Best Recent Screen Portrayals of Mental Health Issues

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REEL INSIGHTS

Recent years have seen a remarkable increase in public discourse about mental health issues, with representations of mental illness in popular culture becoming increasingly varied, nuanced, and abundant. Each artist brings their own mental health experiences to their work; however, depictions of mental illness and the mental health care system are often demonizing, sensationalized, or grossly inaccurate. Such misfires can further stigmatize patients with psychiatric disorders. As such, it is important to celebrate accurate representations of psychiatric issues and treatment. As members of the Group for the Advancement of Psychiatry Committee on Arts and Humanities, we wanted to share some excellent representations of mental health issues in film and television over the past year.

Memories and Misperceptions in The Father

Christopher Magoon, MD

When perception diverges from reality, terror ensues. In The Father, the viewer experiences the disorienting decline of Anthony (played by Anthony Hopkins) as he grapples with dementia. Anthony struggles to understand where he is, who he is, and who is around him. Director Florian Zeller deftly places the viewer into Anthony’s frame of mind as he experiences the horror of mistrusting his memories and perceptions. There is no overdramatization or embellishment. Zeller trusts that the stakes of this proud man—a well-off retired engineer—losing his faculties are high enough. As a result, the viewer is left feeling profound empathy. When a nurse hugs a crying and confused Anthony in the final scene, it feels genuinely cathartic to know he is comforted by human touch. The end of the film comes as a relief, as it does for many families with someone suffering with dementia. The Father, an honest portrayal of the fragility of the mind, is well worth experiencing.

Cultural Snapshots of Mental Illness in Shtisel

David A. Sasso, MD, MPH

Shtisel, an Israeli drama about a Haredi (ultraorthodox) family in Jerusalem, began streaming its third season in March 2021, with Hebrew and Yiddish dialogue subtitled in English. This thoughtful series centers on Akiva Shtisel (portrayed by Michael Aloni), an endearing but hapless son, brother, and father. Akiva is an oddity in his family and his insular religious community because of his artistic pursuits—he is a painter—and for his serial failures in love. In this season, we meet Racheli, a new love interest for Akiva, recently widowed and now a single father. Racheli, we learn, quietly suffers from what appears to be bipolar disorder. The touchingly human telling of their love story weaves Racheli’s psychiatric illness into the story seamlessly, neither glamorizing nor minimizing it, neither stigmatizing it nor ignoring its inherent cultural stigma.

Other subplots touch upon mental health themes. Akiva’s sister and brother-in-law navigate their fragile marriage while watching their children strive to build families of their own. Akiva’s niece silently and courageously endures a complicated pregnancy. Through it all, Akiva’s father, widower Shulem, tries desperately to keep his family under his thumb while searching for companionship.

Shtisel gives viewers a fascinating glimpse into a world foreign to most, yet somehow simultaneously familiar. Although our day-to-day culture often either silences mental illness or sensationalizes it, Shtisel’s fictional portrayal seems to bring us closer to reality than real life. That’s good TV.

Compelling Reality in Love on the Spectrum

Kenneth J. Weiss, MD

Love on the Spectrum is an Australian documentary series that streamed its second season on Netflix in 2021. It is about young men and women with autism spectrum disorder who are looking for romance. The episodes are without commentary and with minimal intervention from the filmmakers and crew who chaperone dates. The otherwise high-functioning participants are behind the developmental curve in the worlds of sex and love, although they have touchingly supportive, loving, and nonjudgmental families (a series highlight).

There is little suggestion of mental health treatment, except for light coaching from a specialist—a mature, patient, and direct woman. She gives concrete advice on icebreaking, social conversation, and showing interest in the other, and she literally diagrams uncomfortable moments. The participants have structured dates and even speed-dating with a matching matrix. Sometimes they decide to be friends, and at other times, they get sidetracked by their single-minded focus on specific topics, as is common in individuals with autism spectrum disorder.

The series is remarkable for what is absent: insincere and staged competition, pathologizing, disability emphasis, and creepy voyeurism. While the characters are mostly straight, there are also gay and bisexual individuals integrated seamlessly by the filmmakers. The episodes are compelling, and we cheer on the participants. However, we return to reality with an understanding that these individuals face the same obstacles as everyone else. They suffer disappointment but show resilience. At least one couple married. For the viewer, Love on the Spectrum is uplifting and affirming in showing how intimacy and love are not out of reach for those on the spectrum.

The Power of Positivity in Ted Lasso

Andrew Lustbader, MD

An American football coach, Ted Lasso (Jason Sudeikis), is hired to run an English Premier League soccer team without any knowledge of how to play the game. He has tremendous confidence and an optimistic attitude toward the human condition. He evokes a positive response in others—undaunted by their negative responses to him—bringing them along to elevate their own personal experiences. Happily, a new star player, Danny, appears, whose credo is “football is life.” When Danny accidentally kills the team’s mascot dog with a penalty kick, he is traumatized and becomes quite depressed. His new motto becomes “football is death.”

