An Analysis of Psychosis Framing in Television Programing: Implications for African American and Hispanic Adolescents in Psychosis

Background/Purpose: Many effective treatments exist for early or first-episode psychosis, but adolescents often fail to utilize these services. In keeping with framing theory, television programing plays a key role in shaping societal perceptions about psychosis. The populations that are represented and underrepresented in media convey messages about the groups for whom psychosis is a relevant, and irrelevant, concern. Similarly, how characters are framed in popular television programing can either accentuate, or mitigate, stigma, which is important as stigma is a key impediment to seeking treatment.

Despite the importance of media characterizations, few, if any, studies have examined representations of psychosis in influential television programing. This is a significant oversight as nationally representative data suggests approximately 40 percent of individuals will have a psychotic experience before they reach the age of 30, with African Americans and Hispanics being disproportionately likely to report such experiences (DeVylder et al., 2023). To address this gap in the literature, this study sought to answer two questions: 1) how are characters with psychosis framed in popular television?, and 2) are characterizations changing over time?

Methods: To answer these two questions, the 50 most popular fictional television programs, as determined by Nielsen Company, were analyzed for each year from 2011 to 2021. One hundred and twenty characters with psychosis were identified and coded by two individuals. Twenty variables were coded in three domains related to: 1) demographics, 2) life status, and 3) character framing. Inter-rater reliability—assessed by intraclass correlation coefficients—ranged from “good” (0.76) to “excellent” (1.00). Descriptive statistics were used to address the first research question while the Cochran-Armitage and Jonckheere-Terpstra tests were used to detect significant changes in characterizations across the decade examined.

Results: Descriptive data reveled that African Americans and Hispanic youth were underrepresented while European American characters with psychosis were overrepresented. Regarding the second research question, trend tests revealed few significant changes in the demographic and life status domains, but a different picture emerged in the character framing domain. Over the decade examined, characters with psychosis were progressively less likely to be depicted as formerly incarcerated, engaging in criminal activity, and as villains, and increasingly more likely to be portrayed as victims, protagonists, attractive, and having a positive effect on society.

Conclusions and Implications: As perhaps the first study to examine psychosis framing in popular television programing, this study has important implications, perhaps especially for African American and Hispanic adolescents in psychosis. The underrepresentation of African American and Hispanic adolescents implicitly sends the message that psychosis is not an issue for African American and Hispanic adolescents and, consequently, may discourage help-seeking among youth from these populations.

Conversely, the fact that characterizations are generally becoming more positive over time may help reduce the stigmatization associated with psychosis. In turn, this may encourage adolescents to seek assistance. Further research is needed to explore the relationship between psychosis representations and help-seeking among adolescents. In the meantime, the findings help inform practice with adolescents by highlighting specific beliefs that may hinder and facilitate adolescent service utilization.