However, when the subject matter pertains to the devastating mental disorder schizophrenia, it’s important that the makers of the entertainment are conscientious about how the disease is portrayed. There’s already a lot of stigma about schizophrenia in society, including the misguided notion that schizophrenics are running around with uncontrollable, violent alter egos.

Movies like Me, Myself & Irene (promotional photo shown above) don’t do the schizophrenic community any favors. Other movies, like The Soloist, appear to have given much more thought to the complexities of this disease.

In this post, I’ll try to give a simple explanation of what schizophrenia is and how it affects people’s lives, then I’ll do a rundown of movies and books that tried to depict schizophrenia and either failed miserably or made a respectable effort.

In short, no one can tell us why schizophrenia occurs or what exact biology is responsible. We know what schizophrenia looks like: it’s a breakdown of thought and emotion leading to significant social dysfunction. I think it is safe to say that schizophrenia must be characterized by at least two of the following:

1. Hallucinations. (You hear things [most common], see things, smell or taste things that no one else can sense but you.)

2. Delusions. (You may feel like you’re being persecuted in ways that seem bizarre to others; e.g. “I can’t go out in public because the CIA wants me dead and they have people outside my house watching me.”)

3. Disorganized thinking or speech. (Your train of thought is nearly impossible to follow because your speech is incoherent and you switch tracks mid-thought.)

4. Disorganized or catatonic behavior. (Your behaviors are illogical or inappropriate, or you have a flat affect.)

Paintings of cats done by 20th century artist Louis Wain, over a period in which he developed schizophrenia. The effect of the disease on his perception is apparent in his art.

A combination of factors, from genetics to environment to drugs, have been suggested to explain why schizophrenia afflicts people. A genetic link is almost certainly involved, with over 40% of schizophrenics’ identical twins also having the disease (as compared to the 6.5% risk shared by first-degree relatives). Urban living during child- or adulthood has been shown to increase the risk of schizophrenia two-fold. Cannabis use has even been implicated as having a causal role in schizophrenia development. Half of the world’s 24 million schizophrenics use drugs and/or alcohol to excess, but it is difficult to say how much of this behavior can be attributed to coping mechanisms.

So, I never set out to do a study on the depiction of schizophrenia in entertainment media. But I did come to realize that I’ve seen a number of movies and read a novel that all gave unique representations of this disorder…some of those representations were enlightening, and some were cringe-worthy. Below, I will grade works of art and describe what they did right, or, what they did very, very wrong.

1. Me, Myself & Irene. To be fair, I think I’ve only ever enjoyed 20-25% of Jim Carrey’s
movies. Me, Myself & Irene falls into that 75-80% that is almost unwatchable. The synopsis is that Carrey plays the role of a state trooper who is mild-mannered and lovable, until he goes off of his medicine and becomes abusive and violent. The movie that was “pure fun” for Carrey was viewed by the National Alliance for Mental Illness (NAMI) as “irresponsible.” The premise is that Carrey has “advanced delusionary schizophrenia with involuntary narcissistic rage” and is a “schizo” (according to his love interest in the movie, Rene Zellwegger).

What the audience sees is a guy who is normal and likable while on his medication, but when he’s off of it, he poops on his neighbor’s lawn, suckles at a stranger’s breast, and generally has uncontrolled rage. This, unsurprisingly, did little to help the societal stigma that schizophrenics are violent, dangerous people to be feared. In fact, if anything, Carrey’s character in the movie is closer to being a crude, insulting depiction of someone with dissociative identity disorder (aka multiple personality disorder), rather than someone with schizophrenia.

“We’re certainly not out to make fun of anybody,” Carrey said of the film. No, you’re just propagating negative stereotypes about a horrible disease by targeting the very age group with the peak incidence of the disorder, and telling the world that these people are dangerous (and maybe not so much worth helping, since that wouldn’t be as funny). The movie made $150 million worldwide, so a lot of people got the message.

Grade: F-

2. A Beautiful Mind. It was clear to me that this movie was making a more serious, sincere attempt at depicting schizophrenia. The main character, John Nash, was a real person, an actual schizophrenic, and a Nobel laureate at that. The real John Nash was plagued by paranoia, such as the idea that everyone who wore red ties was part of a communist conspiracy against him. He saw himself as having a special purpose, with schemers and enemies trying to persecute him.

