In popular culture, for anyone other than Canadian sports fans, the hockey mask is the badge of the psychotic ax murderer and, by extension, anyone with mental illness.

"The hockey mask as a symbol of dangerousness and insanity has no basis in reality," said Otto Wahl, Ph.D., a professor of psychology at George Mason University in Virginia. "It is solely a creation of Hollywood."

Wahl spoke in March at the Baltimore conference "Spring to Action: A National Mental Health Symposium to Address Discrimination and Stigma" sponsored by the Center for Mental Health Services of the Substance Abuse and Mental Health Services Administration.

Since so many Americans obtain their view of the world through movies, television, and the news media, however, the perpetuation of this and other exaggerated stereotypes of mentally ill people reinforces culturewide stigmatization.

In reality, said Wahl, mental illness is a poor predictor of violence, ranking well after these factors: youth, male gender, history of violence, or poverty. Aside from people who abuse substances, people with mental illness commit violent acts at the same rate as nonpatients, and 80 percent to 90 percent of people with mental illness never commit violent acts.

So what has sustained the image of people with mental illness as being dangerous for so long? Both the news and entertainment media share the blame in perpetuating these stereotypes, said Wahl.

"First of all, crime takes a disproportionate amount of news space, and there is a bias toward reporting crimes by people with mental illness," he said. "Crimes connected to mental illness are more likely to lead the news or be on the front page, and there is more multiple, ongoing coverage of crimes involving mentally ill people—arrest, trial, verdict, and sentencing."

The media’s assumption of a link between mental illness and violence is hard to break, especially when the mainstream press repeats falsehoods as if they were certainties, said journalist Phyllis Vine, Ph.D., M.P.H., whose brother has schizophrenia. "This transforms a medical issue into a public safety issue and capitalizes on the fear of violence."

News coverage is bad enough, but novels, movies, and prime-time television wrap similar attitudes about mentally ill individuals in polished, powerful, emotional stories. In popular fiction, "mental cases" commit violent crimes. On TV, they are violent and murderous—both in drama and comedy shows. Slasher movies give birth to multiple sequels. Batman’s foes, the Joker and the Penguin, are "insane." Even children’s literature is rife with mentally ill villains. In the Harry Potter books, one character is termed "mad" and hence "a danger to anyone who crosses him."

"On television, 45 percent of all characters are violent, compared with 72 percent of the mentally ill characters—including women, who are ordinarily less violent than men," said longtime television researcher George Gerbner, Ph.D., a professor of telecommunications at Temple University. "Mental illness is the only label on TV that renders women as violent as men."

Gerbner and Wahl agreed that profits accounted as much for stereotyping as ignorance. Producers, they said, want action and violence because such shows are cheap to produce and need no translation for an export market.

"Often there isn’t time within a show for plot exposition to develop a character’s background," said Wahl. "Mental illness then becomes a handy stereotype to establish a motive.

"In short, the media teach people to fear, devalue, and distrust people with mental illness. So people who need understanding are met with rejection and isolation, as well as discrimination in housing and employment."

Worse yet, he said, people with mental illness are not oblivious to their portrayal. The images they see lead to alienation, isolation, and anger. They become afraid to seek needed treatment or disclose their condition to families or coworkers. They even fear that having normal emotional reactions to treatment (like depression or anger) could be misinterpreted as symptoms. In the end, they internalize stigma: "If no one is willing to give me a chance, then I don’t deserve a chance."

Media stigmatization has broader political significance, too, said Vine, when public debates arise over issues like involuntary commitment or legal definitions that equate mental illness with criminal behavior.

However, the media’s view of people with mental illness is not entirely gloomy, said Wahl and others, citing a forthcoming Ron Howard film about Nobel Prize—winning mathematician John Nash, who had schizophrenia, and the recent movie starring Samuel L. Jackson, "The Caveman’s Valentine."

"Media portrayals are moving away from the twitchy killer to characters more troubled and frightened than troubling and frightening," said Barbara Lurie, associate director of programs for the Entertainment Industries Council in Los Angeles. She screened clips from television dramas that offer sympathetic portrayals of mentally ill people or even turn the violent stereotype on its head: a homeless, mentally ill person is first suspected of murder, but then turns out to be a hero who leads police to the real killer.

Lurie said campaigns to change the media can work if they are constructive but not confrontational. They should also be coordinated, she said, citing a show featuring a mental patient who went off his medication and committed murder. One mental health organization liked it because it showed the consequences of noncompliance, while another hated it because it repeated the familiar equation of mental illness and violence.

"Once in a while the media do get something right," added Abigail Padgett, author of Child of Silence and other detective novels featuring a heroine with bipolar disorder (Psychiatric News, February 21, 1997). She favorably cited a short story in Good Housekeeping involving depression and suicide.

"We need to be reading popular fiction and reward publishers, editors, and authors who are educating people we can never reach," she said.

But George Gerbner, who has studied television for 40 years, brings his skeptic’s eye to the media. "I’ll believe in change," he said, "when a headline reads: ‘Ex-Mental Patient Appointed Head of Rotary Club.’" ▪