Mental illness in the movies is about as mixed a bag as you can get. Portrayals range from surprisingly accurate, as in Silver Linings Playbook , to horribly offensive, as in Me, Myself & Irene . But does it matter? Well, when you consider that an academic study showed that 90% of community college students surveyed learned about mental illness primarily through movies, yes, it makes a huge difference.

A national survey from 2006 that found that 60 percent of those surveyed believe that people who have schizophrenia are violent, and 32 percent believe that depressed people are violent. The reality is much different. Mentally ill people aren’t any more statistically likely to be violent than the general public. In fact, they’re statistically much more likely to be victims than the general public. What’s more, of the crimes committed by those with mental illness, only 7.5% were directly attributed to the illness itself—the rest were due to ordinary motives like the rest of the population. But that’s not what most people believe. This is just one example of the harm done to those with mental illness by negative and inaccurate perceptions caused at least in part by portrayals in the film industry.

So what, exactly, is wrong with the portrayals of mental illness in film? And what are these misconceptions doing? Misconceptions of mental illness in film are indeed doing damage and hurting the people who live with these conditions. Here’s how.

Making the stigma worse

I have a very serious mental illness (bipolar disorder), and, while the symptoms can be severe and difficult to deal with, one of the worst parts of it is dealing with the stigma associated with the illness. Many people are scared by the illness, and I have to be very careful who I tell about my condition, particularly in the workplace. The widespread belief that people with bipolar disorder are unstable, unpredictable, and dangerous is a real danger to me socially and professionally, and those who know me would be the first to tell you that these perceptions are largely ungrounded—many people with mental illnesses go on to live fairly normal lives and do well in relationships and careers. But that’s not what we see in the movies.

Early on in cinema, mental illness became a plot device in horror movies, explaining the horrific behavior in villains without any real regard for realism or the people actually suffering from mental illness. The film that started this trend was probably 1960’s Psycho , in which mental illness was the driving force of the killer. That was, admittedly, a brilliant plot, but writers got lazier after that. In 1978’s Halloween , Michael Myers goes on a killing spree after escaping from—you guessed it—a mental hospital. In 1980’s The Shining , Jack Torrance slowly “goes crazy” and loses his grip on reality, which has the effect of turning him into a deranged killer. And the crazy killer trope has been used in many horror films since then. Does this make those movies bad? Well, not entirely, I actually rather enjoyed some of them—but it does make the stigma against mental illness worse.

One Flew Over the Cuckoo’s Nest is often held up as a shining star in tearing down the evil of the mental health industry, but the reality is that it does a lot more harm than good. A scientific study showed that simply viewing One Flew Over the Cuckoo’s Nest significantly hurt the viewers’ image not only of the mental health industry, but also those who have mental illnesses. Even watching a documentary later to dispel some of the myths about mental illness and the mental health system did not undo the damage in perception caused by the film.

And we begin propagating the stigma very early in viewers’ lives. A study of Disney films showed that 85% of them contained passing references to mental illness (including words like “crazy” or “nuts”), which were mainly used to say how awful those characters (21% of principal characters) were. Now, to be fair, I don’t think the writers ever intended to single out specific mental illnesses—like many other filmmakers, they’re just using “crazy” as a generic blanket term to explain evil. But regardless of the intent, the message is very clear: mental illness is a very bad thing that causes bad things to happen.

And you’d think that the industry would have evolved and gotten better about this as the science progressed, but things have actually gotten worse. In 2000, Me, Myself, and Irene showed us a man with disassociative identity disorder whose condition led him to basically be an asshole to everyone. The 2016 movie Split shows us another man with disassociative identity disorder whose multiple personalities kidnap and torture women. And it seems like every week on television, there’s a crime show that diagnoses a killer with borderline personality disorder to explain to the audience why he or she is so terrible. An analysis by a professor at the University of North Carolina – Asheville found that characters identified as having a mental illness were 10 times more likely to commit violent crime than other characters—which is 10-20 times higher than the stats in real life.

And when mental illness is not an explanation for terrible behavior, it’s often a joke. The television series Monk , which first aired in 2002, featured a main character with obsessive compulsive disorder, which mainly manifested in a series of cute, quirky behaviors that were ultimately relatable to neurotypical viewers, leading many of them to think that they too are “a little OCD.” The reality is that OCD can be a debilitating condition that goes way beyond quirky and is certainly not cute. The trivialization of mental illness, while sometimes intended to make these conditions more normal to talk about, instead dismisses the real struggles associated with them. Remember that many mental disorders are classified as disabilities and can be just as debilitating as a physical disability. But struggle like that is not relatable to general audiences, so it rarely makes it onto the screen.

