Hollywood schizophrenia
The portrayal of mental disorders in Hollywood
movies has a considerable negative impact on
public understanding, argue Alison Smith and
Stephen J Cooper
Our culture is full of fictional portrayals
of mental illness, and cinema has become
fascinated with one condition in particular. A
huge number of Hollywood blockbusters
centre around a violent sociopath with a split
personality who, in many cases, is labelled schizophrenic.
Vague implications of mental illness in characters can
be found in some of the most high profile pieces
of cinema. In the Star Wars trilogy, Anakin Skywalker
undergoes a personality flip to become the evil Darth
Vader, as a result of a traumatic event in his life revealed
in parts by the series of movies. In The Lord of the Rings,
Gollum bickers with his alter ego Sméagol, apparently
driven to madness and ugliness by dark forces associated
with the ring he calls his "precious." Beyond the world
of fantasy films, however, Hollywood tends to use the
schizophrenic tag directly, often in an inaccurate and
stigmatising way.
KOBAL COLLECTION
The split personality is born
Alfred Hitchcock's classic 1960 thriller Psycho stars another
dangerous character with dual personality. The seemingly
harmless Norman Bates takes on the persona of his dead
mother when committing murder, his psychosis supposedly
triggered by the stress of her death. As the fictional
psychiatrist Dr Fred Richmond attempts to explain, "When
the mind houses two personalities, there is always a conflict,
a battle..." It seems to be during Hitchcock's era that
Hollywood schizophrenia was born, the symptoms of which
are a split personality and tendencies towards evil, homicide,
and genius.
Ironically, none of these are symptoms of real life
schizophrenia. Split personalities are associated with a
separate illness - multiple personality or dissociative identity
disorder - and violence is not generally related to either
condition. Although patients with schizophrenia can become
hostile and aggressive during periods of acute relapse, in
general they are not. In fact they tend to withdraw from the
rest of society. When aggressive behaviour does arise, it is not
a sudden switch from an apparently calm state to one of
violence. More likely is a steady progression from increasing
suspicion of people surrounding the patient to frank hostility,
sometimes accompanied by hallucinations commanding the
patient what to do. This gradual change, usually recognised
by community nurses or family who know the patient well, is
rarely depicted by Hollywood, which seeks more dramatic
effects.
The notion of split personality may have become
associated with schizophrenia after the ideas of Eugene
Bleuler, who introduced the term schizophrenia in the early
20th century and wrote about the splitting of mental
functions in the condition - a process by which he meant
disintegration of the coherence of thoughts and
personality, something very different from the idea of
separate personalities.
Dissociative identity disorder, the condition associated
with split personalities, is quite controversial, and the
diagnosis is rarely made outside North America. In fact it
is not recognised in the international classification of
diseases (ICD). The behaviour most often portrayed in
Hollywood cinema is more characteristic of psychopathic
or sociopathic personalities. The impulsive behaviour that
such people often exhibit is something that the lay
population finds difficult to understand and therefore
tends to attribute to madness. True psychotic illness is
something with which the general public has little
acquaintance.
Misrepresentations and truths
Hollywood schizophrenia has cropped up in recent
cinema. The protagonist in the 1999 film Fight Club
hallucinates a companion, or alter ego, played by Brad Pitt.
And once again we see a split personality interwoven with
violent behaviour.
One of the most outright misrepresentations of
dissociative identity disorder as schizophrenia is found in
Me, Myself and Irene. Jim Carrey plays a man with multiple
personalities, diagnosed in the film as having "advanced
delusionary schizophrenia with narcissistic rage." This
fundamental inaccuracy caused widespread anger. In the
United Kingdom alone, the Royal College of Psychiatrists
and the mental health organisations Mind and the National
Schizophrenia Fellowship made a joint protest against the
film.1
Shortly after this protest came the 2002 release of a
very different high profile Hollywood portrayal of
schizophrenia. A Beautiful Mind, the biographic movie of
mathematician John Nash, was relatively successful in
illustrating the devastating realities of the condition,
winning the approval of both film critics and the
psychiatric community in the process.
The symptoms of real schizophrenia can be categorised
into two groups - positive and negative. The negative
symptoms often prove the most difficult for patients and
their families to cope with, and respond least to drugs.
They include feelings of emotional numbness, difficulty in
communicating with others, and lack of motivation. The
effects of John Nash's negative symptoms were portrayed
accurately and sensitively in A Beautiful Mind, arguably less
so than his positive symptoms, which included delusions
(strange beliefs), visual and auditory hallucinations,
and paranoid thoughts.
The patient's view
Ian Chovil, who has experienced schizophrenia, explains
how film compares with real life, "Hollywood has a hard
time shooting delusions and hallucinations. It's very hard
to capture the experience of a psychosis on film because it
is mostly internal. They show hallucinations using
ordinary actors, and I've never met anyone with
schizophrenia who experienced hallucinations of people
of such exact detail. At the same time, just because the
voices are invisible doesn't mean they aren't as real as real
people. You relate to them as if they are real, and this
movie conveys that very well."
Although films that attempt to represent true life
mental illness often get it wrong, fantasy films
can be obscurely accurate. There is evidence that
dissociative identity disorder is a subtype of post-traumatic
stress disorder caused by childhood trauma.2 It makes some
sense then, that Anakin Skywalker and the hobbit
Sméagol would experience personality changes after
dramatic events early in their lives. The fact that
characters become evil and dangerous is still stigmatising,
although probably less so when they are non-human and
come from either Middle Earth or a galaxy far far away.
