Media images of mental distress

GREG PHILO, JENNY SECKER, STEVE PLATT, LESLEY HENDERSON, GREG McLAUGHLIN and JOCELYN BURNSIDE

From Heller, T., Reynolds, J., Gomm, R., Muston, R., & Pattison, S. (Eds) (1996) Mental Health Matters: A Reader, London: Macmillan/OUP ps 163-170

This article reports on the findings of research on the media coverage of mental illness conducted by the Glasgow University Media Group and the Health Education Board for Scotland. The research used content analysis and an audience response study. This extract from the article begins with a description of the methods used.

Methods

Content analysis

The sample for the content analysis comprised a range of local Scottish and national media output for the month of April 1993, including factual and fictional formats aimed at both adults and children. Factual formats included news items, comment and analysis in the press; news and current affairs programmes on television; and feature items, medical columns and problem pages in magazines. Fictional formats on television included soap operas, single dramas and films. In the press and magazines they included short stories and comic strips. In some cases, for example when soap opera story lines ran before or after the sample period, it was necessary to record material from outwith the period. Otherwise relevant output was recorded and/ or stored for a month.

The purpose of the content analysis was to reveal the dominant messages about mental health issues presented across the range of media examined.

For the initial stage of our study we established a general profile of media content examining the focus of news items, magazine features and story lines in fictional drama (including soap operas). For this initial profile, each of these was counted as a single item. Such profiles give a sense of the main areas of media interest and the general contours within which the coverage is grouped. In the second phase of the content analysis we engaged in a detailed examination of individual texts. This method of analysis had three dimensions:

(1) explanatory or interpretative themes were identified:

(2) the way in which each theme was developed in its specific context was examined;

(3) the frequency with which different themes appeared and their relative power in terms of the size of audience they can be expected to reach were assessed.

The audience reception study

The sample for the audience reception study consisted of seven groups with an average of ten people participating in each. A total of 70 people took part. Six of the groups comprised a general sample drawn from the west of Scotland and structured to be broadly representative of the area. The other group consisted of seven people who had used psychiatric services and who were working in a computer skills training programme in Edinburgh.

The sample was not large enough to make generalisations about the whole Scottish population. Instead, the intention was to explore the process by which media accounts are interpreted and contribute to the formation of beliefs. For this reason an effort was made to work with people in naturally occurring units, for example a family, couples living in the same housing block, or a group of people who worked together, in order to preserve elements of the social context within which people might read newspapers, watch television programmes, and discuss the issues raised.

The methods we used to examine the audience sample's beliefs involved three phases:

(1) A series of exercises involving sub-groups of two or three people: each sub-group was asked to write news reports prompted by copies of the original headlines; those who watched Coronation Street were also asked to write dialogue for an episode of the programme prompted by still photographs.

(2) Individual group members were asked to write answers to a series of nine open questions. Two questions related to the content of the exercises, while the others were intended to enable respondents to express beliefs about mental illness and to indicate where their ideas had come from.

(3) Individual in-depth interviews designed to explore respondents' answers to the written questions.

Findings

Content analysis

The survey of media output yielded a total of 562 items relating to mental health. Five main categories of coverage emerged from the content analysis: violence to others; sympathetic coverage: harm to self; 'comic' images; and criticisms of accepted definitions of mental illness. Table 1 shows the distribution of the 562 items across these five categories.

TABLE 1 Media coverage of mental health/illness, April 1993

Number Percentage of

Output category of items total items

Violence to others 373 66

Sympathetic coverage 102 18

Harm to self 71 13

'Comic' images 12 2

Criticism of accepted definitions of mental illness 4 1

Total 562 100

Similar themes emerged from the fictional accounts in this category. For example, in films shown on television, Richard Dreyfus pursued a 'crazed killer' (Stakeout, ITV, 27 April), while Kurt Russell played a reporter involved with a 'psycho killer' (The Mean Season, BBC1, 30 April). In forging the link with violence, films of this genre also linked mental illness with the notion of 'split personality', and this theme was reproduced during the sample period by most of the main soap operas. From early 1993, for example, Coronation Street developed a story line concerning an angelic-looking nurse, 'Carmel', who was portrayed at first as a 'fresh-faced, home-loving Irish girl'. In later episodes, however, it emerged that behind this angelic front lurked an intensely manipulative character who would clearly stop at nothing to win the married man with whom she had become obsessed.

