From “Macbeth” to “The Shining”: Perceptions of Mental Illness

From the lecture series: The Skeptic's Guide to Health, Medicine, and the Media

By Roy Benaroch, MD, Emory University

For better or for worse, our perceptions of mental illness are largely informed by the media, particularly film and literature. Discover how depictions of mental illness in Macbeth and contemporary movies, both shed light upon and shape our understanding of various mental illnesses.

Mental illness type on vintage typewriter
(Image:  Nokuro/Shutterstock)

Mental Illness in Macbeth

William Shakespeare’s Macbeth was probably first performed in 1606. It is a story of political ambition and power, and it’s also a story about mental illness, as the central characters become wracked with guilt and paranoia. Macbeth is an example of a media portrayal of mental health in the 17th century. 

To set the scene: Macbeth and his wife feel guilty after murdering King Duncan to secure the Scottish Throne.

Painting of The sleepwalking Lady Macbeth by Henry Fuseli 1781-1784
Lady Macbeth sleepwalking and muttering to herself. (Image: By Henry Fuseli/Public domain)

Macbeth’s wife has been acting especially strange—sleepwalking and muttering to herself. Macbeth asks a physician about her in Act 5: “How does your patient, doctor?”

The doctor replies, “Not so sick, my lord, as she is troubled with thick-coming fancies that keep her from her rest.”

It’s interesting. The doctor here makes a distinction between mental and physical illness—she’s “not so sick,” he says.

He then describes a subconscious motive for her behavior, one that fits well with Freudian theories that wouldn’t be published for another 300 years. “She is troubled by fancies”—that is, mental processes—“that keep her from her rest.” It’s mental processes that are, in effect, making her sick in a different way than a physical illness.

Macbeth’s response to the doctor is also telling: “Canst thou not minister to a mind diseased, pluck from the memory a rooted sorrow?” Here, Shakespeare again anticipates Freud, blaming disease of the mind on a repressed memory, in his words, a “rooted sorrow.”

Macbeth then asks the doctor to “Raze out the written troubles of the brain and with some sweet oblivious antidote cleanse the stuffed bosom of that perilous stuff which weighs upon her heart?”

This is a transcript from the video series The Skeptic’s Guide to Health, Medicine, and the Media. Watch it now, on Wondrium.

This is a great insight from Shakespeare. He says mental illness is a brain problem, a problem in the organ of the brain itself, and it needs an antidote, or what we might call a psychiatric medication, to ease her trouble.

The doctor, though, is not so confident that he can help Lady Macbeth. When he voices doubt, Macbeth replies, “Throw physic to the dogs. I’ll have none of it.”

Macbeth first begs for help, but then when the doctor can’t guarantee success, he changes his mind, throwing medical care (physic) “to the dogs.”

In many ways, as much as we’ve learned, little has changed.

We know we need help for mental health problems, but we still don’t always trust that kind of help. There is an undeniable stigma to the diagnosis and treatment of mental health problems.

And, as in Shakespeare’s time, we still can’t decide whether people with mental health struggles should be treated like people with other kinds of illness.

How Mental Illness is Misrepresented: Words and Images

Whether Macbeth wants a doctor’s help or not, mental health is undeniably an important part of the medical landscape. In any given year, about one in five adults in the United States experiences a mental illness; over a lifetime, roughly 50% of the population will receive a mental health diagnosis.

And yet, 58% of Americans don’t want people with mental illness in their workplace and 68% don’t want someone with a mental illness marrying into their family. How could something so common, that’s touched most people’s lives, carry such a stigma?

In large part, it’s because media representations have driven a misleading, skewed, and overly negative view of mental illness.

What kind of image do you conjure up when you think about someone with mental illness? What you imagine is probably someone who looks very different from the average person.

Picture disheveled hair and wild, wide eyes, maybe ill-fitting or stained and tattered clothes. Video games, movies, comics, the cover of a paperback book—people with mental illness are typically depicted like Jack Nicholson’s character in the movie The Shining.

His teeth are bared like those of an animal, he’s unshaven, his hair’s a mess, and he is undeniably scary looking. But that’s not what real people with mental illness look like.

The vast majority look like just people, and they’re not bashing down hotel doors and grinning. They’re buying coffee in coffee shops, working, or sitting at home.

In reality, people with mental illness look like the rest of society, because they are part of the rest of society—our neighbors, our family members, and ourselves.

Words, too, are used in the media and common conversations in offhanded ways that are misleading and reinforce stereotypes and misinformation.

People say, “I’m so OCD,” when they want their food a certain way at a restaurant. That is not an obsessive-compulsive disorder, which is a real and debilitating disease.

Or you might say, maybe when you’ve been dealing with the cable company or something, “They’re driving me insane!” No, they’re not, and insanity (or the more proper medical term, psychosis), is a very real, serious mental health condition.

Learn more about how the depiction of the mentally ill in TV and film has skewed our perceptions of the risk they pose to society

The Association of Mental Illness with Criminality

But the most damaging portrayals that continue to insidiously warp our notions about people with mental illness come from the way the media portrays people as violent or criminal if they have mental health challenges.

