The output of Hollywood cinema over the last decade indexes an increasingly sympathetic orientation towards issues surrounding mental distress, especially in biopics such as Ron Howard’s A Beautiful Mind (2001)…

…Stephen Daldry’s The Hours (2002)…


…and Christine Jeffs’ Sylvia (2003)


In Britain, as in many Western countries, television drama also sympathetically addresses the causes and consequences of serious mental distress, as in the young adult drama Losing It (Channel 4, 2002)…

…and institution-set dramas such as Poppy Shakespeare (Channel 4, 2008)

British soap operas such as the BBC’s EastEnders, meanwhile, have addressed issues surrounding mental distress in long-running storylines, such as those involving the bipolarity of the character Jean Slater…

…and the subsequent bipolarity of Jean’s daughter, Stacey.

Such dramatic representations have a strongly pedagogical purpose and their actors are often to be found ‘speaking out’ about mental health issues. For example, Lacey Turner, who plays Stacey Slater in EastEnders, mobilised her celebrity status in support of National Carers Week in 2006.

By setting out to improve the psychological well-being of the public, television documentaries such as The Happiness Formula (BBC, 2006) reproduce the sympathetic, advisory and pedagogical orientation of these fictional representations.


Freaks, geniuses or biological citizens? Discourses of mental distress in British television documentaries

by Stephen Harper

Ever since Michel Foucault published Madness and Civilisation in the 1960s, the public representation of madness has fascinated cultural critics. Today within the broad field of media and communication studies, a growing number of scholarly articles examine the mediation of mental distress, as well as several full-length books, including Otto Wahl’s Media Madness (1995), the Glasgow Media Group’s Media and Mental Distress (Philo et al., 1996) and, more recently, Gary Morris’s Mental Health Issues and the Media (2006) and my own Madness, Power and the Media (2009). Many of these writings catalogue and critique common media stereotypes about mental distress. Among other things, they seek to dispel the commonplace associations of madness with violence, stupidity, incompetence or incurability — stereotypes which, as I shall suggest here, persist in contemporary media representations of mental distress as part of the dominant ideological imagining of madness.

Yet dominant ideologies are as slippery as eels. In fact, the field of mental health and illness provides a pre-eminent example of how hegemonic media discourses are scrambled and rearranged as quickly as they can be identified. As well as generating old stereotypes, contemporary Western media forms now proliferate what might be called “positive” images of mental distress, that is, representations underpinned by an anti-stigma or awareness-raising agenda. From Ron Howard’s A Beautiful Mind (2001) to Stephen Daldry’s The Hours (2002), a plethora of Hollywood films from the last decade, while often reproducing stereotypical ideas about mental distress (mad women are tragic, for example, while madmen are heroic) attests to an increasing public awareness of – and sensitivity towards – issues of mental distress. This affirmatory shift is underwritten by a constellation of interests including those of pharmaceutical companies, health-promotion agencies, the state itself, and the subjective investments of individuals who are increasingly enjoined to monitor their mental well-being as part of their “will to health.”

One manifestation of this upswing in public awareness of mental health is the growth in cultural texts that stress the importance of cultivating happiness. Weighing the importance of happiness as a life goal, Zygmunt Bauman (2002: 138) argues,

“For most of human history, happiness was not the self-evident purpose of life. If anything, the contrary assumption prevailed. Suffering and pain were seen as permanent companions of life.”

Although Bauman may be underestimating the ancient Greek concern with eudaimonics here, the publication of books such as Richard Layard’s Happiness: Lessons from a New Science (2005), which argues that happiness can be taught, certainly do seem to signal a renewed social-scientific and governmental interest in the cultivation of psychological well-being. At the level of popular culture, meanwhile, television dramas and soap operas increasingly feature storylines that not only depict mental distress sympathetically but also implicitly offer guidance on how to avoid it in the first place. Thus a 2004 storyline in the long-running British soap opera, EastEnders, deals with Garry Hobbs’ mental breakdown and concludes with Garry receiving advice from his father-in-law about the importance of communicating one's negative emotions. Indeed, contemporary television’s images of mental distress are not only sympathetic towards sufferers – as attested by a range of dramas from young adult ‘infotainment’ films such as Losing It (Channel 4, 2002) to the institution-set Poppy Shakespeare (Channel 4, 2008) and the long-running EastEnders storylines involving the bipolar character Jean Slater and her daughter Stacey – but also have a pedagogical purpose, highlighting issues of social stigmatisation and medical prevention. Actors involved in such dramas often ‘speak out’ on mental health issues or champion mental health causes. Lacey Turner, who plays Stacey in EastEnders, for example, participated in National Carers Week in 2006.