Such items linking violence and mental illness outweighed the second most common category, sympathetic coverage, by a ratio of almost four to one. Even these figures exaggerate the relative coverage of the two categories, because items portraying violence tended to be given a high profile, whereas sympathetic coverage was largely confined to back-page material in newspapers and magazines such as problem pages and health columns. Unsurprisingly, given its origin, the content of this coverage revolved mainly around the theme of how to 'cope' with mental health problems.

The majority of items in the third most common category, harm to self, were non-fictional reports of suicides or attempted suicides. For the most part these reports portrayed the events concerned as tragedies by focusing on their human context of depression and anxiety. For example, The Sun reported the death of a model under the headline, 'Death Leap a Cry for Help' (4 April), and the death of a Conservative Party worker was reported by the Daily Record under 'Secret Pain of Suicide Tory' (8 April).

In some cases, however, reports of suicides and attempted suicides emphasised a 'bizarre' aspect of the events described. Extensive coverage of this sort was given, for example, to the story of a man who had apparently jumped from a high-rise block and survived by landing on a car: 'Nissan impressed as man falls 200 ft' (The Guardian, 3 April). In similar vein, some newspapers focused on sexual angles which could be linked to suicides: 'Suicide of Sex Slave Nutter' (Sunday Sport, 24 April); 'Tragic Patient had Sex Fantasy' (The Sun, 20 April).

Audience reception study

In writing their own stories under the headlines they were given for the first media exercise, the audience groups demonstrated a remarkable ability to reproduce the style and language of the popular press. The first headline they were given related to a story, later proved to be completely untrue, about an arson attack on a young boy. Most of the stories produced in response to this headline included phrases like 'evil maniac', and many stories also made clear the fears which such a report can generate. This passage was written by three women whose agreement with the sentiments it expresses became apparent as they worked on it: 'Police are today looking for the evil maniac who tried to disfigure this innocent child. What kind of world do we live in when a child can't even be allowed to play in the street?' In response to a written question about the original story, 18 people stated that they remembered it, but only nine of them knew that it had proved to be untrue.

A very different note was sounded by a second headline relating to a man who had spent 33 years in hospital before receiving his Diploma in Education. The stories written by the audience groups reflected the more upbeat tone of this report, again in terms which closely paralleled the themes of the original. Some stories also developed other themes relating to mental illness and community care. Although these were not contained in the original, they clearly derived from other media accounts.

The second exercise, involving writing dialogue prompted by stills from Coronation Street's 'Carmel' story line, produced a dramatic response: as soon as the pictures were shown there were murmurs of recognition and animosity. Although they were given no information at all about the plot and had to work entirely from photographs, some group members were extremely accurate in their reproduction of the dialogue. For example, a key moment occurs when 'Carmel' is put out of the house by another character, 'Sally', and this scene recurred in some of the audience groups' own work with startlingly accurate dialogue.

A question included in the second phase of the study referred to the 'Carmel' story line and was intended to tap attitudes to people portrayed as experiencing mental health problems. Group members were asked: 'How would you have reacted to Carmel, if you have been Gail?' (the wife of the man with whom Carmel was obsessed.) Two-thirds of the people in the general sample gave replies threatening aggression or violence. These varied from: 'Battered her bloody mouth in', to the more genteely expressed but no less aggressive: 'I would have been very upset and taken violent action and chucked Carmel out of the house'. However, nine respondents among the general sample were more sympathetic in that they suggested obtaining medical help. Their responses were in part related to personal experiences of mental illness, but such experience did not always lead to a sympathetic response to 'Carmel'. The issue of how media output can inter-relate with direct experience and other cultural factors is crucial, and this was the focus both of the other written questions, and of the individual interviews.

One of the key issues explored was whether mental illness was believed to be associated with violence. Almost two-thirds of the people in the general sample believed this to be so, and two-thirds of these people, or two-fifths of the whole general sample, gave the media as the source of their beliefs. In many cases they referred to a combination of factual and fictional sources. These extracts from two interviews illustrate how beliefs could be shaped through the interaction of the two formats:

A lot of things you read in the papers and they've been diagnosed as being schizophrenic. These murderers - say Donald Neilson, [Dennis Nilsen?] was he no schizophrenic? - the Yorkshire Ripper ... in Brookside that man who is the child abuser and the wife-beater - he looks like a schizophrenic - he's like a split personality, like two different people.

I always thought mental ill people would not be able to do much for themselves and would be looked after by someone, but then you get evil people like the Kray twins who were evil, violent men who I suppose must have had some

form of mental illness to do the things they have done to other people and seemed to enjoy it ... I seen the film - they looked like pretty normal people but they weren't.

