By Alexandra Matisoff-Li
Illustration by Malcolm Garris/PhotoDisc
March 25, 1999

When an NBC affiliate in metropolitan Washington, D.C., recently ran a promo for its "Frasier" reruns showing a photo of actor Kelsey Grammer swaddled tightly in a straight jacket and the tagline: "You don’t have to be crazy to be crazy about ‘Frasier,’ " complaints from mental health professionals and those with mental illnesses poured in to the National Mental Health Association’s Stigma Watch hotline. After negotiating with the affiliate, the NMHA persuaded it to pull the promo.

It is estimated that nearly 51 million Americans have some form of mental illness. The "Frasier" example is but one of many illustrating the sometimes insensitive and inaccurate portrayals perpetuated by the mass media, mental health experts say. In the midst of all the noise, healthcare professionals say it is their job to filter out the negative messages and focus on sensitivity toward patients with mental illness.

Negative images

A 1990 survey by The Robert Wood Johnson Foundation on public attitudes about mental illness found that many Americans get most of their information on mental illness from the mass media—newspapers, television, films, and contemporary literature. And, experts in the field say the mass media often portray those with mental illnesses as violent, dangerous, psychotic, or out of control—or all of the above.

Those with mental illness are often depicted in the most sensationalistic terms, reduced to stereotypes instead of shown as "human beings with treatable conditions," said Melanie Gantt, spokesperson for the Mental Health Association of Texas in Austin. "This remains an area that can be easily exploited, " Gantt said. "It’s easy for the media to pick up on stories from out of the headlines that have a salacious tint to them, focusing on the people’s illnesses instead of possible treatment solutions to their problems."

Filtering the messages

More public education is needed to raise awareness about damaging or insulting terms the media use to describe those with mental illnesses, said Pam Gaurke, RN, a board member of the American Psychiatric Nurses Association and a long-term care nurse with the Sheboygan County Comprehensive Health Center in Sheboygan Falls, Wis. "Some [portrayals] are accurate, some are OK, and some are just off the wall," Gaurke said. "On local newscasts especially, it’s the verbiage that irritates me—they throw around words like mental unit, mental patient, and mental hospital in a gratuitous manner."

Medical dramas are sometimes the worst offenders. Benny Marrett, MSN, RN, president-elect of the Emergency Nurses Association and a clinical nurse specialist with Emergency Care Consultants of the Carolinas in Rock Hill, S.C., said she has seen medical dramas showing health professionals raising their voices to patients or shining bright lights on them, showing a lack of understanding for the difficulties and particular sensitivities faced by patients with mental illnesses. "Having watched some of these shows, I’m not sure mental illnesses are portrayed with real actuality," Marrett said.

Experience and training

Healthcare professionals can’t help but be influenced by negative media images, said Otto F. Wahl, PhD, professor of psychology at George Mason University in Fairfax, Va., and author of Media Madness: Public Images of Mental Illness. "Even though they are trained individuals, they may share the same misconceptions that the general public has," Wahl said. "This can lead them to approach patients with the same stereotypes often portrayed on television."

That’s where training comes in. "As a general rule, we find a lack of appreciation in primary care facilities toward mental illnesses and a tendency to misdiagnose these problems," said Rusty Selix, executive director of the Mental Health Association of California in Sacramento. "There needs to be adequate training to address these problems. If you are a healthcare professional and don’t understand that mental illness should be a factor [in diagnosing patients], then you haven’t had adequate training."

Experience can also solve the problem. Jean Proehl, MN, RN, president of the Emergency Nurses Association, said ER nurses—who often treat patients having their first bout with a mental illness—are most focused on keeping patients who present symptoms of mental illness from harming themselves and others. They also concentrate on looking out for possible conditions that might mimic the symptoms of psychiatric ailments, such as hypoglycemia and metabolic imbalances, Proehl said.

"I think most of us have so much experience caring for these types of patients that the media doesn’t have that much impact because we know what happens in real life," she said.