“This house believes that psychiatry has been unfairly treated in the media” Royal Society of Medicine Debate

I gave this speech at the Royal Society of medicine at an event called Psychiatry as a career: Everything you wanted to know but were afraid to ask.  It loses something without having the opposing view available but I hope will be of some interest.  There’s a list of links I used for research which may be of use. 

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I wish to propose the motion “This house believes psychiatry has been unfairly treated in the media”

By the end of what I have to say, you will have no difficulty in agreeing with me that this is indeed the case.

First allow me to define what I wish to examine:

  • Psychiatry’ has no exact meaning but encompasses psychiatric disorders, their treatments and those who provide them.  I include psychiatric patients also; not least as many people – including doctors – are unaccustomed to separating the disorder and the patient.  
  • The media is collection of means for mass communication.  Here the newspapers, television, radio and cinema continue to be the most influential.  
  • Fairness’ is very much in the news, and to be fair is to be just and to be aware of the right way to value things.  

The vehicles for mass communication in this country regularly treat people who work in or are treated by psychiatry as if they have no need for any consideration, as if they have no value.  

This is unfair

Unlike psychiatry, the media is a business, and is subject to very different pressures.  

As a result it is uniquely ill suited to report the richness of the fascinating human stories with which psychiatrists daily deal.

In essence the people who work within the media are primarily interested in one thing: selling the content they produce.  

This could be newspapers or DVDs, TV advertising or cinema tickets.  

Their output is driven by the overriding need to gain and sustain attention.  Their central question is ‘Is this engaging to busy people?”

All other things including truth, and fairness, are subsidiary to this.  

This is a shame, but it is the world in which we live

Under this imperative the media show no contrition in using crude stereotypes of the psychiatrically unwell and those that treat them that are unchallenging to lay people.  

These stereotypes are appealing as they confirm peoples’ view of the world and their place in it.  Whilst in sometimes engaging, comforting and even entertaining, they often misrepresent and stigmatize.  

The Hitchcock film ‘Psycho’ illustrates one of the most repeated and harmful stereotypes.

Maybe you should cover your ears if you don’t already know the ending.

Hitchcock knew how to unsettle his audience.  Although cinematically a masterpiece, Psycho has no shame drawing on and thus perpetuating popular stereotypes and fears.  

The knife wielding maniac

The violent and unpredictable madman.

The film’s anti-hero Norman Bates is a murderous ‘psycho’ whose mother resides in his psyche.  

This is a rather unlikely diagnosis in my opinion.  

Tensions between these alternative personalities drive him towards his crimes.  

Following in Hitchcock’s footsteps, films that feature psychiatrically-disturbed serial killers are now so numerous that they merit their own sub-genre.  

Another example is Halloween – one of the first ‘slasher’ movies- where on Halloween an escaped psychiatric patient stalks and kills teenagers.  He is pursued, with mixed results, by his heroic psychiatrist played by Donald Pleasance.  This film’s popularity was such that it spawned seven sequels and a recent remake.

This stereotype of the dangerousness and unpredictability is also seen in printed media as one of its most consistent features of reports about patients with psychiatric disorders.

Journalists like stories about violence and mental health as they are inherently newsworthy and tap into our fears and anxieties.  

Many newspaper articles leave the unquestioned impression that there is a link between all people with mental health problems and crime or violence.

The Health Education Authority’s ‘Making Headlines’ report found that negative coverage of acts of violence by people with mental health problems outnumbers more balanced reporting by 3:1, with stories about harm and crime accounting for the biggest quantity of all mental health pieces in broadsheets and tabloids.  

Here are three recent headlines from the Daily Mail.  Note that these headlines compound their insult by combining this corrosive stereotype with pejorative language

28 October 2010: Schizophrenic mother who stabbed three-year-old daughter and doused body in acid to stay in secure hospital

11th October 2010: Why was a drug-abusing schizophrenic left free to kill my son? And why will no one take the blame?

5th October 2010: Schizophrenic man hooked on cannabis stabbed stranger 81 times… after NHS said he ‘posed no danger’

There is an increased risk of someone with psychosis being involved in an act of violence, but such headlines leave all people with mental health problems under a cloud of suspicion.

Such treatment would not be tolerated if it were applied to other vulnerable groups.

