April 1, 2005  Soraya Roberts

Lost in Translation

Reporters have written thousands of words about people with mental illness. Too few of them get inside their heads

I step into the MacDonalds’s eerie living room, where frilly pink tchotchkes and glowing Christmas lights dress every inch of the wall. I’m attempting to find out, firsthand, the challenges of reporting on mental illness. Seven years ago, Donovan Vincent interviewed the family’s oldest son, Todd MacDonald, for his Toronto Star “Madness” series. At that time, Todd, a certified mechanic who suffers from delusions and paranoia (hallmarks of severe schizophrenia), had told Vincent that a pacemaker had been implanted in his chest and a receiver lodged in his mouth.

As MacDonald gives me his history, my heart beats so fast I wonder if it might take flight. He sits across the room – 40 years old, but with the creamy complexion of a much younger man – calmly explaining his fictional career with the police. His parents and I, like a coalition of sanity, nervously wait for him to finish.

“I’m sorry about this,” his father interrupts, wearily rubbing his deeply creased face. “He must have stopped taking his medication. You made such a long trip for nothing.”

* * *In 1997, Star reporters Vincent and Theresa Boyle proposed a seven-part feature on the shortcomings of Canada’s mental health system. This was after Boyle covered an inquest into the death of James MacIntyre – the 25-year-old drifter with paranoid schizophrenia, who died while living at the Seaton House homeless shelter. He and thousands of others were forced out of mental institutions – dubbed warehouses – after the Ontario government cut health spending in the 1970s. Between 1969 and 1989, the number of psychiatric beds in the province dropped from 11,000 to 4,000, and a slew of mental hospitals closed. Boyle and Vincent hoped their series would draw attention to the lack of community support and housing for mentally ill people. “As institutions were closing or shutting down beds, community supports were meant to be built up to pick up the slack,” Boyle says. “That didn’t happen.”

Yet, in exposing the flaws of Ontario’s mental health system, Vincent and Boyle also revealed the challenges involved in mental health reporting. Despite the fact that one in five Canadians experience mental illness in his or her lifetime, and that mental illness cost Canadians 1.5 million days in general hospitals in 1999, Boyle and Vincent’s “Madness” series still inadvertently portrayed the mentally ill as “other” and the illness as “otherworldly.” Why? Journalists often start with a loose definition of mental illness and a vague understanding of the science behind mental disorders, which increases the already steep challenges of interviewing mentally ill subjects. The result is too often the same: readers are ill-served by the current state of reporting.

In 2001, the Canadian Mental Health Association reviewed the representation of mental illness in the media and found disturbing trends. Only seven per cent of news stories on the subject included the viewpoints of mental health consumers. While Vincent took up the challenge of interviewing MacDonald, most journalists defer to medical professionals for a one-sided and jargon-based portrayal of mental illness. Such stories neglect the voices of the mentally ill and inadvertently portray them as incapable of speaking for themselves. The CMHA also reports that newspapers provide 58 per cent of the public’s knowledge about mental illness, yet readers rarely glean more than a vague understanding of mental disorders from the dailies. While doctors are particularly careful when defining mental illness (they rarely use this general term, instead defining specific disorders, such as schizophrenia), print reporters offer less specific meanings. Vincent, for example, defines mental illness as a “serious long-term chronic emotional, or psychological impairment that, without medication, can affect an individual’s ability to function in society.” Such significantly looser definitions can contribute to a general miscomprehension of mental illness.

* * *“There was a recent TB scare in the Toronto hostels,” Chris Gibson, the Seaton House program director tells me, his eyes creasing into a smile. “Don’t worry, it’s not really contagious.” I nod warmly, trying to hold my breath as inconspicuously as possible. We reach the bottom level of the building. A resident halts our progress. The old man seems to be speaking gibberish, then I hear him mention that he thinks I’m pretty. My feet pull me away as though they know better. I turn to smile at him, feeling guilty but thankful that I avoided his touch, his withered hands potentially harbouring open sores or disease.

