Mental Health in the Media Exam Study

Based of Psyc 365 Study Guide

Psychoanalytic Theory

• Sigmund Freud

• studied psychological development & personality - explored function & structure of the mind, psychosexual stages

• Proposed unconscious & intrapsychic conflicts - subconscious conflicts between ID & superego

• Defense mechanisms - unconscious processes created by ego

Repression

Keep impulse in unconscious

Displacement

redirect impulses towards others

sublimation

redirect impulses to benefit society

reaction formation

does opposite of impulse

projection

attributes impulse to others

denial

refuses to accept reality or facts

application of psychoanalytic/psychodynamic theory to film

• filmmakers often rely on principles for the development of characters & narratives

• the plot reveals themes derived from theory- unconscious dynamics, trauma, family conflict

• portrayal of psychotherapy in film is often psychoanalytic: most popular applied in film

Psychodynamic theory

• neo-freudians

• de emphasized sexual core of freud’s theory

• emphasize unconscious conflicts, trauma, defense mechanisms, emotional expression & interpersonal relations

• subconscious conflicts often deprived from trauma & interpersonal conflicts

carl jung (1875-1961)

“collective unconscious”

alfred adler (1870-1937)

“inferiority complex”

anna freud (1895-1982)

“self-psychology”

Behavioral theory: Classical conditioning

• condition= association= learning

Ivan pavlov (1849-1936)

• association between neutral & conditioned stimuli

• stimulus-response associations

john b. watson (1878-1958)

• “little albert” experiment revealed stimulus generalization & discrimination of behavior: explains acquisition of anxiety/phobias

E.L Thorndike (1874-1949)

• law of effect: behavior will be repeated more often if it is followed by good consequences

B.F Skinner (1904-1990)

• behavior operates on environment & managed by consequences (rewards & punishments)

• behavior “shaping”: new behavior can be learned by reinforcing successive approximations

application of behavioral theory to films

• behavioral theories may be applied to interpretation of characters

• modeling- shaping behavior, learning from others

• reinforcement/punishment- the impact of rewarding or penalizing behavior

Humanistic Theory

• person-centered therapy

• importance of therapeutic alliance

• hierarchy of needs

• both believed that people strived for self-actualization

application of humanistic theory to films

• often applied to narrative & character development

• the consequences of life choices is common theme

• pressure of family, society & others often explain characters actions- dissatisfaction w/ life

Carl rogers (1902-1987)

• person-centered therapy- intrinsic human goodness

• importance of therapeutic alliance: therapist empathy, warmth & unconditional positive regard

Abraham Maslow (1908-1970)

Hierarchy of needs

Humanistic: Existential theory: Rollo May (1950), Victor frank (1959), Irvin yalom (1970)

• discusses angst, anxiety & despair over facts of existence

• people create “meaning” of life, awareness & death through personal decisions

• take responsibility for life choices

Cognitive Behavioral Therapy: Aaron beck (1921-2021)

• Emphasis on the effect of negative thoughts, feelings & behaviors on mood & distress

• the subjective interpretation of events is fundamental to explaining the development of emotional distress

application of cognitive theory to films

• interpretation of significant events (correct/incorrect) may be applicable to character development

• portrayal of psychotherapy in film often illustrates aversion of cognitive therapy, “thoughts affect your behavior”

• often principles are oversimplified or misapplied

Framing of mental illness in film/media (Sief, 2009)

• system of how media information and data are organized, conveyed, and interpreted

• as opposed to static information (literature), media framing is more vivid and interactive

• most people obtain their impressions of mental health from the media

• framing of the mentally ill is frequently negative

Influence of film/ media on audience/ public (Sief, 2009)

• framing affects public perceptions of the mentally ill, treatment, and help-seeking behavior: the public is susceptible to accepting these misrepresentations,

  perpetuates stigma

Negative framing (examples) (Sief, 2009)

• media coverage has been consistently negative

  • stereotyped and flawed representations

• promote perceptions that the mentally ill are different

  • dangerous, bizarre, transient, or cheerful

positive framing (examples) (sief, 2009)

• celebrities sharing personal issues: substance abuse, depression, bipolar disorder

• most accurate movie portrayals

  • present multiple aspects of mental illness

  • however, realistic or sympathetic representations are the exception

• lady gaga, howie mandel

Main mechanisms: frames (examples) (Sief, 2009)

• provide symbols of mental illness

• suggest experiences of mental illness

• guide cognitive processing of information

• schema

• shape formation and persistence of perceptions

frames: function (sief, 2009)

• frames focus on ‘what will be discussed, how it will discussed and above all, how it will

  not be discussed” (altheide, 1996)

• problem-defining

• what is the problem?

