By: Chidinma Okoro, Tiat Mehreen Sazin and Rutvi Patel

Mental health is not an individual concern but a societal concern influenced by cultural views and media representations. Our study examined five (5) television shows from Netflix and HBO, such as 13 Reasons Why, Orange Is the new black, Ginny and Georgia, Euphoria, and Degrassi, depicting mental health topics from Depression, Anxiety, and PTSD. It also framed the causes of mental health illness from Bullying, Rape and teenage depression. We aim to shed light on mental health portrayals in teen shows, knowing that these portrayals may impact their seeking help and shape societal attitudes toward mental health topics.

In Canada, young people also have high rates of suicide. Suicide is the leading cause of death among people aged 10-24, and in 2009, it accounted for nearly one-quarter (23%) of all deaths for Canadian youth aged 15 to 19. Unfortunately, the negative portrayal of mental health topics in television shows acts as a deterrent for young people to seek help and, in worse cases, leads them to engage in the act of suicide as one article points out that “51% of viewers believed viewing the show increased their risk of suicide”(Hong et al., 2018, p. 6). This shows how influential media shapes the youth’s perception of mental health and perpetuates stigmas and stereotypes about mental health.

The study’s findings offer valuable insights that can spark innovative approaches to improving mental health views and assistance. Understanding how societal stigmas are conveyed through TV series, according to stigma communications theory, can help combat public stigma and encourage acceptance (Smith & Bishop, 2019)—for example, studying the portrayal of mental health in “13 Reasons Why” underlines the importance of addressing the usage of insensitive language and its possible impact on adolescent audiences (Grant et al., 2020). Cultivation theory emphasizes the significance of long-term exposure to media depictions of mental illness, implying the necessity to investigate how different shows impact viewers’ views and behaviours (Study Academy). Similarly, media dependency theory emphasizes television’s impact on people’s mental health knowledge, implying the significance of encouraging appropriate portrayals to offset detrimental consequences (Yin Lin, 2015, December 17).

Nonprofits and mental health activists can work with media outlets to develop rules for responsible reporting that coincide with initiatives to combat stigma communication (Smith & Bishop, 2019). Community workshops and events can increase mental health literacy by encouraging critical analysis of media portrayals and offering opportunities for people to share their personal stories (Grant et al., 2020). Advocacy activities might concentrate on legislative changes to address systemic elements contributing to mental health problems, such as access to services and social support networks, thereby using theoretical findings to enhance mental health perceptions and support.

Research Report

By: Chidinma Okoro, Tiat Mehreen Sazin and Rutvi Patel

Mental health is significant, and individuals facing mental illnesses often encounter stigma, which can complicate their challenges. Media plays a vital role in shaping and portraying challenging conversations, especially regarding mental health. Our study examines how media can create negative portrayals of mental health and the impact it has on Youth perception from five (5) TV shows from 2013-2023, focusing on mental health topics, framing, language and the use of stigma. This study holds theoretical importance regarding stigma communications, cultivation, framing, and media dependency theories. Additionally, the study helps to raise public awareness about mental health and the impact that negative depictions of television shows can have on youths and pose a challenge in seeking help.

Literature Review

In Canada, “suicide is the leading cause of death among people aged 10-24, and in 2009 accounted for nearly one-quarter (23%) of all deaths for Canadian youth aged 15 to 19. A study examining Canadian youth suicide rates between 1980 and 2008 found a significant increase in the suicide rates for females aged 10 to 19”(Victoria et al., 2018, p.1). It is important to note that Mental health in Youths is very concerning, significantly when the media they watch can shape their ideas/perception of mental health. In an article by Hong, youths were asked about their vulnerability and the impact of 13 reasons why and “12% of students who watched the show expressed that it made them less likely to talk to anyone about their mental health”(Hong, 2018, p.). A clear example of this is how language is used in the show, such as when Sky (Hannah’s friend) says, “Suicide is for cowards. This is why you do not commit suicide” in season one episode 5 and in season one episode 3 where Jessica says “you cannot believe/trust a dead girl” and calls her crazy. All these examples sum up how language and the depiction of mental health in a TV show can impact young people being open about their struggles.

