Has Mental Health Representation Improved? Lessons From Stranger Things Across Television and Theater

Introduction

A 2024 report from the USC Norman Lear Center used a database of more than 170,000 television and film scripts to track 47 mental health-related keywords across categories including conditions, treatments, professionals, negative outcomes, self-care, and dehumanizing language. After excluding scripts whose only matches were dehumanizing terms, mental health keywords appeared in 19% of available scripts in 2015-2019 and 27% in 2021-2022; the report described this as a relative increase of 39%. Mentions of the terms "crazy," "insane," and "psycho" decreased by 15%.¹

The report also compared audiences for 13 storylines that were informed by mental health experts, aligned with best practices in the Mental Health Media Guide, or both, with relevant nonviewer comparison groups.¹ Among the 13 storylines, viewer-nonviewer comparisons were conducted across several outcomes. Viewers of 10 storylines showed greater topic knowledge; viewers of 8 storylines showed lower personal stigma toward people who had received mental health treatment; and viewers of 7 storylines showed greater willingness to seek therapy.¹ These comparisons should not be interpreted as evidence that viewing itself produced the differences. The findings are encouraging, but they raise a central question: does increasing mental health visibility in entertainment correspond to increasingly accurate and nuanced representation?

The question is especially timely for Stranger Things. The Netflix series has completed its fifth and final season, and its prequel stage play, Stranger Things: The First Shadow, is playing in London and New York.²⁻⁴ The stage play revisits Henry Creel’s adolescence before his transformation into Vecna, the series’ supernatural antagonist, giving the franchise an opportunity to revisit the same character’s psychological distress across media.³˒⁴ The official London production warns that the play includes "depictions of various mental health conditions and disorders."³ This notice does not establish the accuracy of those portrayals, but the franchise’s expansion from television to theater offers an opportunity to consider how psychiatric themes are represented across different forms of popular entertainment.

A Comparative Lens Beyond Stranger Things

Evidence from other media shows that increased representation can improve some outcomes without eliminating every form of stigma. In a representative survey of the Irish population, viewers of a popular television soap opera featuring a realistic portrayal of schizophrenia were better informed about where to seek help and more optimistic about recovery than nonviewers.⁶ However, viewers also expressed greater concern about having an intimate relationship with someone with a history of mental illness, suggesting that a portrayal may improve some aspects of mental health literacy without uniformly reducing stigma.⁶ A more recent analysis of widely watched American television programs found that from 2011 to 2021, characters with psychosis became less likely to be framed as criminals or villains and more likely to be portrayed as protagonists, victims, attractive individuals, or people who contributed positively to society.⁷ Together, these findings suggest movement in a more constructive direction while underscoring the need for continued improvement.

Other portrayals can move audiences in the opposite direction. In a randomized survey study of 164 adults, participants assigned to view Joker had prejudice scores toward people with mental illness that were 0.37 standard deviations higher (95% CI, 0.19-0.55) than those assigned to the control film, Terminator: Dark Fate.¹⁰ This contrast suggests that visibility alone is not sufficient; the way mental illness is framed within a narrative may also shape audience attitudes.

The Promise of Visibility

At its best, popular storytelling gives language and emotional form to experiences that can otherwise remain hidden. Stranger Things repeatedly depicts young people struggling with grief, guilt, fear, isolation, and difficulty disclosing distress. In the television series, Max Mayfield’s withdrawal after the death of her older stepbrother, Billy, is not presented as an abstract list of symptoms. Her grief affects her friendships, sense of self, and ability to imagine a future; music and memories of connection become lifelines when she is most psychologically vulnerable.⁵

Such scenes may prompt viewers to notice distress expressed through withdrawal, avoidance, and disconnection rather than direct disclosure. Max’s symptoms, including nightmares and nosebleeds, complicate a purely psychiatric interpretation because they also function within the story as signs of Vecna.⁵ Even so, her experiences may give adolescents and families a shared reference point for beginning conversations that may feel too personal to approach directly. Rather than asking, "Are you depressed?" a viewer might first ask why Max stopped confiding in her friends or why a personally meaningful song helped her reconnect with them.
Visibility also matters because it can portray support as ordinary rather than exceptional. Social support is widely recognized as protective for child and adolescent mental health.⁸ Stranger Things repeatedly shows peers refusing to abandon one another. This does not replace treatment, but it can model listening, persistence, and the importance of taking another person’s distress seriously. More broadly, when entertainment depicts characters seeking professional help, receiving support, and remaining full participants in their families and communities, it can challenge the assumption that psychiatric illness is a defining or disqualifying identity.

