More threads by David Baxter PhD

David Baxter PhD

Late Founder
Made for high drama
BP Magazine
Summer 2009

It?s the moment of unwelcome truth for Detective Elliot Stabler?s character on NBC?s Law & Order: Special Victims Unit. Tension mounts in the scene in his daughter Kathleen?s hospital room:

DR. PARNELL: Mr. and Mrs. Stabler, your daughter is very sick.

STABLER: You mean she?s a junkie.

DR. PARNELL: No. She?s self-medicating with street drugs to cope with her illness.

KATHY STABLER: What?s wrong with her?

DR. PARNELL: Based on her behavior and the history you gave me?Kathleen?s drug and alcohol abuse, the DWI, hyper-sexuality, stealing your credit card?we think it?s bipolar disorder.
Synopsis: In NBC Universal?s Swing, Episode 3, Season 10 of the popular television drama, Stabler investigates a home burglary only to find that the trespasser?s wallet is Kathleen?s. She?s apparently abusing drugs and exhibiting promiscuous behavior. Her doctor diagnoses bipolar disorder, but Kathleen resists. Stabler visits his estranged mother, Bernadette, who also has bipolar disorder, to ask her to testify on Kathleen?s behalf and thus establish the family connection to bipolar. Kathleen agrees to finally accept treatment because of her grandmother?s experience and takes responsibility for her life.

Veteran writer and co-executive producer Amanda Green?who worked in a special victims unit (SVU) in Brooklyn, New York?wanted the Swing episode to be true to the show?s successful formula: ?the social conscience inside a mystery package. We?re not seeking to sensationalize,? she says.

Research occupies 75 percent of Green?s typical script preparation?the rest is writing. Story, ideas, and characters must be as multidimensional as possible, she says. For ?Swing,? Green pored through 10 nonfiction books about bipolar disorder, but avoided ?telling someone else?s story.? In her work, she frequently consults advocacy groups or technical advisers and ?goes out into the field? to draw upon broader-based commonalities and thus tell a story that will resonate with viewers.

Swing did just that: ?We received lots of wonderful letters and emails saying ?thank you,?? Green reports.

In the Swing episode, Stabler has little faith in psychotherapy and is initially relieved that Kathleen?s medical condition is treatable. ?Still, it?s a difficult thing for a parent to hear,? Green admits. Not unexpectedly, the veteran cop is angry that Kathleen is defiant, even self-destructive. Her character, age 19, had experienced past behavioral problems: drinking, self-medicating, and over-spending when manic.

?The diagnosis couldn?t just come out of thin air,? says Green. ?Our previously established audience connection enables us to ask the audience to trust us. We strive to tell the story accurately and with compassion, to give people an opportunity to explore an issue they might not otherwise, and to start a dialogue.?

?Amanda and the show wanted to write a really wonderful script,? confirms actor Allison Siko, 21, of Westfield, New Jersey, who plays Kathleen.

?They ensured everything was captured in a real way. There was no ?Okay, so this is the scene where she goes crazy, makes crazy eyes.? Instead, it was ?She?s manic, having a swing, so be as specific as possible.??

Viewers frequently see a person acting out because that?s dramatic, Siko says. ?This episode, although crime-based, was much more emotional, about family, with the feel of a movie that showed you the inside, the other side, of the characters.?

Whether on purpose or not, the Swing episode, which first aired in October 2008, coincided with Britney Spears media mania, rife with speculation about bipolar disorder. Siko was dismayed by the negativity about Spears but formulated her own response via Kathleen?s character. ?This was the kind of role actors dream about playing, with a range to show your skills,? she says. ?I wanted viewers to understand just why the character did what she did.?

Siko diligently did her homework, spending a day visually dissecting Stephen Fry?s British documentary, The Secret Life of the Manic Depressive, which showed that ?aha!?not every person with bipolar disorder is affected the same way. Siko also studied every line in the Terri Cheney autobiography, Manic: A Memoir (Harper Paperbacks, 2009).

Siko found that ?pretty much everyone knows someone who has bipolar disorder, or who has some connection to it.? She opened her MySpace page to comments about her performance, including: ?Allison, you were great. As a person with a mental illness, I?m glad somebody is showing what a struggle it is to deal with it.?

Siko wasn?t just playing a role?the role had consequences. ?We know with certainty that people get their health information from family, friends, and from television, including entertainment programming,? says Marie Gallo Dyak, Entertainment Industries Council (EIC) executive vice president, program services and government relations. EIC was founded by industry leaders to provide information, awareness, and understanding of major health and social issues; it also sponsors the annual PRISM Awards, which honor entertaining, honest depictions of mental illness, substance abuse, and addiction (see sidebar article). The Swing episode won a PRISM award for its accurate portrayal.

?When we choose to watch certain [TV] shows, we love or hate the characters, we have affinity with them, and we get information from them,? Dyak says. That can be a good or bad thing, she admits, but with media watchdogs ready to pounce, today?s entertainment is markedly more responsible and engaging, while delivering real value. Many themes are carried through multiple episodes.