This relates to the TV show Euphoria, where young people described it as being challenging to watch because some scenes triggered personal experiences and feelings, with an individual saying, “…I have dealt with PTSD and depression for years…Yes, some episodes regarding the drugs and everything else are harder to watch than others.”(Kaufman et al., 2021, p.4). This reveals that youths/young people are not put off by TV shows talking about social issues such as mental health, which are a lot of people’s life experiences to generate conversation around the issue. Also, the main character ‘Rue, will most likely encourage adolescents who can relate to this character to take similar steps in using drugs to deal with mental health crisis(Pirkis et al., 2006, P.3).

However, the challenge is how it is portrayed and the ways that portraying mental health in the following shows can hurt its intended audience and further contribute to the stigma and image of mental health that persist in our society. Parallels can be established between media portrayal and its impact on youth mental health, such as the character Terri’s experience on the television series “Degrassi.” Terri vulnerably reveals in one touching episode, “No one wants to dance with a fat cow,” expressing her constant fear. This representation portrays Terri’s issues and shines a light on the societal influences that dictate looks and their relationship to self-worth. Terri’s story highlights the ubiquitous consequences of low self-esteem and how people, particularly adolescents, struggle with body image standards. Terri’s narrative in “Degrassi” is a microcosm of the more significant concerns—highlighting the delicate relationship between media portrayal, societal expectations, and juvenile mental health.

Also, in Ginny and Georgia, Ginny’s mental health leads her to self-harm; it is equally horrifying and painful as it is to commit suicide. Ginny harms herself in Season 1, Episode 2, after a rough and overwhelming day as a way to deal with her anxiety, depression, and lack of instability in life. Amidst all this, Ginny seemed to be fine and happy in front of her family and friends. From our analysis, this can have an impact on how young people are able to express themselves and their vulnerability when it comes to seeking help as signs of mental health are never evident, and young people tend to deal with mental health alone which can have an impact on younger viewers and how they choose to navigate their struggles alone or either with a parent.

The intersection of Media dependency theory, Cultivation theory, and Stigma communication theory provides a comprehensive framework for how media can shape our perceptions of mental health and influence how youth perceive mental health, eventually leading them to seek help. The type of language and stigma these shows depict to which youth/young people can internalize. Media dependency theory states, “the more dependent an individual is on the media for fulfilling his or her needs, the more important media will be to that person”(Lin, Britannica). Cultivation theory focuses on long-term television viewing from an individual perspective of the world around them”(Study Academy). Stigma communication considers many reactions to managing stigmatization, from avoidance to advocacy and proposing ways to accept or challenge a public stigma”(Smith and Bishop,2019, Pg. 1). These theories reference how media can impact the perception of shows and its profound influence on its audience.

Methods

For this study, five(5) series were chosen, four(4) from Netflix and one (1) from HBO MAX, namely 13 Reasons Why, Ginny and Georgia, Orange is the New Black, Degrassi: Next Generation and Euphoria, all between the year of 2013-2023. The total number of episodes viewed/watched equals 25, and they are all from season one. The demographic for this study is focused on youths/young people to see how negative portrayals of mental health impact youths and their perceptions of it. The study underwent coding of demographic details (Show ID, Publication Date, Type and Specific shows), mental health topics (depression, anxiety, stress, PTSD, and general illnesses), Framing (teenage depression, bullying, socialization factors, and racism), Tone/Emotion (Sadness, Anger, Uncomfortable, and Pain), and Stigma cues (Language and Responsibility). As part of this study, coders (group members) watched five(5) episodes of all the shows in their first seasons to code for the following categories previously mentioned.

Results

Regarding variables, we found (2) instances of anxiety from Euphoria and Degrassi. When coding for depression, (1) instance from 13 Reasons Why, stress (1) from Orange is the new Black, PTSD/general illnesses (2) from 13 Reasons Why and Euphoria and Past trauma (1) from Ginny and Georgia. Regarding cause framing, we found a socialization factor (1) instance from Degrassi. We found bullying (1) from 13 Reasons Why. We found teenage depression (1) from 13 Reasons Why as well. Moreover, we found racism (1) from Ginny and Georgia. Regarding the tone and emotions, we get sadness (1) in 13 Reasons Why. We got anger (1) in Orange in the New Black. We got uncomfortable (1) in Degrassi. We got pain (1) in 13 Reasons Why and Dramatic (1) in Ginny and Georgia. Moreover, regarding stigma cues, we found Language (1) and Responsibility (1) in 13 Reasons Why.

