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Media and mental illness: Relevance to India

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April-June 2014 | Volume 60 | Issue 2

Journal of Postgraduate Medicine • Volume 60 • Issue 2 • April-June 2014 • Pages 113-226
Narrative Review
Media and mental illness: Relevance to India
Padhy SK, Khatana S, Sarkar S

Department of Psychiatry, Abstract

Nehru Hospital,
Postgraduate Institute of
Medical Education and
Research, Chandigarh,
India
Address for correspondence:
Dr. Siddharth Sarkar,
E-mail: sidsarkar22@
gmail.com
Received : 31-05-2013
Review completed : 26-06-2013
Accepted : 05-09-2013
Media has a complex interrelationship with mental illnesses. This narrative review takes a look at the various
ways in which media and mental illnesses interact. Relevant scientific literature and electronic databases
were searched, including Pubmed and GoogleScholar, to identify studies, viewpoints and recommendations
using keywords related to media and mental illnesses. This review discusses both the positive and the
negative portrayals of mental illnesses through the media. The portrayal of mental health professionals and
psychiatric treatment is also discussed. The theories explaining the relationship of how media influences
the attitudes and behavior are discussed. Media has also been suggested to be a risk factor for the genesis
or exacerbation of mental illnesses like eating disorders and substance use disorders. The potential use
of media to understand the psychopathology and plight of those with psychiatric disorders is referred to.
The manner in which media can be used as a tool for change to reduce the stigma surrounding mental
illnesses is explored.
KEY WORDS: Media, mental illness, portrayal, psychiatric

Introduction India being the largest democracy and with fairly unrestricted
media is likely to be a case in point about how media influences

T      he term media collectively refers to the main means

of mass communication. The means of media can be in
the form of Internet (the World Wide Web), television, radio,
newspapers, magazines, newsletters and various forms of print
media. The primary aim of the media is communication, with
the goal of educating, informing and entertaining the audience.
Media acts as a mirror of the society and, in turn, influences
the perception and behavior of individuals.
Media and mental illnesses interact with each other in many
complex ways as shown in Figure 1. Media may act as the
primary source of information about mental illnesses and may
shape the perceptions and attitudes about mental illnesses.
Media portrayal may stigmatize mental illnesses as well as act
as a means of reducing inaccurate perceptions. Media can act
as risk factors for certain forms of mental illnesses. Specific
forms of media, especially films, can be used as a means of
understanding psychiatric disorders and the treatment methods
that are available.
Access this article online
Quick Response Code:
the perception of mental illnesses. This narrative review takes a
look at the interface of media and mental illnesses from various
perspectives, including how media portrays mental illnesses,
how it impacts patients with mental illnesses, how it can act as a
risk factor for mental illnesses, how it can be used to understand
psychopathology and how it can be used as a tool for change.
Portrayal of Mental Illness, Mental Health Professionals
and Treatment
It has been shown that media portrayal can influence one’s
perception about mental illnesses. Media influence can
override personal experiences in relation to how mental illness
are viewed.[1,2] Media can perpetuate the negative stereotypes
associated with mental illnesses. Often, persons with mental
illness are depicted with negative attributes like being unlikable,
dangerous, aggressive, violent, asocial, untrustworthy and
incompetent.[3-8] Media reports of homicides attributed to the
mentally ill seem to be depicted in a more stigmatizing manner
as if to emphasize that they were different from homicides
committed by others.[9] Labeling people with mental illnesses
as dangerous and violent reinforces the public view of fear and
anxiety toward the mentally ill.[7,10]

Website: Perpetuation of stigma by the media towards mental illness

www.jpgmonline.com
is an important problem that requires concerted attention.
[7,11]
One feature of depiction of mental illness in the media is
the omission of specifics. Often, the description is carried out
of a “psychiatric patient” or “mentally ill.” Because there is a