* * *In the summer of 1997, Vincent and Boyle visited Seaton House, the last stop on one of their first days of field research. “Satan house” – as residents called it before its renovation – is a men’s hostel located on a questionable side street in central Toronto. It has faded turquoise parquet floors and that faint cafeteria smell that nauseously haunts large institutions. Here, the two journalists figured they would find compelling stories to humanize their “Madness” series. Seaton staff pointed out potential interview subjects and briefed Vincent and Boyle on their medical pasts. Though a shelter for the homeless – not a mental institution – about 15 to 20 per cent of the residents here are “severely mentally ill.” One of them became Vincent’s first interview.

The boy was about 19, good looking, with dark hair and vacant eyes. He said he was from out of town – St. Thomas or London, Ontario – and was slightly shorter than Vincent, who stands a solid six-foot-one. Staff were nearby, yet Vincent felt uncomfortable and slightly fearful, his mind flooding with decades of Hollywood imagery about psychosis. “Do I even want to do this series?” he asked himself. “No matter how progressive you try to be, that fear sort of nags at you a little at first,” Vincent tells me years later, between sips of tea at a sports bar across from the Star building. “I wasn’t thinking, ‘Oh God, this guy’s going to jump me with a knife.’ But there was that subconscious level of emotion that ensures those things are conjuring and spinning around.”

For decades, medical professionals have debated the connection reporters assume exists between mental illness and violence. But results remain inconclusive. Dr. Julio Arboleda-Flórez, the head of the psychiatric department at Queen’s University and a specialist in forensics, says that removing all mental patients from a population will only result in marginal savings in violent behaviour. He says alcohol abuse among the mentally ill is what determines violence, the same way drunken people act out in the general population.

But Dr. John Bradford, a forensic psychiatrist at the Royal Ottawa Hospital, and former colleague of Arboleda-Flórez, disagrees. “There is a connection,” he says firmly. “To pretend there isn’t, now that’s crazy.” He says minimizing the connection between violence and mental illness can cause policy makers to underfund mental health research. “It’s important to acknowledge [the connection] because violence can be controlled and reduced,” Bradford explains. “If the connection is not acknowledged, research is underfunded.”

Still, Bradford does agree that the media overemphasize violence in the mentally ill. As an example, he says that while subway pushing is tremendously rare, 90 per cent of the incidents are committed by schizophrenics. Yet newspapers often leave out that context, resulting in the misconception that all schizophrenics in subways are lethal. The CMHA review supports his view. It reports that nearly two-thirds of news stories involving psychiatric disorders could be classified as crime news. But crime only comprises 10 per cent of daily news coverage – rather than crime dominating the media, mental illness dominates crime news. Mental health activist Pat Capponi puts it bluntly: “These days, the media are slightly more sympathetic [toward mental illness], but they lose that at the drop of a body.”

* * *Nick Pron hunches over his coffee cup. All six-foot-seven of him seems to have shrunk to the size of a child. The Star crime reporter looks sheepish, as he explains why the police shooting of Edmond Yu, while initially exciting, was not his most riveting assignment. “Whether or not the cops were right [in shooting Yu], he’s a homeless guy,” he says, almost apologetically. “Your interest flags.”

* * *Prior to becoming a reporter with The Windsor Star, Veronique Mandal was a nurse and midwife at a psychiatric hospital. Her background afforded her a smooth transition to writing about science, but she – like her peers at the Toronto Star – had difficulty pitching some stories. For five years, Mandal pushed a series on schizophrenia to various editors, and for five years, they dissuaded her from pursuing it. But, in 2002, two events changed the mind of her editor at the time, Marty Beneteau: a local doctor, Percy Demers, was shot by his mentally ill son, and A Beautiful Mind – the biopic about mathematician John Nash and his struggle with schizophrenia – dominated the box office. That day, Beneteau took a stroll to Mandal’s desk and said, “That work on schizophrenia? Now might be a good time to look into it.”

The fortuitous timing of events “gelled and created an opportunity to do the piece,” says Mandal. It didn’t hurt that the handsomely brooding image of Russell Crowe as a mathematical genius with schizophrenia suddenly rendered mental illness attractive and trendy.

“In the early ’90s, schizophrenia was not a sexy topic,” Mandal says. The Star‘s Vincent concurs that celebrity cachet makes mental illness more palatable. “With geniuses like Glenn Gould or John Nash, mental illness becomes a quirk of their character rather than a flaw.”

