More Realistic Physical Representations in Media Will Support Youth Mental Health

More Realistic Physical Representations in Media Will Support Youth Mental Health

For many years, parents, child advocates, and mental health professionals have expressed their concerns about the influence of mass media on children and adolescents’ perceptions of body image, body satisfaction, and self-esteem. Over the past decade, with the rise of digital media and young people’s nearly constant engagement with media and technology, there has been an increasing alarm. Sadly, the media is filled with unrealistic representations of what our bodies should look like and do not accurately reflect the range of body shapes we see within our society—female characters and models often have bodies that are smaller and thinner than average, and males are often shown as physically strong and muscular. On top of this, these characters are often portrayed as being successful, accepted, sexually desirable, and happy while overweight characters are commonly used as comic relief, are often ridiculed in social situations and regarded as unattractive. 

recent report looking at children’s television in both the US and Canada showed that the majority of human characters in children’s television, especially females, were portrayed as thin or very thin. In addition, female characters were nearly twice as likely to be sexualized in the US based on factors such as revealing or flattering clothing, long eyelashes, and sensual lips. 

While many things can contribute to one’s body satisfaction (or dissatisfaction) and self-esteem, several research studies have established that children and youth are indeedvulnerable to mass media images and messages that encourage and reinforce distorted body images and unhealthy perceptions about dietary health. 

In one striking example, a landmark study over the period that television was introduced to a community in Fiji demonstrated the dramatic effect these images had on young adolescent girls, showing how they internalized the Western images of beauty, resulting in disordered eating habits and patterns. Moreover, a meta-analysis of 25 experimental studies examined the immediate effect of exposure to a variety of images and found that body image, especially for females younger than 19, was significantly more negative after seeing thin media characters than after seeing average or plus-size media characters or inanimate objects. 

Exposure to hundreds and thousands of these inaccurate and unrealistic images over time sends the message that they are common and normal within society, when in fact, they are difficult if not impossible for most people to achieve. In fact, these images are almost always digitally manipulated, modified and enhanced to achieve this ‘ideal’ body image, creating an even larger gap between reality and what we see in the media. The impact of not being able to look like these characters in the media is associated with decreased self-esteem, body satisfaction, depression, and eating disorders.

Moreover, exposure to sexualizing media leads to self-objectification in both men and women – which feeds a destructive cycle of measuring self-esteem by physical appearance. At a time when rates of anxiety, depression and suicide are on a steep rise, especially among young women and girls, putting a stop to these distorted media representations is long overdue and more important than ever.

While the problem remains significant, we have seen some positive improvements in advertising and marketing campaigns in recent years. For example, Aerie, the lingerie retailer, created a campaign, #AerieREAL, which intends to promote body positivity by using raw, unretouched images that feature models of different racial backgrounds and body types and more recently, models with disabilities and other medical issues. Similarly, Dove’s Girls Self Esteem campaign has a similar mission. Many popular retail brands, such as Target, Old Navy, Nike, and Forever 21, have followed suit by incorporating a diversity of body types and/or scaling back on re-touching photos in their advertising. 

In TV and film, avoiding these distorted physical stereotypes is still the exception, not the rule. There are a handful of shows making a solid effort to promote more “body positivity” through inclusion of a variety of body types and characters, but they are unfortunately few and far between. We need to see much more of this – and urgently – especially for any hope of stemming the tide of rising rates of anxiety, depression and suicide among our youth. 

Inclusive and realistic portrayals can promote body acceptance and reinforce self-esteem – and wellness should be prioritized over ratings. If done well, the ensuing culture shift should open the door for a new era of creative, representative content that viewers can relate to and embrace. 

To contribute to positive body diversity in media, here are some actionable insights for content creators:

  1. Offer more realistic cultural standards of beauty through a diversity of body types and experiences.

  2. Avoid characters fixating on weight loss and beauty. 

  3. Create characters who model body positivity and acceptance. 

  4. Deviate from cultural norms of women needing to be slender and men, strong and muscular.

  5. Offer an alternative narrative to one featuring women and girls as sexual objects and men as fixated on female physical characteristics above all others.

  6. Show characters who deviate from the cultural norms of beauty as romantically desirable and socially accepted, not just as sidekicks or comic relief. 

Vicki Harrison, MSW

Program Director, Center for Youth Mental Health and Wellbeing

Stanford Psychiatry Center for Youth Mental Health & Wellbeing

Adrianna Ruggiero

Senior Research Coordinator for CSS

Avoiding Mental Health Stigmatizations & Encouraging Help Seeking Through Entertainment Media

Avoiding Mental Health Stigmatizations & Encouraging Help Seeking Through Entertainment Media

Mass media have the power to shape our perceptions, attitudes and beliefs toward certain groups, issues and individuals. For better or worse, most forms of media, including entertainment media, serve as primary sources of information for many viewers, influencing our understanding of those around us and in turn, our future behaviors and actions.