Making treatment undesirable

As I mentioned, I have to be careful who I share my disorder with, but that doesn’t mean I’m completely silent about it. In many areas of my life, I’m actually quite open about it. What has surprised me the most is that the people I tell usually feel bad for me not because I have this condition, but because I am treating it. The stigma against treating mental illness is almost as bad as the stigma against mental illness itself; in the movies, the stigma against treating mental illness is significantly worse.

We’ve talked about lousy and harmful portrayals of mental illness in film, but let’s look at a film that got it right and see what it has to say about treatment.

In the 2001 film A Beautiful Mind , brilliant mathematician John Nash suffers from schizophrenia. Hallucinations and paranoia cause major problems for him, so he goes on medication, but it makes him lethargic, so he stops. He learns to control his symptoms through sheer willpower alone.

Even in films that show mental illness in a sympathetic light, treatment is off-limits. There are a few reasons for this, including the simple idea that someone beating mental illness through their own strength makes a better story than taking a pill for it. But this is where we really start to see the dark legacy of films like One Flew Over the Cuckoo’s Nest . Even though mental health treatment has come a long way since the 1950s, any doctor prescribing an effective medical treatment for a mental illness is often still seen as the evil Nurse Ratched, oppressing and controlling the patients in her care without regard for what it does to them.

In any movie where someone with mental illness gets better, this is usually what happens. Here are a few more examples:

Garden State (2004)

(2004) Spider-Man 2 (2004)

(2004) Patch Adams (1998)

(1998) The Apartment (1960)

(1960) 500 Days of Summer (2009)

(2009) Me, Myself, and Irene (2000, and can you tell I hated this movie?)

Are there any movies that prescribe effective medical treatment? There are a few. Let’s take a look at one: The Perks of Being a Wallflower (2012).

Charlie, our protagonist, suffers from severe depression and PTSD. As a freshman, a group of eccentric seniors take him under their wing and introduce him to their quirky culture. We also see throughout the film that Charlie’s parents still provide a lot of help, even completing some of his homework assignments for him. In the end, it’s a major breakdown that drives Charlie to get treatment and it’s clear that he will need to be taken care of for a while longer.

I’ll admit, for major depression, this isn’t entirely unrealistic. It can be crippling (it is, after all, a legitimate disability) and there are no easy solutions. But compared to the other characters in the movies above, Charlie seems like he’s made of glass and will shatter at the slightest touch. And even the decision to get treated is not his—it’s imposed on him in an emergency situation. The Perks of Being a Wallflower was a great film, but it illustrates why films don’t want characters that seek treatment: it’s seen as weak and only to be used as a last resort.

The impact

With mental illness portrayed as negative and effective treatment portrayed as more negative, where does that leave us? Without treatment, we’re seen as the villains: crazy and dangerous. With treatment, we’re seen as the victims: weak and deluded. This leaves no room for us to be the heroes of our own stories—or anyone else’s stories. After all, who would want a dangerous villain or a weak victim to help them with anything?

The stigma extends to all areas of social discussion. How many times have you heard a violent criminal or unstable politician described as clearly mentally ill? How many times have you heard that we don’t have a violence problem; we have a mental health problem? Just like in the movies, mental illness is a scapegoat for bad behavior, often perpetuated by people who don’t understand it.

This stigma isn’t solely because of the film industry, but film portrayals of mental illness certainly aren’t helping. Remember that study I mentioned above where even viewing a documentary with the facts couldn’t undo the damage done by watching One Flew Over the Cuckoo’s Nest . Until we start seeing more compassionate—and accurate—portrayals of mental illness in film, we’ll continue to see more damage than can’t be undone with exposure to the facts, and this will continue to hurt the many people who live with mental illness, including myself.

But there is a glimmer of hope. Thankfully, some films are becoming more sympathetic to those with mental illness. 2012’s Silver Linings Playbook gave us a story of two mentally ill people that fell in love, and it’s amazing how normal these two characters and their relationship—and the treatment of their conditions—feel. 2001’s A Beautiful Mind gave us a sympathetic, if not entirely accurate portrayal of a brilliant man with schizophrenia. 2006’s Little Miss Sunshine gave us a portrayal of depression that captured the struggle without crippling the character, and he ends up being one of the most likable characters in the film. And the television show Homeland , which aired its first season in 2011, features a main character with bipolar disorder who is very good at her job. We are seeing progress in sympathetic portrayals of people with mental illness—even if portrayals of effective treatment are still lagging behind. Though things are far from perfect, I am still grateful for that progress and hope to see that trend continue in the future.