Working with TV script writers and blogging and writing on mental health has opened my eyes to so much. But one thing that I’ve found really interesting is striking a responsible balance and ensuring that stigma is appropriately addressed.

Here are a few tips I’ve learnt on striking the right balance when portraying mental health in fictional settings:

  1. Stigma CAN be shown – it’s all about getting the context right

There’s no point pretending that stigma doesn’t exist – and whilst it’s always going to be a bad thing, it’s not necessarily a bad thing to expose it and demonstrate its negative impact. This is why, when working on scripts with Mind and The Road to Recovery Trust, we don’t just scan through and ask to remove every single word or sentence we find offensive.

For example, in the case of addiction and recovery storylines, just because the word ‘alkie’ has been used doesn’t mean it doesn’t have a place. People use these descriptors and it causes shame. So we need to talk about that. Similarly, if a character calls another character with a mental health problem ‘crazy’ there could be much that we learn from this.

We need to think about why stigma is used and who by. Did a character who is known for getting things wrong, for being judgmental say the word? If it’s a character who doesn’t demand the viewer’s respect then this can work. However, this stigma should still be addressed. A more well-loved character might challenge this stigma, for example. The character may apologise. We might show the impact that saying these words has on the character that the insult was aimed at. Additionally, if a well loved character uses stigma out of ignorance, that’s OK – it happens – but it must be addressed. It’s important to understand that stigma does have an impact – hopefully in portraying it in a responsible way we can encourage viewers to think twice before using it.

Carrie’s story in Homeland is a good example of how it’s wrong to always assume somebody with a mental health problem is unable to make informed decisions

2. The unreliable narrator / character can be used to expose self-stigma

Self-stigma is when we begin to internalise stigma and use it against ourselves. It is also a factor in gaslighting. The Girl on The Train is a brilliant example of this – although I won’t include any spoilers – but it’s interesting to see how the narrator’s own understanding of her past is challenged as the book progresses.

The US drama Homeland (this link will take you to a piece I wrote on this for Digital Spy) is another good example where we’ve seen characters doubting Carrie’s judgment because of her bipolar disorder, when in fact, she was on the money all along.

The balance to strike here is not letting the doubt or self doubt run for too long if it has the potential to reinforce stigma to the viewer or reader (especially if they give up on the story half way through). Alternatively, we can make sure that there is enough that we love and respect about the character so if a big twist is what needs to happen towards the end of the story, anyone who may have given up on the read doesn’t see things through a black and white lens.

3. Never rely on a factsheet to tell the full story

If a character is experiencing a specific type of mental health problem, knowing the facts about this illness is a pre-requisite. However, this doesn’t paint a very holistic picture in isolation. It is always important to speak to people with lived experience to ensure a portrayal is nuanced and captures authentic experiences. A fact sheet on psychosis, for example, might talk about hallucinations and what they are, but it might not necessarily explore how they make somebody feel. In speaking to people about voice-hearing, I’ve come across a really interesting array of experiences that range from the person being terrified of the voices, to finding value in them that enhances their day-to-day life.

4. Don’t force characters to respond perfectly to mental health problems

In reality, it can be difficult to support somebody with a mental health problem, and symptoms and behaviours don’t fit into neat categories. For example, when I went through periods of extreme anxiety, I experienced distress myself, but I also caused it too! The impact on my family wasn’t great when I was constantly in panic attack mode or getting angry or frustrated and lashing out at everyone around me. Nobody is perfect – whether that be the person supporting someone with a mental health problem or the person experiencing the mental health problem. If we show that it’s easy, it can make the audience feel inadequate. Seeing some consistently calm and patient character supporting another – especially a loved one – with a mental health problem isn’t necessarily accurate. Get the balance right and give the viewer hope – but show the imperfections too because life isn’t perfect.

5. There is an ugly side to mental health problems – let’s not be afraid of it

We shouldn’t romanticise mental health problems – and it’s sometimes tempting to do this to let others know they have nothing to be ashamed of. But in reality, if we don’t portray the bigger picture, this can make people feel ashamed. For example, it might seem more acceptable to talk about a panic attack that causes shortness of breath, feeling dizzy or sick. But in my experience, it’s also caused diarrhoea and made me pace around the room chuntering to myself. And it’s one thing to say that having social anxiety can cause us to feel nervous about giving public presentations, but it’s another to admit that we can become overwhelmed by the fear of peeing our pants in front of a crowd (one of my anxiety obsessions). These behaviours and symptoms are certainly not pretty, but they’re real. So why not talk about them.

6. Don’t be afraid to use comedy – but do it in the right way

Humour can make such a difference to how we deal with and learn about mental health problems. For example, when chatting to a friend about our strange obsessions, we were able to roar with laughter and find relief. But that was because we were talking about our own problems. If somebody else was laughing at me, that might have a very different impact. Humour absolutely can be used, but it’s often best for the character experiencing the mental health problem to discover the humour in their experiences, rather than pointing and laughing from others.

To read more on my top tips for writing about mental health, see my previous blog here.

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