Fiction does a disservice to psychiatry

I just saw Center Stage's production of "Next to Normal," a play portraying a family grappling with the wife/mother's bipolar disorder. I am not a theater critic. I am however, a psychiatrist on the teaching staff of Sheppard Pratt, University of Maryland and Johns Hopkins, and I speak around the country about how movies and plays present mental illness, its treatments and its treaters.

Though accurately portraying a family's anguish about mental illness, sadly, "Next to Normal" incorporates some of the common distorted tropes that so often appear in entertainment. For example, a common dramatic tool, as seen in this play, is two psychiatrists with opposing methods — the uncaring, weird (or sometimes evil) one who prescribes medications and the good, trustable, normal guy who treats patients without medications, through caring talk therapy alone. Yet, psychiatrists are trained to do both, and many still offer both therapy and meds, which can be mutually complementary, each with benefits and risks.

Another trope that appears here is portraying the side effects of modern psychiatric medication as vastly outweighing the benefits. Yet state-of-the-art treatment for most people is generally tolerable, effective and often life-saving. Electro-convulsive therapy, one of the most remarkably effective treatments in psychiatry, is a favorite whipping post; it's typically mis-portrayed, as in this play, to have exaggerated effects on memory and no lasting value, making things worse. In "Next to Normal," the ill character concludes that the best approach to recovery is to distance herself from her family, particularly her remarkably supportive and devoted husband. Yet, research has shown that those who can sustain supportive family connections have the best outcomes.

Having consulted to some Hollywood filmmakers about the portrayal of mental illness and psychiatrists, I have learned that the needs for dramatic tension and box office sales sometimes call for exaggerations, stereotypes and oversimplifications. So many people who need psychiatric treatment are not getting it, often due to the misunderstanding of many aspects of mental health treatment. The Centers for Disease Control notes that one in four Americans has a clinically significant mental health problem severe enough to need clinical intervention. Yet, the National Comorbidity Survey showed that only 30 to 40 percent of people who could benefit from state-of-the-art treatment are accessing any kind of mental health care. There have also been a number of research studies documenting the negative effects of TV and film portrayals of mental illness and mental health professionals, which measurably discourage viewers from seeking treatment and diminish confidence in treaters. Even cartoons have been studied and found to contain distorted stereotypes of mental illness and treatment to children.

Most people have not consulted a psychiatrist or any mental health professional, nor have they even informally known a psychiatrist socially to neutralize the stereotypes commonly seen in entertainment. This leaves movies, TV and stage productions as the primary educators about mental illness, psychiatrists and treatments. Even when we know that these portrayals are fiction or "just one example," we carry away residual impressions and feelings from them, on top of potential misinformation. If we do not have other experience, powerful fictions become our educators. I myself think I know a thing or two about the life of cowboys, or what it's like to experience war. But my education about such matters really is strictly from movies. I have tried to be very mindful of this in my consultations to Hollywood productions, attempting to make portrayals of mental illnesses and those who treat them as accurate as possible, within the demands of the dramatic necessities.

That is why, as good as a performance might be, I cringe when I think of the residual off-putting lessons that plays like "Next to Normal" and a whole host of movies and TV shows leave in the minds of audiences about the world of mental illness, its treatment and its treaters. Treatment is not perfect, but it's typically far more effective than Hollywood and Broadway would lead you to believe. That's why we need to help ourselves and our loved ones to access it more often and more easily.

Dr. Mark Komrad is author of, "You Need Help: A Step-by-Step Plan to Convince a Loved One to Get Counseling" (YouNeedHelpBook.com). His email is mkomrad@aol.com.

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