Revamping Teen Mental Health on Screen

The subject of teenage depression is generally played for high-octane drama in showbiz. In 2017, “13 Reasons Why” fell under rapid-fire controversy for its inclusion of a graphic suicide scene, which was ultimately removed by Netflix. Conversely, in Hulu’s true crime miniseries “The Girl From Plainville,” the pinnacle suicide scene is kept off-camera. And then there’s “Euphoria,” HBO’s Emmy-winning, millennial-targeted juggernaut charting the disease of addiction in Rue (Zendaya), whose rampant substance abuse-cum-debilitating anxiety is punctuated by police chases, drug lords and toxic teenage love triangles.

But depression isn’t always — or even most of the time — the stuff of season-ending cliffhangers. It’s dull, weighty. It is as heavy as a rock chained to one’s ankle. In the United States, rates of adolescent depression have climbed to epidemic proportions.

Per the Centers for Disease Control and Prevention, 13% of adolescents reported having a major depressive episode in 2019, a 60% jump from 2007. In 2018, suicide rates for people ages 10-24 also leapt 60%. Suicide is a leading cause of death among youth ages 10 to 19 years.

Given this catastrophic trend and in May, dubbed Mental Health Awareness month, Hollywood should consider normalizing its depiction of mental illness, centering (at least some) stories on the millions of adolescents who cope with clinical depression.

“Our recent research on film and our prior work on television suggests that very few teens are depicted with a mental health condition at all in popular media,” says Stacy L. Smith, founder of the Annenberg Inclusion Initiative at USC.

“Even though there may be a few examples of shows that present mental health issues in teens, the reality is that the underrepresentation of mental health conditions in this age group means that adolescents rarely see storylines that present them characters who reflect back the experiences they have. This is even more so the case for teens from underrepresented racial/ethnic groups, who identify as LGBTQ+ or those with disabilities.”

To that end, the Mental Health Storytelling Coalition, an organization formed in 2021 and comprising MTV Entertainment Group, the Annenberg Inclusion Initiative and companies such as Amazon Studios, has launched the Mental Health Media Guide, a “resource for those working in entertainment to support telling more authentic, nuanced and safe portrayals of mental health.”

Monya De, a Los Angeles-based specialist in internal medicine who treats adolescents with major depressive disorder, contends that producers and writers could also benefit from conducting “more research.”

“With more effort and more [time spent] talking to experts, there are ways to make a really compelling and interesting storyline that involves an insidious brain illness — as opposed to something shocking, like a psychotic break,” she says.

There are, of course, some accurate portrayals of adolescent depression in film and TV. Showtime’s “Shameless,” HBO’s “In Treatment” and Kelly Fremon Craig’s “The Edge of Seventeen” all featured teenage characters struggling with mental illness in ways that are largely believable.

In “The Girl From Plainville,” Elle Fanning’s ability to depict the internal psychosis of Michelle Carter, a teen sentenced to prison on an involuntary manslaughter conviction in a high-profile 2015 texting-suicide case, is mesmerizing. The brief scene in which Michelle takes her antidepressants is one rarely seen on TV. Content about clinical depression includes more boys, which is key as a 2019 study shows they die by suicide at a rate higher than girls.

Risa Sugarman, a Connecticut-based social worker and mental health blogger, credits the Netflix series “Heartstopper” for its understated and convincing portrayal of a male teen with “a real level of clinical depression.”

In “Plainville,” the quiet, desperation of Conrad (played by Colton Ryan), the boy who dies by suicide, is, likewise, a revelation. The performance is exquisite, because it is so restrained, and that’s what makes it real. To maintain the authenticity of both Conrad and Michelle, co-showrunners Patrick McManus and Liz Hannah partnered with the American Foundation for Suicide Prevention and the National Eating Disorder Assn.

“Conrad was intelligent, talented, insightful and cared immensely for his family and friends,” say McManus and Hannah. “Ensuring that all of our characters are portrayed with empathy and realism was our top priority. We know this is a story that will speak to audiences who are dealing with their own mental health issues or those of their loved ones.”

“The tides have begun to shift now, with more content creators whose shows or movies deal with themes of mental health or suicide reaching out in advance for guidance while still in development, wanting to ensure they portray stories in relatable, authentic and safe ways,” says Brett Wean, director of writing and entertainment outreach at the American Foundation for Suicide Prevention.

Wean, who consulted on “Plainville” and USA Network’s “The Sinner,” notes that when creating content about clinical depression, “subtle choices” can make a world of difference.”

“In my experience, creators have good intentions. It’s just about educating people about what to avoid, and how to balance out the tougher aspects of their story. Just as there is sometimes the possibility of a show being harmful, there is just as much potential for stories to encourage help-seeking, demonstrate how characters can exhibit healthy coping strategies, manage their mental health, and have caring, authentic conversations. Entertainment reflects our culture, and it can also help lead the way.”

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