PORTRAYALS OF MENTAL ILLNESS OF TEENS IN POPULAR TV SHOWS: 13 REASONS WHY AND ATYPICAL

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Authors Carter, Savannah

Citation Carter, Savannah. (2020). PORTRAYALS OF MENTAL ILLNESS OF TEENS IN POPULAR TV SHOWS: 13 REASONS WHY AND ATYPICAL (Bachelor's thesis, University of Arizona, Tucson, USA).

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Link to Item http://hdl.handle.net/10150/650934 PORTRAYALS OF MENTAL ILLNESS OF TEENS IN

POPULAR TV SHOWS: 13 REASONS WHY AND ATYPICAL

By

SAVANNAH MARIE CARTER

______

A Thesis Submitted to The Honors College

In Partial Fulfillment of the Minor With Honors in

Health and Human Values

THE UNIVERSITY OF ARIZONA

M A Y 2 0 2 0

Approved by:

______

Dr. Christina Cutshaw Department of Public Health Carter2

ABSTRACT

Background: Mass media, specifically television, has provided information and influenced perceptions of audiences on the topic of mental illness. Aims: To explore the extent that the popular dramatic television programs: 13 Reasons Why and Atypical, use stigmatizing or non- stigmatizing language about mental health conditions portrayed by the main character, the representation of mental health treatment, and how stigma is reflected in these portrayals.

Methods: The author conducted a qualitative content analysis of four episodes of each show.

Results: The depictions of mental illness through stigmatizing language, context, and plot were found to emphasize both public and self-stigma in each show. There were both positive and negative examples of treatment in each show with a more positive impression in Atypical than in

13 Reasons Why. Conclusion: Stigmatizing language continues to be used in popular shows that portray teen characters with a mental illness with mixed representation of treatment. Concerns include how teen audiences interpret the language and its contributions to stigma about mental health.

Keywords: mental illness, stigma, teens, television, media, portrayals of therapy, negative, positive Carter3

INTRODUCTION

We can learn a lot through television, some lessons are positive while some are negative.

What can we learn about mental illness? Mental illness affects all ages, including teens and young adults who consume a lot of media, and thus may be in a position to be influenced by television depictions of mental illness and mental health treatment.

Youth Mental Health and Stigma

A mental illness is a condition that affects a person’s thinking, feeling or mood (CDC,

2018). It may also affect one’s ability to relate to others and function each day (CDC, 2018).

Approximately 1 in 6 young adults experience a mental illness each year (NAMI, 2019). Many mental disorders have increased incidence in the teen years, including mood disorders, anxiety and substance abuse (Paus, Keshayan, and Gless, 2008). Around 50% of youth children received treatment for a mental disorder in 2018, with the average delay between symptoms and treatment being 11 years (NAMI, 2019).

One barrier to addressing mental illness are multiple kinds of stigma (Corrigan. Watson,

2002). Stigma is “a mark of disgrace that sets a person apart from others” (STIGMA, 2009).

More specifically, self-stigma is “the prejudice which people with mental illness turn against themselves” (Corrigan. Watson, 2002, p. 16). Public stigma is “the reaction that the general population has to people with mental illness” (Corrigan, Watson, 2002, p. 16). Stigma is a barrier between the success in treatment of symptoms among those with a mental illness (Ezell, Choi,

Wall, and Link, 2017). When a person is labeled by their illness they may no longer be seen as an individual but as part of a stereotyped group. Living in a society where stigmatizing ideas are promoted might make someone believe they are less valued because of their mental illness, Carter4 resulting in one’s self-esteem suffering (Corrigan, Watson, 2002, p. 17). Negative attitudes and beliefs toward this stereotyped group create prejudice which leads to negative actions and discrimination” (STIGMA, 2009). Prejudice can develop anger which leads to hostile behavior and results in the withholding of help for one mental illness (Corrigan & Watson, 2002, p.16).

A concern about stigma is that it may affect people seeking help (Corrigan & Watson,

2002). Out of 1.5 million young adults, around 545,000 believed that getting mental health services would cause them to experience discrimination from others, such as employers, friends, or family (SAMSHA, 2015). Stigmatized views of people with a mental illness are not limited to just the general public but also well-trained professionals from mental health disciplines

(Corrigan & Watson, 2002, p. 16).

Media Portrayals of Mental Illness

There are different representations of mental illness, both positive and negative, that impact not only those with a mental illness but also how the public views people with a mental illness. Media comes in many forms; “television, film, newspaper, magazines, social media, radio, and even mobile applications (i.e. apps). Media provides information that influences how people perceive and understand the world” (Maiorano et. al, 2017, p.703). Social Learning

Theory suggests that learning is not only through experience but through observation

(Srivastava, Chaudhury, and Mujawar, 2018), thus those who spend a lot of time watching television are likely to assume the television view of mental illnesses (Srivastava, Chaudhury, and Mujawar, 2018).

Several sources of negative attitudes toward people with mental illness include: labels, behaviors, attributions, misinformation, particularly regarding the association between violence Carter5 and mental illness (Link and Phelan 1999). Portrayals of mental illness are “often presented in such a manner that foster misconceptions about specific disorders” (Pirkis, Blood, Francis, and

Mccalum, 2006 p.530). They create an impression that some rare disorders are common, and they present misleading information about certain disorders (Pirkis, Blood, Francis, and

Mccalum, 2006). There is a history of often negative portrayals of mental illness in dramatic media such as television and film through depictions of violence, language such as ‘freak,’

‘dangerous,’ or ‘crazy,’ and mostly extreme portrayals of anxiety and depression characteristics

(Smith, Choueiti, Choi, Pieper, Moutier, 2019).