Journal of Postgraduate Medicine April 2014 Vol 60 Issue 2 163 

 Padhy, et al.: Media and mental illness
Figure 1: Media and mental illness – interplay
variety of mental disorders each with different manifestations,
giving a common label to all may lead people to generalize.[12,13]
The qualifiers like “severe” if used indiscreetly may lead to an
inaccurate portrayal of mental disorders and misunderstanding
of psychiatric diseases. Movies like “Psycho” and “Halloween”
may increase the anxiety and fear about the mentally ill patients
among the general public and lead to further distancing and
stigmatization.[14]
Whether particular forms of media impart a balanced view of
the mentally ill has been scrutinized. Some forms of media like
general circulation magazines have been suggested to present
a more accurate and positive depiction of mental illness than
prime time television.[15,16] Individuals who reported receiving
their information primarily from the electronic media (e.g.,
television, film) reported less tolerance toward individuals with
mental illness than those receiving information primarily from
the print media.[17]
Media not only portrays mental illness in a negative manner but,
at times, also provides positive depictions. Movies, newspapers,
magazines and newsletters have made attempts to correctly
inform and educate people about mental illnesses. Personal
accounts of patients and sensitive depictions in movies like
“As Good As It Gets” have attempted to deliver a fairly accurate
image of psychiatric illnesses and their sufferers. Mass media
provides an opportunity to fill the knowledge gaps of the general
public about mental illnesses. Whether the gap is filled by
accurate and correct description or by inaccurate inflated reports
remains a question that requires consideration. This question
is especially important as the knowledge about psychiatric
illnesses is generally low in India and misconceptions about
mental illnesses abound.[18]
As with mental illnesses, media portrayal of psychiatrists and
mental health professionals might not have been always positive.
They were quite often portrayed as neurotic, unable to maintain
professional boundaries, substance users, rigid, controlling,
ineffectual, uncaring, self-absorbed or mentally unstable.[19]
 164 Journal of Postgraduate Medicine April 2014 Vol 60 Issue 2
In very few films like Good Will Hunting (1997) and Ordinary
People (1980) have they been depicted as empathic. In Indian
cinema too, as in the West, psychiatrists have been caricatured
and at times shown as vile or unprofessional.[20,21]
In both Bollywood and Hollywood movies, the depictions of
psychiatric treatment, especially electroconvulsive therapy
(ECT), were inaccurate, distorted and dramatized. ECT
was shown to be administered by force to punish, to torture,
to obliterate identity and to induce insanity.[21] The clinical
evidence of safety and usefulness of ECT, which is one of
the most effective forms of psychiatric treatment in severe
mental illness, had been largely overlooked.[22] ECT treatment
has been depicted to cause mental disturbance and amnesia
without clinical improvement in movies like Raja, Damini,
Khamoshi, Jewel Thief, Rat aur Din, etc.[23,24] Other extreme
forms of treatment like lobotomy and forced medication
have been depicted in movies without a clear indication and
rationale, suggesting a rather coercive side to psychiatric
treatment.[25]
It seems likely that psychopharmacological treatments have
been subjected to a negative portrayal too. Psychotropic drugs
have been found to have a lower acceptance than cardiac drugs,
and were believed to cause significantly more severe side-effects
and provoke more fear of losing control. Such opinions rather
seemed to be fueled by media reports.[26] Psychotropic drugs
are apparently discussed less objectively in the medical context
than the other medications.[27] Such negative attitudes have
been apparently decreasing with time.[28]
At times, live electronic and print media give a comparatively
positive picture of psychiatrists and psychiatric treatments.
Some magazines and newspapers publish columns and write-
ups about psychiatric illnesses and their treatment, and aim to
dispel myths. Live chats and interviews also give an opportunity
to hear out practicing professionals and ask pertinent questions
about psychiatric disorders.
Attempts have been made to understand how media imparts
knowledge and influences the attitudes, behaviors and views of
individual. Two mass communication theories are particularly
relevant in this regard: The “social cognitive theory”[29] and the
“cultivation theory.”[30] A major component of social cognitive
theory is “symbolizing capability,” which means that people
process and transform transient experiences into cognitive
models using symbols that act as guides for judgment and
action. Depictions of people who are mentally ill act as symbols
of mental illness as a whole and can also provide viewers with
the virtual experience of what a person with a mental illness
must be like. Television is a primary example of a tool used
to provide people with such vicarious experiences. Heavy
exposure to these vicarious experiences may become reality
to the viewer through the cultivation theory. The cultivation
theory states that the more one views certain material, the
more likely it becomes the reality for him, i.e. people who
watch a lot of television are more likely to express opinions
and hold values similar to those represented on television and
the content watched.
 Padhy, et al.: Media and mental illness
Does Media Act as a Risk Factor for Mental Illness?
Whether media predisposes a person to mental illness has been
a matter of query. The association of media and various mental
illness and psychiatric disorders has been evaluated.
Media and eating disorders
Exposure of women to glamorously thin images in the media
has been suggested to lead to body image dissatisfaction and
low self-esteem. This has been suggested to lead to a drive for