When the coach is not able to help pull Danny out of his depression, the team brings in a therapist who helps him move forward. After seeing the therapist’s success with Danny, many other, often macho, members of the team engage her services. They realize that by simply talking about what is on their minds, they are able to feel better and move on in their lives. Ted also reluctantly seeks her services when he has to leave the sidelines because of a panic attack during a critical match. When knowledge of Ted’s panic disorder becomes public, he challenges the media to look at the treatment of mental health in sports.

Although the show later depicts unrealistic boundary violations after the therapist suffers from a biking accident, the two agents of change, Ted Lasso and the therapist, are complementary in advancing the inner lives of the team members. Much of the success of the series is due to the viewer also being exposed to the possibility that positive change can occur with optimism, self-confidence, and good therapy.

Human Connections in Pig

Fernando Espí Forcén, MD, PhD

Pig stars Nicholas Cage as Rob Feldman, a former chef who makes a solitary living by truffle foraging with his beloved and talented pig. From the beginning, it is hinted that Rob is coping with tragedy, and as a result, he is no longer interested in engaging in society. From time to time, Rob receives visits from Amir, who supplies truffles to high-end restaurants. One day, Rob’s pig is stolen by unidentified assailants. Rob, blaming Amir because he had spread word in town about the pig’s abilities, asks Amir to accompany him to Portland and find his pig. The duo goes through an odyssey with the hope of rescuing Rob’s lost love. 

The portrayal of Rob, who shows traits of autism spectrum disorder, such as impaired social skills and a restrictive pattern of interests, is laudable. His fixation on cooking and food makes him the best chef and truffle forager in town. Rob copes with his loss with support from an unlikely friend. Despite being very different, like Rob, Amir is also coping with the loss of an important figure in his life. As such, a peculiar bond and attachment is formed between the two, and this human connection across differences has a healing power.

Lies, Suicide, and Growing Up in Dear Evan Hansen

Donald Fidler, MD

The movie version of this Broadway musical, Dear Evan Hansen, is populated with mental health issues. In this story, both teenagers and adult parents present their guarded, inauthentic selves to the world. As often happens in worthwhile musicals and operas, when characters sing, their true selves blast out of mental shackles. “Why should I play this game of pretend?” asks Evan, the protagonist, played by young actor Ben Platt, who originated the Broadway role. He painfully stutters incoherent phrases, retracting and contradicting every word, avoiding eye contact with his world. He is on a trio of psychiatric medications. His single-parent mother unconsciously imprisons him by considering him “sick.”

A schoolmate’s mother embraces the pathologically shy Evan, mistakenly believing he was close friends with her son, Connor, who recently died by suicide. In fact, the only moment of contact between the boys was when Connor bullied Evan. However, Evan not only perpetuates the lie, but develops a fantasy of his and Connor’s friendship, using Connor as an idealized transitional object, a teddy-bear of warmth. As long as Evan is immersed in the lie, Connor’s family welcomes Evan into an accepting family he never had, and his awkwardness fades. Eventually, his lie thrusts him onto the world stage as an icon for adolescent mental health. Evan appears a star, but inevitably, the lie is revealed and Evan’s world crashes. Will traumatized Evan fall from grace or transform into maturity? Can real-world actions and emotions match truths that once were only sung in songs? Sometimes in therapy and the outside clinical world, disillusionment leads to growth.

Coming of Age in Never Have I Ever

Christopher Snowdy, MD

Never Have I Ever is a coming-of-age comedy whose second season launched this past July. Never’s central protagonist, Devi Vishwakumar (played by Maitreyi Ramakrishnan), is a 15-year-old Indian-American girl. Less than 5 minutes into the first episode, narrator John McEnroe (yes, that John McEnroe) tells us that Devi’s parents immigrated to the United States in September 2001 (“Not a super-chill time to be a brown person in America”); her father died of a sudden heart attack during her freshman year; she developed functional paralysis in her legs shortly thereafter; and the paralysis resolved suddenly 3 months later while she was straining to get a look at her crush. Devi is an overachieving nerd struggling with the unprocessed grief of her father’s death, her complicated relationship with her mother, and her cultural identity. The conflict of the show hinges on Devi’s vows to improve her social status and experience “normal” American teenage life.

The show’s pacing and occasionally over-the-top performances set the tone for its comedic content, but they also mirror aspects of the adolescent experience that can be confusing, chaotic, clumsy, and replete with drama. While not all the psychiatric themes feel authentic (eg, the paralysis resolution), the underlying struggles of the teens generally do, and the show tackles issues including grief, coming out, family dynamics, and, briefly, anorexia. Similarly, Devi’s exchanges with her therapist (played by Niecy Nash) are often too compressed and laden with wit to serve as a how-to for supportive therapy, but, far more important, they do provide a positive, destigmatizing depiction of a helpful therapeutic relationship. On its surface, Never Have I Ever is a typical teen rom-com, but at its core, it has a lot of heart.

Dr Magoon is a fellow of the Group for the Advancement of Psychiatry Committee on Arts and Humanities. Dr Sasso is chair of the Group for the Advancement of Psychiatry Committee on Arts and Humanities. Other committee members include Anish Ranjan Dube, MD, MPH; Fernando Espí Forcén, MD, PhD; Donald C. Fidler, MD; Andrew Lustbader, MD; Christopher Snowdy, MD; Kenneth J. Weiss, MD; and Helena Winston, MD, MPhil, MS. ❒