A Longitudinal Examination of How People with Psychosis Are Framed in Primetime Fictional Television Programing

Background/Purpose: People with psychosis experience elevated levels of stigma which, in turn, can impede access to services (Tabar et al., 2025). How characters are framed in popular media can either accentuate, or mitigate, stigma (Bandura, 2009). Despite the importance of media characterizations, few, if any, studies have examined representations of psychosis in primetime fictional television programing, perhaps the most influential media format (Crothers, 2021). To address this gap, this study sought to answer two questions: 1) how are characters with psychosis framed in influential American primetime television programing?, and 2) are characterizations changing over time?

Methods: To answer these 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 subsequently coded by two individuals. Inter-rater reliability was assessed using Cohen’s kappa for categorical variables and intra-class correlations (ICCs) for continuous variables. Coefficients ranged from “fair” (0.57) to “excellent” (1.00) across all ten character traits coded (Cicchetti, 1994). Descriptive statistics were used to answer 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: Of the 120 characters with psychosis, most were depicted as major characters (66.7%). Alternatively, a minority were framed as villains (39.2%), currently engaging in crime (37.5%), victims (32.5%), protagonists/heroes (19.2%), an object of comedic relief (9.2%), having a history of past incarceration (9.2%), and being labelled as “psychopaths” or “sociopaths” (6.7%). The mean values for attractiveness and effect on society were, respectively, 3.44 (SD=2.01) and 2.33 (SD=2.03), indicating the average character with psychosis was depicted as being slightly more attractive, but exhibited a somewhat more negative effect on society, relative to the population mean (3.00) for all other characters.

Regarding the second research question, trend tests revealed characters with psychosis were progressively less likely to be depicted as formerly incarcerated, engaging in criminal activity, and as villains over time, and increasingly more likely to be portrayed as victims, protagonists, attractive, and having a positive effect on society.

Conclusions and Implications: As the first study to examine psychosis framing in primetime fictional television programing, the findings have important implications. For example, the fact that people with psychosis were twice as likely to be framed villains, as opposed to heroes, may accentuate the stigma and discrimination people with this condition commonly experience (Tabar et al., 2025). Practitioners should be sensitive to the effects such depictions can have on people with psychosis, including their family members, in clinical settings. Conversely, the fact that characterizations are generally becoming more positive over time is a beneficial finding that should be encouraged as it may help reduce the stigmatization associated with psychosis. In turn, this may encourage people to seek assistance. Further research is needed to explore the relationship between psychosis portrayals and help-seeking. In the meantime, the findings help inform practice with people with this condition by highlighting specific beliefs that may hinder and facilitate service utilization.