thinness and a quest for dieting, which may result in eating
disorders.[31-34] It is difficult to conclude whether media plays
a causal role, acts as a trigger or is just another confounder for
those who are otherwise predisposed. It is possible that only
those individuals having pre-existing anxiety, depression, low
self-esteem or genetic liability are vulnerable to cultural demand
and develop symptoms of eating disorders.
Regional variations exist in the body image dissatisfactions in
relation to the media. In Iran, ban on Western media after the
fall of the Shah precluded being exposed to the thin body beauty,
leading to a higher body esteem of Iranian female students.[35]
Eating disorders had not been recorded until the advent of
televised media on the Fiji islands.[36,37] Countries like India and
China also reported cases of eating disorders after 1990 with
wider exposure to the Western media.[38] Muscular dysmorphia,
a type of “reverse anorexia” in males with preoccupation on
muscle bulk, has emerged as a male counterpart of anorexia
nervosa seemingly fuelled by media portrayal of lean and
muscular men.[39]
Media and suicide
The role of fictional portrayal of suicide-leading imitative acts
began in the late 18th century, when Goethe released his novel
“The Sorrows of Young Werther,” wherein the protagonist
ends his own life due to unrequited love. A few deaths by the
same means as the protagonist led to use of the term “Werther
effect” to describe the hypothesized association between
media portrayal of suicide and imitative acts by observer. Such
imitative suicidal behavior has been observed worldwide.[40]
In India, Chowdhury et al.[41] reported 18 cases of copycat
suicides after media reports of a judicial hanging, and 17 other
imitation acts. Such copycat suicides and attempts have even
been observed in young children,[42] and have otherwise led to
political repercussions.[43]
Many factors have been evaluated as risk factors of imitative
suicidal behaviors. It has been seen that imitative suicides are
more common within 2 weeks of the first event, with greater
media coverage, repeated coverage and high-impact stories,
when the person described in the story and the reader/viewer
are similar in some way, when the person described in the
story is a celebrity and is held in high regard by the reader/
viewer and particular subgroups in the population (e.g., young
people, people suffering from depression and substance use
disorder).[44-47] Farmer suicides is another issue that has been
highlighted by the media, constructively raising awareness
about the stress and plight of the farmers[48] and sensitizing
the authorities.[49]
Journal of Postgraduate Medicine April 2014 Vol 60 Issue 2 165 
Media and substance use
Media can play a key role in the initiation and accentuation of
substance use. Research has revealed that advertising may be
responsible for up to 30% of adolescent tobacco and alcohol
use. [50,51] Exposure to tobacco marketing and advertising
increases the smoking initiation rates in teenagers more than
two-fold.[52] Advertisements and promotion of cigarettes have
been increasing in developing countries like India due to a
sharp decline in sales in Western countries, and pose as a
major concern.[53]
Media research also shows that, alcohol and tobacco appeared
in the majority of the movies. Illicit drugs were commonly
shown in a large proportion of movies[54] as well as through the
television.[55] Characters in the movies or television are often
shown smoking as a part of daily life. Covert sponsoring of mega
sport events like international cricket matches and bravery
awards surreptitiously aim to promote tobacco products. These
may attract the vulnerable adolescents toward smoking as a
desirable “grown up” activity.[56] A study from India suggests
that those children who are exposed to cigarette brand names
through television are more likely to smoke, while those exposed
to anti-tobacco messages are less likely to smoke.[57] Such
marketing strategies need to be countered to reduce initiation
to substance-taking behaviors.
Media and internet addiction
Internet addiction has emerged as a new form of behavioral
addiction with the popularization and easy access of the World
Wide Web.[58] Dependence on the Internet seems to have
criteria similar to that of pathological gambling and other
substance use disorders. It has been seen that Internet addiction
is present in a significant proportion of the youth in countries
like South Korea and Taiwan.[59] It has been suggested that
Internet addiction coexists with other psychiatric disorders like
substance use disorder, attention deficit hyperactivity disorder,
depression and anxiety.[59,60] Because India also possesses a
gradually expanding Internet-using population, it is likely
that Internet addiction and comorbid problems would be
encountered more frequently.[61]
Media and sexual behavior
Media in the form of television, magazines or movies has
been found to be an important source of sexual information
to the teenagers.[62] Adolescents who selectively viewed more
sexual content on television were more likely to have sexual
intercourse in the preceding year.[63,64] Media exposure to
pornography may lead to experience of conflict, suffering and
sexual dissatisfaction.[65] Media exposure to sexual themes may
have a negative effect on the attitudes toward women, and may
portend to a greater propensity to indulge in coercive intimate
encounters and experimentation.[66-68] On the other side, when
used correctly, media can have significant positive impacts on
sexual health-related attitudes, beliefs and behaviors.[69,70] Mass
media can provide knowledge about healthy sex, contraception,
family planning, sexually transmitted diseases and treatment
of sexual disorders. Viewing advertisements about human
immunodeficiency virus (HIV) have led to a reduction in the
reported number of sexual partners by both men and women
 Padhy, et al.: Media and mental illness