I put it to you this is unfair.  Psychiatry is treated unfairly in the media

So psychiatric patients get a raw deal.  But it goes wider than that.  The Psychiatric Bulletin has reported that psychiatry in general gets a bad press when compared to medicine.  

Balanced discussion of psychiatry’s controversies is of course to be welcomed but what has emerged in the media is rarely sober and considered. 

This is unfair

Our treatments are often under fire:

Our antidepressants are addictive.

We reach too quickly for a prescribing pad.

The  draft of the new fifth edition of the Diagnostic and Statistical Manual of Mental disorders was met by a hailstorm of criticism about how psychiatrists wishing to medicalize ‘normality’.  

Psychiatrists are not well represented by the media either.  

Who do you think is the best know psychiatrist in popular culture?

I’d say Hannibal Lecter.  Off the back of this grimly compelling character The Silence of the Lambs has sold over 10m copies in book form and the Oscar winning film grossed $300m.

Who is Hannibal Lecter?

Not a learned clinician or venerated academic, but a murderous serial killer with a curious lack of insight into his own condition and a penchant for torture and cannibalism.  

Dr Lecter is hardly a good role model for aspiring psychiatrists.  

Another TV psychiatrist is Fraiser Crane from the long running American TV show.  He is uptight and pompous and has great troubles sustaining romantic relationships.  

That doesn’t sound like anyone I know

This is an improvement on Dr Lecter, but not exactly complementary figureheads for a profession soberly striving to treat humankind’s most difficult of diseases.

Worst of all is Dr Silberman, who in Terminator 2 is responsible for incarcerating Sarah Connor who we know – but Dr Silberman cannot see – is trying to save the world.  

I put it to you that it is truly unfair to accuse psychiatrists of trying to stop planetary salvation.
 

It’s a shame that the media has proved so unbalanced in its portrayal of our work.  Not least because we are all interested in the same thing: attempting to explain human behaviour and motivations.  

The media do not cope well the subtleties of meaning that psychiatry regards as commonplace and instead dehumanisation, inaccuracy and sensationalism are their stock-in-trade.  

Their portrayal of psychiatry is demonstrably unfair.  

Please join with me in supporting this motion.

Thank you.

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Resources

Health Education Authority Making Headines: Mental Health and the National Press

The Psychiatric Bulletin (2000) Newspaper coverage of psychiatric and physical illness

The Guardian 22 July 2010 Hollywood’s mental block

Advances in Psychiatric Treatment Psychiatry and the media

The Psychiatric Bulletin Terminator 2: Judgement Day

Politics of Health Group The media: agents of social exclusion for people with mental illness?

The Psychiatric Bulletin The stigma of mental illness: how you can use the media to reduce it

7 Responses to ““This house believes that psychiatry has been unfairly treated in the media” Royal Society of Medicine Debate”

  1. Christopher Crook says:

    Not sure the media owes psychiatry anything and I don’t think you can blame movies for telling stories. Psychiatry doesn’t help itself by telling people they have incurable diseases of the mind when they don’t, thefore making them seem more threatening.

  2. Kate L says:

    Well said sir!
    I’m a 3rd year biochemist, I also have bipolar disorder. I’m currently doing a scientific journalism project- my dissertation is on the coverage of bipolar disorder and schizophrenia by the media and the, often stark, difference between the two.
    Those of us with bipolar disorder keep getting told that we are so creative and that our IQ is ten points higher on average- with no mention of the functional impairment and problems with cognition. People with schizophrenia are constantly told that there dangerous and violent. Go figure.
    Thank you for the extra reading material!

  3. Annika says:

    Is this for real? Seriously? An endless list of “evil schizo kills innocent child” and “who’s to blame for psycho rampage” and “new psych unit proposed – not in my back yard!” actually DOES affect the public’s idea of people on the receiving end of psych services. However I can’t think of a single person who would believe for a second after watching Silence of the Lambs that all psychiatrists are like him, and if all you have to quote after that is the markedly inoffensive Frasier Crane then I have no sympathy for you whatsoever. Seriously, Frasier?!
    If I started counting right now how many people I know who are suicidal over the way service users are currently being portrayed in the media as not only psychos and madmen but also scroungers and cheats, I’d lose count after about twenty. You show me the psychiatrist who’s suicidal over an Arnie movie or a spinoff sitcom and I’ll show you someone with too much time on their hands.
    You wait until psychiatrists are insulted, vilified, hated, scorned every single day in every single newspaper and every single news website and TV programme not to mention the fiction in the movies and soap operas, then I’ll stand by you and say how awful it all is. But until then – well, if this is all you have to worry about and write speeches about then I envy you from the bottom of my heart.