• what creates the problem?

• what is bad about the problem?

• how is the problem treated?

framing: structures (sief, 2009)

• syntactical structures: use of headlines or style (inverted pyramid)

• thematic structures: offer explanations or causes

• thematic structures are more complex: less likely to grab attention than syntactical structures

framing: elements (sief,2009)

• specific elements for framing information about mental illness

• metaphors: symbolic

• exemplars: examples

• catchphrases: slogans or tags

• depictions: descriptions

• visual images: pictorial

individual framing (sief, 2009)

• repetitive and consistent: reinforces public perceptions and understandings

• cognitive schema: affects how information is processed and recalled

• persistent: recurring cues activate perceptions that are difficult to modify

Cinematic portrayal of mental illness (Pirkis et al., 2006)

• mental illness represented in few (less than 5%) films and television programs: however, much larger (20-85%) representation in children tv programming

• majority of portrayals are negative stereotypes

• film techniques are used to frame negative portrayals: perspective, music, setting, lighting, makeup, etc.

• negative terms and labels are often used to stereotype mentally ill characters

Major study findings and conclusions (Pirkis et al., 2006)

Nature of mental illness portrayals (negative) (Pirkis et al., 2006)

• homicidal maniac: aggressive, violent

• female seductress: seduce others for self interest

• narcissist: privileged, self-absorbed

Nature of mental illness portrayals (positive) (pirkis et al., 2006)

• humorous: witty

• enlightened: god-like

• creative: artistic

Portrayals of mental health professionals and treatment (Pirkis et al., 2006)

• mhp have higher representation (about 10%) in tv programs

• portrayals are negative and positive (feared and endeared but mostly negative)

• mostly inaccurate and negative: severe, distorted, unrealistic, unethical

Suture

filling in gaps of narrative, character & cause

projection

anticipate the narrative, plot, ending

identification

relate w/ a character (protagonist, antagonist)

Major cinematic elements (themes, pacing, sound, dialogue, mise-en-scene, etc.)

Common stereotypes in film (Hyler et al. 1991)

Dominant themes in film (Hyler, 1988)

Most common mental health conditions portrayed in film and study recommendations (Smith et al., 2019)

Background of DSM 5 (structure)

• categories of mental disorders

• nearly 300 disorders

• each dsm edition increased # of disorder, except dsm 5

• does not address etiology or treatment issues

Background of DSM 5 (checklist)

• minimum # of symptoms

• timeline

• level of impairment

Background of DSM 5 (history)

• DSM-5: published in 2013 by APA- TR released in 2022

• DSM I- 1952, DSM II- 1968, DSMIII- 1980, DSMIV- 1994

• dominantly psychiatric

Pros versus cons of DSM (Frances & Wittchen, 2013)

• Pros: incorporates latest scientific research, universal, facilitates communication between clinicians, provides insight on mental health for patient & family

• Cons: did not increase diagnostic accuracy, does not address prevention, some diagnostic labels are stigmatizing, dsm 5 will do more harm than goof

Future directions of DSM

• should consider dimensionality

• medical model is limiting

Common misconceptions of psychotic disorders in film

• schizo. is multiple personality: common misnomer (split personality

• visual hallucinations: only 20% recorded in psychotic patients

• linked to genius & creativity

• violent, aggressive nature

Main characteristics of psychotic disorders

• rare: occurs in 1% of population

• relapse is high (about 50%)

• equally prevalent in f & m

• dominantly biological in origin

main domains of psychotic disorders

• delusions

• hallucinations

• negative symptoms

• disorganized thinking/speech

• abnormal motor behavior

Most common types of hallucinations and delusions

• delusions: irrational false beliefs - grandeur or persecution

• hallucinations: sensory events w/o external stimulus - auditory

Delusional Disorder

• at least 1 mo. or longer

• criterion a. for schizophrenia has never been met

• not markedly impaired & behavior is not obviously odd or bizarre

Brief Psychotic Disorder

• positive symptoms of schizophrenia

• less than 1 mo.- full remission w/in 1 mo.