But where does this leave the mentally ill who are not prodigious musicians or mathematicians? If sufferers are middle class, they fare better; the CMHA review reports that news stories are more likely to focus on their social standing, rather than detailing the symptoms they suffer (only 14 per cent of these stories do). But, if subjects are lower class, 89 per cent of the stories focus on their symptoms.

Consider the disparate coverage of Yu’s shooting versus the murder-suicide by Dr. Suzanne Killinger-Johnson: Police shot Yu on a Toronto streetcar in 1997. Two days after the shooting, Star crime reporter Jim Wilkes revealed that Yu was homeless and suffered from schizophrenia and presented him as “a paranoid schizophrenic whose violent behaviour got him barred from a downtown homeless shelter.” His story included anecdotes by shelter staff describing Yu as “engaging in repeated chanting and obsessive behaviour” and that he was “obsessed with collecting things.” The theme running through Wilkes’s article suggests there is a discrepancy between mental illness and affability or intelligence. A Scott Mission counsellor was quoted as saying, “even in the madness, there was a very likable person,” and that Yu displayed “an impressive intellect.”

Conversely, the theme of the articles following the murder-suicide perpetrated by Killinger-Johnson in August 2000 focused entirely on creating a contrast between the doctor’s wealth and her mental illness. The beautiful “psychotherapist” and “mother” from “Forest Hill” suffered from postpartum depression, which reportedly led her to jump in front of a subway car with her baby. The headline over Michael Valpy and Krista Foss’s Globe and Mail story, “When Looks Deceive,” perpetuated the societal misconception that mental illness rarely affects the affluent.

Star reporters Michelle Shephard and Hamida Ghafour also wrote of the late psychotherapist: “She was a woman who seemed to have the picture perfect life.” In the stories about Killinger-Johnson, her upper-class status became her defining characteristic, in contrast to the mental illness and homelessness that defined Yu. The Killinger-Johnson stories primarily mention general symptoms of depression, rather than particular symptoms (one said that on the day she died, she was “acting strangely”).

“In the case of Suzy Killinger, there was an enormous appetite for any information because she was a young rich doctor, and good looking,” says Valpy. “It’s far more difficult to perform public education if the person is some homeless guy on the street.”

* * *After telling the psychologist at Toronto’s Centre for Addiction and Mental Health that I was interviewing him for an article on the topic of mental illness and the media, the other end of the phone went silent for the first time in our conversation. “Isn’t that a bit heavy for a journalism school assignment?” he asked.

* * *In the summer of 1997, Vincent and Boyle interviewed CMHA director Steve Lurie in a pristine boardroom at his Eglinton Street office in Toronto. The reporters arrived, having read all the literature they could find on Canada’s mental health system. They had talked to shelter staff, outreach workers, mental health activists, Ontario’s chief coroner, and a number of physicians at the Centre for Addiction and Mental Health. But the pair was unprepared for the mountain of information Lurie would unleash on them. The director gave them a Cook’s tour of the mental health system: information about drugs, Ontario’s mental health policy, the Diagnostic Statistical Manual-IV (a book of symptoms that psychiatrists use to diagnose mental illnesses), and epidemiology (the study of the causes and repercussions of disease). The two reporters filled four cassette tapes over three exhaustive hours of interviewing. When Lurie interrupted his diatribe to leave the room for a moment, Boyle and Vincent looked at one another with wide-eyed horror. “It was like standing under a dump truck and somebody had dropped all this mental health stuff on us,” says Vincent. The reporters, who had set out to personalize mental illness, suddenly felt lost in a mire of medical information.

Because of the complex science underpinning many medical stories, health reporters typically simplify the topic. The problem is twofold: Boyle says journalists get a small amount of space for their stories and, because of this, technical information doesn’t always make the cut.

The CMHA’s Lurie adds that contextualizing data doesn’t always make the cut either: “Only one-twentieth of those with mental illness will be chronic sufferers. But rather than breaking it down [quantitatively], papers go for the grand story.” For example, in the “Madness” series, Boyle and Vincent mention that one in five Ontarians will experience a mental illness in their lifetime without qualifying this (until later in the series when the damage has already been done) by adding that only two per cent of the population are chronic sufferers. Lurie says that advocacy groups who want to convey urgency and “move the body politic” to fund mental health research encourage reporters to focus on the negative aspects of mental illness rather than reporting on the whole story.