In absolute contrast to dissociative identity disorder, the
causes of schizophrenia are unconnected to events in
childhood. Biological factors are involved comprising
disturbances of brain development and disturbances in the
brain dopamine system. Wrongly placing blame on parents
and upbringing for the development of schizophrenia -
failing to recognise its biological basis - is one of the
damaging effects of misinformed portrayals of the
condition.
From a patient's point of view, Ian Chovil is equally
aware of the negative impact society and the media can
have. He says two factors need to be overcome in
recovering from schizophrenia, "There is the illness itself,
and the way we, as a society, treat people who develop it."
Chovil agrees that the premise of Me, Myself and Irene was
stigmatising, but he finds a positive message in the film. "It
was a comedy that actually had considerable compassion
for the hero. When he took his medication he improved,
and, when he didn't, he hurt himself more than anybody
else." Conversely, he feels that the plot of Fight Club carries
dangerous connotations for people with schizophrenia. At
the end of the movie, the main character shoots a hole
through his own cheek in an attempt to destroy his
hallucinated alter ego - and it works. "I know people who
start cutting themselves to get rid of their delusions when
their symptoms flare up. I hope none of them see this film."
Chovil's worries are supported by psychiatry. Copycat
behaviour is recognised in upsurges of people presenting
with deliberate self harm after depictions on television,
although this phenomenon has not been shown to be
associated specifically with cinematic releases. It should be
emphasised that self harm by patients with schizophrenia
is most often related to distress due to their psychotic
symptoms or a sense of hopelessness about their illness,
rather than from an external influence. Patients with
psychosis may sometimes mutilate themselves in response
to a hallucination or a delusional idea, but this is relatively
uncommon, as most will not see any real link between what
they experience and what is portrayed on screen.
In Ian Chovil's experience, movies certainly did reflect and even become involved in his psychosis. "My
experience of delusions were somewhat like the story of
Terminator - powerful enemies, nobody realising the truth
you have learnt, and the fate of humanity resting on your
shoulders." Speaking of his persistent delusions, Chovil
says "Sometimes it seems like I'm living in The Matrix. The
real world is very much different than the one we know."
This is evidence indeed for how deep into our psyches
Hollywood can reach: how many of us stepped out of the
cinema after seeing The Matrix, in full mental health,
experiencing similar what ifs? If movies can affect our view
of the world so profoundly, then, on some level, even if we
are fully educated to the contrary, perhaps we expect to
come across a violent, split personality schizophrenic.
Similarly, people who believe that dissociative identity
disorder is highly rare or non-existent speculate that its
high cinematic profile can increase the frequency with
which people present such symptoms and increase
diagnoses made by doctors.3 Reinforced mental health
clichés are therefore dangerous to us, both as members of
the susceptible public and as medical professionals.
KOBAL COLLECTION
Not all is well in
film and fiction
Reality of the unreal
Film makers often use cinema's deep reaching effects to
play psychological games with their audiences. Part of what
makes The Matrix, Fight Club, and A Beautiful Mind such
effective films is their presentation of what is not real as if
it were real. Later in the films, the viewer comes to realise
that things they wholly believed about the world they are
absorbed in are not true - giving them a taste of the loss
of grip on reality that comes with mental illness.
This is a scarier notion than any knife wielding psycho,
and movies that use mental illness in this way are often
more moving and impressive than films that create
caricatures of split personality. Split personalities are useful
tools for film makers though, providing a tangible human
flipside to an extreme or evil character, making it easier for
an audience to sympathise with them. It is likely, then, that
the epidemiology of dissociative disorders will remain very
different on the silver screen to the reality.
A Beautiful Mind has low profile predecessors and
successors that give accurate and moving portrayals of the
true schizophrenia, notably Through a Glass Darkly (1961)
and to some extent Donnie Darko (2004). Much of the
mental health community agrees, however, that the Oscar
winning blockbuster A Beautiful Mind has improved
public understanding of the condition. Although public
attitudes towards mental illness in the 1990s were actually
worse than in the '50s,4 the optimist might speculate that
Hollywood, the media, and society as a whole are now
becoming increasingly aware of the realities of
schizophrenia, as well as how damaging fundamental
mistakes, misconceptions, and prejudices can be.
In the words of Ian Chovil, it is important that we
recognise schizophrenia as "a tragic illness that can have a
happy ending."
Ian Chovil fully documents his experience of schizophrenia at
www.chovil.com.
Competing interests: None declared.
Alison Smith, fourth year medical student, Queen's University Belfast
Email: alismith88@hotmail.com
Stephen J Cooper, senior lecturer, Department of Mental Health, Queen's
University Belfast
studentBMJ 2006;14:309-352 September ISSN 0966-6494
- 1 Baron-Faust R. Review: Me, Myself and Irene. BMJ 2000;321:770.
- 2 Ginzburg K, Koopman C, Butler LD, Palesh O, Kraemer HC, Classen CC,
et al. Evidence for a dissociative subtype of post-traumatic stress disorder
among help-seeking childhood sexual abuse survivors. J Trauma
Dissociation 2006;7:7-27.
- 3 Byrne P. The butler(s) D.I.D. it: a cinematic history of dissociative identity
disorder. Medl Humanit 2001;27:26-9.
- 4 Link BG, Phelan JC, Bresnahan M, Stueve A, Pescosolido BA. Public
conceptions of mental illness: labels, causes, dangerousness, and social
distance. Am J Pub Health 1999;89:1328-33.