Over one-third of people polled in Great Britain believe that those with mental health problems are violent—despite the fact they’re far more likely to be the victims of crime than the perpetrators.

Macbeth’s physician even commented on this. Speaking of sleepwalking, which was thought of as a manifestation of Lady Macbeth’s mental illness, the doctor said, “I have known those which have walked in their sleep who have died holily in their beds.”

Here, holily means that they weren’t guilty of anything. Shakespeare, over 400 years ago, had to have his character point out that not all people with mental illness were criminals. 

Image of criminal behind bars after being arrested
(Image: Skyward Kick Productions/Shutterstock)

From May 2013, the Milwaukee-Wisconsin Journal Sentinel proclaimed, “Triple Homicide Suspect Long Struggled with Mental Illness,” or from The Daily News of Jacksonville, North Carolina, “Officials Say Crime and Mental Illness Go Hand-in-Hand.”

Despite that headline, which just about equates mental illness with criminal behavior, the Jacksonville article itself presents a more nuanced picture. Clearly, the people being interviewed are not equating mental illness with a crime.

Rather, they’re decrying the lack of support for mental health evaluation and treatment. They’re discussing how mental health issues are sometimes neglected, leading to a crisis that can include people getting hurt. But that headline is a good example of how a complex topic can be oversimplified into a few very misleading words.

Learn more about how to think like a skeptic when reading news in any medium

Why Crime is Blamed on Mental Illness

Here’s another headline, from a newspaper in eastern Connecticut: “Mental Illness Dominated Top Crimes of 2016.” The headline makes it sound like mental illness is itself a crime, and a top crime to boot.

What they meant to say was that people with mental illnesses committed the area’s top crimes in 2016, even though even that isn’t objectively shown in the article, which is more of a recap of selected criminal stories from the year.

The author focuses on crimes he characterizes as committed by those with mental health problems, even though many of the individuals hadn’t been diagnosed, or had been diagnosed in the distant past. Still, the article is peppered with graphic details of some truly gruesome crimes—implying that the people who committed them had to have been mentally ill.

There’s a circular logic here, and it sneaks up on journalists and the general public. Truly horrible crimes, when described, sound like they could only have been committed by someone who’s mentally ill.
Mass shootings, child murders, horrible things, are impossible to even think about without making yourself feel sick. We need a defense mechanism, and, unfortunately, it often involves shifting blame to mental illness.

“That guy,” we think to ourselves, “must have just been a psycho.” We’ve been blaming the portrayal of mental illness as criminal in the news, but sometimes the news is just a reflection of our own prejudice.

Learn more about how to read beneath the hyperbole-filled headlines

Positive Portrayals of Mental Illness in the Movies

Not all media portrayals of mental illness are negative. Director Ron Howard did a wonderful and powerfully sympathetic job in his movie A Beautiful Mind.

Portrait of n Forbes Nash Jr. (2000)
American mathematician and economist John Forbes Nash Jr. (Image: By Peter Badge/Public domain)

The movie is about the life of a Nobel Prize-winning mathematician, John Nash. His struggles and recovery from paranoid schizophrenia, and especially the way his illness affected his family and career, paint a memorable, if not quite literally true, picture of mental illness.

For instance, though auditory or sound hallucinations are common in schizophrenia, visual hallucinations are not. Still, it’s a movie, and it’s easier to show things people can see.

The movie to some degree also implies that people with mental illness can overcome their struggles if they try hard enough and persistently enough, and that’s not necessarily true, either.

Another memorable portrayal of mental illness occurred in the 1997 romantic comedy, As Good as It Gets. The male lead, played by Jack Nicholson, had obsessive-compulsive disorder. The movie accurately depicted the effect of his illness on his everyday life and relationships.

What was somewhat less accurate, however, was the ending of the movie, when, after falling in love, his character was able to abandon his compulsive rituals. Yes, it’s just a movie, but as powerful as love can be, it’s seldom the cure for someone with a mental illness.

Learn more about how to better understand and evaluate the media descriptions

What we need, then, are more stories that realistically depict what it is like to live with a mental illness, neither demonizing the illness nor undermining its severity. This accuracy will lead to people feeling compassion for others who suffer from mental illness, which in turn, will lead to better treatment options becoming available.

Common Questions About Perceptions of Mental Illness

Q: How does stigma form around mental illness?

Perceptions of mental illness are greatly distorted by media and gossip. Stigma results from exaggerating the perceived negative aspects and dangers of mental illness, which often are not accurate.

Q: Is it possible to change the stigma associated with mental illness?

It is entirely possible to change the stigma associated with perceptions of mental illness, by having more open communication and safe spaces so that those who suffer can speak freely and a deeper understanding of the actualities of mental illness can form in the public’s mind.

Q: Is there a general age in human development where mental illness begins?

According to studies, 50% of people with mental illness develop it by the age of 14 and 75% develop it by the age of 24. This is important when understanding that signs of major problems like schizophrenia appear early and almost never occur out of nowhere.

Q: Can mental illness be cured?

Mental illness cannot be completely cured, which is one of the facts that leads to negative perceptions of mental illness, creating stigma. It can, however, very successfully be treated.

This article was updated on December 9, 2020

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