Portrayals of “mental illness” in media are a long-standing controversial topic. How to avoid romanticizing, how to avoid stigmatizing, how to avoid triggering audience members who may share similar experiences—these are all valid concerns. But perhaps more importantly—and at the center of them all—who’s holding the narrative? And whose narrative does it align with?
Recently, I finished reading a memoir that encompassed subject matter including emotional abuse and eating disorders (EDs), both of which I have personal experience with. Initially, I was concerned about how the material might trigger me, so I was sure to continually check in with myself as I was reading. But despite graphic detail about self-induced vomiting, caloric restriction, extreme overexercising, and memories of abuse alarmingly similar to my own, I ended up being surprised: These were not the parts that I found triggering. The parts that I did find triggering were about the author’s recovery from their ED.
Why was this? Well, I am a psychiatric survivor with trauma from ED treatment and sanism. That could explain why the treatment-related parts bothered me, but not why the ED and abuse-related parts didn’t; those traumas didn’t cause my other traumas to disappear. I’ve read book reviews stating that this memoir was triggering for those with EDs. I realized that it would’ve been for me a few years ago, too, though I can’t say the difference is simply because I’m recovering now. There must be something deeper.
The Narrative
We talk about “the mainstream narrative of mental illness” all the time here in the critical psychiatry realm, yet we hardly ever bother to define it. So…what is it? Well, any narrative must have a proper narrative arc, of course. It goes something like this:
Exposition: Establish protagonist (main character), the afflicted.
Rising Action: Establish conflict: Symptom onset. Illness develops.
Climax: Protagonist confronts their obstacle, seeking professional help and receiving a clinical diagnosis.
Falling Action: Protagonist diligently attends therapy and/or takes medication, and starts to get better.
Resolution: Full recovery! Victory!
Evidently, this narrative does not leave very much wiggle room. There is good reason why the “Success Story” is the most dominant narrative endorsed by the Mental Health Industrial Complex (MHIC), society in general, and “mental health awareness” advocates: It encourages people to seek professional services with the underlying message that a desirable outcome from mental health treatment is guaranteed. Because it is such effective marketing, the Success Story is the compelling story arc that most of us psychiatric survivors initially thought we were signing up for.
However, since its treatments are only “effective” part of the time, the MHIC must find a way to account for any alternate routes that a patient’s journey may take. Rather than simply ignoring these alternate possibilities altogether, it is crucial for the MHIC to maintain control of these narratives as well. They generally take on one of three forms—the “Treatment Resistant,” the “Non-Compliant,” and the “Cautionary Tale.”
The Exposition, Rising Action, and Climax of the Treatment Resistant arc are identical to the Success Story. It differs after the Climax, something like this:
Falling Action: Protagonist is diligently attending therapy and/or taking medication. They may improve somewhat at first, but symptoms always seem to reappear. They try different combinations of different treatments. Still no luck.
Resolution: Protagonist is informed that their mental illness is treatment resistant. Though they will need to depend on treatments for the rest of their life to manage their symptoms, they may never make a full recovery. With this knowledge, they come to a point of acceptance about their condition.
The Treatment Resistant narrative is less widely known than the Success Story, and is typically thought of as a rare exception, only introduced to patients after they have already been seeking treatment for some time without improvement. Although the ending is not as satisfying as the Success Story’s, we still get a sense of closure. The protagonist is still regarded as a “Good Patient.” They did everything they were supposed to do: seeking help, trying hard to find the right treatment, and accepting everything their doctor told them. Even though mental health treatments failed them, it was conveniently reframed as a failure of the patient instead—not of their character, but of their biology—and they did not question or challenge this notion.
But what about when things still don’t go according to plan? What about when a patient does question or challenge the MHIC instead of accepting everything they’re told? How does the MHIC not only encourage people to use services, but also discourage people from not using services? Well, this is where the “Bad Patient” tales come into play: the Non-Compliant and the Cautionary Tale. In the Non-Compliant story arc, the protagonist is presented as not willing to face their problems. Though they may be reluctant to seek help, they eventually do, whether by choice or by force. However, their unwillingness persists throughout treatment, and they may eventually quit their medications or therapy suddenly. Their rash choices result in their own demise, causing disastrous consequences: potentially even violence, homicide, or suicide. The Cautionary Tale, on the other hand, ends similarly, though the primary difference is that the Non-Compliant refuses services that are offered, whereas the Cautionary Tale never obtains services in the first place. This framing presents the Cautionary Tale as a literal “cautionary tale” of “untreated mental illness.”
