Can Hollywood Get Mental Illness Portrayals Right?

On a good day, Tara Gregson answers to "Mom" or "Tara." She may sit at her desk and contemplate sketches for a new mural or drive her kids home from school. But on bad days, like when she finds her daughter's stash of emergency birth control, she stops answering to "Mom" altogether and she doesn't see herself as "Tara" either. On those days, especially if Tara isn't taking the medications which treat some side effects of her multiple personality disorder, Tara is more likely to transform into one of her "alters"—a teenager, a prim and proper 1950s-style housewife, or a beer-guzzling, gun-loving male named Buck.

Though Tara's story is fictional, scripted for a new Showtime television series, her disorder is a reality for those diagnosed with what is formally called Dissociative Identity Disorder (DID). This kind of illness is an easy plot device, but it is one that carries the risk of becoming caricature. Like many programs that hinge on medical issues, "The United States of Tara," has to walk that line between entertainment and accuracy. And there's a lot of pressure these days to get it right. "Tara" comes on the heels of a decades-long push by mental-health advocates to end the stigmatization and stereotyping of those with mental illness as villains, "schizos" or soap-opera characters with "good" and "bad" alter egos. There are now organized watchdog groups and activists that don't hesitate to complain when a depiction veers toward stereotypical or is overly negative.

To stay on the right side of the facts, producers hire medical advisors. But even those folks don't have an easy time of it. Richard Kluft, the clinical psychiatrist who serves as the consultant for the "Tara" series, took a look at the first episode and had concerns about how the seriousness of DID (and that its most common cause is thought to be childhood abuse) would be translated. It "was so funny, and so raucous, and so sexual," he says, that it gave him pause. But subsequent episodes became "more nuanced, more complex, more bittersweet, and much more genuinely like what we may see [as therapists]," he says. Kluft offers as much advice on the medical accuracy of the show as he can, though he says the writers may not always use it. At one point after glancing over a preliminary script, he pointed out that Tara's alters would not just pop out one right after another without commenting on the presence of the alter before her, and the script was changed—though Kluft isn't sure it was adjusted because of his input, or if the alteration was something the writers already had in mind. Though he's happy with the show overall, he admits he still winces at some of the depictions of Tara and DID and notes that the main character's more flamboyant alters are typical of only 1 in 20 DID cases.

Tara's creators are focusing on a rare type of mental illness, and an uncommon presentation of it at that. But the mere fact that Tara is a likable main character helps promote greater awareness. Until the last decade or so, well-rounded depictions of people with mental illness were rare. More often they were seen as a nonrecurring character, villain, or criminal. A 1992 episode of "Roseanne" suggested that "psychos" and "schizos" could easily dupe lie detector tests because they have no feelings. Schizophrenia—a mental illness whose symptoms can include hearing voices, hallucinations, and disordered thinking, is a common butt of television jokes. "He votes like a schizophrenic," quips one character on a 2005 episode of "The West Wing" to describe one member of Congress with an erratic voting record. This kind of flip and inaccurate portrayal can be a problem when more than half of regular television viewers report learning something new about a health issue or disease from TV programming, according to a report from the Centers for Disease Control.

One of the first breakthroughs in how the arts handle mental illness came a decade ago, when Tipper Gore, then the wife of the vice president, admitted to suffering from depression; as the president's official mental-health policy adviser she successfully lobbied for the first White House Conference on mental illness. Social organizations got in on the game, too. The Centers for Disease Control, after fielding medical consultancy questions for years, founded a separate California-based Hollywood, Health, and Society program. It's now a free medical resource for Hollywood writers, researchers, and producers. The Entertainment Industries Council (EIC), a nonprofit that had worked on substance abuse and other social issues since the mid '80s also widened its net to include mental illness.

These collective efforts laid the foundation for change. But the problem hasn't gone away, by any stretch. In November some mental-health advocates mobilized a campaign against ABC via e-mails, calls, and letters, protesting an episode of "Desperate Housewives" which, in their eyes, reinforced ubiquitous stereotypes linking mental illness and violence. In the controversial episode, it is revealed that Dave Williams, a stranger in the neighborhood, was released from "a center for the criminally insane." When confronted by his psychiatrist, he kills him and sets fire to a nightclub. Bob Carolla, head of the StigmaBusters program at the National Alliance on Mental Illness, which tracks such depictions, stresses the need to have positive portrayals of individuals with mental illness. "It really turns the stereotype around," he says.

For those in the industry, "entertainment is always the first priority," says Elizabeth Klaviter, the director of medical research for "Grey's Anatomy" and "Private Practice." But she says, "there's a responsibility to be as accurate as possible within those restraints," and to that end she is in almost constant communication with Hollywood, Health, and Society and sources like the EIC. Neal Baer (a doctor himself) who used to write for NBC's "ER" and is now the Executive Producer of "Law and Order: Special Victims Unit," also on NBC, remembers being critiqued for one episode of "ER," in which a young man with schizophrenia killed a doctor. He suggests one episode of a show is not a fair snapshot of the show's sensitivities to the subject of mental illness.

But the issue is about more than just sensitivity or social stigma, according to mental-health experts. Inaccurate depictions of mental illness can have serious consequences. Story lines that romanticize suicide as heroic, or the only way out of depression or a difficult situation can trigger "an already vulnerable person's motivation to engage in suicidal behaviors," explains suicide-prevention expert Madelyn Gould, an epidemiologist at Columbia University. Rarely is suicidal behavior and treatment a storyline in itself—though there are exceptions—such as "The Sopranos" storyline wherein Tony Soprano's son attempts suicide and is taken to a hospital for treatment. The show doesn't just leave it at that, following up with references to his psychological therapy.

Perhaps the most engaging recent portrayal of someone with a serious mental illness was Sally Field's Emmy winning 2001 role as "Maggie" on NBC's "ER". Her character struggles with bipolar disorder. Maggie's symptoms clearly leave her on-screen daughter distraught at times, but she is still depicted as a loving and lovable parent who gets treatment. Ironically, Sally Field is also responsible for one of the early television depictions of serious mental illness. In another Emmy-winning performance, she played "Sybil" in the groundbreaking 1976 television movie based on the true story of a woman with DID. While it has since been criticized for some inaccuracies, "Sybil" was one of the first sympathetic, fully developed depictions of mental illness on television. But it has taken a long time to get back to that kind of character.

"Tara," the newest face of DID, has joined the USA Network show "Monk" as the only current examples of television protagonists who are successful and have a social-support system, despite their respective mental illnesses. "Monk," a show about a highly specialized detective with obsessive compulsive disorder, has received mixed reviews from the mental-health community because some feel his condition never improves and his illness is sometimes fodder for laughs on the show. Still, mental-health advocates often point to the show, now in its eighth and final season, as a landmark.

For Klaviter, the growing discourse on such conditions both on- and off-screen means that "America is getting ready to let mental illness out of the closet." This summer, the Entertainment Industries Council brought together members of the media and entertainment industries, alongside medical professionals, mental-health advocates, and members of Congress to talk about perceptions of mental illness and ways to address them. But there's still a long way to go. As Carolla of NAMI says, "It's still two steps forward, and one step back." So stay tuned.