What Scriptwriters Get Wrong About Mental Illness

It’s interesting how mental health diagnoses are included so casually in our vernacular. Our friend who likes things to be clean and tidy jokes about how “they have such bad OCD.” The co-worker who experiences some jitters before a presentation says their “anxiety is through the roof.” The person who isn’t interested in a topic of conversation quips that their “ADHD is acting up.”

Personally, I don’t find these comments as offensive as I do ignorant. And with the film and TV industry's willingness to assign such stereotypical symptoms to their “quirky yet lovable characters,” they’re an easy (and accurate) target. Regardless of the source of this ignorance, today’s post will discuss the actual symptoms of mental health disorders that I feel are among the most misunderstood in our culture: OCD, ADHD, anxiety, and eating disorders*.

1. OCD is not just about liking things to be clean and tidy.

I’ve learned that most people have no idea what OCD is. Obsessive Compulsive Disorder (OCD) is a type of anxiety disorder where people have recurring, unwanted thoughts or urges that cause increased symptoms of distress. The individual attempts to neutralize or decrease this distress by performing certain actions. So, the “obsessions” are the unwanted thoughts and the “compulsions” are the things someone does to silence those obsessions and get rid of the stress they cause.

The most “familiar” example of OCD in the media is someone who is either obsessed with cleanliness or someone who flicks light switches on and off. In reality, however, there are many different subtypes of OCD that can come with their unique form of obsessions and compulsions. Here are some examples:

Harm OCD: this is a fear that one will cause harm to other people as a result of not being careful enough. These people are not murderers or predators on the loose, bound to “lose control” and do something awful. No. These are people who actually feel very responsible for their actions—and even events that are totally out of their control—and obsess about the possibility of somehow losing control.

• Obsessions in someone with Harm OCD might involve doubting if they’ve hit a pedestrian while driving, doubting if they forgot to turn off the stove, worrying that they will cause harm by impulsively hurting someone (i.e. punching their boss in the middle of a meeting), or fearing that they will do something non-violent but illegal, like stealing.

• These obsessions naturally increase one’s feelings of distress and anxiety, so they engage in a number of compulsions to help alleviate themselves of that stress. In this case, these compulsions might include repetitive checking (i.e. making sure you’ve turned off the stove over and over again), mental compulsions (i.e. telling yourself, ’I’m not a violent person, I’m not a violent person…’), or avoiding certain places to reduce all chances of hurting someone.

Sexual OCD: this is when someone has unwanted sexual thoughts about highly stigmatized or “taboo” topics, like having sexual thoughts about family members, children, religious figures, etc.

• Obsessions in this case might involve ruminating about your sexuality for hours, wondering if/why you are sexually attracted to certain groups.

• Compulsions in this case can be mental, such as reviewing all the times you enjoyed sexual experiences that were more “appropriate” or telling yourself over and over that you “aren’t a pedophile.” One might also engage in checking compulsions, like watching same-sex porn to assure themselves that they aren’t getting sexually aroused if they have a fear of being homosexual.
  

The above examples highlight a few important points:

1. People with OCD do not wish to act out their obsessions. Rather, they feel like they are inappropriate, immoral, or unpleasant and therefore experience a high degree of shame, guilt, and embarrassment. Without the knowledge that these are actually symptoms of OCD rather than just “really weird thoughts they’re having,” they may keep the thoughts to themselves and experience more isolation and shame.

2. Compulsions are not always obvious and external. Rather, someone can have mental compulsions that no one sees and that might look like a healthy coping behaviours, even though they’re only maintaining the vicious OCD cycle.
   

On the bright side, OCD is extremely treatable. That said, you 100% have to work with a therapist who knows what they’re doing, otherwise you risk experiencing a worsening of symptoms. Additionally, I generally find that people with OCD are some of the most thoughtful and considerate people I’ve ever met. After all, the severity of their anxiety often stems from a fear of hurting or disappointing others, which is a reflection of their sensitive, kind-hearted, and empathetic nature.

