Psychosis: An Open Letter to Hollywood Producers
Dear Hollywood Producers: Your depiction of mental illness is pretty terrible.
I am writing to offer my services as a psychiatrist with nearly 20 years of experience working with both adults and kids. I think, hired as a consultant, I would be able to help you improve the quality of your movies and shows. I furthermore believe that your increased revenue from a better product (which I can help produce) will more than pay for my services. My rates are quite reasonable.
To be fair, I’m not a film buff, and haven’t seen all the movies and shows. And there are a few psychiatric disorders that some actors have done extremely well. But you really, really need help with the vast majority of conditions. Can’t we have one – just one – movie that accurately portrays bipolar disorder? Or depression? Or schizophrenia?
It doesn’t have to be a main character, nor the focus of the story. A realistic portrayal would not only make for a more powerful film, but it would also be a step toward dispelling some of the myths about mental illness and misconceptions of the general public. Now that would be a truly worthy cause!
To give you a head start and because I feel urgency to begin somewhere, let’s talk about what you, as Hollywood producers, can do to improve your depictions of psychosis.
Recommendation #1: Don't use "psychotic" and "psychosis" incorrectly.
Recommendation #2: Include more depictions of auditory hallucinations in your films.
Recommendation #3: Stop making people psychotic for no reason.
Recommendation #4: Use the term "delusional" correctly, or don't use it at all.
Stop using the terms “psychotic” and “psychosis” incorrectly.
What is “psychosis,” or the state of being “psychotic”?
Before we dive into my recommendations, I'll provide a short primer on psychosis. A textbook definition of psychosis is “impaired reality testing,” which basically means you can’t tell what’s real and what’s not. There are really only two ways the brain can’t tell what’s real from what’s not. The first is by the brain’s senses not working right (i.e., having hallucinations), and the second is by the brain’s thinking not working right (i.e., having delusions).
So, in general terms, if you do not have hallucinations or delusions, you are not psychotic.
Let’s see more hearing things, less seeing things in your films.
What is a hallucination?
- It’s seeing or hearing (or theoretically smelling, tasting, or feeling) something that isn’t there.
- Visual hallucinations are less common than auditory hallucinations. Everybody thinks of visual hallucinations, or “seeing things,” when they think of mental illness. Far, far more common is “hearing things,” or auditory hallucinations.
- Auditory hallucinations usually take the form of hearing voices. Most often these voices say nasty things about a psychotic person or tell the person to hurt or kill themselves. There are other things that psychotic people hear, but let’s keep it simple for now.
- Visual hallucinations are uncommon in psychiatric illness. They occur much more often in medical illnesses and conditions. Some examples include being delirious from a high fever, having a neurological disorder like Alzheimer’s disease, or being intoxicated by illicit drugs.
Use the term “delusional” correctly, and, if in doubt, stick to paranoia.
What is a delusion?
- It’s a “fixed, false belief.” That means you believe that something is true (usually something extremely unlikely), and don’t change your opinion no matter how much evidence to the contrary you are presented with.
- The most common kind of delusion is
paranoia, or believing people are after you in some way. It might be the CIA, police, or your neighbors. You might think people are following you, stealing from you, playing tricks on you, or trying to kill you.
- Not all delusions are made the same. Some are “grandiose,” like believing you are the second coming of Jesus Christ sent to save the world. Some are “somatic,” like believing your insides are rotting. Some are “bizarre,” like believing another person is living in your eyeball. Yes, that’s one I’ve personally seen.
Quit having people be psychotic for no reason.
What causes psychosis?
- Psychosis always happens for a reason. You don’t just become psychotic without other symptoms. (A rare exception is “delusional disorder,” but don’t worry about that for now).
- You don’t have to be schizophrenic to be psychotic. Folks with bipolar disorder and even bad depression can hear voices or have delusions as well. Some neurological conditions, like Alzheimer’s Disease, also cause psychosis.
- It’s very rare for young kids to be psychotic. Schizophrenia, bipolar disorder, and depression don’t fully develop until later in life. Although you may see other symptoms of these disorders earlier, you rarely see true psychotic symptoms until the late teens, at the earliest.
What is psychosis NOT?
- Psychosis is not “acting all crazy” or doing irrational things. In fact, it has nothing to do with behavior. It has everything to do with
sensing and
thinking. Remember, if you don’t have hallucinations or delusions, you aren’t psychotic.
- Very few killers in real life are psychotic.
A huge pet peeve of mine is the notion of “psychotic killers” in movies, shows, and books. They don’t hear voices or have delusions. Usually, they are angry or sadistic people who don’t care about others. They may be
psychopaths, which are basically people with zero empathy. It’s like being a sociopath but more extreme. But
psychopath and
psychotic are two entirely different kettles of fish.
In short, don’t call people psychotic unless they have hallucinations or delusions.
I’m here to help. Together, I think we can really make some progress in more accurate portrayal of psychiatric conditions on the big screen, and at the same time improve the public’s understanding of psychiatric conditions. Feel free to contact me by email if you’d like to talk more about our potential partnership. In the meantime, I’ll be at home watching some movies.
End of lesson.
Sincerely,
Duncan Gill, MD
