AIMS AND METHOD
To compare how newspapers cover psychiatric and physical illness. We conducted a survey of relevant headlines in nine daily newspapers over a one-month period and judged whether the content was essentially positive, neutral or negative.
Over the one-month period, 213 article headlines about various aspects of medicine and 47 on psychiatry were identified. Ninetynine (46%) of the former were critical in tone as compared with 30 (64%) of the latter (odds ratio=4.42, 95% CI 1.64-11.94). We gained the impression that negative articles about physical medicine tended to criticise doctors whereas negative articles about psychiatry tended to criticise patients. Tabloid and broadsheet newspapers did not differ in their rates of negative coverage.
Psychiatry, psychiatrists and particularly psychiatric patients tend to be represented negatively in the newspapers. Psychiatrists should strive to influence the news agenda by proactively reporting positive messages, such as treatment advances.
Stereotyping and stigmatising attitudes towards psychiatric patients are maintained and periodically reinforced by the ‘bad press’ that psychiatry receives (Angermeyer & Mattschinger, 1996, Hammond, 1996; Philo, 1996).Numerous recent examples testify to the concern that this arouses in the general public (Philo, 1996), but media coverage of psychiatric disorders has probably always been selective, negative, misinforming and melodramatic (Nunnally, 1961). The recent emphasis on community care may, however, have been associated with an increase in such reporting, although there also appears to have been a recent surge in the frequency of negative reports in the media about medical practice in general. It is possible, therefore, that psychiatry receives no worse treatment in the media than other medical specialities. We set out to answer this question by comparing newspaper portrayals of medical and psychiatric issues.
Daily newspapers were monitored for one month (during November 1996) and any article headlines about health-related issues were kept. The nine newspapers surveyed were: The Times, Telegraph, Independent, Guardian, Herald, Scotsman, Daily Mail, Sun and the Daily Record (i.e. six broadsheets and three tabloids). We later made group consensus judgements as to whether the headlines were about psychiatric or general medical issues, and whether they are mainly positive, neutral or negative in tone. Headlines were regarded as positive if they reported clinical or research advances, negative if they criticised standards of care, and neutral if they gave a mixed or unclear message.
We tested the hypothesis that newspaper coverage of psychiatric issues would be more critical than that of medical issues by comparing the rates of only positive and negative articles. This allowed the calculation of an odds ratio, together with 95% confidence interval (95% CI), of negative coverage in psychiatry as opposed to general medicine. We repeated this calculation for articles from the broadsheet and the tabloid newspapers.
Altogether, 306 health-related article headlines were collected during one month. Of these 213 were about general medical matters, of which 73 (34%) were judged to be generally positive, 41 (20%) neutral and 99 (46%) negative in tone. Only 47 headlines concerned psychiatry, of which five (11%) were thought to be positive, 12 (25%) neutral, and 30 (64%) essentially negative (see Table 1 for examples). The remaining 46 articles were judged to concern general health issues rather than specifically physical or mental illness. Very few articles caused any difficulties in deciding about their content or tone and any disagreement was usually settled quickly on discussion.
General medical matters, therefore, get approximately five times more press coverage than psychiatric illness and a much higher percentage of medical articles are generally positive in tone. The odds ratio of an article headline about psychiatry being critical is 4.42 (95% CI 1.64-11.94) times more likely than that of one about general medicine. In addition, it was our impression that negative articles about medicine tended to describe ‘bad doctors’, whereas negative articles on psychiatry tended to describe ‘bad patients’.
Broadsheet article headlines were 4.6 times (95% CI 1.52-13.94) more likely to be critical of psychiatry than medicine (23/27 and 80/144 headlines were critical respectively). The three tabloid papers had a similar tendency, with 7/8 psychiatry headlines being negative as compared to 19/28 medical headlines (odds ratio=3.32, 95% CI 0.35-31.19).
It is clear that psychiatry receives less coverage than general medicine, and the coverage it does receive is four times as likely to be negatively framed. These are not unexpected findings but are, to our knowledge, the first objective confirmation of such subjective impressions. This survey also provides examples of the stereotypes that patients with psychiatric illnesses may face, given that newspapers are probably the most important (even more than television) source of scientific and health information for the general population (Day & Page, 1986).
Our survey of newspaper headlines was comprehensive. Although we may have missed some articles, there is no reason to expect any particular ascertainment bias. The judgements about their tone were inevitably somewhat arbitrary, but they were arrived at by consensus and with very little disagreement. Our figures of 64% negative, 25% neutral and 11% positive reports are similar to the figures of 42%, 40% and 18% respectively in a similar Canadian study (Day & Page, 1986). The recent College survey found that 54% of 1292 reports in the British press over one year were negative (Hart & Phillipson, 1998). There are numerous other reports that the British press discriminate against the sufferers of mental illness, usually by focusing on the negative aspects of the behaviour of a minority of patients and on small numbers of dramatic treatment failures (Barnes & Earnshaw, 1993; Hammond, 1996; Philo, 1996). Our impression of psychiatry coverage was very much in keeping with these views, particularly as negative article headlines seemed to criticise physical medicine practitioners but psychiatric patients. In addition, we have found no evidence that ‘quality’ newspapers are any less stigmatising than the tabloids, given the extensive overlap in their confidence intervals. In retrospect, it would have been interesting to have performed a more detailed content analysis of the differences in coverage by medical speciality, any differences between headlines and articles themselves, and regarding specific issues such as violence.
Newspaper coverage reflects and drives social concerns. Content is also determined by the need for a ‘good story’ which will sell papers. Psychiatrists will not be able to alter the largely negative coverage our speciality and patients receive by simply complaining about it. We must, therefore, strive to work more closely with the media in providing factual information about psychiatric illness and stressing positive aspects such as advances in psychiatric treatment.
This work was conducted as part of a problem-based learning project with first year medical students at Edinburgh University. Katherine Martin, Gregor McNeill, Jennifer Drife, Patrick Chrystie, Adam Reid, Pensee Wu, Shafic Nammary and Joanna Ball all assisted in the design and execution of the project.
- © 2000 Royal College of Psychiatrists