Both of these Bad Patient narratives, alongside the Good Patient narratives, serve an important purpose for the MHIC. There may be some variation on these prototypes (for example, one could start out reluctant to seek help but become compliant later on), but for the most part, they all weave together seamlessly into “The Narrative.” Although these are the prevailing narratives in which the patient takes center stage as the protagonist, in other versions of the story, the patient may play a side character—or even villain—in someone else’s story; usually a family member, romantic partner, or even a mental health professional. Their feelings, perceptions, and judgments about the patient are centered above the patient’s own. In any case, none of these narratives can leave room for a positive outcome from denying diagnosis and refusing treatment, or never seeking treatment in the first place, nor a negative outcome from accepting a diagnosis and complying with treatment. Any dissenting voices must be either consumed or silenced altogether.
Narrative and Power
It is often said that life imitates art. The media we consume plays a crucial role in shaping our cultural and personal narratives. The mental health narratives above are often what we see represented in movies, books, TV shows, and other media portrayals of those deemed “mentally ill.” In fact, many pro-mental health advocates might see those narratives as responsible portrayals of “mental illness.” Getting help equals recovery. Resisting, refusing, or failing to access help equals imminent destruction. After all, we wouldn’t want to romanticize mental illness, or stigmatize getting help, or trigger someone into a relapse, would we? But what exactly makes a piece of media triggering? And how could this explain why I unexpectedly found some parts of the aforementioned memoir triggering and not others? To answer these questions, we must first define “trigger.”
A trigger is typically defined as a stimulus that worsens mental health symptoms. A graphic depiction of violence may be considered triggering to someone diagnosed with PTSD. A graphic depiction of substance use may be considered triggering to someone who struggles with substance use. A graphic depiction of ED behaviors may be considered triggering to someone with a history of disordered eating. Or that’s how it’s typically thought of, at least.
But I would like to take this definition one step further. If we recognize that most “mental illnesses” are really symptoms of trauma (or coping behaviors to deal with trauma), then any “mental illness trigger” is really a trauma trigger. So we can reframe our definition from “a stimulus that worsens mental health symptoms” to “a stimulus that worsens symptoms of trauma.” Well then… how do we define trauma?
“Trauma” is another word that we hear quite often in both the mental health realm and the critical psychiatry realm alike, while rarely ever getting a proper definition. Most may think of trauma as “a really bad event in a person’s life” or “something that leaves psychological scars.” Both of these are fine definitions. After all, trauma means different things to different people. Perhaps it is best, in some ways, not to have a one-size-fits-all universal definition. But… why does trauma mean different things to different people? And why do certain triggers bother some people and not others?
Despite the lack of universality of trauma, I shall attempt a universal definition in a way that accounts for the lack of universality itself: Trauma is, at its core, a profoundly disempowering experience. It strips an individual of their autonomy, agency, and/or voice, rendering them functionally powerless. Trauma forces one to become the victim of a story that they did not write, choose, or consent to. One could say that trauma robs its victim of their narrative. Sure, trauma could also be a lot of other things; it isn’t only about disempowerment. Trauma can be about betrayal. Trauma can be about a lack of safety. Trauma can be about grief. But while not all forms of trauma may be about betrayal or safety or grief, I would argue that what all forms of trauma do have in common is disempowerment. Since everyone’s personal narrative is different, and therefore the narratives they encounter will impact them in different ways, this may explain why there is no universal definition, and different people experience trauma as different things. Not every clashing of narratives indicates trauma, however – multiple narratives can coexist – but trauma occurs specifically when one narrative is imposed upon another person at the cost of their own, accompanied by power imbalance and nonconsent.
So if a “trigger” is defined as “a stimulus that worsens mental health symptoms,” and “mental health symptoms” can be understood as “trauma symptoms,” and “trauma” can be understood as “disempowerment” or “a robbing of one’s narrative,” then it would logically follow that a “trigger” can come to be understood as “a reinforcement or reenactment of a narrative that disempowers.” In other words, whether or not something will trigger someone depends less on what’s being portrayed, and more on how it’s being portrayed, namely 1) who’s holding the narrative, 2) the narrative in power, and 3) the narrative held by the audience member themselves. How these three narratives align or misalign will largely inform whether or not something will be experienced as disempowering – and therefore triggering – by a given audience member.
