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Depicting Mental Health
Understanding Causes of
Mental Illness

Brian NEW HeadshotA Message from EIC's President, CEO & Co-Founder, Brian Dyak

In this fourth edition of EIC’s 2013 series on Mental Health, Wellness and Recovery, we look at ways to understand the causes of mental illnesses, which can be complex and vary depending on the particular disorder and the individual.

Dr. Mark Ragins explores the difficulty of even finding causes for mental illness in the Doctor’s Note. Because we like explanations for things, we sometimes forget that correlation does not imply causation.

Yet, a common theme in many of the lives of people with mental health challenges is trauma. You see it in this week’s Profile On the highly acclaimed film Precious where a young girl was severely damaged through sexual, physical and verbal abuse from family members and others. And in our Research Snapshot, you find’ll staggering proof of the mental health risks that result from childhood trauma.

As biological, psychological and environmental factors can all contribute to the development of mental illnesses, you can explore a wide range of ideas, dynamics and relationships with characters who are living with mental health challenges. You can create rich, textured storylines and characters showing most mental disorders as a result of a combination of several different factors rather than just a single element.

This past year, mental health received quite a spotlight from the entertainment industry both in television and in film from PRISM nominated films like Silver Lingings Playbook and TV shows like Go On and Grey's Anatomy
. Both comedies and dramas alike took up the challenge and excelled in portraying authentic and insightful characters living with mental health challenges and EIC is proud to honor this achievement during our 17th Annual PRISM Awards Ceremony on April 25th. For more information on the nominees and the ceremony visit

 In this issue...
  • A Message from Brian Dyak
  • Suggestions for Depicting Mental Health
  • Doctor's Note
  • Research Snapshot
  • Profile On: Precious
Suggestions for Depicting Mental Health

When depicting the causes of mental health challenges in your characters and storylines, remember the importance of depicting issues that can co-occur with or exacerbate the symptoms of mental health challenges, such as bullying, drug abuse and chronic diseases.
  • Because most mental health disorders are so complex, many people misunderstand the symptoms and causes. Think about briefly exploring the relationship among biological, psychological and environmental factors that might cause the disorder you are portraying.
  • Compelling storylines can be made from the resilience people develop even in the face of underlying biological illnesses and trauma because of protective factors provided to them.

 EIC's Mental Health Resources

Visit for more information!

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 Doctor's Note

Mental health professionals, The Diagnostic and Statistical Manual (DSM), and our mental health educational materials rarely include causes of mental illness beyond the vague reference to a “genetic component,” which is just a correlation and not a cause of disorders.

Knowing something runs in families doesn’t mean it’s a genetic condition. Is being wealthy or poor a genetic condition? It tends to run in families. How about being a Harvard graduate? We leave emotional and environmental causes out because we can rarely prove anything and we often don’t agree with each other.

The lack of proof and agreement on the origins of mental illnesses creates serious treatment difficulties. The recovery process begins with an assessment telling someone what’s wrong with him or her. If we just give them a name, like “bipolar disorder” or “schizophrenia” without any explanation, they may feel left out of the treatment process. The client may assume that the professional knows what’s wrong, but they don’t have a story they can understand. Without a personal narrative with a cause-and-effect formulation, it’s hard to make a plan of what to do to get better.

Recovery comes, not as much from psychiatrist’s ability to relieve symptoms through medications, but from forming a shared vision with our clients describing what can be changed (often some by the person themselves or by other people in their lives, and some with our help) to transform their lives.

The causes behind a mental health challenge or diagnosed mental illness vary. Though as we talk with the person about a personal narrative, the different types of causes can be understood and expressed using a computer analogy:

  • Physical causes (“hardware errors”) – The brain has physical damage, such as with developmental disorders, drug and alcohol brain damage, traumatic brain injuries, fetal alcohol syndrome, dementias, and neurological and medical conditions that impact the brain.
  • Neurochemical disorders (“software errors”) – Areas of the brain are not communicating correctly, such as in schizophrenia, bipolar disorder, “endogenous” major depression or obsessive-compulsive disorder.
  • Environmental causes (“user errors”) – Occur when individuals have been mistreated or mistreat themselves and are disturbed as a result, such as post-traumatic stress disorder, personality disorders and other broader effects of trauma.

There is overlap even within a system like this, and lots of uncertainty and disagreement, but it makes sense to people. It’s also a way to communicate and build trust.

 --Dr. Mark Ragins

 Research Snapshot
Childhood Trauma
ACE PyramidWhen exploring the causes of mental disorders in your character, childhood abuse, neglect and exposure to other traumatic stressors—termed adverse childhood experiences (ACE)—can become important to your story.

Almost two-thirds of the over 17,000 people who voluntarily participated in a study to find out about how stressful or traumatic experiences during childhood affect adult health reported at least one adverse childhood experience, and more than one of five reported three or more adverse childhood experiences.

The study uses a score to account for the total number of adverse childhood experiences that each person reported. The ACE Score is used to assess the total amount of stress during childhood and has demonstrated that, as the number of adverse childhood experiences increase, the risk for the depression, hallucinations, post-traumatic stress disorders, suicide attempts, illicit drug use, alcoholism and alcohol abuse, and other mental and behavioral health problems increases in a strong and graded fashion. For more information, visit

We are not, however, helpless in the face of trauma. A number of “protective factors” have been identified that help children be more resilient and thrive even in the face of serious trauma, reducing both mental and physical health effects. Protective factors include secure housing, enough money to make it through the month and for emergencies, family, other concerned and protective adults, and a self image that includes growing up to be something positive.

Profile On: Precious

gabourey_sidibe_in_precious Winner of two Oscars, Precious is set in 1987 Harlem, where 16-year-old Claireece 'Precious' Jones (played by Gabourey Sidibe) is an illiterate, overweight girl who is pregnant with her second child—both children by her biological father who has continually raped her since she was a child. Her infant daughter lives with her grandmother, while Precious lives with her mother Mary (played by Mo'Nique) who physically and emotionally abuses Precious. Dissociating herself from the violence and abuse, Precious constructs a fantasy world full of celebrity, romance and social possibilities. Due to her pregnancy, she is transferred to an alternative school where a sympathetic teacher, Miss Blu Rain (played by Paula Patton), gets Precious to believe that she can have a future by learning how to read and write. Through the intervention of a social worker, Mrs. Weiss (played by Mariah Carey), Precious finally sees she can escape the grips of her abusive mother and lead her life in a new direction.

Characters like those explored in Precious show audiences the impact of childhood trauma as a source of mental illnesses. The storyline doesn’t excuse the behavior of family or undermine life experiences, but rather helps to explain and understand the trauma surrounding life, how one’s outlook and other people’s behavior can protect people, the need for better social service interventions and the resiliency that can come with even the slightest glimmer of hope.

Think about how you can explore characters, like Precious and Mrs. Weiss, in your creative efforts. How can your characters show the impact of adverse childhood experiences on individuals and families? How can they help your audience understand the complex relationship among factors that affect mental health, recovery and wellness?

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The 17th Annual PRISM Awards are set to take place on April 25, 2013 at the Beverly Hills Hotel

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Click here for a full listing of nominees!

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