Media and mental health

In India, people are increasingly using new media technology (e.g., smartphones, tablets, laptops, and desktops for Internet access), with increasing frequency to text message, E-mail, blog, as well as access social networking websites (like Facebook, Twitter, WhatsApp, Instagram etc.) for business, entertainment, and to stay in touch with family and friends and simultaneously acquiring information about national and world events from other traditional sources of mass media (like television, newspaper, magazines, books, movies, radio etc.). Mass media have a strong effect on our expectations for family, parents, and children, creating standards for our way of life, affection, worship, and society. In simple words, we view reality in terms of our own experience that is influenced by primary groups (Family and Friends); secondary groups (School, religious institutions, and government), and mass media. While the influence of the primary group is waning and the secondary groups are time limited, the influence of mass media is increasing as it is a pervasive and permanent fixture of our lives. The influence of mass media increases when the number and strength of the other sources of influence decrease. There is no longer debate about the impact of the media on the thinking, behavior, and emotions of the general population. In addition, the effects may be pro-social or even anti-social. Mass media serve as socializing agents that aids in construction and perpetuation of perceptions and learned behaviors.[1] Serving as a central source of information, mass media not only reflect public attitudes and values but also take part in shaping them. The effects of mass media are partly unintentional due to news and entertainment programs. However, the media also do this intentionally for monetary gain (by advertisements), achieving social good (sponsored programs), or political purpose (biased or “paid” news). Media have played a role in breaking down misconceptions and myths about homosexuality, leprosy, and HIV/AIDS. It is hoped that it can do the same for psychiatric disorders.

Media and stigma of mental illness

The media contribute to mental illness stigma through the exaggerated, inaccurate, and comical images, they use to portray persons with psychiatric disorders as well as providing incorrect information about mental illness.[2] Two mass communication theories, cultivation theory, and social learning theory work in tandem to influence the construction and perpetuation of mental illness stigma.

Cultivation theory proposes that those who spend more time “living” in the virtual world of television may perceive the “real world” as per the imagery, principles, and portrayals depicted on the small screen. People who spend a lot of time watching television are likely to assume a television worldview of mental illness.[3]

Social learning theory suggests that learning is achieved not only through direct experience but also through observation. People acquire knowledge about behaviors as well as social conventions such as rules of conduct from television. Television teaches or reinforces social conventions about how to treat persons with psychiatric disorders.[1]

In the absence of actual experience with people with mental illness, individuals rely on the media for their perceptions of those who have mental illnesses.[4] Unfortunately, the media consistently portrays persons with mental illness as violent, murderous, unpredictable and have themselves to blame for their condition, are gross exaggerations and misrepresentations of reality and completely untrue.[2,5] This has resulted in the belief in the general population that persons with psychiatric disorders are uncontrollable and dangerous and should be feared and avoided. Research has shown that negative views of individuals with mental illness are directly proportional to the time spent in watching television. Regular viewers hold more negative views compared to those who watch television for very short period.[6]

Representation of psychiatric disorders in the media

Distortion of images

News reports often are sensationalized including dramatic descriptions of violent attacks and murders committed intentionally by persons with psychiatric disorders. Indeed, mental disorders are among the causes for the rise in violence among children and youth.[7] The media do not make it clear to the public, however, that only a minority of those afflicted with Mental Disorder commit severe crimes and that the actual occurrence of violence by persons with mental illness is less than by so-called normal people.[8,9]

Very common in television dramas or films are depictions of persons afflicted with Mental Disorder as violent and unpredictable, as victims, or as incapable of holding down a job.[10,11] What is prominent in television programs is not only the connection of violence with people afflicted with mental disorders but also the tendency to place responsibility for scandals and tragedies associated with them on the policy that supports deinstitutionalization and community-based services.[12]

Gender bias

Another type of mass media distortion of mental disorder is evident in the sexist stance applied to them. Men were overrepresented as having serious mental illness such as psychoses, personality disorders, and childhood problems. In contrast, women were over-represented with problems and models of sexual dysfunction, neuroses, and so on. Discrimination of women is apparent, too, in the higher proportion of male experts portrayed in the mass media as involved in the mental health field than is the case in reality.[11]

Distortion of images of professionals and healthcare services

Mass media not only stigmatize psychiatric disorders but also male psychiatrists who are portrayed as weird jesters, evildoers, crazy, sexually depraved, lustful, oppressive, and vindictive. On the other hand, female psychiatrists are portrayed as persons with emotions bottled up, controlling, and deprived of love and satisfaction.[13] Advertisement of psychotropic drugs add to the distorted images of the psychiatrists by emphasizing the psychiatrists' power over patients' subservient status and their control of patients by means of these drugs.[14]

Distortion of the causes of mental disorders and their treatments

In coverage of the discovery of the genes associated with schizophrenia and manic depression, there was a marked tendency to genetic determinism and overoptimism in regard to the genetic causes of psychiatric disorder and their treatment. Moreover, such descriptions could foster a public perception of genetic research as involved in a moral problem because of its comparison with eugenics.[15] Mass media also are largely responsible for the negative attitudes of the general population as well as medical students toward the use of electroconvulsive therapy for persons with psychiatric disorders and its perception as being cruel and painful, as a cause of brain damage, and its use solely as punishment for persons with mental disorder who are violent or uncooperative.[16]