It?s well-known that consumers may wait years before seeking help?living with an undiagnosed, untreated disorder?and be hesitant to explore the problem with their health-care professional. Film or television, Dyak says, enable people to actually watch and absorb, then visualize seeking treatment, learn how to ask questions, and often witness a person in recovery who is successfully managing a disorder. Families considering inter-vention can get comfortable with the issues and thus encourage treatment sooner rather than later, she points out.

We are back to Law & Order, the scene has now changed to Grandmother?s beach cottage. Stabler speaks to his mother:

STABLER: Kathleen has emotional problems.

BERNADETTE: My little Katie? I don?t believe it.

STABLER: The doctors say she?s bipolar. Manic-depressive.

BERNADETTE: Doctors. Idiots, all of them. She?s high-spirited, that?s all. She gets it from me.

STABLER:?C?mon, Mom. You know what I?m talking about.

BERNADETTE: No, I don?t?

STABLER: Your mood swings. The crazy ideas?
Choose your words carefully, counsels Bob Carolla, who began his career with the National Alliance on Mental Illness (NAMI) in 2000 and is now NAMI?s director of media relations. According to Carolla, a script that isn?t totally up front about a disorder, perhaps referring covertly to ?being psychotic? or ?being deranged??with no explanation of the disorder?does a real disservice. ?Language is really very important,? he says.

Indeed, its correct use allows us to become more comfortable with recognizing and conversing about mental illness, a transition that was a long time coming?some would say too long. Carolla recalls that in 1999, stigma was finally formally identified as a barrier to people with mental illness receiving help when they needed it. That year, language in the U.S. Surgeon General?s Report on Mental Health officially declared that stigma leads others to avoid living, socializing or working with, renting to, or employing people with mental disorders, especially severe disorders; reduces patients? access to resources and opportunities such as housing and jobs; leads to low self-esteem, isolation, and hopelessness; deters the public from seeking and wanting to pay for care, and at its worst, results in outright discrimination and abuse; deprives people of their dignity; interferes with their full participation in society, and is inevitably and inaccurately linked to fear of violence.

NAMI?s grassroots StigmaBusters is a network of dedicated mental health advocates who seek to fight inaccurate and hurtful representations of mental illness. The campaign has identified crucial ?red flags? as its general balancing test of stigma in media, says Carolla. These include inaccuracy, stereotypes, characters portrayed only as antagonists or villains, linkage to violence, disparaging language, devaluation or trivialization, using mental illness as the butt of a joke, and offensive or insensitive symbols such as straitjackets.

Carolla, who serves on judging committees for media awards shows, is an erudite historian on mental illness in media. What didn?t work in his view? The ABC-TV series, Wonderland, which also didn?t escape the stigma police in 2000. Pulled after only two episodes, the show based its plot upon the supposed inner workings of a psychiatric hospital.

What did and does work: the ?breakthrough? film, A Beautiful Mind, from 2001, loosely based on a Nobel Laureate in economics who was diagnosed with schizophrenia. The four-time Academy Award-winning film ?made a deep impression on pop culture, raised public awareness, and was for the most part accurate, veering away from stereotypes,? says Carolla. He also lauds The Soloist, which premiered in April to strongly positive reviews with Jamie Foxx and Robert Downey Jr., as a sensitive characterization of schizophrenia based upon the real-life character, a gifted cello player who lives on Los Angeles? Skid Row.

Other favorites include ER and episodes from 2000 forward that guest-starred Emmy-winning Sally Field as Maggie Wyczenski, diagnosed with bipolar disorder. He also likes episodes from NYPD Blue in 2003-2004 that broke ground with the attractive, high-functioning character Dr. Jennifer Devlin and her bipolar diagnosis. The storyline ended with her suicide.

?Devlin wasn?t cast as a villain, yet this showed the hard, accurate side of the illness, not sugar-coated and done respectfully,? says Carolla. When mental disorders, including bipolar, ?come out? via appropriately dramatic storylines, the effect can?t be undervalued. ?Bipolar disorder is now breaking through to the next ?level? beyond where understanding of depression once was,? says Carolla. ?People hear ?bipolar? and understand the framing of it as a specific medical condition versus the tired term ?manic-depression??a positive step forward.?

The scene now shifts to a restaurant where Stabler?s partner, Detective Olivia Benson, speaks with his mother, Bernadette:

BERNADETTE: My mother used to call me a flibbertigibbet. I?ve been accused of being impulsive, irresponsible, flighty?and those are just the G-rated ones.

DET. OLIVIA BENSON: But you never saw a doctor.

BERNADETTE: In my day, eccentricity was tolerated. Today, there?s a pill for everything.
Media portrayals are moving away from ?twitchy killers to characters more troubled and frightened than troubling and frightening,? says Barbara Demming Lurie, director of the Mental Health Media Partnership (MHMP) in Los Angeles. Lurie eschews being judgmental and works side-by-side with the industry. ?I can?t be a censor and resource at the same time,? she says.

