How Media Destigmatizes Mental Illness?

Web Series Breathe: Into the Shadows, brings light on showcasing Dissociative Identity Disorder

Author: Ms. Priyanka Bhattacharjee, Consultant Clinical Psychologist, Founder, PsychSpace

Breathe: Into the shadows, a recent Indian web series have stirred up a lot of review and discussion. No doubt, the quality of Indian web shows and media have escalated to a different level, particularly in terms of addressing and focusing on mental health concerns, which I am extremely happy about. I felt this is one of those few shows/movies which attempted to showcase a mental disorder with quite near scientific accuracy and understanding. Common people are totally unaware of, or less sensitive to, or stigmatized, or occupied with incorrect understanding of the “condition” being showcased in this series. It has taken major efforts of detailing the character in terms of symptomology, the pathological behavioural profile, and the course of development of the disorder.

My idea of writing about the show is nowhere near to review the show from viewership point of view and the technicality of the show, rather it is an effort to focus on the technicality of the psychiatric condition being shown and enlightening more about it. I have been reading a lot of articles people are penning down their experience with the show. I appreciate everyone has a view point and likings and dis-likings majorly differ. While reading through the articles, I realized there should be a clarification required in how people see the mental illness portrayed by the actor in lead, the efforts of the makers in bringing this up in the silver screen and place it adequately in front of the viewers. Sadly, I have mostly have heard and read people criticizing that this show has distorted the image of a patient with psychiatric illness to be a criminal or a serial-killer, that this show has been insensitive in portraying a patient as a criminal, that the patient’s dignity and self- respect has been at stake, that this show has further stigmatized psychiatric illness. But answer to all these is, certainly- NO!

Our society is under a major transition in terms of awareness towards mental health. Yes! I can begin to say that people in our society are gaining better awareness and sensitivity towards mental health and mental illness. It’s not the same anymore like the earlier times when people call these as devils’ possession, witch haunting or past life sin. But at the same time, because of increased accessibility to Google knowledge, self- claimed psychotherapist available in the social media market, increased number of quacks, this sensitivity towards mental health concerns are losing its way it seems. It is hard for the common people as well as these quacks to believe and understand, the wide range of psychiatric illness and their levels of severity. Usually people consider psychiatric illness or mental illness as just “one disorder”, and as if we mental health professionals are also treating “one disorder.” As we are gaining better awareness towards mental health and mental illness, it is equally important to understand that there exist numerous types of mental illness, with different levels of severity and different levels of prognosis. It is just not about showcasing the easier side of mental illness, people require to understand what extreme level it goes to; and it’s purely the result of symptoms and the neurochemical malfunctioning.

Indian media and movies are gaining small momentum in accurately showcasing mental health issues. If I have to list it, I can talk about Dear Zindagi, Bhul Bhoolaiya, Barfi and now this series Breathe: In the shadows. Talking about this series in particular, where they are portraying Dissociative Identity Disorder, it beautifully shows the predisposing as well as the precipitating factors adequately involved in developing the disorder. It went on further to explain the perpetuating factors which are scientifically correct in maintaining his illness, and finally showing the full- blown episodes of the disorder depicting with scientific accuracy. Dissociative disorders refer to a group of conditions, which involves disruptions in a person’s normally integrated functions of consciousness, memory, identity, or perception (APA, 2013; Spiegel et al., 2013). The word dissociation means to the capacity of the human mind to engage in some complex mental activity in channels split off from, or independent of, conscious awareness (Kihlstrom,2005), and this usually occurs in a situation which is beyond the perceived capacity of the person to cope with situation. In other words, the patient would experience the dissociative spell at the face of a stressful situation Talking about what makes it happen- early childhood experiences, coming from broken family, inadequate stress coping mechanism to name a few. During the split off period from consciousness, patients would engage into activities which they are not conscious about, like exactly shown in the show of the actor engaging into unlawful activities. Now as I said about the growing sensitivity towards mental illness and impact of falsely available information about psychiatric illness, I came across articles stating that this series did not leave back a positive note to the viewers, that mental illness is again negatively and cruelly portrayed, the patient with mental illness is shown to be culprit and so on. But the reality is, these instances are quite relatable to the real- life cases of psychiatric illness, particularly Dissociative Identity Disorder.

