As I settled in to catch up on HBO’s award-winning series “Barry,” an atypical opening announcement took me by surprise. In a show about a former hit man looking to start anew, pre-show warnings on violence are the norm. However, this disclaimer stated that “the following program contains post-traumatic stress disorder,” quickly followed up by “and it’s ok.” The next announcement was a reminder to call a mental health hotline run by both HBO and the National Institute of Mental Health if the viewer or someone they know is in crisis, with an additional website address for further information. 

These new mental health-oriented “bumpers” are a part of HBO’s initiative to increase awareness for mental illness. However, as opposed to issuing viewer discretion warnings for depictions of mental illness, as Netflix did with the controversial “13 Reasons Why,” HBO’s alerts serve another purpose. They highlight the reality that living with a mental illness is normal and provide a reminder that there is no shame in seeking help. Rather than advising those who are sensitive away from certain scenes because of their content, these bumpers act as invitations of discussion on specific mental illnesses. These “viewer conversation encouraged” advisories will accompany some of HBO’s most popular programs, such as “Euphoria,” “Girls,” “Succession” and “The Sopranos.” In addition to the use of mental health-oriented bumpers, HBO’s partnership with NIMH includes a series of educational videos with expert commentary on myths surrounding mental health issues as well as discussion on their portrayal in the episode. 

This initiative by HBO represents the beginning of a larger societal change regarding mental illness. The media has a profound influence on the reinforcement of public perception of a certain population based upon their common portrayal. The American aversion to conversations on mental illness is often augmented by inaccurate portrayals in popular culture. However, current depictions in TV programs and movies demonstrate drastic progress in the understanding of mental health over the past century. 

In the 1950s, for example, the majority of the U.S. populace equated all mental illness with psychosis. During this era, issues pertaining to mental health were often avoided, contributing to such inaccurate perceptions. The danger and violence often associated with mental illness is highlighted by Alfred Hitchcock’s 1960 horror film “Psycho.” In the film, serial killer Norman Bates develops what is now known as dissociative identity disorder and engages in a series of violent murders. The horror genre’s emphasis on violence and mental illness continues with John Carpenter’s famed 1978 classic, “Halloween.” The storyline of this film involves an escaped mental asylum patient, Michael Myers, and his deranged killing spree of teenagers in his suburban hometown. 

Breaking away from horror films, mental illness was again in the spotlight in the Academy Award-winning 1975 film “One Flew Over the Cuckoo’s Nest.” Based on the popular 1962 novel of the same name, the film stars Jack Nicholson as Randle Patrick McMurphy, a convict who feigns mental illness to avoid a prison sentence. In many senses, “One Flew Over the Cuckoo’s Nest” was a radical, innovative portrayal of mental illness. The oftentimes patronizing and inadequate care experienced by institutionalized patients is at the forefront of the plot. The characters involved are treated as children by their caregivers and have little hope for life after release. As opposed to portraying them as violent killers, the mental health patients here are humans condemned to life in a health care system that cannot properly care for them. 

However, the movie’s most memorable scenes involve terrifying moments as McMurphy’s character undergoes violent electroconvulsive shock therapy as a punishment for unruly behavior. Eventually, the once-lively McMurphy is lobotomized and left in a zombie-like state before being euthanized by his roommate. “One Flew Over the Cuckoo’s Nest” certainly challenged the status quo in terms of typical representations of mental illness. However, the popularity of the film influenced common ideas of mental illness for years to come. A 1983 study finds that college students viewed those with mental illness more negatively after viewing the film.

Understandings of mental illness began to change at the end of the 20th century. In contrast to perceptions in the 1950s, Americans in 1996 showed a deeper understanding of the non-psychotic symptoms of mental illness. However, these same results also found that U.S. society by the late 1990s still maintained negative attitudes toward those with mental illness. Representation of mental health in pop culture seemed to turn a corner with 2001’s “A Beautiful Mind.” The biographical film about the life of famed mathematician John Nash and his schizophrenia diagnosis demonstrated those with mental illnesses as capable of achieving remarkable goals. “A Beautiful Mind” depicted the vivid, haunting hallucinations that followed Nash throughout his life while also showing his triumphs, including a Nobel Prize for economics and his ability to have a family.

The relationship between public perception and pop culture portrayal of mental illness cannot be ignored. All too often, movies and TV shows fail to accurately demonstrate the reality of mental health problems, further stigmatizing an already marginalized population. However, the HBO-NIMH initiative represents changing ideals on popular culture’s handling of mental illness. While films such as “Psycho” and “Halloween” demonized those with mental illnesses, more contemporary depictions represent a different path. NIMH has praised movies such as “Silver Linings Playbook” (2012), “The Skeleton Twins” (2014) and “The Perks of Being a Wallflower” (2012) as examples of humanizing, accurate portrayals of mental illness. However, negative and harmful portrayals of mental illness still persist. “13 Reasons Why” received criticism for targeting a vulnerable teenage audience while highlighting a suicide revenge fantasy and failing to mention mental health or mental illness at all in the first season. M. Night Shyamalan’s 2015 thriller “Split” once again features a violent villain with dissociative identity disorder, reviving a trope seen since “Psycho.” Despite these instances, Hollywood seems to be reversing the trend of demonizing mental illness. More and more films released recently have received praise for accurate displays of mental illness. The HBO-NIMH partnership represents a societal trend on opening honest dialogue surrounding mental illness, as opposed to the demonization of it from days past.

Alanna Berger can be reached at

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