In a review (Goodwin, 2013), psychosis is commonly stigmatized within media and presents inaccurate depictions. Another study found that in dramatic television, 1 in 10 characters (8.7%) are killers and 4.3% are killed; and of those characters, 21.6% of those characterized with a mental illness were killers and 20.7% are killed (Signorielli, 1989).

Characters that had portrayed people with mental illnesses were more likely to be depicted as being victims of violence, as being unsuccessful and failures at their jobs more than half of the time, compared to 15% of average characters (Sieff, 2003). Wilson (1999) found that characters affected with a mental illness were portrayed as dangerous, violent, had low intelligence, and were unproductive members of society (Sieff, 2003; Henson et al., 2009).

Mental health treatment also has negative portrayals. Psychiatric facilities within films are shown with negative depictions such as acute psychiatric wards where inmates are deprived of basic human rights (Damjanovic, Vukovic, Jovanovich, & Masonic-Gašic, 2009; Goodwin,

2013). Mental health professionals have also been depicted negatively among movies and TV shows. A study done by Schneider (1987) categorized mental health professions into 3 types which others have used when considering mental health professionals in film: “the Dr. Dippy, Carter6

Dr. Evil, Dr. Sexy, and the mental health professionals as ‘rationalist foils’ have all been set up to be ridiculed, feared, or otherwise treated with contempt” (Pirkis, Blood, Francis, and

Mccalum, 2006, p. 532).

When some form of media portrays an organization or class of people in a negative way it can cultivate prejudice and discrimination and have a damaging impact on those with mental health problems by diminishing levels of self-esteem, discouraging help-seeking behaviors, and increasing discrimination and possibly decreasing their chance to recover (Maiorano et. al,

2017). Furthermore, “media depiction of mental disorders contributes to the level of fear, hostility, and intolerance in the general population,” relating back to public stigma (Mairoano et al. 2017, p. 703). Positive portrayals of mental health such as recovery stories and positive depictions of mental health professionals or treatment centers are often lacking (Pirkis, Blood,

Francis, and Mccalum, 2006). These representations impact not only those with a mental illness but also how the public views people with a mental illness: “the recent release of A Beautiful

Mind exposed the public to the idea that not all people with schizophrenia are violent criminals”

(Sieff, 2003 p. 262).

Non-fictional media may also perpetuate stereotypes. Henson (2009) found that 36% of human interest news coverage stories were categorized as ‘ordinary citizen with, or who has recovered from a mental illness’, 19% were depictions of people’s experiences with a mental illness or recovery, and 29% were neutral in their depiction of mental illness. In Canada, 88.5% of citizen journalism videos contained positive tones about mental illness and 61.5% of those videos also had recovery/rehabilitation emerge as the theme. In 61.5% of these videos, stigma was discussed as a negative social issue that affects people living with a mental illness

(Carmichael et al. 2019). Carter7

The current study

Teens have a lot of television exposure: “When it comes to television platforms, ‘a new generation is coming of age,’ teen and young adult audiences are watching hours of television programs each day, settling into the televisual flow of binge watching” (Matrix, 2014, p. 123-

124). This may indicate that young adults are exposed to images about mental illness and mental health treatment that can increase self-stigma (internalization of negative stereotypes about people who seek help), or public stigma (the reaction that the general population has to people with mental illness) ((Corrigan, Watson, 2002, p 16). While many studies have focused on representation of people with mental illness in television or film (Pirkis et al, 2006; Stuart, 2006;

Wahl, 2003; Stout et al, 2004) including children (Lawson & Fouts, 2004), fewer have focused on television about teen characters that many teens have likely watched (Mueller, 2019). This study will seek to explore to what extent popular dramatic television programs use stigmatizing or non-stigmatizing language about mental health conditions portrayed by a main character. Specifically, the author looked at how a character identified their own mental health and how other characters identified them using stigmatizing or non-stigmatizing language.

The author also examined the portrayal of treatment for mental illnesses and how stigma may be reflected in this portrayal. Carter8

METHODS

Sample and sources

Selection of dramatic television sources among youth

In this study, the author decided to focus on episodic television shows because of their popularity and because they specifically allowed for the development of story plots, characters, and themes due to the long run time compared to that of a single movie. The first step was to identify what kinds of television teens were likely to watch. A Google search ‘popular television shows in 2019’ led to locating an article: “The Top 20 Streamed Shows of 2019: All but One Are on Netflix” (Feldman, 2019) (See Table 1). This article was considered the primary on the list because it was the first search result, indicating high viewership and likely quality content

(Hubspot, 2018; SEO, 2020), and the reputable source, Forbes Magazine. This article listed 19 shows on Netflix and one show on Hulu.

Two other Google searches in December of 2019 were used compare results with the primary list e.g. Keyword searches of ‘Most popular on Netflix’ yielded multiple sources (See

Table 1). The next article used was on the Variety website: “Stranger Things 3,’ ‘The Witcher,’

‘When They See Us’ Among Netflix’s Most Popular TV Shows in 2019” (Littleton, 2019).