Example: The Memoir
In addition to the general “mental illness” narrative, the widely held narrative on EDs includes the idea that EDs are inherently competitive. This is the default justification for why detailed descriptions of ED symptoms or behaviors may be “triggering” to those with EDs. If an ED sufferer feels that their symptoms are not as bad as the symptoms being described (e.g. their weight or caloric intake is not as low), they may feel as though they are “not sick enough” by comparison, thus motivating them to engage in the described behaviors in order to feel valid.
Although I bought into this narrative myself for many years, I now believe it takes too many shortcuts, obscuring the real reason for this apparent “competitiveness”: the diagnostic criteria and setup of the MHIC itself. As I wrote in The “Sick Enough” Paradox in Eating Disorder Treatment, the arbitrary DSM criteria that determine whether or not someone may qualify for a diagnosis and/or ED-related healthcare necessitates that patients “prove” they are “sick enough” in order to obtain resources. Gatekeeping of resources brought on by a capitalist healthcare-as-business framework induces manufactured scarcity and subliminally encourages sufferers to “compete” with one another for access. If, for example, an individual is engaging in restrictive eating and experiencing mental and physical distress, yet they are not “clinically underweight” according to BMI, and when they seek help they are told they “don’t really have a problem”—and are perhaps even praised for their weight loss and “disciplined” eating and exercising regimen – what kind of response is that likely to elicit? Could that perhaps encourage someone to believe they need to lose more weight and engage in more behaviors in order to be taken seriously and get their needs met? Beyond the practical implications alone, there is the human desire for one’s pain to be seen and validated by others; the experience of being told it’s “not bad enough” can feel invisibilizing. However, like most issues within the MHIC—such as “treatment resistance” and “non-compliance”—this phenomenon is conveniently reframed as the fault of the patient or the nature of the illness itself.
This is why, a few years ago, reading this memoir could’ve easily triggered me. Because my narrative was ruled by the mainstream narrative of EDs, and my ability to access care or even compassion was contingent upon how well I conformed to this narrative in the eyes of others, I was constantly plagued by this “not sick enough” imposter syndrome. Any narrative that reflected and conformed to the mainstream narrative “better” than I did—according to behaviors, symptoms, physical appearance, etc.—felt like competition. I would’ve even read stories like this as “motivation” to “help” me lose weight. Though I realized I was doing this, I would not have been able to articulate an explanation at the time, except by falling back on that which had conveniently been provided to me: It’s just my sick brain. Yet another narrative imposed upon me by the MHIC.
At the root of my psychiatric trauma was the disempowerment I experienced from the MHIC. This was reflected in the author’s descriptions of therapy, and even how others treated them regarding their ED. They described their partner threatening to break up with them if they did not seek professional help, their friends quietly surveilling them at meals, and their therapist forcing things that made them uncomfortable. However, none of this was portrayed as problematic. Their partner, friends, and therapist were all cast in a flattering light of simply being concerned. They were “good” and “right.” The ED was “bad” and “wrong.” Although these paternalizing, pathologizing, power-stripping dynamics sounded familiar to me, the author’s narrative of them very much did not align with my own. Instead, they aligned with the mainstream narrative. This misalignment catalyzed a mental reenactment of the initial disempowerment I felt from the MHIC, ED treatment, and sanism, reinforcing a dominant narrative that had eclipsed my own. In one word, I felt “triggered.”
The reason why these segments bothered me far more than the parts detailing emotional abuse is because the author clearly recognized the emotional abuse as being “bad,” and the person(s) enacting the abuse as “wrong.” Rather than triggering, this actually felt validating to my experience. Our narratives aligned. Although the mainstream narrative on abuse is generally condemnatory of it, emotional abuse in particular is often underrecognized. I’ve seen other portrayals of emotional abuse in media that do feel triggering, and this is typically because the behavior being portrayed is not even recognized as abusive or “wrong,” and may even be romanticized. Thus, seeing my own narrative represented in the author’s felt empowering.
Trigger Warnings vs Censorship
Nearly any media portrayal or discussion of “mental illness” or trauma is likely to be deemed “sensitive content,” oftentimes with a “trigger warning” applied accordingly. This awareness and sensitivity towards “mental health issues” may be considered progress on some fronts. However, since triggers can be so variable even amongst people with similar traumas or mental health labels, and they depend more on individual, authorial, and cultural narrative alignment than the actual subject matter itself, it calls into question the usefulness of such “trigger warnings” to those that they are, in theory, meant to protect.