and increased condom usage.[71] In India too, mass media
including television and radio were the most important sources
of information about HIV.[72] Several international studies have
found that women who view more family planning messages
on television, radio and print media are more likely to use
contraceptives than those who see fewer messages.[73,74]
Media and depression
Exposure to significant levels of television and other electronic
media during the teenage years has been suggested to influence
depression during young adulthood, especially among men.[75]
Media exposure at night may disrupt sleep, which is important
for normal cognitive and emotional development. In addition,
messages transmitted through the media may lead to fear,
anxiety and aggression. The new face of social media in
the form of Facebook and others may cause depression in
teenagers.[76] The association between social media use and
depression may not be a very robust one as there evidence to
the contrary.[77] Whether media multitasking is used by persons
who are depressed and anxious as a means of distraction needs
to be evaluated.[78]
The rise and acceptance of social media has been particularly
marked in India. Although it may act as a means of making
friends and gathering social support, it may lead to stress in
some individuals.[79] Because social media websites are among
the most commonly accessed websites in India with a large
quantum of users,[80] it is likely that social media may negatively
affect a large segment of the population through concerns about
social image.
Media and post-traumatic stress disorder (PTSD)
Media viewing of tragic events may produce PTSD symptoms
in vulnerable populations such as children. It was seen that
5.4% of children who indirectly witnessed through media the
terrorist attacks of 11 September 2001 developed symptomatic
PTSD.[81] The amount of television viewing predicted increased
risk of PTSD. Similarly, in adults, PTSD symptoms markedly
developed in those who had high-trait anxiety and were exposed
through the media to the terrorist attacks.[82]
Media and aggression
The potential relationship between media exposure to violence
and subsequent violent behavior has been a matter of clinical
enquiry for quite some time. Reports have shown that childhood
television watching is associated with higher rates of aggression
in later life.[83,84] The time spent on the media devices has been
found to be a better marker of further violent behavior than
the actual content.[85] On the other hand, there are studies to
suggest that television violence does not influence children’s
behavior or make them excessively prone to violence.[86,87]
Neurogenetic and environmental factors apparently interact to
increase the risk of the development of aggression in violence-
prone personalities.[88] Media may just act as a stylistic catalyst,
i.e. when an individual with high-violence proneness decides to
act violently, he or she may model it on what was encountered
through media. However, because aggression is multifactorial in
origin, no single factor including media influence can be pinned
down as a dominant influence.[89]
Media to understand psychopathology
Media can be used to understand psychopathology and learn
about mental illnesses. Although movies are rarely made to depict
psychiatric illnesses per se, they often aim to show real human
beings with emotions and afflictions. Psychiatric disorders
that are out of the ordinary experience are often used to build
characters that intrigue and entice. Such character depictions
may provide an opportunity to understand psychopathology in a
far interesting manner rather than conceptualizing from books.
Some of the representative movies with depiction of specific
psychiatric disorders are shown in Table 1.
Through movie club discussions, psychopathology can be
deliberated and understood better. [90] It can be used to
understand the dynamics of suicide – about the intent to
die and the wish to be rescued, which have been depicted in
films like Scent of a Woman (1992), Ordinary People (1980)
and Night Mother (1986). Traumatic experiences related
to dissociative disorders include death, witnessing death or
exposure to death (as in Three Faces of Eve).[91] Bipolar disorders
have been suggested to fuel the creative process of numerous
artists and composers, and some of the movies have been able
to capture this effectively, e.g. Patch Adams (1998). Movies
can be helpful in understanding not only specific psychiatric
disorders but also for unconscious defense mechanisms, e.g.
altruism of a doctor who devotes himself to people in India in
City of Joy (1992), suppression in Gone with the Wind (1939)
and intellectualization in Lorenzo’s Oil (1992).
Indian cinema has also aptly depicted psychiatric ailments.[20,92,93]
While Raaz deals with personality disorder, Taare Zameen Par
takes dyslexia as a theme of the movie. Devdas dwells on alcohol