Information from Variety Magazine was selected because it was the second search result on the page and was popular (e.g. around 17% of web traffic clicks on the second result after the first)

(Lee, 2020) and because it is a long-running (1905) source of information on entertainment (e.g. vaudeville, stage, motion pictures, and television features (UCLA library, n.d). The last source used to corroborate popularity with the primary list was the Internet Movie Database (IMDB). Carter9

The IMDB has been used to identify media sources in other studies of media and stigma

(Maiorano et al, 2017). The article: “TV Series, released between 2010-01-01 and 2019-12-31,” listed shows in order of popularity. Next, the author cross-referenced shows from each of the three sources to find repeated mentions and applied inclusion and exclusion to the unduplicated shows. Shows were included if the show’s main character was a teen or young adult, if the show included reference to mental health content and was focused on the U.S. Exclusion criteria included: if the show was animated, in a different language other than English or if it was a crime, fantasy or science fiction genre.

To identify if there was mental health content in the show, the thesis author and advisor searched the title in the Netflix search bar to examine its descriptor key words. A list of search terms in Netflix was also used to identify shows including: mental problem, mental illness, trauma, psychological, depression, anxiety, and mental. From there we scrolled through each TV show and movie title to determine if the specific show we were looking for popped up when one of those identity terms was searched. See Table 1 for the lists of shows and indication of reason for exclusion.

Based on additional research, the author concluded that television shows offered by

Netflix were the appropriate focus as they were likely to have large teen viewership. Netflix was the most in-demand video streaming service in the United States in 2019 with 59.9% share, followed by Amazon Prime with 9.3% (Watson, 2020). Globally Netflix also dominates viewership at 182 million subscribers (Watson, 2020). Netflix appeal for those age 18-24 in

2015 was the highest at 34% compared to the rest of the demographic age groups (Albert, 2017).

“Teens report that bingeing on television comedies or dramas provides a “sanctuary for comfort and relaxation” (Matrix, 2014, p. 130). Carter10

Table 1: Popular Television Shows in 2019 Primary List: The Top 20 Streamed Shows Of 2019: All But One Are On Netflix (Feldman, 2019) 1. Lucifer (Ex-Age) 2. Stranger Things (Ex-Genre) *3. 13 Reasons Why (Also on list 2) (S) 4. Money Heist aka La Casa de Papel (Ex-Not U.S.) 5. Orange Is the New Black (Ex-Age) 6. The Handmaid’s Tale (Hulu) (Ex-Age) *7. Sex Education (Also on list 2,3) (S) 8. Elite (Ex-not MH) 9. You (Ex-Genre) 10. Chilling Adventures of Sabrina (Ex-Genre) 11. The Umbrella Academy (Ex-Genre) 12. Black Mirror (Ex-Age) 13. Dark (Ex-Not U.S.) 14. Marvel’s The Punisher (Ex-not MH) *15. Atypical (S) 16. Love, Death & Robots (Ex-not MH) 17. Mindhunter (Ex-Genre) 18. Marvel’s Jessica Jones (Ex-Genre) 19. Big Mouth (Ex-Anim.) 20. The Society (Ex-Genre) Supporting information List 2: Stranger Things 3,’ ‘The Witcher,’ ‘When They See Us’ Among Netflix’s Most Popular TV Shows in 2019 1. Stranger Things 3 (Ex-Genre) 2. The Witcher (Ex-Genre) 3. The Umbrella Academy (Ex-Genre) 4. Dead to Me (Ex-Genre) 5. You: Season 2 (Ex-Genre) 6. When They See Us (Ex-Genre) 7. Unbelievable (Ex-Age) 8. Sex Education (S) 9. 13 Reasons Why: Season 3 (S) 10. Raising Dion (Ex-Age) List 3: TV Series, Released between 2010-01-01 and 2019-12-31 listed shows in order of popularity 1.Sex Education (S) 2.The Witcher Ex-Genre 3.You (Ex-Age) 4.Vikings (Ex-Genre) 5.Mandalorian (Ex-Genre) 6.Grace and Frankie (Ex-Genre) 7.Titan (Ex-Genre) 8.Game of Thrones Ex-Genre) 9.Chilling Adventures of Sabrina (Ex-Genre) 10.Arrow (Ex-Genre) 11.The Crown (Ex-Genre) 12.Shameless (Ex-Age) 13.Peaky Blinders (Ex-Genre) 14.The Good Place (Ex-Genre) Carter11

15.The Morning Show (Ex-Genre) 16.The Marvelous Mrs. Maisel (Ex-Genre) 17.Stranger Things (Ex-Genre) 18.Power (Ex-Genre) 19.The Expanse (Ex-Genre) 20.Ray Donavan (Ex-Genre) 21.Schitts Creek (Ex-Genre) (S) Selected, (Ex-Age) Excluded for age, (Ex-Genre) Excluded for genre, (Ex-Anim.) Excluded for being animated, (Ex-Not U.S.) Excluded for not being focused on the U.S., (Ex-not MH) Excluded for not having a main character with a mental health issue.

Final selection of television shows and episodes

The final list included three shows that have a ‘realistic’ representation of a teen in a high school setting: 13 Reasons Why, Atypical, and Sex Education. It was later determined after reviewing the first episode of Sex Education that it would not be analyzed because conditions discussed in the episode were more focused on sexual health and not primarily mental health.