Perhaps trigger warnings can sometimes be helpful to survivors in making informed decisions about the kind of content they consume during their recovery. However, “Trigger Warning: ED” or “TW: abuse” tells me very little about if and how much something will trigger me. Furthermore, as a survivor, I sometimes actively want to consume media about EDs, emotional abuse, psychiatric trauma, etc.—not as an act of self-sabotage, but as a recovery tool. Finding relatable art and stories—by survivors, for survivors—not only helps me feel less alone; it also helps heal the wounds of disempowerment by making me feel seen and heard while challenging the dominant narratives that invisibilized and silenced mine.
However, when these stories are sanitized for fear of bringing harm, they no longer hold the same power. Trigger warnings can be not only unhelpful, but even damaging to those they claim to protect, increasing stigma and reinforcing taboos. People forget that survivors can be more than passive audiences to these stories; we are often the storytellers ourselves. By putting trigger warnings on the content we consume, it implies that we must, in turn, place trigger warnings on what we share. This sends a subliminal message: that our stories are triggering, our bodies are triggering, our voices are triggering, our very existence is inherently triggering to others. So we fall back into invisibility and silence. We learn to self-censor for fear of causing harm, without consideration for the harm it is causing us, and the potential good that our unsuppressed truth could do for ourselves and others. This forces us to relive the dynamics of disempowerment and narrative-robbing that created our trauma in the first place. In short, trigger warnings are not always meant to protect the vulnerable: They are meant to protect the status quo.
“Romanticizing” vs “Stigmatizing”
“Romanticizing mental illness” or, on the other hand, “stigmatizing mental illness,” are also common talking points in the media portrayal debate. Any representation of “mental illness” outside of the dominant narrative seems to fall prey to these accusations. Like trigger warnings, however, these concerns masquerade as protecting the “mentally ill,” while in practice being weaponized against those most vulnerable. When we, survivors, share our experiences of madness in a positive way—especially more stigmatized experiences/behaviors, like voice hearing, self-harm, and suicidality—we are accused of “romanticizing” it. On the other hand, the “sane” are able to get away with glamorizing and commodifying our struggles all they want. When we share any negative experiences—especially of mental health treatment—we may be accused of perpetuating “stigma.” Meanwhile, the “sane” portray us as villains of horror movies and scapegoats for gun violence without criticism. There is a clear double standard here: Stories are far more scrutinized when the Mad tell them. But the thing is, when you romanticize or stigmatize what’s yours, that’s not “romanticization”/ “stigmatization,” that’s narrative reclamation. When you romanticize or stigmatize what isn’t yours to begin with, that’s narrative robbing. It matters who is holding these narratives: survivors or “experts,” patients or doctors, Mad or “sane,” those who’ve lived it or those who’ve studied it.
Closing Thoughts
Narratives hold power. The portrayals of “mental illness” we consume through media can be dangerous to those most vulnerable. But the solution isn’t censorship, nor is it simply more representation. To quote trans activist Alok Vaid-Menon: “I actually think we’re overrepresented in media by their projections, and we’re underrepresented in media by our realities. And the crisis of trans [or Mad] America is that we prioritize cis [or sane] people’s anxieties and insecurities about us over our actual lives.” Although this quote was originally said in regards to trans media representation, the same could be said of Mad media representation. “Sane” understandings of Mad experiences take precedence over Mad ones. “Sane” discomfort is prioritized over Mad suffering. Only the Mad who conform to sanist ideas of madness and recovery are allowed to participate in this monopoly of narrative. This is not to say that they do not have a right to share their stories. But they surely do not represent all of us. And sometimes, proximity to saneness and power can motivate some Mad people to silence the dissenting voices of other, less conforming, Mad people. Any alternative narratives may feel like a threat to their own, and therefore to the fragile stability afforded them by conditional sane acceptance. However, allowing space for narratives that fall outside these norms does not take away from theirs, but adds to it.
As Mad people and trauma survivors, sharing our stories (when safe to do so) can be a profoundly empowering experience. If the opposite of trauma is healing, then the opposite of narrative theft is narrative reclamation. We deserve and need to create our own representation through stories and art—for ourselves and each other—even if they don’t make it mainstream. Our voices matter. Narratives have the power to lock us up—sometimes literally. But they also have the power to set us free.