MHMP collaborates with the Writers Guild of America, and in doing so, Lurie, a self-described ?stickler? for getting it right, encourages authors to avoid what is hackneyed and trite??an anathema to good writers,? she says. ?More writers now view mental health issues through a different lens.?

While empirical data is scarce, Lurie recognizes that change is afoot because of the following factors: ?concern for political correctness, increased sensitiv-ity, and a growing awareness that these moth-eaten depictions are very clich?d.?

It used to be that a character with a mental disorder was like ?the proverbial gun on the mantle,? says Lurie. ?If it?s shown in the first act, it?s bound to go off by the third and probably kill someone.? Now that character, suspected of murder, may evolve to be a bystander or hero, ?someone who teaches a lesson rather than simply pumps up the action,? she says.

Lurie cites a recent 90210 episode on the CW Television Network in which the character ?Silver,? played by Jessica Stroup, was behaving erratically around baffled family and friends. One friend, whose mother was diagnosed with bipolar disorder, recognized the symptoms. The episode?s conclusion featured a public service announcement on bipolar disorder with information on where to get help.

?People often look away from issues around mental health,? says Law & Order?s Green. Television done right is a great chance to educate.?

When it is done right, ?real? characterization is a more effective informational tool than going to tired extremes. Paul N. Barkopoulos, MD, is an enthusiastic clinical psychiatrist with a master?s degree in public health; he?s all about ?real.? An in-demand speaker and panelist, Barkopoulos has consulted with writers for 15 years without charge on behalf of the EIC, typically on the telephone in Los Angeles.

Medical inaccuracies can be tempting in the interest of high drama, Barkopoulos admits, but he cautions that extreme or bizarre acts of behavior are really more the exception than the rule. Bipolar disorder, he says, is actually fairly ?quiet.?

?Individuals with bipolar disorder may be more likely to exhibit impulsivity, overspending, substance abuse, sexual promiscuity, inability to concentrate or sleep, or isolation,? he says. ?Often what is shown in TV or film is that when not diagnosed or managed correctly, bipolar disorder slowly erodes people?s lives, resulting in factors such as damaged relationships or inability to attain sufficient functionality and employability.?

To accurately portray cumulative effects requires time, a luxury not often afforded in one episode. The specialist notes that TV shows also don?t normally address the often unrecognized population within the bipolar spectrum, with different levels of intensity that are subtle or difficult to recognize. ?Individuals may not exhibit dramatic mood swings, but experience symptoms such as agitated or irritable states.?

He continues: ?It?s difficult enough to encourage individuals to seek treatment. If media reinforces stereotypes?making characters laughable or otherwise over-the-top?people simply won?t see themselves and relate.? With that, an opportunity for recognition, treatment, and recovery may be missed.

The episode is drawing to it?s conclusion. The scene shifts to the court- room, where Kathleen?s arraignment is taking place:

JUDGE RIDENAUR: Miss Stabler, are you prepared to cooperate with your doctors?

KATHLEEN: Yes. I know I have a problem, and I want to get help. I?ll take medication.

JUDGE RIDENAUR: I will accept the guilty plea. If the defendant completes treatment, the charge will be dismissed. See you back in six months for a status check.
Joining television and feature films is the in-your-face realism created by the documentary filmmaker. A two-part series on the BBC by actor and filmmaker Stephen Fry aired in 2006 to widespread acclaim in Britain.

In Canada, producer Laura Sky seeks to tell a true story with every frame of her documentary films.

?We often use argument and logic to convince others to change their minds about discrimination directed at people with mental health and addiction problems,? says Laura Sky, executive director of Sky Works Charitable Foundation of Toronto, Ontario. ?The people who live with that stigma can persuade us to change our attitudes,? she says.

Sky?s 2007 commissioned feature-length documentary Extra Ordinary People?one of four she produced dealing with mental health? has not yet aired on television, but has been screened across Canada by groups and can be ordered at www.skyworksfoundation.org.?

Her foundation?s campaign has been what she terms ?an uphill, backwards struggle. Every time something terrible happens in the news, it carries forward at a propelled rate.?

Alfonso V. Guida is a public affairs and government relations specialist with expertise in reducing social stigma around mental illness. His viewpoint closely parallels Sky?s: ?We do see a net increase in positive portrayals of people with mental illness in popular entertainment vehicles.? says Guida, who provides counsel on the annual VOICE Awards. ?But still the heaviest media coverage occurs in the wake of mass tragedies, such as shootings,? he says. Unfortunately, following those events, one observes that terms of mental illness are often casually bantered about in media reports, often without substantiation.

Still, we as a society have come so very far. Media is not operating in a vacuum or a void, as represented by the 1992 hit song, 57 Channels (And Nothin? On) by rocker Bruce Springsteen. Chances are greater than ever that when we click on our television remote or go see a movie, mental illnesses, including bipolar disorder, will play a starring or a minor role, having finally emerged from the darkness into the spotlight.

Stephanie Stephens is an award-winning journalist, specializing in health, who lives in California and New Zealand.

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