Table 1: Depiction of psychiatric disorders in the movies

Disorder
Dissociative disorders
Schizophrenia
Substance use disorders
Personality disorders
Anxiety disorders
Mental retardation, pervasive
developmental disorder
Hollywood movies Bollywood movies
The Strange Case of Dr Jekyll and Mr Hyde (1986), Three Bhool Bhulaiya (2007), Kartik Calling Kartik
Faces Of Eve (1957) (2010)
A Beautiful Mind (2001), Running With Scissors (2006) 15 Park Avenue (2005), Who Lamhe (2005)
Requiem For A Dream (2000), Clean And Sober (1988) Devdas (2002), Dev-D (2009)
Prozac Nation (2001), A Clockwork Orange (1971) Raaz (2002), Sholay (1975)
As Good As It Gets (1997), The Aviator (2004) Chhoti Si Baat (1975), Anupama (1966)
Rain Man (1988), The Black Balloon (2008) My Name is Khan (2010), Barfi (2012)

 166 Journal of Postgraduate Medicine April 2014 Vol 60 Issue 2

 Padhy, et al.: Media and mental illness
abuse and dependence and My Name is Khan talks about
Asperger’s disease. Indian cinema is among the most productive
in terms of the number of films made per year, and many other
examples abound about the depiction of psychiatric disorders.
Apart from cinema, the television and print media in the
form of books and magazines can be useful in understanding
psychopathology. Therein too, the character development
recourses on certain attributes placed on the protagonist and
the other supporting individuals.
Impact of Media on the Mentally Ill
Media portrayal can influence those who suffer from psychiatric
disorders. About half of the patients with mental health
disorders reported that media coverage had a negative impact
of their lives, about one-third reported that it increased their
anxiety and depression and one-fourth endorsed that they
had hostile behaviors from their neighbors due to newspaper
reports.[94] Patients with mental illness are usually shown as
victims of verbal and/or physical abuse in entertainment media,
who when pushed “too far” become dangerously aggressive
and even violent.[13] Being stressed and the trauma of being
victimized can increase an individual’s sense of vulnerability
to further victimization and exacerbation of symptoms of
the mental illness.[95] Negative portrayals of mental illness
has been suggested to interfere with the social integration of
patients with psychiatric illnesses and hamper their self-image
and family life.[96] Not only the patients but also their families
can be affected due to “courtesy stigma.” The most common
depictions of mental illness in the popular media involving
mentally ill people as violent and criminal is not in keeping with
the epidemiological data that suggests that rates of violence
with only schizophrenia are not greater than that in the general
population.[97]
Media can have an impact on the course and outcome of mental
illness. Stigma due to negative media reporting can impair the
self-confidence, impede recovery and create barrier for seeking
treatment.[98,99] Stigma due to negative media coverage can
increase anxiety, distress and depression and cause hesitancy in
disclosing difficulties.[100] People who suffer from a mental illness
may internalize negative references and develop avoidant coping
mechanisms that become obstacles to treatment. Experiences of
discrimination and violence can result in psychological distress.
Additionally, inaccurate portrayals of mental illness and
psychiatry in films may have a range of adverse effects, including
promoting inaccurate knowledge in the society, accentuating
negative attitudes, increasing the stigma perceived by patients,
their families and mental health professionals and causing
patients to be less willing to seek psychiatric help.[10,101]
Media as a Tool for Change
Media is a tool that can be effectively used to increase
knowledge, create favorable attitudes and change overt
behavior.[102] If the media can exacerbate stigma in the field of
mental illness, it is reasonable to assume that media can be used
Journal of Postgraduate Medicine April 2014 Vol 60 Issue 2 167 
to reduce stigma as well.[103,104] When used correctly, media can
have significant positive impacts on health-related attitudes,
beliefs and behaviors. Documentary films can be used to educate
the general public about mental health and disease. Viewing
a documentary about schizophrenia led schizophrenia to be
perceived as less dangerous.[105] Reading an article containing
corrective information has led to a greater acceptance of persons
with mental illness and less fear about mental illnesses.[106]
Keeping this in view, the National Mental Health Program of