Both 13 Reasons Why and Atypical had two or three seasons, so the author and author’s thesis advisor determined that the focus would be on Season One of each show and the first two episodes and the last two episodes of each season with the assumption that there would likely be more content on the main characters in these episodes and time constraints did not allow viewing and coding of two full seasons on both shows. Plot summaries for these shows are included for reference (Table 2).

Table 2: Plot Summaries and Mental Health Issues: 13 Reasons Why and Atypical Show Plot Summary Mental Illness or Mental Health Problem 13 Netflix's 13 Reasons Why garnered criticism and praise in its first season Suicide Reasons thanks to the teen show's graphic depictions of suicide and sexual assault. It Rape Why was never an easy viewing experience, but the heartbreaking story behind Hannah's death was a reminder of the impact we have on each other's lives. Season one began with Clay Jensen receiving a box of tapes from Hannah Carter12

Baker, his former classmate who had recently died by suicide. Each tape took Clay deeper into Hannah's world, and revealed a tangled web of secrets that seemed to involve all of the major players in his high school. By the time the first season ended, Clay had learned the terrible truth about Hannah's suicide, and another one of his classmates was driven to attempt to take his own life” (Bowman, 2018). Atypical “Atypical introduces us to the Gardner family: mom Elsa and dad Doug and Autism their teenage children Casey and Sam. The show explores the changing dynamics between different family members as the children go through the agonies of adolescence, while keeping the main focus on how Sam’s autism has impacted them all as individuals. The main theme of Season One is Sam’s search for love, something his therapist Julia is keen to help him with” (Wallace, 2018).

Data collection

A coding chart was created to abstract information from the two TV shows. The information the author was coding for can be seen in Table 3. The author and the thesis advisor discussed all coding issues prior to and during the coding process, they looked for: how principle characters identified themselves, any typical/non-stigmatizing terms, the representation of treatment, and writers’ attitudes/tone towards characters and mental illness situations (not included in these analyses). The data coding spreadsheet was completed for each episode by the author and the author’s thesis advisor coded the first two episodes of each show as well but not the last 2 episodes.

Table 3: Information Coded in Each Television Show 1.Mental health issue/illness identified by another character/s or a different way (specify) character and peer representation, terms used to describe it. The terms looked for were taken from (Rose, Thornicroft, Pinfold, and Kassam, 2007) and are listed below: Disturbed, scary, nuts, confused, dumb, psycho, ill, spastic, loneliness, deranged, crazy, loony bin, bonkers, depression, psychiatric, disabled, screw loose, mad, unpredictable, violence, Insane, Brain dead, Loony, Demanding, Mental, Demented, Schizophrenia, Distressed, Weird, Embarrassed, Depressed, Different, Frustrated, Freak, Isolated, Odd, Sad, Problem, Retard, Stress, and Withdrawing.

2. How characters identify themselves (i.e. mental health issue/illness) 3. Representation of treatment (i.e. therapist, guidance counselor, etc.) based on 4 characteristics (Dr. Evil, Dr. Sexy, Dr. Dippy, Dr. Wonderful and 5 myths and key Carter13 characteristics) The four characteristics looked for can be described by (Pirkis, Blood, Francis, Mccalum, 2006) as:

Dr. Evil: sinister character who is outwardly charming but inwardly manipulative, malevolent, and trust breaching Dr. Sexy: de-professionalized, seductive female with her sexuality represented as an important role in the patient-therapist relationship Dr. Dippy: comic character whom is bumbling, idiotic, incompetent Dr. Wonderful: attractive, selfless, dedicated, always available, extraordinary skillful

4.Positive and Negative terminology used in either three sections 5.Writers attitudes/tones towards characters and mental illness situations

The 5 myths and key characteristics looked for are described by (Butler and Hyler, 2005, p. 514-

519):

1. " a child with 'mental illness' can be cured with enough love": Dr. Wonderful, the

perfect psychiatrist, yet a psychiatrist cannot accurately diagnose, give enough love,

attention, and cure.

2. "there is nothing to psychiatry; anything can be considered treatment and anyone a

psychiatrist": inexperienced imposter evoking radical changes through off-the-wall

approach; Dr. Dippy, Evil, Wonderful are included

3. "if you do not do what we want, you will be locked up forever": psychiatrists are

portrayed as jailers for nonconformists and the ‘mental hospital’ is unrealistic and

harsh

4. ‘mental illness is actually a gift; psychiatrists take away that gift”: account the

emotional and social toll mental illness costs its sufferers

5. "mental illness and evil overlap in their presentations": possession by an angry spirit

is what is responsible for a diagnosed psychiatric condition. Patient would be violet

and antisocial Carter14

Analysis

The author coded and read through the coded information, and analyzed each episode based on the above factors in Table 3. A content analysis was used to “allow quantitative analysis of seemingly qualitative data” (Kondracki, Wellman, and Amundson, 2002, p. 224). The content consisted of words, phrases, and concepts were identified and an inductive qualitative approach; which is defined as a systematic procedure for analyzing qualitative data where the analysis is guided by specific objectives such as a hypothesis (Thomas 2003), allowed for the author to make conclusions based on the presence or absence of particular ideas (mental illness stigmatization/non- stigmatization from main character or peers) and theories (e.g. portrayals of

