Why is mental illness so controversial? Part 2 – Media coverage

Media coverage of mental illness is biased and melodramatic. There are far fewer articles in the press about mental than physical illness, and they are much more likely to be negative.[1,2] Things are just as bad on social media like You Tube, but may be slightly better on Twitter.[3,4]  Whilst some coverage legitimately criticises bad practice or poor services, far more is ironic, sarcastic, prejudicial or simply inaccurate. This wouldn’t matter if it weren’t for the fact that we all get most of our information about the outside world from these sources. And because they influence attitudes as well as reflect them, media misinformation maintains the stigmatisation of the mentally ill.

And things aren’t really getting much better. Coverage of mental illness has slightly increased over the past decade, and there are slightly more positive articles, but the majority are still negative.[2] Targeted measures like changing the name of schizophrenia in Japan hasn’t had any much effect on press coverage there [5] – although it has to be said that the new name, integrative disorder, doesn’t have much to recommend it.  Even clear guidelines for press coverage – such as for the reporting of suicide – are often contravened for the sake of a sensational story [6].

These unfortunate articles are presumably penned by journalists seeking to make their mark, or simply get a story in print, headlined by sub-editors trying to attract reader attention, and approved by editors keen to boost sales for their wealthy owners. (Although I have never bought or seen anyone else buy a paper for the dodgy headline or story on the inside pages). Of course, others write articles as well – including disgruntled users, carers and staff, who often have a point; people who have little if any direct experience of trying to help people, and various professionals promoting their own trade. Often, however, they fan the flames of controversy, generate more heat than light, and can give the impression that mental health field is not progressing, which is very far from the case.

There is a general tendency to criticise a scientific or medical approach to diagnosis and treatment.[1-4] Indeed, just about every story is an opportunity for some psychiatry or psychiatrist-bashing. Anti-authoritarian reporting can perform a useful role, but a continued favouring of talking treatments and an implicit assumption they always work and don’t do any harm is just biased [7].

A recent example highlights some of these issues. In March this year, an academic paper reported increasing rates of antidepressant drug prescribing in children and adolescents across Europe [8]. In The London Times, both a leader (provocatively titled ‘Just say no’, Mar 10) and an associated article made the mistake of assuming the increase is inappropriate and blaming doctors for this. (The issue was reported even more irresponsibly in the Huffington Post under the headline ‘chemical lobotomy’ which I am not even going to honour with a reference). Neither article reported that the actual proportion of those receiving prescriptions in the UK was 1.1%, that the rates of prescribing in the UK have fallen from 2005-12 in those under the age of 10, and that the overall proportions prescribed antidepressants have risen to 0.3% in the 10-14 age group and 3.2% in those aged 15-19.

Three percent sounds quite a lot but a systematic review by Palnczyk and colleagues, published in 2015 [9], found that anxiety states affect about 6% of our children, and depression about 3%, to the extent that they impact on their day to day functioning. Rates are higher still in those aged 12-18. Given that antidepressants are sometimes prescribed for anxiety and other problems in childhood and adolescence, it is perfectly possible that antidepressants are under-prescribed in those aged 10-14 and ‘dished out’ appropriately in those aged 15-19. Without information on why these drugs were prescribed and for how long, and how those receiving them fared, journalists and the rest of us  should not jump to false and potentially dangerous conclusions.

Knee-jerk doctor-bashing does no-one any good at all and inflammatory remarks about medical or bodily treatments of mental illness are just part of the stigmatisation of mental illness. We need subtle, nuanced and contextualised reporting of mental illness and its treatment. Some of the differences in opinion can be attributed to different professionals seeing different types of patient – those in primary care or referred to psychology by their GPs will often have mild illnesses, prefer and be more suited to talking treatments; while those in secondary care tend to more ill and often have more than one problem. Psychiatrists must accept their share of responsibility, and make themselves aware of and promote accurate figures about the pros and cons of treatment options they offer their patients.

In the final analysis, however, the media reflect as well as reinforce controversy. They rarely set the agenda. And in the background there is something philosophical about this raging debate…..about the nature of mind, the self, and human relationships. That is possibly why so many people are so interested in mental illness from so many different points of view. Mental illness is so controversial because it is so complex and fascinating. [857 words]

REFERENCES

[1] Lawrie SM. Newspaper coverage of psychiatric and physical illness. Psychiatric Bulletin 2000; 24: 104–6. http://pb.rcpsych.org/content/24/3/104?ijkey=5cd63777b718e83d46699b37f517f8664fca65a7&keytype2=tf_ipsecsha

[2] Thornicroft A, et al. Newspaper coverage of mental illness in England 2008-2011. Br J Psychiatry Suppl. 2013 Apr;55:s64-9. http://www.ncbi.nlm.nih.gov/pubmed/23553697

[3] Gordon R, Miller J, Collins N. YouTube and ‘psychiatry’. BJPsych Bulletin 2015; 39: 285-287. http://pb.rcpsych.org/content/early/2015/06/06/pb.bp.114.050013

[4] Joseph AJ, et al. #Schizophrenia: Use and misuse on Twitter. Schizophr Res. 2015 Jul;165(2-3):111-5. http://www.ncbi.nlm.nih.gov/pubmed/25937459

[5] Koike S, Yamaguchi S, Ojio Y, Ohta K, Ando S. Effect of Name Change of Schizophrenia on Mass Media Between 1985 and 2013 in Japan: A Text Data Mining Analysis. Schizophr Bull. 2016 May;42(3):552-9. http://www.ncbi.nlm.nih.gov/pubmed/26614786

[6] Utterson M, Daoud J, Dutta R. Online media reporting of suicides: Analysis of adherence to media guidelines. Psychiatric Bulletin (in press).

[7] Wessely S. The ‘drugs v talking’ debate doesn’t help us understand mental health. 29 Mar 2016. http://www.theguardian.com/commentisfree/2016/mar/29/drugs-talking-mental-health

[8] Bachmann CJ, et al. Trends and patterns of antidepressant use in children and adolescents from five western countries, 2005-2012. Eur Neuropsychopharmacol. 2016 Mar;26(3):411-9. http://www.ncbi.nlm.nih.gov/pubmed/26970020

[9] Polanczyk GV1, Salum GA, Sugaya LS, Caye A, Rohde LA. Annual research review: A meta-analysis of the worldwide prevalence of mental disorders in children and adolescents. J Child Psychol Psychiatry. 2015 Mar;56(3):345-65. http://www.ncbi.nlm.nih.gov/pubmed/25649325

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