This more sympathetic and advisory orientation towards questions of mental health is also commonly adopted in factual television. In the 2006 BBC2 documentary The Happiness Formula, for example, a variety of psychologists emphasize the importance of holidays, artistic endeavor, and other unalienated labour in combating “stress” and promoting happiness. The documentary ends with its narrator’s claim that “governments are now realizing people need to be happy as well as wealthy and are now working out how to convince us to change our lives.” In advanced capitalist countries, where most people are becoming poorer rather than wealthier — and where workers increasingly face longer working hours and fewer holidays (Bunting, 2004) — we should regard such economic progressivism and statist utilitarianism with due scepticism. Nonetheless, the documentary’s conclusion correctly identifies managing mental health as a central component of late-capitalist governmentality. In view of this institutional shift, some of the prevailing theoretical assumptions in this area may need reassessment. As the regulation of mental health assumes increasing importance in shaping people’s subjectivities, it seems increasingly less appropriate simply to discuss good and bad, accurate and inaccurate images of mental distress. In addition to a concern with verisimilitude — or perhaps in relation to it — we must also consider how discourses of mental health are articulated with, and animated by, contemporary capitalism’s ideological and bio-political imperatives.

In responding to this challenge we may draw some lessons from the history of cultural studies. In the 1970s, anti-sexist and anti-racist cultural studies began to replace the binary framework of “good/accurate” versus “bad/inaccurate” images of minority groups that had theretofore prevailed (Pollock, 1977) with a more flexible, anti-essentialist emphasis on difference. As the burden of representational correctness has lifted, critiques of minority representation have been loosed from their positivist prison, problematizing any talk of “true” or “accurate” representations of women or visible minority groups. In the same way, I would suggest, studies of media representations of madness can no longer rest upon essentialist psychiatric definitions of mental illness that take no account of class, gender or racial difference. Our task today is not to replace one set of images with another or to force every media representation of mental distress into a preconceived representational paradigm, but to understand how public images of madness are filtered through ideological discourses of race, gender and social class — discourses whose operations and effects much of the existing critical literature in this field fails to analyze.

It is equally important to consider how media images of madness intersect with Western societies’ regnant ontological assumptions about mental distress. One of these is the dominant psychiatric understanding of madness as “illness.” Put simply, the major problem here is that despite the recent growth of interest in the biomedicine of madness, most if not all psychiatric diagnoses are scientifically indefensible. Patients identified as “schizophrenic,” for example, share neither common symptoms nor prognoses (Read, 2004) and the clinical credibility of “schizophrenia” has been comprehensively demolished (Boyle, 2002). As the psychologist Elie Godsi (2004: 47) says of psychiatric diagnoses:

“Countless attempts to define particular illnesses through obsessively detailed descriptions have failed to achieve anything like acceptable levels of consistency. In any other branch of science this level of unreliability would have led by now to the abandonment of the original concept and a search for another.”

The validity of the medical model of madness, then, seems rooted in discourses of power rather than in empirical reality. Since the end of the period of post-war reconstruction and social reformism in the 1970s, the medical model of madness has enjoyed a resurgence, switching the focus of research from social to biological contexts. As a result, the parameters governing public discussions of the causes of mental distress have narrowed. As Bradley Lewis (2006: 47) puts it:

“This is an era that seems naïve and unsophisticated about the multiple dimensions of depression. The vast majority of clinical discourse embraces a biological model that describes depression as a medical disease involving neurological pathology.”

This medical paradigm exerts an increasing influence on psychiatric treatment. As Western nations transition between Foucauldian “disciplinary societies” characterized by physical enclosures (such as psychiatric institutions) to more “fluid,” Deleuzian “societies of control,” pharmaceutical regulation assumes an increasingly central role in the project of social domination, despite unconvincing evidence for the efficacy of most psychiatric medications. More and more, madness is individualized as a brain disorder in need of pharmaceutical intervention rather than seen as the result of social inequalities and stressful living conditions that require political and structural redress (Fisher, 2009).