Dr. Dippy, Dr. Evil, Dr. Sexy, Dr. Wonderful.) Carter15

RESULTS

Depictions of Mental Illness Through Language

In Table 4, in episodes 1, 2, 12, and 13 of 13 Reasons Why (See Appendix A, Table A1 for raw data), examples of negative terms supporting characters are calling the main character,

Hannah, are underlined. These terms included: retarded, weird, liar, needy, unstable and phrases including ‘She was practically begging me to f--k her. If that’s rape, then every girl at this school wants to be raped’ and ‘Hannah was a user and a liar’ but no evidence of positive language regarding mental illness that supporting characters are calling the main character or the main character identifying themselves is present. In Atypical, Table 4 episodes 1, 2, 7, and 8 (See

Appendix A, Table A2 for raw data), there were examples of negative terms supporting characters are calling the main character Sam underlined below, including: weirdo, retarded, not ordinary and phrases like ‘he’s not all there’ and ‘he is not like us.’ There was evidence of positive language when the main character described their own mental illness and when the main characters mental illness was described by others, for example phrases like ‘when I was little I used to hit or bang my head or yell and now I try to use replacement behavior’ and ‘I am all there, I am!’ Atypical also had evidence of the main character being described negatively although it was not about mental illness specifically. For example, the supporting character

Casey sister to Sam: ‘why do you make things so literal? God, you suck.’ Carter16

Table 4: Summary of Depictions of Mental Health Through Language: 13 Reasons Why and Atypical 13 Reasons Why (4 episodes) Atypical (4 episodes) Main character/mental illness described by others Negative - weird, emotionally unstable - retarded, weird, not all there, Quote example - Courtney solidifying story for has major problems deposition: "Hannah was a [liar]. She was -Mom about Sam: 'he’s not like [jealous] and [needy] and emotionally us' unstable. She thought everyone was out to - "His life isn’t ordinary" get her. She was the one with problems" - Bailey: "I know your brother - “Hannah was practically has major problems" begging me to f--k her. If that’s - "He’s not all there" rape, then every girl at this school wants to be raped. You want to call it rape, call it rape. Same difference" Positive N/A - Sam: "when I was little I used Quote example to hit or bang my head or yell and now I try to use replacement behavior" Supporting character mental illness described by others Negative -retarded N/A Quote example - Basketball Team member to Justin about Jessica: "She looks bad" Tell her to get her sh*t together. She’s acting like a [nutjob], drawing attention to herself" Positive N/A N/A Quote example Main character -[slut], [liar], [easy] -Sam’s sister to Sam: "why do described negatively you make things so literal? God, (not about mental you suck. Find me if you don’t illness specifically) have anyone to eat with to Sam. -- nuance: Sam is not affected by the negative words of his sister, and the context in which his sister Carter17

uses the words is not negative.

How characters identify themselves – their own mental illness or mental health issues Negative/ - Hannah: "It seems like no - Sam: they think I’m weird- Quote example matter what I did I kept letting regarding girls people down. I started thinking how everyone’s lives would be better without me. And what does that feel like? It feels like nothing. Like a deep, endless, always blank nothing."

Positive N/A -Sam to Dad: "I am all there, I Quote example am!"

Depiction of treatment

In Table 5 you can see the four episodes of 13 Reasons Why (See Appendix A, Table A3 for raw data) and the representation of treatment with the guidance counselor Mr. Porter and the rest of the characters. You can also see the four episodes of Atypical (See Appendix A, Table A4 for raw data) and the representation of treatment with therapist Julie and the main character Sam who is autistic. The main issue in 13 Reasons Why was the guidance counselor’s negative and unhelpful attitude towards the main character Hannah with statements like: ‘Look something happened that day Hannah and I believe you, but if you won’t confront him then the only other choice is to move on” matching that of Dr. Dippy whom is incompetent and ineffective and Carter18 suggests the Dr. Dippy therapist stereotype. The main issue in Atypical was the positive portrayal of the patient and therapist relationship, with her helpful attitude mentioning: “you just have to put yourself out there”, “there are strategies I could teach him” matching that of Dr. Wonderful stereotype.

Table 5: Summary of Representation of Treatment/Help Seeking: 13 Reasons Why and Atypical

13 Reasons Why (4 episodes) Atypical (4 episodes) Representation of - Mr. Porter matches Dr. Dippy’s - Julia matches Dr. Wonderful treatment/help- incompetent and bumbling attitude selfless and dedicated attitude seeking Negative Quote - Mr. Porter to Hannah: "Did he force himself - Julia was upset with Sam after he example on you, did you tell him to stop, did you say confessed his feelings for her and she said no?"… "if you cannot give me a name there is it was unprofessional, was yelling, saying really only one option. you can move on" … how she could lose her job "Look something happened that day Hannah and I believe you, but if you won’t confront him then the only other choice is to move on”

Positive Quote - Coach to Clay (main supporting character): " -Julia (Sam’s therapist) “you just have example Just know I’m here" to put yourself out there”, “there are strategies I could teach him” Carter19

DISCUSSION

The teen years represent an important time of risk for mental illness as 50% of all lifetime mental illness begins by age 14 as well as suicide being the 2nd leading cause of death among people aged 10-34 (NAMI, 2019). Television and film can influence stigma-self and public- through the “exaggerated, inaccurate, and comical images, they use to portray persons with mental illnesses as well as providing incorrect information about mental illness” (Srivastava

2018, p.1). If there are continued negative and inaccurate representations of mental health conditions and treatment, teens may be influenced by these forms of media in ways that may lead them to be wary of seeking help from the proper resources. In this study, eight television episodes from two popular television shows watched by teens with main teen characters experiencing mental health issues were examined for their use of stigmatizing terminology for mental health issues and for their representation of mental health treatment.