As a practicing Clinical Psychologist, apart from treating people with mental illness, it is also a prime part of professional  duty that I disseminate accurate information and awareness about mental illness to the common people; and being in country like India, we Clinical Psychologists literally struggle with the stigmatized approach on a daily basis. But I what I want to significantly share is that in my daily clinical practice I get different patients with different psychiatric illness or mental health condition, with differing levels of severity. At the same time, different levels of chances of recovery as well as different prognosis levels. After beautiful movies like Dear Zindagi, people are motivated to express themselves and take therapy. People are talking more about Depression and Anxiety, people are reporting more of childhood behavioural problems, emotional issues etc. But these conditions have better prognosis as compared to many other psychiatric illnesses. The other type of cases that I (or all Clinical Psychologists) deal with are severe cases of Schizophrenia, Bipolar Affective Disorders with or without psychotic symptoms, Dissociative Trance and Possession Disorder, Severe Mental and Behavioural Disorders with Substance Abuse, Personality Disorders, Severe Obsessive Compulsive Disorders which require long time treatment and recovery is challenging. Then comes patients, which a common man can relate with in these psychological thrillers, who, under active psychotic episodes or active mental illness episodes engage into criminal offenses. I had dealt with cases when a patient had killed his father under an active hallucinatory voice, a patient who had chopped off his own hand because he was instructed by his hallucinatory voice, and a lot of cases of killing under hallucinatory behaviour and delusions. My point of stating is that this series shows a confluence of Forensics and Criminology. But in no point such patients are demeaned or brutally sentenced considering there condition of mental illness. These patients are also treated with equal empathy and dignity like we treat patients with Marital Conflicts, Mild level of Depression or any other condition of level severity and better prognosis and recovery. Relating with the series, where the actor in lead suffering from Dissociative Identity Disorder, and found guilty of engaging into kidnapping and serial killing during the altered personality, is actually put in an institute of mental illness for treatment and rehabilitation and not in the prisons which is always done with such case, however with strict police force around for security. From a point of view of a practicing Clinical Psychologist, who also has an expertise of dealing with such cases, I never found that this series was an attempt to stigmatize mental disorders, only because of the not so fascinating look of the lead actor when he is into his altered personality- his behavioural profile of limping, slightly twisted lips, his gaze etc. In a real clinical picture, this can quite happen!

One thing which I majorly would like to highlight and it might have gone missed by the viewers of how the Principal had ‘reinforced’ his spilt personality behaviour after the psychiatrist who was treating him had left the town and there was no one else available for the treatment. Because there was not adequate therapeutic approach available, and certainly because the Principal isn’t a therapist, he just let the condition to be sustained. Usually in cases of Dissociative disorders with early intervention and psychotherapy, it makes better progress, but in his condition, his illness has been indirectly reinforced for avoiding any other complications from developing as well as non -availability of treatment opportunity, because of which this condition sustained and carried forward to his adulthood. Also, since the child had no one as family, there was only the Principal to have taken care of him. The important message behind this is that, any mental illness requires early intervention and requires to adequately addressed through clinical intervention and psychotherapy. Childhood mental illness have far deteriorating impact upon adult life as well highest chances of leading to other psychiatric illnesses in later life. Further, prognosis of Dissociative Disorder depends upon a lot of factors, – early intervention, duration of the illness, reinforcing factors around the patient to just name a few and certainly they are quite challenging cases of psychotherapy. They usually require long standing therapeutic support as well as pharmacological management in some cases.

With such media and movies, it develops better opportunity for discussing mental health, which I really appreciate; because only then we would gain awareness and sensitivity towards mental illness in a real sense. The world of mental health and illness shown on social media is very different from where and what we Clinical Psychologists practice, and when people would understand this difference and gravity, then that would be considered as a true awareness and concern towards mental health and illness.