2. ADHD is not just about getting distracted by the squirrel that just ran by.

If you ask someone to imagine a person who has ADHD, they’ll likely think of some hyper teen who can’t sit still, has bad grades, and who’s constantly getting into trouble from being “too impulsive.” While this is one expression of ADHD, there are countless others.

It’s overly simplistic and inaccurate to say that ADHD is an attention disorder. On the contrary, those with ADHD do not have a hard time paying attention to things; their main struggle is simply what to pay attention to and when. To use a metaphor, a “regular” brain has self-charging batteries, while the ADHD brain has batteries that need to be manually charged throughout the day. Someone with ADHD can only charge their batteries by engaging in something that’s personally stimulating; if they don’t, they will be unable to complete other tasks if they’re not interested in them.

There are three main categories of ADHD-related symptoms:

• Inattention, which involves struggling with: giving close attention to details, holding attention, listening even when spoken to directly, doing tasks that require sustained mental effort for long periods of time, losing things frequently, and being forgetful.

• Hyperactivity and impulsivity, which involves struggling with: sitting still, partaking in leisurely activities quietly, talking excessively, impatience, listening without interrupting others, and more. A key symptom here is feeling like you are constantly “on the go,” as if driven by a motor.

For an ADHD diagnosis, one would have to have a certain number of the above symptoms to a degree that is quite disruptive and for at least six months.

Now, here’s where things get complicated:

• Someone with ADHD might go years without getting diagnosed because their stimulating behaviours are more socially acceptable. For example, rather than playing video games for eight hours a day, they read eight books at once or engage in five art projects at the same time. Rather than being seen as “hyperactive,” they’re seen as “creative.”

• People might have internal skills, values, or coping behaviours that make it seem like they are unaffected by ADHD. For example, even though studying a subject of little interest would be physically painful for someone with ADHD, they might be naturally smart and able to get good grades. Or, they might visit their T.A. regularly in university and learn how to study more efficiently. As a result, they might get good marks despite going through very intense, invisible struggles that are foreign to someone without ADHD.

• If someone finds an activity like organizing stimulating, then their room might be very neat, contrary to the stereotype that comes to mind of the disorganized mess that follows the ADHD individual.

Everyone forgets their phones at home sometimes. Every job comes with moments of having to engage in monotonous tasks you don't want to do. However, the difference between diagnosable ADHD and feeling unmotivated or bored can be distilled to the amount of effort required to engage in said tasks for someone with ADHD and the impact of these coping behaviours on their mental health.

The bottom line is that there are plenty of very successful, organized individuals who have ADHD. These are typically people who have found stimulation in activities that are socially acceptable or whose hyper-active symptom of feeling “driven by a motor” has caused others to just see them as driven or ambitious. Behind the scenes, however, they could be dealing with exhaustion, shame, embarrassment, imposture syndrome, and more.

3. Anxiety isn’t just about having a panic attack once in awhile or “being dramatic.”

There are many different sub-types of diagnosable anxiety, but I’ll focus on Generalized Anxiety Disorder (GAD) today, which involves worrying excessively about a variety of topics, events, or activities. What makes it diagnosable is that the worry is obviously excessive, occurs more days than not for at least 6 months, and impairs the person’s life in significant ways. For example, they might avoid certain situations or people, lose hours of sleep from engaging in rumination, or constantly seek reassurance from others about different topics.

While “stress” and “anxiety” are often used interchangeably, stress can be defined as the cause of someone’s anxiety, while anxiety is the brain and body’s response to it. Additionally, worry can be defined as the thought process that fuels anxiety, while anxiety is, again, the brain and body’s reaction to those worries.

To illustrate this point, let’s say two people have to give a work presentation the next day: John (who has anxiety) and Bob (who does not). John worries about the presentation for hours the night before. His body’s fight-or-flight system is activated and stress-related hormones like cortisol and norepinephrine start pumping through his body. His thoughts become frantic, his pulse quickens, and he starts to feel nauseous.

