In any discussion about depictions of mental illness in pop culture, we must examine who is mentally ill, and how it is framed. Pop culture reflects social attitudes at large and this can be seen especially markedly with mental illness, where the gendering and racializing that play critical roles in the disparities in mental health diagnoses in society also show up in your pop culture.

Cast your mind back over the depictions of mental illness you’ve encountered most recently; there’s a chance many of them were women, from madwomen in the attic to crazy exes, and there’s a chance that at least some of them were people of color. There is a long history of pathologizing resistance to oppression that plays a key role in the depictions of mental illness in pop culture.

Think about what mental illness, or craziness, lunacy, insanity, mean to you, and how you know a character is mentally ill without being specifically told. The character behaves irrationally. Is perhaps violent. Doesn’t respect personal space. Think, too, about how some of the very epithets we use to disparage mental illness are gendered; women who do not behave as expected are “crazy bitches.” An angry woman is “hysterical.” Think about how some of these behaviors can arise in legitimate protest against oppressive social structures; anger, for example, is a very legitimate response to sexism.

The pathologization of what some might consider perfectly reasonable responses to oppression has an ancient history. For thousands of years, women have been marginalized with a variety of diagnoses meant to keep them in their place. Ancient Greece and Rome, two cultures that contributed heavily to western pop culture—which is what we’re focusing on in this series because it’s what we know best—were both heavily patriarchal. Medical attitudes from both these societies continue to be prevalent today, including beliefs about mental health. Gender bias in mental health diagnoses is an ongoing and significant issue, as is the fact that women are more at risk of some mental health conditions exacerbated by stress, feelings of helplessness, and experiences of abuse.

Many of the suffragettes who fought for equality were considered mentally ill by their peers. Some were subjected to psychiatric torment in an attempt to curb their “antisocial behaviors.” For their hunger strikes, they were force-fed, and some were subjected to attempts to declare them mentally ill so they could be institutionalized. All for demanding the right to vote. These were the crazy bitches of the early 20th century.

These attitudes about women can be seen played out in the depiction of mental illness in pop culture. A woman who is intent and single minded, who screams and yells, is often meant to be viewed as “crazy” by viewers, even as a male character with the same traits may well be a hero. Women who resist abuse are likewise framed as mentally ill, which reinforces larger social attitudes about mental illness and women, that women who speak up and do not tolerate oppression are simply insane, and thus can be dismissed and ignored.

Inequalities in mental illness are not just about gendering. They are also heavily racialized. In the United States, some of the most blatant examples of the racialization of mental illness come from within the black community. Historically, diagnoses like “drapetomania” (“this troublesome practice that many [slaves] have of running away”) and hebetude (“laziness”) were used to pathologize the behavior of people held in slavery. Clearly no person would have a reason to flee slavery, or to experience depression while being held in slavery, so it must have been the result of disease.

With the end of slavery came new diagnostic weapons to use against black men and women; for example, schizophrenia diagnoses are much higher among the black community, particularly among men. This is not, researchers believe, because members of this community are at any particular increased risk of schizophrenia. It is because this condition has been used literally as a weapon against people who resist racism, just as drapetomania was used to dismiss the very real and understandable need to flee slavery.

When we see depictions of mental illness in people of color and nonwhite people, they are often dangerous and frightening. Work made by white creators for white viewers tends to underscore how dark and scary it all is, and this carries out into the way white people view resistance to racism, and the very real anger within communities that are not white. The use of mental illness as a weapon has been a direct contributor to the rise of the tone argument used against people of color and nonwhite people; you can be angry, as long as you are nice about it.

Furthermore, research shows that just as women are at higher risk of mental health conditions because of the oppression they experience, people of color and nonwhite people are also at increased risk of mental illness. Exposure to systemic, unrelenting racism can cause severe mental distress; we are living in a society that literally makes people sick with oppression.

It is very rare to see a mentally ill white man in pop culture, and even then, it often appears in the guise of mental illness as superpower, or in the form of a likeable character with mental illness, like Dexter, the humanized serial killer. Others may be creepy and scary, but it’s treated as specific to their characters, not intrinsic to all people like them. This contrasts markedly with the depiction of mental illness in other groups, whom we are supposed to find frightening, alienating, and scary both because of their illness and because of who they are. The next time you engage with a piece of pop culture that depicts mental illness, take note of who is depicted, and how it is framed. How are you supposed to feel about that character? How does the character’s behavior reinforce, or resist, stereotypes about mental illness?

Here’s Russell Crowe living the mental-illness-as-superpower dream in A Beautiful Mind.

Related Reading: Transcontinental Disability Choir: 9021-Oh No!

Previously: We’re All Mad Here: Intake Interview, We’re All Mad Here: Fighting Stigma Through Humor