Mental health on screen: A DSM-5 dissection of portrayals of autism spectrum disorders in film and TV
Introduction
The mass media is considered the general public's most significant source of information about mental illness and psychiatric disorders (Cloverdale et al., 2001). Fictional portrayals of persons with psychiatric disorders on film have contributed to mystification of various disorders leading to misconceptions in the society at large (Butler and Hyler, 2005). As early as 1936 an annotation in The Lancet stated, “In the talking cinema, we suggest, psychiatry has an instrument not only for entertaining the mentally afflicted, but also for educating the uninitiated.” (Annotations, 1936). The accuracy of portrayals is central to this distinction between beneficial and detrimental representations in the media.
Autism spectrum disorders (ASD) is recognized as one of the more common neurodevelopmental disorders (Baird et al., 2006). However, most people will not have substantial or direct contact with people on the autism spectrum and, as a result, must draw their understanding from other sources. Even when personal experience is available, people may rely on media representations to understand how experience relates to the broader range of presentations contributing to the stereotyped attitudes that are prevalent (Draaisma, 2009, Garner, 2014). Specifically, it has been proposed that savant skills, while being more prevalent in autism than in the general population (Howlin et al., 2009), are over-represented among fictional autistic characters on screen (Belcher and Maich, 2014).
We continue to lack systematic data on the accuracy of representations of autism on screen, evaluated by experts in the field, with some welcome exceptions that pre-date DSM-5 (Conn and Bhugra, 2012; Garner et al., 2015). Here we use the latest, DSM-5 (APA, 2013) criteria in addressing to what extent such characters display features and behaviours that are required for an ASD diagnosis. We explore this with a view to determining how portrayals of ASD on screen might influence public opinion and/or be used in education.
Section snippets
Methods
This study reports on 26 films (n = 22) and TV-series (n = 4). The sample consists of fictional portrayals where the character's ASD diagnosis was clearly stated, but also includes influential portrayals where characters have not necessarily been described as such by the filmmaker, but where an ASD diagnosis has been linked to a character in popular media and in academic discourse. To reflect the DSM-5 intellectual disability criterion, one half of the sample consisted of characters that
Results
Characters typically demonstrated a very high match to diagnostic characteristics found in the DSM-5 descriptions, with seven characters scoring at the maximum possible on the total symptom scale (Fig. 1). The prevalence of savant-like skills was reported in 12 of the 26 characters (46%), which is higher than estimates from the real-world population of people with ASD (Howlin et al., 2009).
Discussion
The large majority of the characters evaluated obtained a very high score against DSM-5 criteria for ASD. Even the lowest scoring character scored at 50% of the possible total in both the social communication and restricted repetitive behaviour domains. This is in line with Garner et al. study (2015) on ASD-characters in film where they reported “very high levels” to “extreme levels” of autism related symptoms. This raises the question of whether meeting all diagnostic criteria (seven
Declaration of interests
None of the authors declare any conflict of interests.
Ethical approval
No ethical approval was sought as data only included fictional characters.
References (16)
- et al.
Prevalence of disorders of the autism spectrum in a population cohort of children in South Thames: the Special Needs and Autism project (SNAP)
Lancet
(2006) - et al.
Hollywood portrayals of child and adolescent mental health treatment: implications for clinical practice
Child Adolesc. Psychiatr. Clin. N. Am.
(2005) Diagnostic and Statistical Manual of Mental Disorders (DSM-5®)
(2013)The cinema in psychiatry
Lancet
(1936)- et al.
Autism spectrum disorder in popular media: Storied reflections of societal views
J. Educ. Res. Pract.
(2014) Movies as a vehicle to teach addiction medicine
Int. Rev. Psychiatry
(2009)- et al.
From source material to news story in New Zealand print media: a prospective study of the stigmatizing process in depicting mental illness
Aust. N. Z. J. Psychiatry
(2001) - et al.
The portrayal of autism in hollywood films
Int. J. Cult. Ment. Health
(2012)
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