Director Ron Howard goes to great lengths to make the viewer understand the all-consuming paranoia that a schizophrenic can feel. And Russell Crowe garners incredible sympathy for schizophrenics with his role. However, it seems like it was only for entertainment purposes that John Nash was seen to vividly hallucinate multiple individuals with constant personalities that stay with him for years and years. Not only that, but the John Nash of the film thinks everyone else sees his hallucination-people and is shocked to find out that others don’t accept reality as he understands it.

A true schizophrenic is much more likely to have auditory hallucinations, which he doesn’t expect others to hear, than to have “imaginary friends” that he believes are fully real. Still, there’s a reason multiple high school teachers made me watch this movie: it takes schizophrenics seriously, and depicts them as people you can respect and even begin to empathize with, even if the movie does take certain creative liberties in the name of entertainment value.

Grade: C+

3. The Soloist. Also based on a true story, The Soloist portrays Nathaniel Ayers, a  prodigy musician who develops schizophrenia and becomes homeless. Ayers inspires numerous newspaper columns (written by Robert Downey, Jr. in the movie), and I won’t ruin the ending for you, but rest assured that you will laugh with, cry over, and root for Jamie Foxx‘s Ayers.

Although the movie only has a Rotten Tomatoes score of 56% (i.e. it’s deemed “rotten” by movie reviewers), this is mostly attributed to a “lack of narrative focus.” The outstanding performance by Foxx is vibrantly complex and, moreover, clinically accurate. Efforts are made throughout the movie to reference Ayers’s childhood and to show the gradual build of his schizophrenic tendencies even from a young age, when he chooses to live in his basement and always be surrounded by his instruments.

Foxx plays a schizophrenic who is both believable and lovable in The Soloist.

One of the most beautiful things about this movie is that before you know anything about Ayers’s illness, you know about his incredible gift for music, and he’s inherently likable because his love of music is so pure. Even once the viewer starts to see the rapid, unexpected shifts in Nathaniel’s moods or the rambling, topic-jumping nature of his monologues, it’s impossible to write him off as just “crazy” — his insights about his home city of Los Angeles are spot-on, and he asks compassionate and worldly questions during his conversations with LA Times columnist Steve Lopez (played by Downey, Jr.). Even Nathaniel’s hallucinations are exclusively auditory (as is most common with schizophrenia) and his voices tell him that others can hear his thoughts (a belief commonly held by schizophrenics).

Clearly, people did their research into the nuances of schizophrenia before setting out to make this film. One could criticize the nature and believability of the friendship between Ayers and Lopez, but I think this movie does much to propagate a view of schizophrenia that makes more room for compassion, kindness, and aid, and leaves little space for fear and ostracism.

Grade: A

This post is getting long, but I just want to make one more plug for a novel that is truly spectacular in that it not only represents a schizophrenic in a factual, dynamic way, but it makes this representation through the eyes of this schizophrenic’s identical, mentally healthy twin brother. In this novel, I Know This Much Is True by Wally Lamb, the narrator goes through life as the privileged twin, preferred by their stepfather and more quick to make friends, but he is also fiercely protective of his less socially adept brother. As his brother develops schizophrenia, a progression which is written with attention to the typical age of onset and early signs of the disease, the healthy twin shoulders increasing amounts of the burden of care for his brother.

This novel does a stellar job of showing the reader that schizophrenia is far from a disease of the individual; schizophrenia affects everyone in a schizophrenic’s life, and even people outside of it. Add to that the fact that the identical twin brother is mentally sound, and thus suffers from the worry of becoming sick and the guilt of not being sick, and you have a book that paints an impressively complete picture of life with this disorder. Selected for Oprah’s Book Club in 1998, I Know This Much Is True is an intensely emotional, comprehensive, and profound read. Don’t be put off by the daunting 928 pages – it’s worth the time, and I definitely give it an A.

In summary, watch whatever you want, read whatever you want, but when it comes to at-risk groups in our society, know what’s real and what’s just for your amusement.

Stay nerdy

Picchioni MM, & Murray RM (2007). Schizophrenia. BMJ (Clinical research ed.), 335 (7610), 91-5 PMID: 17626963

van Os J, & Kapur S (2009). Schizophrenia. Lancet, 374 (9690), 635-45 PMID: 19700006

Large M, Sharma S, Compton MT, Slade T, & Nielssen O (2011). Cannabis use and earlier onset of psychosis: a systematic meta-analysis. Archives of general psychiatry, 68 (6), 555-61 PMID: 21300939

"That arsenic really worked like a charm!"