• precipitated by trauma or stress

• high rates of relapse

Schizophreniform Disorder

• psychotic symptoms (2 or more)

• between 1-6 mo.- greater than 6mo= schizophrenia

• associated w/ relatively good functioning

• lifetime prevalence: 0.2%

Schizophrenia

• delusions

• hallucinations

• disorganized speech/thoughts

• abnormal motor behavior- grossly disorganized or catatonic behavior

Schizoaffective Disorder

• symptoms of schizophrenia w/ the experience of a major mood episode

• psychotic symptoms must occur outside mood disturbance

• occurs more often in females

• prognosis is similar for ppl w/ schizophrenia

• lifetime prevalence: 0.3%

Scientifically known causes of schizophrenia spectrum disorders (biological, psychological, and social)

• dopamine hypothesis: overactive dopamine

• structural & functional abnormalities in brain: enlarged ventricles, hypofrontality

• genetics: inheritable tendency for schizophrenia

• role of stress

• family interactions

Scientifically supported treatments for schizophrenia spectrum (medical, psychological/ psychosocial)

• medical: ECT as last resort, antipsychotic meds (chlorpromazine)

• psychological: social reintegration & relapse prevention

Portrayal of schizophrenia in film (Owen, 2012)

Study hypotheses, findings, conclusions (Owen, 2012)

Common portrayals of depressive and bipolar disorders in film (stereotypes, misconceptions)

• bipolar: overplay relationship between creativity & disorder

• depressive: suicidal, hopeless, poor self-esteem

Main differences between depressive and bipolar disorders categories (episodes, symptoms, prevalence)

• there is no cycling between depression & mania: unipolar- dysphoric episodes- occurs 7-10% of pop. w2:m1

• cycles with depressive episodes: bipolar- occurs 1-3% of pop. m&f equally

Major Depressive Disorder

• episodes involve extreme depressed mood &/or loss of pleasure (anhedonia) - at least 4 other cognitive & somatic symptoms

• consists of 1 or more episodes

• prevalent 7% adult pop; occurs 2x the rate in females compare to males

Persistent Depressive Disorder

• a chronic, low-grade depression

• at least 2 depressive symptoms for at least 2 yrs.

• depressed mood most of the days, more than 50% of days

• earlier onset associated w/ worse outcome

Disruptive Mood Dysregulation Disorder

• severe temper outburst occurring frequently

• at least 1 symptom present for at least 12 mo. diagnosed on in children 6-18

• designed to combat overdiagnosis of bipolar disorder & ADHD& conduct disorder in youth

Premenstrual Dysphoric Disorder

• significant depressive symptoms prior to menses

• at least 5 total cognitive/mood& physical symptoms (at least 1 in each area)

• prevalent in 2-3% of women

causes of depressive disorders

• cognitive: depressogenic thoughts, cognitive triad- psychoanalytic: subconscious morbid impulses

• biological: primarily a serotonin deficiency, genetic heritabilty

treatments of depressive disorders

• psychological: cognitive therapy

• medical: antidepressants - selective serotonin reuptake inhibitors SSRIs

Bipolar I

• at least one manic episode

• occurrence of manic& major depressive episode(s) not better explained by a psychotic disorder

• alterations between major depressive episodes & manic episodes

Bipolar II

• at least 1 hypomanic episode& at least 1 major depressive episode

• minimum duration is 4 days of episode

• not severe enough to cause marked social or occupational impairment

• there has never been a manic episode

Cyclothymic Disorder

• chronic version of bipolar disorder

• alternating periods of mild depressive symptoms & mild hypomanic symptoms

• chronic alterations between less severe depression & hypomanic periods

Scientifically known causes of bipolar disorders (biological, psychological, and social)

• biological: genetic heritability evident but neurobiological mechanisms unclear, possible neuronal disruption w/ calcium & glutamate transport

Scientifically supported treatments for bipolar disorders (medical, psychological)

• medical: medication- lithium carbonate (lithobid), anti-depressants

• hospitalization

Demographic differences in suicide

• 10th leading cause of death in USA

• 2nd leading cause of death in teenagers/college

• females attempt suicide more; males commit 4x more- using more lethal weapons

• most common among whites, american indians, rural

• risk increases with age (middle age & older)

Major risk factors for suicide

• difficult to predict

• past suicidal behaviors

• mental disorder

• impulsive or aggressive tendencies

• stressful life event

Major protective factors for suicide

• social/family support

• hopefulness, problem solving

• access to supportive clinical services

• cultural & religious beliefs

Suicide assessment strategies (examples)

SAFE-T

1. identify risk factors

2. identify protective factors

3. conduct suicide inquiry (plan; access to lethal means)

4. determine risk lvl/ intervention

5. document assessment of risk, intervention, follow-up

Common portrayals of suicide in film (misconceptions)

• attempted/committed more by young ppl- actually more frequent in older pop.