Bob is also worried about the presentation, but his boy’s fight-or-flight system remains inactive. Rather, he prepares for the presentation and feels relatively safe in his body. John, on the other hand, is starting to doubt himself tremendously based on the physical symptoms he’s already experiencing and eventually decides to call in sick for work for fear that he'll make a fool of himself tomorrow.

While treatment often focuses on changing anxiety-fuelling thoughts (which can certainly be helpful), it can be important to teach people tools that promote feelings of safeness in their physical bodies as well. Additionally, treatment aimed at exposing the person to situations that fuel uncertainty and anxiety can be highly effective as it acclimatizes them to anxiety.

Saying someone with anxiety is “being dramatic” is like saying someone's pancreas is being "dramatic" in Type 1 Diabetes. You’re labeling a symptom as a personal failing, which only causes the person to feel embarrassed and misunderstood—and makes you look uninformed.

4. Anorexia isn’t just “never eating anything.”

I remember Glee once tried to shed some light on anorexia nervosa by having one of their characters, Mercedes, avoid eating for about six hours.

When I say the media isn't always skilled at portraying mental health diagnoses accurately, this is what I'm talking about.

There are many different types of eating disorders, including anorexia nervosa, bulimia nervosa, binge eating disorder, orthorexia, and avoidant and restrictive food intake disorder (ARFID).

Orthorexia can be defined as having an unhealthy obsession with healthy eating. Though it’s not formally recognized by the Diagnostic and Statistical Manual, the term was coined in 1998 and is highly common in today's diet-obsessed world. Symptoms include: compulsively checking ingredients and nutrition labels, cutting out an increasing number of food groups (i.e. carbs, dairy, meat), being unusually interested in what others are eating, spending hours thinking about what food might be served at future events or gatherings, showing high levels of distress when “safe” or “healthy foods” aren’t available, and more. In this case, the disorder has the ability to greatly impact one’s quality of life, causing them to avoid going to certain social gatherings or losing weight as a result of following so many different diet-related “rules.”

Anorexia is also about more much than “not eating.” It’s more accurately defined as the “restriction of energy intake relative to the requirements,” so you might see someone with anorexia eating frequently, though they might only consistently consume 800 - 1,000 calories a day.

People with anorexia also experience intense fears of gaining weight even if they're already quite thin and place a very high degree of self-evaluation on their appearance and weight. When they lament about “feeling fat,” it’s not because they’re trying to get attention; it's genuinely because they have a skewed image of themselves in their mind.

Finally, someone can have an eating disorder and not be thin—something that most people don’t know. In fact, it is not uncommon for people with bulimia nervosa, characterized by binge eating and purging through vomiting, over-exercising, or using laxatives, to gain weight as they may over-estimate how many calories they’re ridding themselves of in the purge phase.

The Bottom Line

The ways that we explain or “show” mental health diagnoses in the media and during everyday conversations are powerful. I’ve been shocked at the number of people who describe a certain list of symptoms, only to tell me that they had no idea they were symptoms at all. Rather, they’re convinced that needing to work on 59032859 projects at once is “normal,” not potentially a way of managing ADHD. They might think that compulsively reading food labels and only drinking smoothies with specific ingredients is just because they’re a “health enthusiast,” not because they potentially have an undiagnosed eating disorder. Whatever the case, it can be very useful and empowering to work with a therapist who knows what to look out for and is skilled at treating specific diagnoses rather than using a one-size-fits-all approach.

*Of course this list is not exhaustive and I could make a lengthy post about what the media gets wrong for practically every mental health disorder. However, I’ve included OCD, ADHD, anxiety, and anorexia as these appear to be the most misunderstood disorders among the clients I see in my private practice.

Note: an earlier version of this post was entitled 'What the Media Gets Wrong About Mental Illness.' However, a journalist friend reminded me that the news has intense guidelines and vetting procedures when reporting about anything related to mental health. Given that most people think 'news' when they hear 'media,' I've corrected the title of this blog to more accurately highlight the ways that the film and TV industries misrepresent mental health issues.

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If you or someone you know could benefit from nutritional counselling or individual, couples, or family therapy, please contact kristina@fresh-insight.ca. We have locations in Markham and Vaughan.