EFFECT OF MEDIA ON CHILDREN AND ADOLESCENTS

Negative effects of Media on child's mind are due to factors such as immaturity (concrete thinking) and inability of the child to distinguish fantasy from reality, particularly when programs are similar to “real life” situations. In addition, time spent with media decreases the amount of time available for pursuing other more healthy activities such as sports, physical activity, community service, cultural pursuits, and family time. Children who watch more television than their peers experience significant impairments in comprehending stories, a crucial skill in achieving academic success.[17]

Mass media viewing and social isolation

As children spend more total time watching/gaming on mass media, they spend a significantly shorter amount of time with friends as compared to those who don’t and similarly less amount of time with their families.[18] As a result, excessive media viewing may lead to poor peer relationships (risk for social isolation) and antisocial behavior (including aggression and gang involvement). Social isolation, in turn, causes them to turn to TV for entertainment and companionship. In addition, children who are marginalized by their peers use TV to escape the stresses of their lives and meet their social needs. Violent television viewing may influence younger children to be more antisocial; resulting in their becoming socially isolated which, in turn, attracts them to more violent media.

Media and violence

Violence on television is often glamorized. Violent acts are perpetrated by good characters. Violent acts go unpunished, and perpetrators show no remorse for their actions. At the same time, violence is often sanitized. Victims of violence show no pain or momentary and minimal pain. Violence is also trivialized. Violent scenes are lethal but are portrayed as humorous.

Effects on children of violence shown on television

Children who are constantly seeing violence in mass media become more used to thinking about violence. They tend to believe that the world is more hostile than it really is. Violence in television promotes aggressive behavior in children who are less likely to believe that aggression and violence are wrong. It promotes the acceptability of behaving aggressively and desensitizes him to thinking about violence.

After observing violent actions in media, children may imitate aggressive behaviors through modeling and identifying with actor, especially if the actor is rewarded for his aggressive behavior. After watching violence on television programs, children learn social scripts of complex, aggressive behavior for social problems solving. With the scripts, child fantasizes behaving in that way to solve problems.

Exposure to media violence (through excessive violent video games or violent TV programs) has been positively related to subsequent aggressive behavior, ideas, arousal, and anger. Excessive exposure to violence through media adversely affected psychosocial adjustment and school performance of children.[19] Some of the fears, tensions, bad dreams, and tendencies toward the delinquencies of children are a result of frequent and regular exposure to television serials filled with violence and torture and murder-mystery movies. Association between TV viewing and suicidal behavior has also been reported from India.[20] A direct relationship exists between the frequency of viewing films depicting horror and violence during childhood, and the frequency of playing violent electronic games in adolescence with the quantum of violent behavior and delinquency at the age of 14 years.[21]

MEDIA AND GENDER

Display of gender differences as reality

Mass Media (Television serials and movies) consistently stereotype girls as obsessed with shopping and boys. They discuss frivolous topics and are incapable of having a serious conversation about academic interest or career goals. Messages sent through media about sexuality usually center on the male sexual role. A common theme is that men usually view woman as sexual objects, and value them based on their physical appearance was particularly common. Messages on female sexual role underline that women are attracted to physically strong, attractive, wealthy, romantic, or sensitive men (brawn or bank balance not brain). Mass media often portrays sexual harassment in humorous ways with victims experiencing little harm or difficulty in stopping the harassment.[22]

Portrayal of sexual behavior in media

Sexual portrayals in media often provide young people with powerful messages concerning the expression of sexuality, appropriate sequences of sexual behavior, and reasons for having sex. There is a trend of initiation of sexual intercourse by younger adolescents, which is partly blamed on exposure to sexual content in the mass media.

MEDIA AND SUICIDE

There is evidence to suggests that particular mode of reporting and portrayal of suicide in the mass media may result in increased rates of suicide in vulnerable people.[23] By modifying their reporting and portrayal of suicide, the media can contribute to suicide prevention as was proved by the Vienna experiment where changes in media reporting resulted in a > 80% reduction in the number of subway-suicides and suicide-attempts.[24] The protective media effects are termed the Papageno effect, as opposed to the harmful Werther effect.[25] The consensus at present is that prominent display of media reports about suicide result in a significant increase in suicide attempts, especially among adolescents and young adults, within the media outlet's coverage area. Based on research experience, a number of guidelines on media reporting have been formulated.[5,26,27,28] While reporting suicide, media have to avoid generalizations based on little evidence and shun catchy, sensational but inaccurate expressions such as “epidemic of farmer suicide” or “suicide capital of the world”; etc. Before releasing the news, the journalist/editor should consider its effect on families and other survivors regarding both stigma and psychological suffering. Sensational reporting in explicit detail of suicides or self-harm especially when a celebrity is involved is probably the norm and may be legitimate news. However, it should actually be avoided or minimized to the extent possible. Detailed descriptions of the method used and how it was procured should be completely avoided.