Use of stigmatizing terminology

Stigmatizing terminology was represented in both shows. Results 13 Reasons Why and

Atypical, indicated there were instances of negative images of mental illness or mental health related issues (i.e. behavior by a character that committed suicide or a character living with autism) of main characters suggesting public stigma. Negative images were indicated by stigmatizing language applied to main characters by supporting characters referencing their Carter20 mental illness included “weird” and “retarded.” This finding is similar to other studies of fictional media characters that included “pejorative language - e.g. terms such as ‘crazy’, ‘mad’,

‘losing your mind’, ‘psycho’, ‘deranged’, ‘wacko’, and ‘loony’” (Pirkis, Blood, Francis, and

Mccalum, 2006, p. 528), or other issues (e.g. Hannah as a “liar” or Sam was “not all there”).

There were, also, instances of self-stigma. Stigmatizing language also applied to the main character identifying their own mental health issue with Sam mentioning “I know when I’m being picked on, I don’t always know why which is worse” and Hannah stating, “no matter what

I did I kept letting people down”, “none of you cared enough and neither did I.”

Context may be important when considering the use of stigmatizing language. Looking at the two shows together in terms of stigmatizing language – the impression for the viewer may be considered positive or negative was based on the context in which the language was used. The context of Atypical portrayed a mix of positive and negative stigmatizing language based on the context and what character spoke. The main character Sam would identify himself as weird because he knew that’s how others viewed him based on what other characters called him. He knew he was different but that did not stop him from doing normal things like getting a girlfriend. Other supporting characters such as his sister Casey would challenge Sam with her language and although she would use negative terms like ‘you suck’ or ‘weird’ she did not mean them in a negative way. Characters who did not personally know Sam would use negative stigmatizing language like ‘he has major problems’, ‘he is not all there’, and ‘retarded’. In both

13 Reasons Why and Atypical, the effect of this language on stigma of mental illness/health cannot really be determined unless the viewer’s impressions are analyzed.

Plot and language may also be important when considering stigmatizing language.

During the first two episodes of 13 Reasons Why there is plot exposition as the main character Carter21

Hannah’s story was set up and the negative language came from all the supporting characters. In the last two episodes of season one’s plot resolution, she was always attacked, bullied and she wasn’t even alive anymore in the show, just a voice over. The negative stigmatizing language came from both supporting characters talking about Hannah’s suicide as well as Hannah talking about her feelings leading up to her suicide. In Atypical the plot of the story is a teen with autism trying to live and function in society. The exposition of the show had the main character, Sam being attacked verbally by the supporting characters and towards the plot's resolution, Sam was more understood by others.

While not a primary focus of this study, it is important to note that there are similarities as well as differences between our results and those of previous research indicating characters with mental illnesses were more likely to be depicted as victims of violence and as unsuccessful in life compared to other characters (Sieff, 2003). Hannah could be considered as a victim of self-violence, i.e. suicide. On the other hand, based on the findings from Atypical, Sam, the main character, is represented positively, as he learns new skills to cope: "when I was little I used to hit or bang my head or yell and now I try to use replacement behavior.”

Previous literature also suggests that characters with mental illness almost never express signs of recovery or hope for improvement, and they rarely make any productive contribution to their community (Pirkis, Blood, Francis, and Mccalum, 2006). While the mother of the main character Sam says, “he is not like us Neurotypicals” and others say: “I know your brother has major problems and is not all there,” Sam is also portrayed as a perceptive character who realizes: “people don’t think I know when I’m being picked on, but I do” and “people think autistic people do not have empathy but that is not true.” Sam tries to have a typical high school life for a high schooler and achieves his goal of getting a girlfriend at the end of the season. His Carter22 family also grows with them coping with Sam’s development as a person. Sam can be considered a victim of verbal harassment due to his mental illness, making him unsuccessful in day-to-day tasks until one day he finally achieves it, as his development as a person takes longer than the average.

Representation of treatment

Mental health treatment was represented in both two shows as seen in Table 5. In this study, the author looked for a) evidence of the stereotypes as suggested by Schneider (1987): Dr.

Dippy, Dr. Evil, Dr. Sexy and Dr. Wonderful,” and b) that the mental health professionals would be portrayed as people “set up to be ridiculed, feared, or otherwise treated with contempt”

(Pirkis, Blood, Francis, and Mccalum 2006, p. 532).

In Atypical, each episode has a session portrayed between the main character, Sam, with his therapist. The portrayal of the patient-therapist relationship appears positive and the therapist could be compared to the Dr. Wonderful stereotype as she helps Sam regulate and figure out the world. She is shown as competent when Sam is asking many questions about her “anyways, it’s great you’re showing so much interest in others, we've been working on that.” The author did not find in the four episodes of Atypical evidence of the use of the Dr. Dippy, Dr. Evil, or Dr. Sexy and therapy seemed to be portrayed as being potentially effective, though Sam’s attempt to get his therapist to see him as a romantic partner was a comedic storyline.