Discussion

Our analysis focuses on a variety of mental health issues depicted in television shows, including depression in “13 Reasons Why,” anxiety in “Degrassi” and “Euphoria,” stress in “Orange is the New Black,” PTSD in “13 Reasons Why,” and prior trauma in “Ginny and Georgia.” These portrayals highlight the intricacy and frequency of such concerns in media narratives. Various series approach societal difficulties differently, with subjects such as socialization, bullying, adolescent depression, and race being tackled. Emotional depictions differ, with series like “13 Reasons Why” evoking loss, “Orange is the New Black” provoking rage, and “Degrassi” depicting anxiety. These depictions provide depth and relevance to storylines about mental health, captivating viewers. However, our study reveals stigma cues, particularly in “13 Reasons Why,” emphasizing the necessity of responsible storytelling in overcoming stigma. Overall, while television can shine a light on mental health concerns, misrepresentation, sensationalism, and stereotype reinforcement can hurt young people by producing confusion, normalizing hazardous behaviours, and perpetuating stigma.

Limitations

The study’s limitations are as follows. The study examines the five shows to answer how TV shows negatively portray mental health and the impact on youth perceptions. The limitation of this study is that we only watched one season for the first five episodes due to the limited time that we had to complete the assignment, which made it difficult to code depression, anxiety, PTSD, Tone/emotion and stigmas. If we had more time to complete the assignment, the report’s content would be filled with more information than it has. Another limitation of the study is that coding for emotion/tone can be very subjective, which could impact the study if done by another person due to differences in depicting certain emotions/tones, such as sadness instead of anger. Another limitation would be that we had a limited amount of resources. If there were more, we could go more in-depth in the analysis to understand how the media influences young people’s mental health and that some of the shows are new, hence the scarcity of peer-reviewed articles. Lastly, the research can be inaccessible due to how expensive it will be to replicate when it comes to paying for subscriptions to Netflix and HBO to watch the show, analyze it and code it.

Implications, Recommendations, and Conclusion

We recommend that people have a larger sample size than we had, which would facilitate coding and make more information available in the lit review section and in coding for stigma cues, which the research needed to have. We also recommend that people watch the selected show to have a full scope of it and how they can be used in the coding process because if the shows are not watched or have prior knowledge about the shows, it can be challenging to navigate the literature review and code based on specific categories such as the mental illness and the frames. An implication of the assignment is how the coding result can differ for people, as watching and coding are from an individual’s perspective. This makes the results and every part of the report subjective, as coding for Tone and stigma can be subjective and concluded based on the individual’s perspective and experience with this topic. Another implication is how expensive it can be for anyone wanting to do this research, as subscriptions to Netflix and HBO are expensive, making people hesitant to view our research.

In conclusion, our findings suggest that negative portrayals of mental health in television shows harm teenage perception. We discovered common themes of depression, anxiety, PTSD, and stress when analyzing five episodes from 2013 to 2023, which were frequently framed within tales of bullying and adolescent problems. These depictions contribute to the cultural stigma associated with mental health, reducing young people’s willingness to seek treatment. While our findings are intriguing, constraints such as the time frame of analysis, subjectivity in emotion classification, and restricted resources highlight the need for additional research. Moving forward, collaboration between media outlets, mental health activists, and politicians is critical for developing responsible media rules and improving mental health literacy, as well as creating a supportive environment for youngsters to discuss their mental health difficulties openly.

 

References

Ben-David, S., Campos, M., Nahal, P., Kuber, S., Jordan, G., & DeLuca, J. (2024). Applying the Visual-Verbal Video Analysis Framework to Understand How Mental Illness is Represented in the TV Show Euphoria. International Journal of Qualitative Methods, 23. https://doi.org/10.1177/16094069231223653.

Carmichael, V., & Whitley, R. (2018). Suicide portrayal in the Canadian media: Examining newspaper coverage of the popular Netflix series “13 Reasons Why.” BMC Public Health, 18(1), 1086–1086. https://doi.org/10.1186/s12889-018-5987-3.