• associated with depression& trauma

• romanticized, glamorized, graphic, violent

• leave suicide notes- signs of suicide may be subtle

Suicide clusters (research findings)

• publicity about a suicide may increase for someone who is vulnerable to suicide

• media accounts may worsen the problem

Pouliot et al. (2011) “Werther effect” definition

Study hypotheses, findings, conclusions

Common portrayals of anxiety disorders in film

• the visibility of anxiety disorders facilitates legitimate portrayal

• humor employed b/c anxiety considered an exaggerated emotion

• often muddle anxiety symptoms w/ OCD, PTSD & depression

• causes are often trauma-based

Common portrayals obsessive compulsive disorders in film

• less portrayed in films, less accurately portrayed

• symptoms often unclear, confused w/ anxiety- disorder

• origins are stress or trauma-based

• considered weird or strange

Generalized Anxiety Disorder

• excessive worry about minor, everyday concerns

• anxieties shift from crisis to crisis

• chronic psychological & physical symptoms

• symptoms present for at least 6 mo.

• prevalence; 3.1% (1 yr.), 5.7% (lifetime)

Panic Disorder

• uncued panic attacks- psychological & phsyical symptoms

• persists for 1 mo. or more

• children- hyperventilation is common

• prevalence; 2.7% (1 yr.), 4.7% (lifetime), f2:m1

• was linked with agoraphobia, separated due to treatment differences

Agoraphobia

• intense fear/anxiety by a public or enclosed space

• feels as if unable to escape

• symptoms present for at least 6 mo.

• prevalence: 2% of adults (lifetime), f2:m1

• begins adolescence/ early adulthood

Specific Phobia

• extreme& irrational fear of a specific object or situation

• fear/anxiety is out of proportion to actual danger

• symptoms present for at least 6 mo.

• significant impairment/distress

• prevalence; 8.7% (1yr), 12.5% (lifetime)

• among most common anxiety/psychological disorders

Social Anxiety Disorder

• extreme/irrational concern about being negatively evaluated

• fear of social situations in which they might be scrutinized

• leads to significant impairment &/or distress

• prevalence; 6.8% (1yr), 12.1% (lifetime)

Common types of specific phobias

• animal phobia: associated with real danger, onset usually childhood

• blood-injection-injury phobia: may be linked to inherited vasovagal response

• natural environment phobia: heights, storms associated w/ real danger

• situational phobia: fear of specific phobia (flying, driving), risks (plane crash)

Obsessive-Compulsive Disorder

• obsessions- intrusive & dysfunctional thoughts, images

• compulsions- irresistible thoughts or actions to ward off distress

• consume significant portions of day

• prevalence: 1-2% of us adults (1yr)

• females exhibit slightly more often, malae onset is younger

Body Dysmorphic Disorder

• severe preoccupation w/ perceived flaws

• perceptions unrealistic

• excessive body checking or comparing

• prevalence in 2-3% of us adults (1 yr)

Hoarding Disorder

• difficulty w/ discarding any items

• feels distress at thought of parting w/ possessions

• prevalence; 2-6% of us (1yr), no significant gender differences

Trichotillomania/ Excoriation

• trichotillomania- hair pulling disorder

• excoriation- skin picking

• irresistible, repetitive behavior

• visible signs of symptoms

• more often seen in female adults

Empirical causes of anxiety disorders (biological, psychological, social)

• psychological: learned through classical conditioning, learned via operant conditioning

• biological: Gamma Aminobutyric Acid (GABA) deficiency, disruption in threat alarm, fight or flight response

Empirical causes of obsessive-compulsive disorders (biological, psychological, social)

• psychological: mowrer two factor theory of learning, classical & operant conditioning, maladaptive interpretation of intrusive thought

• biological: serotonin imbalance (deficient) involved but needs more study

Evidence supported treatments for obsessive compulsive disorders (medical, psychological)

• psychological: exposure & ritual prevention (ERP)

• cbt- based psychotherapy

• medical: antidepressants