Common Mental Health Misconceptions in Media
As a licensed social worker who has worked as a therapist, as well as visited clients in inpatient psychiatric settings, nothing annoys me more than seeing therapy, social workers, and psychiatric wards misrepresented – and stigmatized – in books, TV shows, and movies.
So I recently got into a great Twitter conversation with several other writers who have worked in the mental health field or written about mental health, and learned that I’m not alone in feeling this way. Therefore, I decided to write this post about common misconceptions about mental health that I’ve noticed in books, movies, and TV.
Please remember that this is not an “all hospitals / therapists / social workers” list, and there will always be exceptions. These are only from my personal experiences. If anyone is writing about mental illness or therapy (which I’d love to see more books about!) I’d always encourage extensive research first.
So here they are.
Myth #1: All patients in psychiatric hospitals are held there against their will.
Reality: It’s VERY hard to legally hold someone in a psychiatric ward involuntarily. In order for this to happen, a person must pose a significant threat to themselves or others. Even if a client says, “I want to kill myself,” it’s very hard to hold them in a facility if they don’t want to be there. They must show intent (desire to die / hurt someone else), means (access to weapons, pills, etc.), and a plan (not just blowing off steam, they’ve thought it through). For example, if a client says, “I want to kill my boss,” you can’t commit them. If they say, “I want to kill my boss, I bought a gun, and I’m planning to shoot him at work tomorrow,” that’s a different story. Likewise, in 99.9% of cases, it is illegal to force a client to take medication against their will unless they are a direct threat to themselves or someone else.
Most clients I’ve met in psychiatric hospitals want to be there, and actually, many are forced out sooner than they’d like due to insurance restrictions.
Myth #2: Modern psychiatric hospitals are like dirty prisons, full of people who are either belligerent, or muttering to themselves.
Reality: First of all, if psychiatric wards were as dirty as they are depicted in TV and movies, they would be shut down by the department of public health. I feel like every time a psych ward is depicted on TV, this is the scenario: a group of half-unconscious, half-belligerent individuals are crowded around a dirty, broken TV. Someone’s talking to themselves, and someone else is screaming. This couldn’t be farther from the truth.
Most psychiatric wards in which I’ve visited clients (and I’ve seen a range) look more like college dorms than prisons. They are full of light, and have decorations on the walls. Often, they will have various therapy groups during the day (including groups like AA / NA, and DBT), and free time, time outdoors, or other activities, like movies, in the evenings. Many I’ve visited also have computers, and clients can decorate their rooms. While some clients wear medical robes, most wear their regular clothing.
Again, this is not an “all psychiatric wards” list, this is simply a “the psychiatric wards I’ve visited.” I’m sure there are exceptions, but as a whole, I’d say that if your contemporary novel has a psychiatric facility that looks like something out of “One Flew Over the Cuckoo’s Nest,” you need to do more research.
Myth #3: You can stay in a psychiatric hospital for months.
Reality: Insurance doesn’t allow that. Honestly, I’ve struggled getting insurances to allow clients to stay in a hospital longer than a couple days. In my experience, most clients stay in a hospital for less than a week. There are “extended stay” programs, and residence options, but they are very expensive, and many insurances won’t pay for them. Another option is called “partial hospitalization,” which is a little cheaper and more common, and essentially is where the client goes to the hospital during the day and participates in all the daily therapy groups, but goes home to sleep at night. Still, insurances will likely constantly ask for proof of need and doctors’ notes in order to justify paying for any of these.
Granted, this is in America. I can’t speak for other countries’ health systems.
Myth #4: “Multiple Personalities” is Schizophrenia.
Reality: The media loves to depict people with Dissociative Identity Disorder (commonly known as “multiple personality disorder”) as having Schizophrenia. They are two completely different diagnoses, with different treatment and different symptoms. If you are writing a character with mental illness, I recommend you read through the diagnostic criteria in the DSM V, which you can find in the reference section of your local library.
Myth #5: The curmudgeonly old therapist who grumbles and constantly asks “how do you feel about that?” in a monotone while doodling in his sketchpad and only half paying attention.
Reality: I’ve never seen, been to, or worked with a therapist like this. I’m sure there are some out there, but I always groan when I see this representation on TV. Most therapists are actively engaged in their client’s treatment, and ask more creative questions than the same one over and over.
Myth #6: If you clean / alphabetize / wash your hands a lot, you have OCD.
Reality: No. Just, no. As a professor in college told us, “you can have obsessions, and you can have compulsions, but that doesn’t make them Obsessive Compulsive Disorder.” OCD is when obsessive compulsive behaviors and magical thinking (i.e. “if I don’t step on any cracks in the sidewalk or tiles, my parents won’t get divorced”) interfere with your daily functioning. I see OCD stigmatized and misused all the time. Being anal-retentive Type A personality does not mean you have OCD. Also, for the love of God, don’t ever say “I’m so OCD about this.” If you wouldn’t say “I’m so diabetic about this” or “I’m so asthmatic about this,” don’t say it about OCD. If you are writing a character with OCD, I’d strongly recommend reading up on it in the DSM.
