychotherapy are Portrayed in Film” Honors Projects. 56, Fall 2010, Accessed 17 February 2020.

“A Beautiful Mind: Analyzing How Schizophrenia is Portrayed in Movies versus Reality”. The Ohio State University, Accessed 17 February 2020.

Foulkes, Sarah. “The Joker's Origin Story Should Explore Mental Illness”. Film School Rejects, 24 August 2017, Accessed on 18 February 2020.

Gabbard, Glen. “Psychotherapy in Hollywood cinema”. Australian Psychiatry, 1 December 2001. 365-369.

“Mental Illness” National Institute for Mental Health, 2019, Accessed 17 February 2020.

“Mental illness and violence”. Harvard Health Publishing, January 2011, Accessed 17 February 2020.

“NAMI Calls ‘A Beautiful Mind’ A Historic, Authentic Achievement”. NAMI, 15 January 2002,,-Authenti Accessed 17 February 2020.

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