Unfortunately, for those struggling with mental illness, the depictions of characters with mental health issues often focus on negative and extreme stereotypical traits that portray these individuals as a danger to society and themselves. These depictions are not only inaccurate and unrepresentative of the millions of people worldwide who face mental health challenges, but they also reinforce preconceived stigmatizations which can lead to diminished self-esteem and social exclusion

Mental health professionals are often portrayed as odd, unhelpful, unrelatable and/or unavailable, which can have major consequences on those affected by mental illness. These negative portrayals can interfere with help seeking behaviors and prevent individuals from receiving treatment due to factors such as fear, shame, embarrassment and discrimination. A startling two-thirds of individuals with a mental health disorder never seek professional help.

Too often, entertainment programs portray mental illness as something that destroys lives and fail to show viewers that mental illness is common and treatable. By depicting treatment and recovery, the media can help normalize mental health issues, fight stigma, offer hope, and connect viewers with resources for themselves or loved ones.

In a survey commissioned by the mental health organization Mind, based in the UK, findings showed that after seeing a news report or drama involving a character with mental health challenges, more than half of the respondents expressed that it had improved their understanding of mental health issues and a quarter said it had inspired them to start a conversation about mental health. Furthermore, out of the respondents affected by mental health issues, one third were encouraged to seek professional help and get assistance. 

Several other studies have highlighted the power of the media to reduce stigma, increase understanding of mental health and increase help-seeking behaviors. For example, one study found that participants who watched a film depicting an accurate portrayal of an individual with schizophrenia, were less likely to endorse stigmatizing attitudes toward individuals with the illness compared to participants who saw an inaccurate portrayal of schizophrenia. Another study found that having a strong relationship to the main character of a television series who had obsessive compulsive disorder (OCD) was associated with lower OCD stereotypes and greater willingness to seek and disclose mental health treatment specifically among participants with a mental illness. 

It is clear that the media have the power to influence our perceptions, attitudes and beliefs about individuals living with mental illness and also to help those affected. Therefore, it is in the best interest of millions of viewers and their loved ones for content creators to portray characters with a mental illness accurately and positively.

Here are some actionable insights for storytellers: 

  1. Avoid perpetuating stereotypes about mental illness that may be stigmatizing and harmful. 

  2. Avoid including stigmatizing language in scripts, such as “crazy,” “psycho,” “looney,” “wacko,” etc.

  3. Avoid making mental illness the defining feature of a character’s personality. 

  4. Introduce likeable and relatable characters who also might happen to encounter mental health challenges. 

  5. Portray doctors and therapists as helpful and supportive rather than incompetent or unavailable.  

  6. Model help-seeking behaviors such as talking to therapists, talking to trusted friends/adults and calling/texting helplines. 

  7. Model help-seeking behaviors not only for serious or diagnosable problems but also for common challenges such as stress, divorce and death. 

  8. Show supporting cast characters modeling supportive behaviors and describing options for seeking help. 

  9. Insert message of mental health treatment, hope and recovery. 

Vicki Harrison, MSW

Program Director, Center for Youth Mental Health and Wellbeing

Stanford Psychiatry Center for Youth Mental Health & Wellbeing

Adrianna Ruggiero

Senior Research Coordinator for CSS

How Can we Improve Media Representations of Autism?

How Can we Improve Media Representations of Autism?

Collaborate with Autistic People

Have you ever seen an autistic character on TV? Chances are, you answered yes. Since Rain Man introduced autism to the general public in 1988, autistic characters have become increasingly common on TV [1] and in movies. Learning about autism from autistic characters can help people understand and accept autism. Indeed, high quality contact is linked to more positive attitudes toward diversity [2]. However, media representations also have the potential to decrease autism acceptance by promoting stereotypes [3]. So, how can we improve media representations of autism? Hint: You would get the same general answer if you asked other types of minorities how to represent their identities more accurately.

Shows with autistic characters are often developed with substantial input from clinicians and family members of autistic people. For example, the puppeteer behind Julia, an autistic character who is wholeheartedly accepted by her peers on Sesame Street, uses her experiences as the mother of an autistic child to create a believable character. Yet autistic people themselves are generally NOT part of the process of developing autistic TV characters. This lack of involvement is surprising given that autistic people are often more knowledgeable about autism than others [4] and bloom socially through engagement in theatre [5].

By leaving autistic people out of the process of developing autistic characters, we risk creating one dimensional characters that represent only limited aspects of the autism spectrum. Indeed, most autistic TV characters are highly gifted and eloquent, albeit with social difficulties. Not only are savant-like characters overrepresented in media representations of autism, the gifts autistic characters exhibit show repetitive tendencies on the part of content creators. For example, the autistic characters in two separate TV shows (Touch, one of the few shows to portray a non-speaking autistic character, and Waterloo Road, one of many shows with verbally precocious autistic characters) demonstrated savant skills by reflecting on the Fibonacci sequence. Repetitive representations of autism may reinforce stereotypes while also depriving the large population of autistic young people of role models they can identify with.

We, 3 autistic college students, 1 autistic college graduate and a professor, would like to share personal reflections from the autistic members of our team about how media representations of autism get it right, get it wrong, and can get it better.

What do you like about how autism is represented in the media?