In 13 Reasons Why the guidance counselor, Mr. Porter, plays a big role towards the end of the show’ first season. He is portrayed as a sympathetic listener several times, e.g. he asks

Clay: “so what is on your mind today?” However, he is also portrayed as incompetent and Carter23 ineffective, like the “Dr. Dippy” therapist stereotype when he advises her to take a more legal approach regarding the assault that Hannah went through. If this action is not taken, then there isn’t really another option to reprimand the assailant. This conversation sparks controversy about what the “correct” response is to a survivor of assault. The conversation is as follows:

Mr. Porter- "if you cannot give me a name there is really only one option. you can move

on",

Hannah- “you mean do nothing?”,

Mr. Porter- "Look something happened that day Hannah, but if you won’t confront him

then the only other choice is to move on".

Comparing these two shows there seems to be an equal representation of positive and negatives for treatment professionals. In 13 Reasons Why, the guidance counselor although present and sympathetic, seems ultimately incapable of providing/saying the correct things to successfully help the main character in crisis. This may suggest to teen watchers that therapists may be ineffective when needed most. Atypical’s portrayal suggests competence in that Julia the therapist is not ultimately frustrated with her client, always has a happy and helpful tone and works to maintain boundaries and support Sam in his quest to function with autism. This may suggest to teen watchers that therapists can be reliable, effective, and not like the Dr. Evil portrayals in most shows and movies.

Conclusion and Implications

These popular shows that are about teens and feature teens with mental illnesses/health play a role in how the public as well as one suffering from a mental illness treat each other and Carter24 themselves. While some of the influences through the sampled episodes in the selected shows were positive, there are also negative language that may be stigmatizing about mental illness that a large majority of teens are exposed to. Teens are very influenced by the media and those ages

12-17 spent over 18 hours and 23 minutes watching TV in the first 3 months of 2018 (Watson,

2018). This doesn’t even include the amount of time they listen to music or view popular social media platforms (i.e. Facebook, Instagram, and Twitter). These popular shows may alter perception and influence public views on topics such as mental health through the use of negative language and terminology and representations of treatment.

Future research

Further research could include extending coding to more coders to increase reliability, extending coding to more seasons, and studies that use could teen audience surveys where a group could watch the episodes and then be asked a series of questions to assess stigma or impressions of treatment, for example if they witnessed and language about mental illness, noticed any certain attitudes around the mental health topic while watching. The study could also focus and code the behavior of characters to look if they are isolating, withdrawn, or any other characteristics of someone that has a mental illness.

Limitations and Strengths

Limitations of this study included time constraints that limited the sample of episodes coded. Full coding by both the author and thesis director were not conducted, possibly reducing reliability of the conclusions. Strengths include coding of 4 episodes for each show which is more content (i.e. 4 hours) than feature films allowing for more information to be considered Carter25 given the longer form and inclusion of shows that are widely watched. Research that focuses on shows many teens watch and that feature teens seems to be a novel approach based on the author’s review of the literature.

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Appendix A

Table A1: Raw Data of Depictions of Mental Illness Through Language: 13 Reasons Why

S1: Episode 1 S1: Episode 2 S1: Episode 12 S1: Episode 13

*Tony *Hannah: 'maybe * Justin: "Jesus! F-- *Kat: “If I’d been Mental (supporting you did king Hannah!"--> around to help health character): something cruel… when getting served her through it issue/or "Hannah wanted maybe you just subpoena papers she'd still be illness it done this way" watched it * Alex: " Yeah, f-- around today" identified Dad also happen… maybe king Hannah. F--k * Clay: We all let by another mentions that if you didn’t do her for killing her walk away. character/ he pulls anything anything at all herself" (sarcasm She went home, s or like that he will and you should tone). go some things identified kill him have"..."oh and *Courtney in order. She in a *Clay (lead): by the way, I’m solidifying story for returned her different finding out the still dead" deposition: "Hannah uniform, dropped way than truth about what * Jessica: "don’t was a [liar]. She was a package off to language led to Hannah believe jealous and needy a friend, then (specify killing herself. everything you and emotionally she went back terms Doesn’t beat hear" unstable. She home, put on used around the bush *"Are you weird" thought everyone some old clothes, character on the topic "God you are was out to get her. she went into the and peer * Courtney weird" She was the one bathroom, and representa (supporting *Hannah and with problems" she died alone" tion character): Clay: "special, * Zach: "Just cause *Tyler: I get shit identifies a like retarded, I’m Hannah f--ked up every day, mental illness as retarded..." her life doesn’t people trip me. a time where the * Jessica: "Hannah mean she has to f--k Guys would call friends of the is a [user and a up ours too" her a slut and person that was liar]... what she *Bryce talking to say that she was affected need to said on those Clay: "Hannah easy. be there for each tapes, she’s a wanted it, she made *Jessica: tells other [slut] and eyes. She was dad she got * Clay’s [liar]...was a liar" practically begging raped parents: always *Basketball me to f--k her. If * Alex: shot asking 'How was Team member that’s rape, then himself in the school today? to Justin about every girl at this head last night How are you Jessica (supp school wants to be and is in critical Carter30

doing?" in the char): "She looks raped. You want to condition at the tone of worried bad" Tell her to call it rape, call it hospital parent get her shit rape. Same *"it", continued together. She’s difference" talking about acting like a suicide after a [nutjob], drawing week at school- attention to not mentioning herself" suicide *Hannah mom: specifically "bullying"- in regard to Alex list How N/A N/A * Hannah: "It seems * Hannah: ' I characters like no matter what I had poured it all identify did I kept letting out, and for a themselve people down. I minute I thought s started thinking how I could beat this. everyone’s lives I decided to give would be better life one more without me. And chance. I know what does that feel that I cannot do like? It feels like it alone. " "None nothing. Like a deep, of you cared endless, always enough and blank nothing." neither did I" Carter31