In print media, the news should not appear on the front page with a banner or large font headline and not mention suicide. The method should not be mentioned in the headline like “jumped from a building”. Mentioning the full name or other personal information of the deceased or attempter or printing his photo or location may pass a wrong signal to the vulnerable people that committing suicide can make them famous. Do not illustrate the suicide method or venue of suicide in graphic presentation. The reporting should pay special attention to this. The reason for suicide must not be oversimplified.Suicide never occurs due to a single factor or event, but is the result of a complex interaction of a number of factors and often there is a background of psychosocial problems. It should be emphasized that the overt cause was the precipitating event and not the only cause of the suicide. While publicizing the background factors that may have played a causative role is neither necessary nor desirable, they should be acknowledged. Any history of psychiatric disorders including drug abuse should be mentioned.

In the visual media, avoid presenting suicide cases as the headline TV news unless the reporting involves public interest; avoid repetitive, ongoing and excessive reporting of the events. The breathless excitement of the reporter should be tempered by the tragic event that he is reporting. Mourning the dead is appropriate. Glorification of the suicide victims as martyrs may encourage vulnerable persons to imitate the behavior to win public adulation. Highlighting the adverse consequences of deliberate self-harm (brain damage, paralysis, etc.) may deter future attempts.

Celebrity suicide

Undoubtedly, celebrity suicide has great news value; however, it can also influence the vulnerable and suicidal people. The reporting should be cautious, factual and mourning and not glorify, sensationalize or romanticize. While oversimplification of the causes of suicide should be avoided, a history of psychiatric disorder including alcohol or drug abuse should be clearly stated. Repetitive reporting of a celebrity suicide should be avoided since susceptible people may develop enhanced suicidal ideation on being inundated and overwhelmed with details about a specific suicide.[29,30]

Interviewing surviving relatives and friends

In the immediate aftermath of suicide, the grieving relatives and friends may have fluctuating emotions, anger, and even suicidal thoughts. Out of humanitarian considerations, the media should avoid disturbing them for a sound bite. The relatives and friends are unlikely to reveal any earth-shattering news but may say things which they would regret later. Great restraint and sensitivity is called for if the relatives have to be interviewed. Publishing photographs of the deceased or the surviving relatives should be avoided as it may greatly hurt them.[5,26,27,28,31]

REPORTING MENTAL ILLNESS

Good media reports about mental illness are responsible, accurate and balanced. They help the community better in understanding the experience of mental illness by including the perspective of people with mental illness, carers, and mental health workers and encourage help-seeking behavior. Some issues which should be considered while reporting on issues concerning mental health and mental illness are as under.

Humanizing mental illness

Emphasize that mental illness is real, common, and treatable. Feature stories about people with a mental illness playing an active role in the community. Emphasize the impact that mental illness has on family members, friends, and carers.

Offering hope to persons with mental disorders

Highlight stories about the successful management of mental illness by interviewing recovered patients and their carers. At the same time, raise awareness about the challenges associated with managing a long-term mental illness.

Encouraging people with mental illness to seek help

Emphasize the importance of early recognition and treatment of mental illness. Lay stress on the fact that mental illness like most other diseases is amenable to treatment. Raise awareness about mental health services and encourage people in distress not to delay seeking help.

Give accurate information about psychiatric disorders

Provide correct information about psychiatric disorders from reliable resource persons. The complexity of psychiatric disorders should be highlighted. It should be emphasized that mental illness covers a wide range of symptoms, conditions, and effects on people's lives, but most of them improve with treatment.

Language and stereotypes for patients with psychiatric disorders: Every effort should be made by people working in the media to use appropriate language. Negative terms, such as “mental patient,” “nutter,” “lunatic,” “psycho,” “schizo” and “mental institution,” should be avoided as they stigmatize mental illness and perpetuates discrimination. Referring to someone with a mental illness as a “psycho,” “madman” or “afflicted by” a mental illness is pejorative. Do not refer to a person as “an alcoholic” or “a schizophrenic;” they have a diagnosis of, currently experiencing, or are being treated for the disorder. Avoid using colloquialisms in place of accurate terminology for treatments of mental illness, such as “happy pills” for antidepressants and “shrinks” to refer to psychiatrists. It trivializes the illness and its treatment and may discourage persons from continuing treatment.[5,26,27,28,31]

CONCLUSION

Mass media due to its tremendous reach and constant exposure have the unique ability to alter perception and sway popular opinion of large number of people. In fact, the media shape our ideas and understanding of various issues and events. The frequently negative and imprecise portrayals of mental health issues in general and persons with psychiatric disorders in particular, reinforce mistaken beliefs and myths about mental illness. This is worsened by exaggerating and sensationalizing unusual behaviors exhibited by the mentally ill. Persistent repetition along with reporting intricate details about various aspects of suicidal behavior may help TRPs but can and does harm society and should be avoided. An awareness of these adverse consequences and sensitive reporting of issues relating mental illness in general and suicide in particular may contribute to reducing suicide rates and addressing stigma and discrimination associated with mental illness.