Billy: I would say in the past 10 years alone, we’ve come pretty far in the way autism is shown in the media. 10 years ago, the characters you saw on TV shows who had autism were side characters whose only defining characteristic was their disability. Today, you see characters on the spectrum who are stars of their own show like Atypical (2017) and the Good Doctor (2018) and are portrayed as complex characters in their own right. On the Good Doctor, Shaun is shown to be going through personal struggles of his own unrelated to autism such as him having not fully recovered from the trauma of his older brother’s death when they were kids.

Jin: I think Adam (2009) was a good portrayal if you consider the fact that the titular character is not only autistic. He’s depressed (his father died shortly before the film’s start) and that exacerbates the classic withdrawn symptoms that might present in someone who’s autistic. I heard complaints from someone that he didn’t end up “getting the girl” at the end and that this reflects negatively on autistic people and their ability to get into relationships, but personally it felt clear that they weren’t right for each other at the time (I didn’t like Beth anyway). It’s not like they made Adam void of sexual attraction (an issue with disability representation in general), because he very clearly voices it. I think Adam is a good look into someone who has to navigate depression and anxiety along with functioning differently in general.


What do you NOT like about how autism is represented in the media?

Nick: One of the biggest problems with characters with disabilities, not just autism, in media is that when writing a character with a disability, one can fall into the trap of writing a disabled character before one writes a character with a disability. In layman’s terms, the disability becomes the character instead of informing it. However, I’d argue a bigger problem is a hesitancy to portray people with autism who can be unpleasant on purpose. One example of this is The Good Doctor, where all of the ideas the autistic doctor has worked. It would have been a lot more interesting if something that he thought of didn’t work and he would have to take the responsibility of having made a decision that caused a patient’s death.

Billy: One of the biggest problems with how autism is represented in the media is that when a character with autism is portrayed on television, they’re presented as one dimensional characters whose depth is the stereotypical symptoms of their disability. Like Nick said, their disability becomes their character. In Atypical, the main character Sam, who has ASD, is portrayed as hopelessly naive with no idea how to approach social, and by extension romantic situations. We’re also presented as savants with total brilliance in one area, but disabled in all other areas. This goes back to Rainman (1988), in which Dustin Hoffman’s character is portrayed as a math genius, but is unable to take care of himself and lives in an institution.

Bella: Unfortunately, the media doesn’t include everyone on the autism spectrum. While the Good Doctor has an autistic character named Shaun who works as a surgeon in a hospital, there are not a lot of TV shows that show how autistic people struggle to get jobs. Sheldon, a scientist that shows autistic symptoms on the show Big Bang Theory, lived with his friends before he got married which is in contrast to stereotypes about how autistic people live in society as people who can’t have jobs or get married.

How can media content creators better involve autistic people in the process of developing media?

Nick: The best way to write a character with autism is to have it inform their character instead of being their entire character. For example, in Mary & Max (2009), Max is a man who is a social outcast because of the way the world has treated him. This is not always obviously reflective of autism.

Bella: Directors could research what life is like for autistic people. Although some shows illustrate how autistic people deal with their lives, they need to include autistic characters who display diverse symptoms. Autistic people can exhibit great strengths in technology, so directors could hire them to work at their companies. People can interview autistic people so that viewers can understand what life is like for autistic people. If TV shows could show how autistic people struggle to live in society, then society would understand more.

Here are some actionable insights for storytellers:

  • Media creators should employ autistic people as writers, actors, technicians and in other roles helping to create autistic characters. Rather than just having one isolated autistic character in each show, thus magnifying the sense that autistic people are different from “the norm,” diverse communities of people should be represented.

  • Greater representation of non-speaking autistic people is needed. Autistic characters should be as complex as any other character, with autism one aspect of their multifaceted identities. Autistic characters should have opportunities to succeed and to fail, to help and to be helped, and autistic people should play a central role in helping to create them.

Kristen Gillespie-Lynch

The graduate Center; City University of New York

Collaborator of the Center for Scholars and Storytellers

Nicholas Tricarico

The College of Staten Island; City University of New York

Billy Pinkava

The College of Staten Island; City University of New York

Bella Kofner

The College of Staten Island; City University of New York

Jin Delos Santos

Hunter College; City University of New York


1Morgan, J. (2019). Has autism found a place in mainstream TV?. The Lancet Neurology, 18(2), 143-144.

2Corrigan, P. W., Larson, J., Sells, M., Niessen, N., & Watson, A. C. (2007). Will filmed presentations of education and contact diminish mental illness stigma?. Community mental health journal, 43(2), 171-181.

3Draaisma, D. (2009). Stereotypes of autism. Philosophical Transactions of the Royal Society B: Biological Sciences, 364(1522), 1475-1480.

4Gillespie-Lynch, K., Kapp, S. K., Brooks, P. J., Pickens, J., & Schwartzman, B. (2017). Whose expertise is it? Evidence for autistic adults as critical autism experts. Frontiers in Psychology, 8, 438.

5Corbett, B. A., Gunther, J. R., Comins, D., Price, J., Ryan, N., Simon, D., ... & Rios, T. (2011). Brief report: theatre as therapy for children with autism spectrum disorder. Journal of autism and developmental disorders, 41(4), 505-511.