Table A2: Raw Data of Depictions of Mental Illness Through Language: Atypical S1: Episode 1 S1: Episode 2 S1: Episode 7 S1: Episode 8 *Mother: 'he’s not like * Mom: in regards to * Paige (Sam * Bartender:" I Mental us' group therapy " It’s not GF): Who knew think your mom health * Casey guy friend: like we come here for the that meth heads spent a long time issue/or "What is wrong with fun of it" - "His life isn’t and people on the stuck in a role" illness him" (not in a negative ordinary" spectrum had identified way) also "who’s * Bailey Bennet (girl that some of the same by another normal speech" was punched): "I know needs? It makes character/ * "you are weird (co- your brother has major you less annoying s or worker) problems"- "He’s not all talking about identified * therapist: has lecture there" Antarctica in a on autism- not stated * Casey: "why do you different explicitly make things so literal? way than *'retarded', is something God, you suck. Find me if language wrong with your brain you don’t have anyone to (specify * mom: he’s not like us eat with to Sam. terms (re: dating) -- nuance: Sam is not used affected by the negative character words of his sister, and and peer the context in which his representa sister uses the words is tion not negative.

How * Sam (main): knows * Sam: "when I was little N/A * Sam: wants to characters he’s different and what I used to hit or bang my date Julia but she identify autistic is. Knows his head or yell and now I try tells him its themselve self-stimulatory to use replacement inappropriate s behavior and his other behavior" and he had an unique things about * Sam: "people don’t incident and himself (back doesn’t think I know when I’m caused a scene— touch seat on bus, needs being picked on, but I do, Sam’s terms a hard touch). and I don’t always know * Sam: “people *they think I’m weird- why which in some think autistic regarding girls instances is worse" people do not *Sam to Dad: "I am all have empathy there, I am!" but that is not true” Carter32

Table A3: Raw Data of Representation of treatment/help seeking for mental illness or problems: 13 Reasons Why

S1: Episode 1 S1: Episode 2 S1: Episode 12 S1: Episode 13 Representation somber, * Coach to Clay *Mr Porter and *Mr. Porter and Clay: 'so of threatening, about Justin: " Just Sheri: S: "I what is on your mind today'. treatment/help *teacher at the know I’m here" (pos.) wanted to talk to * P: “Look Clay, whatever seeking for beginning *Mom: gives pills at you about Hannah happened to Hannah between mental illness describes to table. I stopped taking Baker…" Mr. P: you and her with other kids, or problems class where to them 2 years ago. "and if you she made that choice to take get "help if you Mom says Dr Ellman remember her own life” need it" said you could have anything or hear P: "we can try to love each them available if anything you tell other better but we are needed us first okay" imperfect. You can still know *Ms. Antilly (first all the signs but still miss guidance counselor): something "… "But if she puts effort to put wanted to end her life we Hannah and Jessica weren’t going to stop her" together even though C: "I took Hannah at her they are nothing alike word which is what you - made out to be should have done" clueless, idiot *Mr. Porter and Hannah: " matching Dr. Dippy I don’t care about anything; the school, myself, my parents, anyone here", "You mean do nothing?" 'P- It’s like it doesn’t even matter what you say," It sounds like there is something that you need but are not getting so let’s start there' "Did he force himself on you, did you tell him to stop, did you say no?"… "if you cannot give me a name there is really only one option. you can move on" ,,,"Look something happened that day Hannah and I believe you, but if you won’t confront him then the only other choice is to move on" Carter33

Table A4: Raw Data of Representation of treatment/help seeking for mental illness or problems: Atypical

S1: Episode 1 S1: Episode 2 S1: Episode S1: Episode 8 7 representation * Julia (Sam’s *Sam and therapist: Julie *Julia helped *Julia was upset of therapist) portrayed as competent skillfully Sam slow with Sam after he treatment/help funny, sympathetic, redirects him when he is dance confessed his seeking for helpful: identifies with asking many questions feelings for her and Atypical first myth as Dr. about her: “anyways, its she said it was Wonderful and Dr. Sexy great your showing so much unprofessional, *Julia Psychiatrist interest in others, we've was yelling, saying (lead): “you just have to been working on that…but how she could lose put yourself out there”, “ how about we get back to her job there are strategies I you”. could teach him” *Support Group for mom: * Sam: seeks constant mom's listened, attentive, help from therapist supportive, provided advice * mother talks to the to friend on her son's therapist about dating, progression therapist suggests mother my talk to someone re: having hard time with having an autistic child mom: “dating is almost entirely nonverbal communication and Sam’s the most literal person I know”.