How Mental Health Is Represented In Pop Culture

Depictions of mental health weren’t exactly nuanced back in the 20th century. Movies, with few exceptions, depicted ‘madness’ with sledgehammer sensationalism. Remember the wide-eyed hysteria of Glenn Close in Fatal Attraction (1987)? The ominous snarl of Jack Nicholson in The Shining (1980)? Crazy was crazy, sane was sane. Terms such as ‘wacko’, ‘nuthouse’ and ‘loony bin’ were tossed around carelessly, while stories fixated on dramatic mental breakdowns, in all their caricaturistic splendour.

Twentieth-century pop culture is littered with examples of how not to represent mental health. Most cases are two-dimensional sketches of something that deserves much greater care and consideration. If they are more carefully rendered today, it’s because of a growing conversation around mental health — as the conversation and awareness has evolved, so too have the depictions. So when did culture get it right? When did it get it wrong?

Back to the beginning

The further you go back, the less nuanced the depictions are. In literature, Charles Dickens gave us Miss Havisham, the archetypal spinster in Great Expectations (1860) who insists on always wearing her wedding dress. Because yes, she’s a ‘crazy’ old lady.

In movies, if a character was depressed (so the thinking went), there must be a damn good reason. Think of James Stewart in It’s a Wonderful Life (1946). He’s ready to throw himself off a bridge because he lost his job and his means of supporting his family. It’s awful, but where is the subtlety? Where are the characters who suffer with depression on a more relatable everyday level? 

Part of the problem was that stories typically favoured extremes. To watch horror movies such as Psycho (1960), in which the psychotic Norman Bates dresses up as his dead mother, is to see how closely linked ‘madness’ and murder were in the popular imagination. Such movies suggest that poor mental health and violence invariably go hand in hand — no examination necessary. 

If Hollywood did ever have decent depictions of mental struggles, it tended to be with youth stories. Case in point: James Dean’s tormented teen in Rebel Without a Cause (1955) and his inimitable line, “You’re tearing me apart!” There’s clearly some inner turmoil simmering beneath the surface, underlying an angst that’s hard to put a finger on.

New Hollywood and the depths of the human condition

In the ’70s and ’80s, young filmmakers were inspired by European cinema to plumb the depths of the human condition. Among the best was Robert Redford’s Oscar-winning Ordinary People (1980), about a suburban family dealing with the loss of a son. It blends trauma, grief, and depression, as the family’s surviving child struggles with suicidal thoughts and the collapse of his family.

Another whip-smart film that places mental health under the microscope is A Woman Under the Influence (1974), in which Gena Rowlands plays a mother whose deteriorating mental state has devastating consequences. The movie asks what such a condition looks like in a loving mother who helps her kids off the schoolbus every day.

A year later, however, the Oscar-winning One Flew Over the Cuckoo’s Nest (1975) arrived. The film — based on the 1962 Ken Kesey novel — depicts a psychiatric asylum as a prison with barred windows and terrifying electroconvulsive therapy, which didn’t do much to dispel the stigma of being sectioned.

Bunny boilers and psycho killers

Anomalies aside, ‘craziness’ was still dangerously synonymous with evil in the ’80s. Jack Nicholson in The Shining is an obvious example, as is escaped mental patient Michael Myers in Halloween (1978). Also see the yuppies’ favourite, Christian Bale as Patrick Bateman in American Psycho (2000). Like other thrillers, it plays into our base fears about psychotic characters who are out of sync with the world.

Then there’s the ‘hysterical woman’ trope. Though it takes many forms — the clingy girlfriend, the nagging wife — it is rooted in stereotypes of women being emotionally unstable and irrational. Think of Ally Sheedy as the ‘basket case’ in The Breakfast Club (1985) or Diane Keaton as the titular role in Annie Hall (1977) about whom Woody Allen quips, “You must be getting your period,” because she’s complaining about something.