…Before we knew better, that is. Thanks to research, we as a society are generally smarter about things than we used to be. In this post, a quick look at how cigarettes, cocaine, heroin, tapeworms, and arsenic weren’t always all that bad.

(Note: There are quite a few images within)

1. Cigarettes: Cigarettes almost didn’t make this list because they’re still widely used and totally legal, but I thought I’d feature some of these vintage ads, the likes of which we’ll probably never see again. And not to pick on Lucky Strike cigarettes more than any other cigarette brand, but their campaigns really stood out:

Sure, women still smoke cigarettes as a means of staying thin, but with the endless list of negative health effects of smoking, cigarette makers can never again encourage a woman to smoke to “keep a slender figure” or threaten her with an ominous double-chinned shadow.

And how can I pass on the irony of another Lucky Strike gem, seen above left, where the selling point is how many doctors are fans of their cancer sticks? Although, the 1949 Camel cigarette ad on the right would argue it’s their cigarettes that doctors prefer to light up. Don’t get me wrong, physicians definitely used to smoke alongside everyone, so these ads are only amusing/horrifying now because we know so much more about what smoking does for our health. ["It's toasted" refers to toasted tobacco leaves, which supposedly made for a better tasting smoke.] And one more ad to make you cringe:

So it's okay for children *over* 6...?

2. Cocaine: Another story many people have heard of is the one behind the name of Coca-Cola. Coca leaves provided cocaine and the kola nut provided caffeine — a winning formula at the time.

Though some people may feel addicted to this soda at times, it’s probably just the caffeine, or the tastiness — today, Coca-Cola only uses a cocaine-free extract of the cola leaf for flavor. Because no one wants even small amounts of something in their soda if it’s known to cause heart attack, seizure, stroke, or sudden death. You probably wouldn’t want it in your toothache drops either:

Believe it or not, a physician in 1909 seemed to think it relieved the pain and shrank the tumors of 14 of his cancer patients, and published his observations in British Medical Journal:

“…The only agent I had ever used having any effect on the growth of abnormal epithelial tissue was cocaine…I determined to try the effect of the internal administration of cocaine.” (Emphasis mine)

This article is old enough that anyone can access it for free, and it was written in the days when research read more like a diary, so I recommend checking it out: The Treatment of Cancer With Cocaine.

3. Heroin: Another drug that’s reviled at present, but Bayer used to think it made a fine cough suppressant:

But I’m being hard on Bayer — they didn’t know that their Heroin was quickly metabolized by the body into morphine, the drug for which Heroin was supposed to be a non-addictive substitute. People tend to stay far from heroin now, because nearly a quarter of its users become dependent.

4. Tapeworms: Today, people don’t look favorably upon tapeworm infections, and with good reason — who wants diarrhea, malnutrition, seizures, or any of the other awful side effects of a tapeworm living in his digestive tract? But I guess in the late 1800s, welcoming a tapeworm into your intestines could have been the start of a new weight-loss plan (and this was before the obesity epidemic!):

5. Arsenic: Lastly, an element now practically synonymous with poison, arsenic was previously used as a treatment for a wide range of conditions:

Instance of the Good Effects of Arsenic in Chorea (chorea is an involuntary movement disorder), A Case of Chorea Successfully Treated by Arsenic, On the Use of Arsenic in the Cure of Chorea, On the Use of Arsenic as a Blood and Cardiac Tonic, and The Successful Use of Arsenic in Certain Kinds of Gastric Pain. (Again, this research is so old that you can access it for free.)

All of this was done even though it’s been known since the time of the Roman Empire that arsenic can kill. Although arsenic can still be found in occasional medical treatments today, such as arsenic trioxide, a compound approved by the FDA in 2000 to treat a resistant form of leukemia (the arsenic is toxic to the cancer cells), we’ve stopped putting it in our facial soaps (thank you, research):

I realize this post was mostly eye candy, but what I hope I’ve done is to show how research shapes society and has the power to switch the common perception of something from “cure” to “poison.” Finally, I want everyone to ask themselves: What do you think we use now, that 50 or 100 years from now will be laughable “stupid stuff” to future society? Energy drinks? Air fresheners? Leave a comment with your best guesses!

Gilchrist RM (1909). THE TREATMENT OF CANCER WITH COCAINE. British medical journal, 1 (2509), 274-5 PMID: 20764279