India has attempted to use media publicity to reduce the stigma
and encourage treatment seeking. The new Mental Health Care
Act also aims to use media to dissipate effectively the various
provisions relating to the new law.[107]
The manner of media reporting can also have an important
influence on the behavior of the people. It has been seen that
introduction of media guidelines regarding reporting suicides
on the Vienna subway resulted in a reduction in the rate of
suicide.[108] Correspondence with newspaper editors led to a
marked change in the manner in which suicides are reported
in the press.[109] Thus, collaboration with the media can help in
reducing the stigma toward mental illnesses and implementing
strategies to reduce harm.
Various guidelines have been developed with regard to reporting
by media, especially about suicide.[110,111] These are aimed at
reducing the negative impact of suicide through the media –
either in the form of copycat suicides or exacerbation of stigma.
The essential elements of these guidelines are as shown in
Table 2. Although specific guidelines are available for suicide,
similar responsible reporting of the psychiatric illnesses is also
likely to prevent misconceptions about psychiatric illnesses.
Similarly, suggestions have been made about how psychiatrists
and mental health professionals should interact with the
media while discussing about psychiatric illnesses. A sensitive
use of language and terminology that preserves the dignity
of those with mental illnesses, and at the same time avoids
miscommunication, is beneficial. Interaction with media should
be taken as an opportunity to dispel myths and give a clear
account of the psychiatric illnesses in question. Speculation
should be avoided and clear information should be provided
about how to avail services when in need.
Table 2: Suggestions for responsible reporting of suicides
Avoid sensational coverage and over-reporting
Avoid front page reporting, reporting in boxes and enlarged headlines
Avoid details of the method and how it was arranged
Avoid photographs/recording of the deceased, the method or scene
Avoid reporting identity of the deceased
Avoid correlating with a cause that is common and applicable to many
Not to glorify victims as martyrs, care in celebrity suicides
Take opportunity to educate public about suicide
Acknowledge presence of psychiatric or physical disorder in the deceased
Show due consideration for people bereaved by suicide
Provide information about where to seek help
 Padhy, et al.: Media and mental illness
Conclusion
Media and mental illnesses interact in many ways and have
a complex relationship. Accurate information and proper
terminology about mental illness is essential to reduce the
stigma of mental illness among the general population. In
order to deliver an expert source of information about mental
illness through media, more psychiatrists needs to be available
to the media. More importantly, language plays a role in stigma
associated with mental illness and should be sensitive to the
concerns of the mentally ill.
Additionally, it needs to be highlighted that media usage
seems to be associated with specific psychiatric problems.
Whether causation can be implicated (and direction thereof
if implicated) is not fully clear in many of those instances.
Still, the role of the media in these situations, like depression
and eating disorders, merits further ardent research. Media
portrayal can be effectively used to understand and teach about
the psychiatric problems.
It must be duly acknowledged that over a period of decades,
media depiction of mental illnesses has improved. Media has
been playing a constructive role in mental health promotion,
conveying reversibility of psychiatric problems and highlighting
the importance of family and societal support for recovery.
However, more needs to be done to improve the portrayal of
the mentally ill.
It must be realized that the media exists primarily to inform
and entertain and, as such, the motive may not concur with that
of a health professional. Hence, the valuable asset of media in
the form of wide reach should be used as an ally rather than
as an adversary to deliver the required benefits to the patients.
Hopefully, with time, effort and a constructive dialogue, media
would be able to reduce the stigma associated with mental
illnesses and remediate the misconceptions.
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How to cite this article: Padhy SK, Khatana S, Sarkar S. Media and mental
illness: Relevance to India. J Postgrad Med 2014;60:163-70.
Source of Support: Nil, Conflict of Interest: None declared.