When Representation Becomes Distortion

More representation is not inherently protective. Stories may use psychiatric language while preserving older stereotypes beneath it. One concern in Stranger Things is the proximity between psychological distress and villainy. The series presents Henry Creel as an alienated child whose troubled inner life and violence precede his transformation into Vecna.⁵ The stage prequel returns to his adolescence, adding emotional context while also risking reinforcement of an association between psychological distress and future violence.³˒⁴

It would be tempting to ask which diagnosis best explains Henry. That question may feel clinically engaging, but it can also be misleading. Fictional characters are constructed to serve plots, not to provide the complete history, longitudinal observation, collateral information, and differential diagnosis required for clinical care. Assigning a definitive disorder may create an illusion of clinical precision while reducing the story to a label. More importantly, explaining extreme violence through psychiatric diagnosis can reinforce the false belief that diagnosis alone reliably predicts dangerousness.⁹

A second concern is the oversimplification of recovery. Music and friendship are among the television series’ most compelling symbols. A meta-analysis of randomized trials found that interventions involving music listening, playing, or creating had a moderate effect on emotion regulation, and a systematic review identified social support as an important protective resource for youth mental health.⁸˒¹¹ Neither should be conflated with individualized professional care. A dramatic rescue can nevertheless imply that the right song, memory, or friend is sufficient to reverse severe psychological deterioration. Professional care is individualized and may include psychotherapy, medication, or both, depending on the person’s needs and clinical context.¹² Recovery is often nonlinear. Stranger Things partly complicates this concern by showing distress, grief, and relationships evolving across episodes rather than resolving every conflict in a single climactic moment; that longitudinal growth is one of the franchise’s more constructive features.⁵

Popular stories can also foreground visible crisis while giving less attention to the quieter work of care. The Norman Lear Center report specifically recommends depicting help-seeking realistically, including common barriers and potential solutions.¹ Against that benchmark, portrayals that omit barriers involving cost, access, family attitudes, cultural mistrust, or continuity of care may leave viewers with an incomplete picture of treatment. When mental health terminology becomes more common without equally developed depictions of assessment and longitudinal care, visibility may produce familiarity without deeper understanding.

From Screen to Stage

The migration of Stranger Things into live theater makes these questions especially visible in a shared physical setting. Theater asks audiences to encounter Henry’s distress and transformation in real time. The official London production explicitly alerts audiences that the play depicts mental health conditions and disorders.³ The notice does not establish whether the portrayal is accurate or beneficial. The production can then be examined for what it depicts, what it omits, and whether its links among distress, unusual behavior, and violence reinforce or challenge familiar stereotypes.

This expansion illustrates how contemporary narratives no longer remain within one medium. A character can move from television to theater, clips, fan edits, discussion boards, and informal diagnostic commentary. Each repetition may deepen empathy, but it may also amplify a simplified label. Because viewing certain entertainment storylines has been associated with differences in viewer knowledge, stigma, and willingness to seek help,¹ healthcare professionals can be prepared for media references when patients themselves raise them. Clinicians do not need to assume that entertainment has shaped a patient’s beliefs; rather, they can ask about a media example only when it is relevant to the patient’s own concerns.

A Role for Healthcare Professionals

Popular media can be useful in clinical conversations when it is treated as a starting point rather than a diagnostic tool. If a patient mentions a character or storyline, a clinician might ask what felt recognizable, what the story seemed to imply about treatment or recovery, and what the patient thought it got right or wrong. The clinician can then distinguish observed behavior from diagnosis, identify clinically important information that fiction leaves absent or ambiguous, and correct misconceptions about risk, treatment, or prognosis. This keeps the focus on the patient’s own experience rather than turning a fictional character into a diagnostic exercise.

Healthcare professionals can also contribute outside the clinical encounter. When invited by content creators, professional organizations, psychiatrists, psychologists, and other clinicians can provide targeted expertise. Individuals with lived experience remain important partners in the process. The Norman Lear Center report found that content creators valued accurate, specific, and culturally sensitive resources and expert feedback.¹ For example, the television drama The Chi depicted healing circles as well as individual and family therapy; viewers of that storyline showed greater familiarity with mental health treatment options.¹ This illustrates how clinically informed depictions can educate without turning entertainment into medical advice.

Clinicians who communicate publicly can also use professional social media, community education, or advocacy to correct common misconceptions raised by popular media, while avoiding unsupported diagnosis of fictional characters as though they were patients. The goal is not to police fiction but to provide context: acknowledge what a story does well, explain its limitations, and point audiences toward evidence-based information when appropriate.

Conclusion

The increase in mental health language across entertainment is meaningful, but its frequency should not be confused with quality.¹ Stranger Things demonstrates the promise of storytelling that makes trauma, isolation, and connection emotionally legible to broad audiences. Its expansion from television to the stage also shows how quickly psychiatric narratives can travel across media and acquire cultural authority.

For healthcare professionals, the task is a practical and achievable one. Clinicians can use media references when patients find them meaningful, clarify where fiction diverges from clinical assessment and treatment, and contribute expertise to public storytelling when appropriate. More mental health on screen and stage is an opportunity. Whether it contributes to progress depends on how responsibly stories are created, interpreted, and discussed.

Conflicts of Interest: 

None reported.

Institutional Review Board (IRB) statement: 

Approval was not obtained because this commentary does not report human participant research or identifiable private information.