These female roles are too easily characterised as ‘crazy’ without any deeper diagnosis by the often male filmmakers. Fatal Attraction (1987) is a great example. Glenn Close’s Alex Forrest is the ‘bunny boiler’ taking the idea of a hot mess to the extreme — but there’s no questioning of her mental health. It’s more about Michael Douglas’s character trying to erase her and the mistake of his affair. Imagine if it was his wife who was the troubled one and how he would deal with and support her through that? In 2017, Close reflected on her role, saying to The New York Times: “She’s considered evil, more than a person who needs help.”

‘Girl, Interrupted’ vs ‘The Virgin Suicides’

In the ’90s, there were some subtler takes, although no vast improvements. Girl, Interrupted (1999), for example, was a gender-flipped One Flew Over the Cuckoo’s Nest that portrayed a psychiatric ward as a fun yet disturbing slumber party. Winona Ryder’s character, Susanna Kaysen, who’s diagnosed with borderline personality disorder, is the most multi-faceted. Yet, the film ultimately slips back into a caricature of ‘crazy’ women with daddy issues that dwells on Angelina Jolie’s sinister smile as she presses a pen to her throat.

That same year, a stronger take on girls dealing with anxiety was found in Sofia Coppola’s The Virgin Suicides. You can tell Coppola was interested in the interior lives of the Lisbon sisters, their deep-rooted depression and actions are misunderstood by the world as ‘a cry for help’. A doctor even tells one of the girls she’s not old enough to know how bad life gets. Her reply? “Obviously, doctor, you’ve never been a 13-year-old girl.”

The birth of the tabloid psychodrama

Pop culture still wasn’t having any meaningful conversations around mental health, even by the early noughties. It’s worth mentioning Britney Spears, who famously had her psychiatric breakdowns in 2007 following a split from her husband. In retrospect, the most shocking thing to observe is how grossly the story was covered in the media. ‘Britney’s suicide drama!’, ‘Britney Shears!’ and simply, ‘Insane!’ were just a few of the tabloid headlines. In that decade, there wasn’t the level of sensitivity you’d see now, when the media would be held to account, if not outright cancelled.

Silver Linings Playbook (2012) seemed to represent something of a positive leap forward in representations of mental health, not least because Jennifer Lawrence won the best actress Oscar for her role as a young widow with an unnamed disorder. Her character meets Bradley Cooper’s bipolar character and an offbeat romance ensues. It’s intelligent and embraces its serious subject with humour. Crucially, it puts a bipolar lead under the spotlight instead of relegating them to a ‘zany’ background character.

The importance of nuanced representation

Only in recent years has the small screen begun to reflect mainstream conversations about mental health awareness. The series 13 Reasons Why (2017) depicted self-harm and suicide. Following her death, the friends of Hannah Baker ask: what were the signs? Why didn’t anyone pick up on her depression? The series showed the dark side of social media and cyberbullying, but according to many, handled some things badly, namely the graphic suicide scene (subsequently removed by Netflix) in which the camera lingered needlessly on Hannah taking her own life.

However, 13 Reasons Why highlighted the issue of how these immensely sensitive subjects should be handled on TV, the importance of depicting certain stories responsibly, and of pre-show warnings signposting graphic scenes.

The small screen has officially become the place where storytellers are taking on the Hollywood big shots. There’s Atypical (2017), which centres on a teenager with autism spectrum disorder, capturing his everyday interactions. (“Sometimes I don’t know what people mean when they say things.”) And then there’s Normal People (2020), which relentlessly mines first love while showing its relatable characters dealing with anxiety and self-loathing without overcooking it.

More recently, Steven Soderbergh received acclaim for his deft handling of mental illness in Unsane (2018), in which Claire Foy plays a woman held against her will in a psychiatric hospital and whose sanity is continually questioned. 

Happily, unlike 20 years ago, Soderbergh’s psychological thriller doesn’t feel like an exception. It suggests that most movies and TV shows no longer portray mental health in simplistic terms for the purposes of a neat narrative. It shows that conversations are being had at the script stage and that red flags are being spotted.

Like any other theme, mental health is a facet of the human condition that warrants deeper examination. For storytellers now, perhaps the question should be how can I make a viewer who relates to this character feel less alone? Because depictions matter. Details matter. Getting it right matters. It could be the difference between leaving someone to suffer in silence and encouraging someone to seek help.

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