The public’s distorted attitude towards mental-health conditions hampers their treatment.
What is so funny about obsessive-compulsive disorder (OCD)? Paul Cefalu, a professor of English at Lafayette College in Easton, Pennsylvania, asked that question in a 2009 article that analysed why OCD is so frequently, and unfairly, represented in the media with “humor and levity” (P.CefaluPMLAhttp://doi.org/c2mtt4;2009). Unlike other mental-health disorders, such as depression and schizophrenia, those who suffer from obsessions and compulsions, Cefalu wrote, “can always be counted on to make us laugh”.
The laughs are thinner on the ground in This Room, an autobiographical one-woman play about OCD, written and performed by Laura Jane Dean. In a review on page 289, Emily Holmes calls it “an affecting, sobering account of a life shaped by, yet transcending, a mental-health condition and treatment”.
The portrayal of mental-health conditions (or, to be less semantically guarded, mental illnesses) in the media and popular culture has a significant influence on the way that many people view both the conditions and those who have them. Next to lawyers and police officers, physicians are among the most frequently fictionalized professionals, and psychiatrists feature heavily. Despite the well-quoted statistic that one in four people will experience a mental illness at some point in their lives, the medical reality is something more easily viewed at a distance, peeking through the silver screen at the misery of somebody else. When that picture is distorted, the result is fear and mistrust, not just of the mental-health professionals but also of their patients.
So why do Hollywood and the rest of popular culture often get psychiatric medicine so wrong? Why do we still talk of the psychiatrist’s couch when most people who see a psychiatrist never sit on one?
Too many accounts show only the illness, or at least a crude stereotype of it, not the person. And, crucially, they do not show how the person can often improve with the right treatment. Miracle cures are as rare in mental as in physical medicine, but many (perhaps most) people with psychiatric problems who receive the right kind of help can start to feel better. It is important to acknowledge and portray this.
The way to break the destructive cycle, to treat the OCD, is to resist the ritual.
A study published in February in the journal Social Science & Medicine (E.EMcGintyetal.Soc.Sci.Med.http://doi.org/2v4;2015), for example, suggested that stories about people who were successfully treated for depression, schizophrenia and drug addiction reduced negative attitudes towards mental illness in those who heard them. Tales of the same problems left untreated produced more willingness to discriminate against sufferers. This discrimination and prejudice is known to act as a barrier to people’s recovery, because they can experience social rejection when word of their condition gets around.
Perhaps here is a way to tackle the stigma of mental illness. It is not enough for scientists, journalists and campaigners to ‘raise awareness’ by highlighting the reality of such conditions, and by publicly criticizing those who misuse the terms and language of psychiatric medicine. It is not enough to point out that phrases such as ‘schizophrenic foreign policy’ and ‘a little bit OCD’ are offensive because they misrepresent and trivialize genuine and serious suffering. It is not enough to emphasize the biological basis of mental illness. To truly change public attitudes, the message must go out more often that this suffering can be alleviated.
In doing so, a powerful cultural myth must be challenged: that mental illness is a gift and comes with benefits. From the supposed enhanced creativity and meaningful visions of those with schizophrenia to the claimed cognitive wizardry and insight of people with autism, mental-health conditions are too often presented as just another way of seeing the world. This sense of instant karma might soften the blow to audiences, to some patients even, but it feeds the damaging impression that psychiatrists are out to rob special people of their gifts and unique potential. It is hard enough for people with mental-health problems to seek help, without their fearing those who are best placed to provide it.
What is so funny about OCD? The answer, Cefalu concluded, is the incongruity of the condition: the harder a sufferer tries to help themselves with comforting rituals, the worse their torment becomes. The way to break the destructive cycle, to treat the OCD, is to resist the ritual, to stop playing to the crowd. That was what Laura Jane Dean managed to do. That was her treatment. That is her story. And stories do not have to be funny to have a happy ending.
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Hollow humour. Nature 519, 261–262 (2015). https://doi.org/10.1038/519261b