  4. Louise says:

    Royal Society of Medicine needs to get this into perspective given mental health service users and anyone with physical health problems/disability who are not employed are being slaughtered in the tabloid media on a daily basis. Perhaps this has impacted on the rise of hate crimes against those groups. So yes service users get a bloody raw deal in the media, so much so that people are experiencing being openly interrogated in their communities regarding their medical/employment histories as they’re fair game now. Members of the RCP are going to be dealing with this ticking timebomb as people are already being readmitted under the stress of it, yet where is their voice? I rather think this carries a higher priority than how psychiatrists are portayed in a few crap Hollywood films. Besides, there are plenty of other films which portray psychiatrists as serious scientists doing their best in the face of people who simply won’t take their medication properly, because finding the ‘right’ medication is all that needs to be done according to those films. As for Terminator 2 I know lecturers who use that as a positive training example – believe what the patient says and work within their beliefs and explanatory framework.
    The bad press psychiatry gets needs to be addressed closer to home – in medical schools. Undergraduates have received lectures about mental health service users I find galling such as ‘people who self harm are generally horrible people with no hope’ – that’s verbatim from a former student now a junior doctor. What on earth does that teach students?
    Medical students also know how entrenched the discrmination is within their own profession so can be reluctant to come foward regarding their own mental distress and who can blame them in the face of institutionalised mentalism.
    Some junior doctors finding general medicine hard can go into psychiatry because they mistakenly believe it will be easier, but it isn’t when it’s done well, critical thinkers pay a price for standing their ground. Med students believe psychiatry is a soft option but only because the profession hasn’t represented itself very well to them.
    Psychiatry and medicine needs to get its own house in order before it moans about the media, and recognise other groups are suffering at the hands of the media far more.

  5. Louise says:

    ps
    I wish service users had half a chance of even getting an article accepted by the Bulletin, even with a consultant submitting it on your behalf it’s like trying to get into Fort Knox with reviewers who won’t accept critique of a medical model of mental health. No matter what the common ground and differences are, many service users are not ‘antipsychiatry’ and actually want to debate with and work with the profession. So perhaps psychiatry needs to be less defensive then we’ll get to see more of the good stuff you have to offer., and maybe then so will the media

  6. Marshal Alert says:

    “This house believes that mental illness has been unfairly portrayed in the media, leading to intrusive control by psychiatry in so called *treatment* of individuals who do not pose a risk to the public”

  7. Louise says:

    http://www.guardian.co.uk/society/2010/nov/22/tv-programmes-mental-illness
    I rest my case, we don’t see psychiatrists portrayed as maniacs in TV dramas on the whole [Hannibal as an exception] but we do STILL for service users. I watched a film with Ewan McGreggor the other night playing a psychiatrist who [as many films I've seen before] played the character as deeply caring and intelligent albeit in an inplausible storyline. Pity films and drama’s didn’t extend us the same courtesy more often. The last drama I saw which was good for the mad character was Donna Franceshild’s ‘Donovan Quick’, but then like ‘Taking over the Asylum’ you could see her characters infused with authenticity borne from her own experiences. Films and drama’s with writing coming from first hand experience bear a certain hallmark. I know Eastenders has been praised but I don’t rate many of the soaps personally for their portrayal of mental distress because it’s typically the same bottom line – the person is ok IF they take their medications, we never see a character who manages their difficulties without medication or using it intermittently. As for medical soaps such as Holby and Casualty, they are often the worst when it’s comes to mental health storylines, I’ve been appalled at some of the stereotyped caricatures which seem to conform to DSM diagnostic criteria all too obviously.
    I used to sit on a media award judging panel and watched more documentaries and dramas than I care to remember and the vast majority had me throwing objects at the screen – this was always in relation to how it was treating the service users or their condition. Some of the good documentaries showed some critical thinking psychiatrists in a great light i.e. David Healey, and where they didn’t look so good it was frankly down to what they were saying out of their own mouths

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