It may also be difficult for neophyte science journalists to avoid being manipulated by sources as newspapers do little to prepare them for the beat. Boyle, who worked the health beat for several years, says the Star dives into major mental health stories every few years. Yet the topic is approached anew each time, without a continuously growing knowledge base. “The tragedy is that despite their experience, Donovan and Theresa aren’t mental health resource people for the Star,” says Lurie. He thinks editors should develop editorial advisory groups comprised of journalists who have done mental health reporting, so that they can help those new to the beat. “So you start fact checking and you start perception checking,” Lurie says. “Otherwise, what a waste. They spent months researching that series and it may have changed their attitudes, but that knowledge is now archival.”

Ontario’s new privacy laws do not make gathering information any easier for reporters. The latest legislation, which traces its roots back to former Supreme Court Justice Horace Krever’s 1980 Royal Commission Report on the Confidentiality of Health Information, prevents journalists from obtaining medical information without the patient’s permission. And although people have a right to their privacy, confidentiality does make researching more difficult for journalists. The Windsor Star‘s Mandal says that it sometimes took her anywhere from two to over a dozen sources to get the documentation she needed for her “Schizophrenia” series. For less tenacious journalists, stories on mental health can be riddled with gaps.

* * *Before she answers my question, the coordinator of advocacy, education, and family support for the Calgary Chapter of the Schizophrenia Society of Alberta (ssa) clarifies my terminology. “Well, see, we don’t refer to them as ‘the mentally ill.'” Fay Herrick talks sweetly, but in a no-nonsense tone. “I actually consider that slightly offensive.” I pause for a moment, my head in a muddle, and my words scrambled in my throat. Even though there are three provinces between us and miles of phone lines separating our voices, my cheeks flush with embarrassment.

 * * *

Mid-February 2002, Herrick remembers opening her newspaper to an unsettling headline: “Slobodan Milosevic, is he a psychopath, schizoid, or just plain evil?” She noted the byline and phoned the offending paper’s office. The journalist, she says, met her for coffee and, during their long conversation, Herrick – sounding more like a kindly grandmother than an angry activist – gently chastised him for his insen- sitive comparison. who had been diagnosed with mental illnesses to assert that it was unfair to compare them to evildoers. The next time Herrick opened the paper to find the journalist’s byline, his words had been miraculously transformed from glib to empathetic.

Such tales are common from the Calgary chapter of the SSA, where a team of several dozen people – who either suffer from the disorder or have family members who do – use their personal experiences with mental illness to offer the public more inclusive portrayals of their disoders. In 10 years, the program has educated over 50,000 people in high schools, hospitals, and newsrooms.

In 1995, the World Psychiatric Association chose Calgary to pilot an anti-stigma campaign called Open the Doors, to be run by local psychiatrists and anti-stigma researchers, Dr. Heather Stuart and Arboleda-Flórez. The campaign involved surveying the Calgary Herald’s coverage of mental illness for a duration of 18 months. They provided journalists with in-depth information on mental illness (in the form of brochures and databases) and exposure to patients, then recorded how coverage changed.

“Our view was that media weren’t going to change unless they got feedback,” says Robert Bragg, former editorial writer at the Herald and an Open the Doors participant. “A way to do that is on a case-by-case basis over time, responding to the negative and positive.”

Results showed news stories – accurate descriptions of diagnoses, profiles of people with mental illnesses, and human-interest pieces – increased in number, and the quality of reporting also improved. Then a series of highly charged cases – a shooting on Parliament Hill in Ottawa, subway-pushing cases in Toronto and New York, and the prime minister being attacked by a man with schizophrenia – hit the headlines, and the Herald’s coverage regressed to its previously stigmatizing form.

The author of Media Madness: Public Images of Mental Illness, Dr. Otto Wahl, tracks media portrayals of the mentally ill, and says that reporters tend to lean more toward presentations of violence and omit positive news.

“The most that you get in stories is some notion that people have gotten better, that symptoms have diminished, or they are out of hospital,” Wahl says. “You rarely get the accomplishments – awards they have may won or jobs they have landed.”

He believes that citing these accomplishments is key to helping readers connect with the mentally ill. The Star’s Vincent agrees: “After all,” he says, “a lot of us are just one breakdown away from being where these people are.”