Indeed, a key premise of my argument here is that the medical model of mental distress is less useful than the social model, according to which social pressures play the most significant role in the onset of psychological disorders. At the microlevel, the term “social” might designate the individual’s relationship with her family. Thus, relationship breakdowns and bereavement are common causes of mental distress. In cases of long-term distress, childhood experiences of neglect or abuse, whether physical, verbal or sexual, also have a causal impact. Godsi (2004: 65) states of those who experience chronic mental distress that “invariably their distress or violence essentially originates from tragic or traumatic childhood experiences.” As Rogers and Pilgrim (2001: 67) summarize,

“Reviews of the literature on the immediate and long-term effects of sexual abuse on child victims come to the conclusion that there is strong evidence that they are significantly more prone to mental distress than non-abused children.”

Such domestic experiences of powerlessness and victimization are, in addition, surely related to the Hobbesian dynamics of capitalist society, which increasingly pits individuals against each other in a battle for employment, resources and status (Godsi, 2004: 198–9).

At a macrolevel, it is easy to demonstrate an overlap between mental distress and social inequality. Studies have long shown links between serious mental distress and social isolation (Faris and Dunham, 1939), unemployment (Brenner, 1973; Clark and Oswald, 1994; Biddle et al., 2008) and poverty or low pay (Brown and Harris, 1978; Campbell et al., 1983; Theodossiou, 1998; Werner et al., 2007). A study conducted by the Greater Glasgow Health Board in 1999 also shows very strong correlations between poor mental well-being, poverty and alcohol and drug abuse (McKeown, 1999: 14). Social class plays a key role here: Brown and Harris (1978), for example, find that working-class women are four times more likely to experience depression than middle-class women. Indeed,

“the finding that higher prevalence rates for a range of mental health problems are to be found amongst those in the lowest social classes is firmly established” (Pilgrim and Rogers, 2003: 18).

Of course, scholars debate the nature and causative direction of this correlation between class and mental illness; they often take sides with social causation theory or “social drift” theory — according to which social deprivation is a consequence rather than a cause of diagnosis, this debate has proved difficult to resolve (Pilgrim and Rogers, 1993: 13–16). But Christopher Hudson’s (2005) large-scale, seven-year study of the correlation between mental distress and unemployment, poverty and the unaffordability of housing in the United States strongly supports the theory of social causation as opposed to drift theory, as well as showing large gaps in mental illness rates between people from rich and poor areas. At the very least, we can say that the research mentioned above, combined with the paucity of evidence for biological causation, warrants the assumption that

“a large proportion of behaviors that are currently regarded as mental illnesses are normal consequences of stressful social arrangements” (Horwitz, 2002: 37).

The objection to the medicalization of madness is not only that it individualizes suffering that is social in its cause and nature, but also that it may even lead to the stigmatization of sufferers. In his assessment of the pros and cons of the “illness model” of mental distress, Len Bowers (2000: 158) suggests that the medical model “facilitates the treatment of ‘mental illness’ in a non-stigmatising, humane manner.” Yet the evidence to support this assertion is far from unambiguous. Kirk and Kutchins (1999) argue that the medicalization of distress increases the stigmatization of sufferers; some research even suggests that

“doctors stigmatize psychiatric patients more than the general public do” (Lawrie, 1999: 129).

Farina et al. (1978) and Fisher and Farina (1979) have shown that those with psychological problems who conceptualize themselves as having a “disease” are more likely than those who do not to feel helpless about their recovery and to abuse drugs or alcohol. Read et al. note that “knowledge” about mental distress is often equated with the espousal of an illness paradigm. Through a meta-analysis of international research, however, they show that most members of the public prefer psychosocial explanations of distress to biogenetic ones and that biogenetic beliefs and diagnostic labelling are positively related to prejudice, fear and a desire for distance from the mentally distressed. They conclude that anti-stigma campaigns should avoid decontextualized biogenetic explanations as well as terms like “disease” and “illness.” Evidence from electric-shock experiments, meanwhile, suggests that while the public is less likely to blame sufferers with disease diagnoses, they tend to treat them more harshly than those who have been given psychosocial explanations for their problems (Mehta and Farina, 1997). More recently, a review article by John Read et al. (2006) challenges the assumption that the “mental illness is an illness like any other” approach is the most effective way to tackle stigmatization.

Drawing all of these arguments together, I argue here that British television documentaries contribute to a growing body of positive cultural representations of mental distress. Nevertheless, they also revive longstanding stereotypes (particularly that of the “mad genius”), express sexist and class-biased assumptions, and typically reinforce the desocialized biomedical framing of mental distress.

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