Most of the people who disagreed with these views and who rejected the dominant media message made their judgement on the basis of personal experience. In particular, the group from Edinburgh cited their own experience and that of meeting other people diagnosed as suffering from illnesses such as schizophrenia. This man, for example, wrote explaining why he did not associate schizophrenia with violence:

Some of my answers came from being depressed myself and through this the people I came into contact with gave me more knowledge.... As a day-patient, out-patient, occupational therapy ... I met about five people who had schizophrenia.

In addition to the Edinburgh group, a third of the general sample cited personal or other direct experience as the key factor informing their rejection of the dominant media message. Conversely, a smaller group of ten people also had experience of mental illness and gave this as a reason for associating it with violence. Such experience could then be confirmed or developed by negative media coverage.

However, 13 people who took part in the study had non-violent experience of mental illness which was apparently overlaid by media influences. A striking illustration was given by a young woman who lived near a psychiatric hospital. She wrote that she had worked there at a jumble sale and mixed with patients. Yet she associated mental illness with violence and wrote of 'split/double personalities'. She went on to say:

The actual people I met weren't violent - that I think they are violent, that comes from television, from plays and things. That's the strange thing - the people were mainly geriatric - it wasn't the people you hear of on television. Not all of them were old, some of them were younger. None of them were violent ~ but I remember being scared of them, because it was a mental hospital ~ it's not a very good attitude to have but it is the way things come across on TV, and films - you know, mental axe murderers and plays and things - the people I met weren't like that, but that is what I associate them with.

Discussion

The relationship between different media messages, our beliefs and personal experience is extremely complex. Although there is little doubt that the mass media can exert great influence over audiences, people are not simply blank slates on which its messages are written. The media exist within developing social cultures. They do not create the whole social world or how we think about it. On the other hand, they are certainly ve important sources of information and can generate strong emotional responses in their viewers and readers. The study reported here was small in scale, but the findings suggest that the media can play a significant role not only in informing the public, but also in fuelling beliefs which contribute to the stigmatisation of mental illness.

The potential for informing the public is illustrated by the accuracy with which our audience sample were able to reproduce and develop media stories with only minimal prompts. News reports and 'factual' programmes are only one part of the development of such social consciousness, but they do appear to have a significant influence.

As a corollary, however, the potential for misinformation is also great. At one level, responses to questions about the 'fire maniac' story illustrate how a completely false account can enter into the public store of memories and beliefs. At another, more subtle, level the use of loaded terms like 'madman' or 'maniac' to describe violent criminals suggests an association with mental illness which recent research in the United States indicates is minimal (Monahon, 1992). That this medium has the capacity to produce intense affective responses within its audience and to direct these against certain characters or types of behaviour is illustrated by our sample's response to writing dialogue prompted by stills from the 'Carmel' story line. The ability to reproduce dialogue and the intensity of response to the story were both sustained by group members over long periods of time, suggesting that the impact of this particular message was very strong. That the portrayal of a 'disturbed' woman should have provoked such a violent response in this 'normal' sample is not without irony.

In some respects, our findings in relation to the interaction of this media output linking mental illness with violence and other influences on beliefs confirm those of previous research in other areas, that personal experience, where it exists, is a much stronger influence on belief than media content (Philo, 1990). But one of the most striking findings of this study was that in several cases this pattern was reversed: in our sample several people appeared to believe media messages in preference to the evidence of their own eyes. Where mental illness is concerned it seems that some media accounts can exert exceptional power over readers and viewers.

Although less obviously problematic, the sympathetic coverage we found also raises questions about the image of mental illness presented. While this coverage was clearly well intentioned, the views presented were almost always those of medical 'experts'. Although people with direct experience of mental health problems have their own, sometimes very different views, these were rarely represented. In keeping with the resulting impression of a group of helpless 'victims' in need of 'expert' advice, coverage depicting people's ability to live relatively competent, independent lives was also very unusual. Taken together with the rarity of any questioning of accepted definitions of mental illness, an issue which continues to provoke intense debate (Johnstone, 1989), these findings suggest that even 'sympathetic' coverage can present a limited version of mental health issues.

References

Johnstone, L. (1989) Users and Abusers of Psychiatry London, Routledge.

Monahon, J. (1992) 'Mental disorder and violent behaviour: perceptions and evidence', American Psychologist, vol. 47(4), 511-521.

Philo, G. (1990) Seeing and Believing.. the influence of television, London, Routledge.