Grant MJ, El-Agha H, Ho TT, Johnson SD. Commentary: Thirteen Reasons Why: The Impact of Suicide Portrayal on Adolescents’ Mental Health. J Ment Health Clin Psychol. J Ment Health Clin Psychol (2020) 4(2): 45–48..

Lin, Y. (2015, December 17). media dependency theory. Encyclopedia Britannica. https://www.britannica.com/topic/media-dependency-theory

Pirkis, J., Blood, R. W., Francis, C., & McCallum, K. (2006b). On-screen portrayals of Mental illness: extent, nature, and impacts. Journal of Health Communication, 11(5), 523–541. https://doi.org/10.1080/10810730600755889.

Niederkrotenthaler, T., Stack, S., Till, B., Sinyor, M., Pirkis, J., Garcia, D., Rockett, I. R. H., & Tran, U. S. (2019). Association of Increased Youth Suicides in the United States With the Release of 13 Reasons Why. JAMA Psychiatry (Chicago, Ill.), 76(9), 933–940. https://doi.org/10.1001/jamapsychiatry.2019.0922.

McFarlane, H. (2023, January 10). Does Ginny & Georgia Have A Race Problem? ScreenRant.https://screenrant.com/ginny-georgia-season-2-race-story/#:~:text=Ginny%20%26%20Georgia%20tells%20the%20story,their%20individual%20experiences%20in%20Wellsbury.

Smith RA, Bishop RE. Insights into stigma management communication theory: Considering stigmatization as an interpersonal influence. J Appl Commun Res. 2019;47(5):571-590. doi: 10.1080/00909882.2019.1675894.

Appendix 1

Definitions

Depression: This is a mental health disorder caused by persistent feelings of sadness, hopelessness and the idea of feeling alone.

Anxiety: A mental health illness characterized by excessive anxiety, fear, or nervousness that impairs daily functioning. Anxiety disorders can take many forms, including generalized anxiety disorder (GAD), panic disorder, phobias, and obsessive-compulsive disorder (OCD).

Stress: is a physical and psychological reaction to perceived threats or difficulties. While it is a natural part of life, prolonged or excessive stress can cause physical health issues and worsen mental health difficulties.

PTSD: This is a mental health disorder that individuals develop when they have experienced traumatic events that cause flashbacks or emotional triggers.

Stigma Communication Theory: considers many reactions to managing stigmatization, from avoidance to advocacy and proposing ways to accept or challenge a public stigma (Smith and Bishop, 2019, Pg. 1).

Cultivation Theory: focuses on long-term television viewing from an individual perspective of the world around them” (Study Academy).

Media dependency theory: “the more dependent an individual is on the media for having his or her needs fulfilled, the more important media will be to that person”(Yin Lin, 2015, December 17)

 