While I’ve yet to read them (my TBR is so long!) I’ve heard the books “OCD LOVE STORY” by Corey Ann Haydu and “DON’T TOUCH” by Rachel M. Wilson are accurate depictions.
Myth #7: The therapist gets into an argument with a client about whether or not his / her visual hallucinations are real.
Reality: Okay. There may be some therapists who do this. But the social work model is that you always “meet the client where they’re at.” Even if the therapist knows the client’s hallucinations aren’t real, they are real to the client, and telling them they aren’t real won’t make them any less real to the client.
Myth #8: Anxiety is a personality trait and not a mental illness.
Reality: It depends. Everyone feels anxious from time to time. When the anxiety is pervasive and disrupts your everyday life, that’s when it can become a disorder. A close friend has an anxiety disorder, and she recently told me one of her biggest peeves is when anxiety is minimized in media, as “just do it anyway, don’t be nervous” or “stop stressing out!” Anxiety can manifest in many different disorders, but some of the most common are phobias and Generalized Anxiety Disorder. Again, read the criteria in the DSM. When a person with an anxiety disorder is written off as “just anxious,” my social work red flags go up – let’s stop stigmatizing!
Myth #9: If you’re a bad parent, a social worker will come to your house and take your kids away.
Reality: As a social worker, this stereotype drives me nuts. I’ve had clients fearful of meeting with me / speaking to me, because they think if their kid throws a tantrum I’m going to haul them off to foster care. It is very hard to legally remove a child from their home. The goal is always for the child to remain with their parents unless there are extreme circumstances of abuse or neglect.
In most cases, if abuse or neglect is reported, a social worker will visit the home and work out a plan with the parents. Sometimes this plan just involves getting the kid and parents into therapy, or helping connect them to resources (like parenting classes). If the situation is extreme and the children are removed (a last resort), the goal will be to fix the situation and reunite the children and their parents. A situation in which a child is permanently removed from their home is extremely rare. It should also be noted that there are scenarios in which social workers report a case, and after a brief follow up, the case is closed – even when the social worker wishes more action would be taken.
Social workers do not want to remove kids from their homes. Their first priority is to keep everyone in the family safe; removing kids from their parents / caretakers is a LAST RESORT.
It should also be noted that while all social workers and therapists are mandated reporters (they are legally obligated to call and report cases of child abuse or neglect), most social workers don’t work in child protective services. The term “social worker” is broad, and could mean many things; social workers are in business employee assistance programs, in non-profits, in community action, in mental health centers, in hospitals, in schools, in the military, and in research fields. Social workers work with cancer patients, children in schools, veterans, the elderly, college kids, people with disabilities, and many others. There is no “one role” social workers fill.
Myth #10: Electroshock therapy is scary, and hospitals use it as a weapon OR electroshock therapy doesn’t exist anymore.
Reality: Electroshock therapy – called ECT – is still around! It’s used only on clients who consent to the treatment. It’s considered a last resort treatment for illnesses like depression, and it’s very effective. It does have some unwanted side effects like memory loss, but to many clients experiencing extreme and pervasive depression, it’s worth it. Despite what movies will show you, ECT patients are put under, and are completely unconscious during the treatment. They will likely undergo a certain number of treatments over a certain number of months.
Myth #11: The therapist hands a child a doll and says “show me where he touched you.”
Reality: I think I can thank police procedural shows for this myth. There are some therapists who might use this, but honestly, I never would, and I’ve never seen any therapist do this. A much more realistic example of play-therapy would be the therapist and the child sit at a doll house, and the therapist asks questions about the dollhouse while the child plays – i.e. “why isn’t the little brother at the dinner table with the rest of the family?” and “show me the kids getting ready for school.” It’s more open-ended.
Another technique I’ve seen a lot in real life practice is “draw a picture of your family.” While this isn’t an end-all to see the inner dynamics of a complex family system, the therapist can use it to make observations. i.e. “Why is daddy standing so far away from you and your mother?” and “I noticed you drew your mother without a mouth” or “I noticed you drew your little sister a lot taller than everybody else.”
Those are just eleven myths I came up with – there are many more! And again, please remember that this is not a definitive list, and there are always exceptions.
For further reading, I’d recommend these books:
If you are writing about a character with a substance use problem, check out DRINKING: A LOVE STORY by Caroline Knapp.
If you are writing about Bipolar Disorder, check out AN UNQUIET MIND by Kay Redfield Jamison.
If you are writing about the mental health system and mental health hospitals, check out CRAZY: A FATHER’S SEARCH THROUGH AMERICA’S MENTAL HEALTH MADNESS by Pete Earley.
And of course, if you are writing about ANY mental illness, check out the DIAGNOSTIC STATISTICAL MANUAL OF MENTAL DISORDERS… also known as the DSM V.
Hope you found this helpful! I’d be interested to hear about other people’s experiences or thoughts on these. 🙂