Appendix 2

Code Definitions and Categories
		Description
1. Demographic Details	A. Show ID	Unique identifier for each show.
	B. Publication Date	2013-2023
	C. Type	0 = Netflix 1=HBO
	D. Specific shows	1 = 13 reasons why 2 = Euphoria 3 = Orange is the new Black 4 = Ginny and Georgia and 5= Degrassi: Next Generation
Variable	Category	Description
2. Representation of Mental Health Topics	0 = No and 1 = Yes for each option
	A. Depression	This is a mental health disorder caused by persistent feelings of sadness, hopelessness and the idea of feeling alone. An example of this in 13 Reasons Why is the second episode. Hannah (lead) is left with no friends as she is constantly being bullied, which leads to her keeping to herself and falling into depression, so she leaves her job in the second episode.
	B. Anxiety	A mental health illness characterized by excessive anxiety, fear, or nervousness that impairs daily functioning. Anxiety disorders can take many forms, including generalized anxiety disorder (GAD), panic disorder, phobias, and obsessive-compulsive disorder (OCD). An example of this can be seen in Degrassi as Terri, one of the characters, was fat-shamed, through which she developed anxiety. An example from Euphoria is where Rue (lead) is faced with retelling her story as she strives to start her life anew in episode 5.
	C. Stress	A physical and psychological reaction to perceived threats or difficulties. While stress is a natural part of life, prolonged or excessive stress can cause physical health issues andisrsen mental health difficulties. An example of this is in ‘Orange is the new black’ it was shown how the main character, Piper, was constantly under stress due to being in an environment where her life was constantly under threat.
	D. PTSD	This is a mental health disorder that individuals develop when they have experienced traumatic events that cause flashbacks or emotional triggers. An example from 13 Reasons Why is in the first episode where Clay Jensen experiences an intense flashback when listening to the tapes that Hannah creates before she dies, leaving him to think that he saw her and causing an injury to his head. The flashback recurred in every episode, leaving him in constant panic.
	E. General Mental Illness	The general illnesses include Bipolar Disorder, depression, anxiety and PTSD. An example of this is from Euphoria: In the first five episodes, there is the representation of Bipolar Disorder, depression and PTSD in Rue (main character) as they are shaped by drug abuse and the traumatic life that she had.
	F. Psychopathic Behavior	A lack of empathy, manipulative tendencies, and disrespect for societal norms or the well-being of others distinguish psychopathic behaviour. An example from Orange is the new black would be a character named Suzzane urinating on the floor because she did not get things her way around.
	G. Past Trauma	Receiving flashbacks from your past is a traumatic experience in itself. Especially when your past revolves around deeper mental health issues that affect your behaviour, moreover, can hint towards physiological issues and breakdowns. An example from Ginny and Georgia is when Georgia’s past was showcased in the form of a flashback, from her being a victim of domestic violence to her relationship with Zion. In addition, Ginny also suffers from past trauma as she struggles with her identity, which led to impacting her mental health.
3. Cause Framing		0 = No and 1 = Yes for each option
	A. Socialization Factors	Physical and genetic features of an individual’s biology contribute to the emergence or worsening of mental health problems. This could include genetic predispositions, neurochemical imbalances, hormonal changes, and structural abnormalities in the brain. An example of this can be seen in Degrassi as Terri was fat-shamed a lot, which later on impacted her mental health and self confidence.
	B. Bullying	This is the intentional hurt towards a person, especially spreading false information about them. Example: In 13 Reasons Why, the show was framed around the idea of bullying where she was teased and was left to feel alone, which unfortunately led to her ending her life.
	C. Teenage depression	This is the depression that affects younger people especially in their teenage years. Example: The show 13 reasons why is framed around signs of teenage depression especially in the first five episodes from anxiety, depression, and PTSD.
	D. Racism	Being different among your classmates and town you have moved to can potentially cause crisis. For example, Ginny from Ginny and Gerogia shifts to a new town at which she is that 1 among 8 black student at her school. And this creates challenges for her fitting in at her new school. Maxine introduced Ginny to some of her friends. However the other girls made Ginny feel as if she did not fit in through different ways fom which one was to bring up her skin tone colour.
4. Tone/ emotions		0 = No and 1 = Yes for each option
	A. Sad	The tone/emotion around the first five episodes is season one of 13 reasons why it is sad because of Hannah’s death and the feelings of all the characters as well.
	B. Anger	The tone/ emotion around the first five episodes in season one of orange is the new black focused a lot on the violent/ anger aspects of it as it was shown a lot of times how people were in prison hence, they were more violent and vulgar with their approach with the main character Piper.
	C. Uncomfortable	The tone/ emotion around the first five episodes in season one of Degrassi showed how the characters dealt with uncomfortable situation such as the characters Toby and Ashley becoming step siblings all of a sudden
	D. Pain	The tone/emotion of pain is evident throughout the five episodes, especially on the primary male actor clay, who has to listen to the tapes and having to recount the time he spent with Hannah by piecing why she would end her life.
	E: Dramatic	Within the first 5 episodes of Ginny and Georgia, the tone/emotion revolves around a blend of overwhelming drama, with a mix of humor, seriousness, betrayal and family dynamics. SpecifThismong Ginny, Georgia and Austwhen she fitshey are a family who is not always proud of the not so wise decisions/actions made or done by one another. For instance, Georgia not liking Ginny’s closeness with Marcus. And both the children not every happy with Georgia’s new love interest.
5. Stigma cues
	Language	“Suicide is for cowards. This is why you do not commit suicide. This affirms the general belief that cutting, a form of non-suicidal self-injury, is better than cowardly attempts at suicide.
	B.Responsibility	Blaming those suffering from mental illnesses for their condition. An example of this is when Hannah was blamed for her death by Kat, Alex and Skye. Alluding that Hannah’s suicide was her fault, which is a negative portrayal of mental health.