Back to table of contents Previous article Next article LettersFull AccessPortrayal of Schizophrenia in a Prestigious Newspaper in BrazilMaria Thereza Bonilha Dubugras, Ph.D., Sara Evans-Lacko, Ph.D., and Jair de Jesus Mari, M.D., Ph.D.Maria Thereza Bonilha DubugrasSearch for more papers by this author, Ph.D., Sara Evans-LackoSearch for more papers by this author, Ph.D., and Jair de Jesus MariSearch for more papers by this author, M.D., Ph.D.Published Online:1 May 2011AboutSectionsView articleView PDFView EPUB ToolsAdd to favoritesDownload CitationsTrack Citations ShareShare onFacebookTwitterLinked InEmail View articleTo the Editor: Several studies have identified low levels of mental health literacy in the general population. People often lack knowledge of psychiatric concepts or may have their own explanations of mental illness (1). Media both influence and reflect popular culture, and therefore, media analysis can be a useful tool to help us understand public perceptions. Previous studies have reported high rates of inaccurate and negative portrayals of schizophrenia in health news. Moreover, articles about non-health-related issues use the terms “schizophrenia” and “schizophrenic” metaphorically or in slang expressions.To investigate these issues, we performed a content analysis (2) of articles published in 2007 and 2008 by the largest Brazilian national newspaper Folha de São Paulo. An electronic search included the terms “schizophrenia,” “schizophrenic,” “psychotic episode,” “psychosis,” and “psychotic.” Metaphorical usage was analyzed by a method adapted from a previous study (3).Of 687 identified articles, 219 fulfilled the inclusion and exclusion criteria. Seventy-five (34%) addressed health issues and stories involving affected individuals, and 144 (66%) used the terms out of the medical context. Health news presented relevant information on genetic factors, the risk of drug-induced psychosis, and the benefits of psychotropic medications. However, another nine articles disseminated inaccurate information—for example, schizophrenia was associated with multiple personality—and the complexity of the disorder was not discussed. Three articles about individuals' stories described community integration. Seventeen focused on crimes allegedly committed by people with schizophrenia, and only one of these articles put the risk of violence into perspective.The 144 articles that used the terms out of the medical context were more stigmatizing. Sixty-nine (48%) used the terms literally, and 75 (52%) used them metaphorically. Literal uses were noted in 37 fiction reviews, 14 common and inaccurate descriptions of schizophrenia, seven pejorative labels, and four comic expressions. Metaphorical meanings of these terms referred to contradiction, incoherence, splitting or multiplicity, oscillation, lack of reality, obsession, withdrawal, indecision, aggression, authoritarianism, peculiarity, intermediate state, creativity, transformation, and boldness. Approximately 80% of the metaphors (60 of 75) had a negative connotation.One difference between our analysis and previous studies is that we identified metaphors with positive connotations (14 of 75, 19%), which associated schizophrenia terms with creativity, multiplicity, aggressiveness, and uniqueness of art. The metaphorical references to multiplicity and aggression had both negative and positive connotations. Although the analogy between schizophrenia and artistic creativity was presented in the newspaper articles as an attractive idea, this association may suggest that only people with schizophrenia who have extraordinary talents will be accepted by society (4) or that medical treatment is unnecessary. (One metaphor [1%] had a neutral connotation.)Folha de São Paulo disseminated information that may promote mental health literacy; however, the stigmatizing messages may have overshadowed the positive ones. The analyses identified misconceptions and concerns that should be elucidated; for example, some news reports of criminal activities demanded that psychiatrists predict and prevent violent behavior.Metaphorical usage can be distressing for affected individuals and families (1). Furthermore, use of terms pejoratively or to comic effect can be interpreted as disrespectful. It is not possible to control the use of medical language, and press censorship is unacceptable. The goal should be to change public perceptions of schizophrenia with antistigma campaigns, until the jokes and slang expressions no longer work.Dr. Dubugras is affiliated with the Collective Health Department and Dr. Mari is with the Department of Psychiatry, both at the Federal University of São Paulo, Brazil.Dr. Mari is also honorary visiting professor, Health Service and Population Research Department, Institute of Psychiatry, King's College London, United Kingdom, where Dr. Evans-Lacko is affiliated.Acknowledgments and disclosuresThis work was supported in part by a grant to Dr. Dubugras from CAPES, the Brazilian Ministry of Education. Dr. Mari is a I-A-level researcher with the National Research Council (CNPq) in Brazil.The authors report no competing interests.References1 Chopra A , Doody GA : Schizophrenia, an illness and a metaphor: analysis of the use of the term “schizophrenia” in the UK national newspapers. Journal of the Royal Society of Medicine 100:423–426, 2007 Crossref, Medline, Google Scholar2 Bardin L : Content Analysis [in Portuguese]. Lisbon, Portugal, Edições, 1979 Google Scholar3 Stone J , Colyer M , Feltbower S , et al.: “Psychosomatic”: a systematic review of its meaning in newspaper articles. Psychosomatics 45:287–290, 2004 Crossref, Medline, Google Scholar4 Rosen A , Walter G , Politis T , et al.: From shunned to shining: doctors, madness and psychiatry in Australian and New Zealand cinema. Medical Journal of Australia 167:640–644, 1997 Crossref, Medline, Google Scholar FiguresReferencesCited byDetailsCited By“Schizophrenia” and “psychosis” in Italian national newspapers: Do these terms convey different messages?Schizophrenia Research, Vol. 197Stigma and need for care in individuals who hear voices4 November 2016 | International Journal of Social Psychiatry, Vol. 63, No. 1Depictions of auditory verbal hallucinations in news media27 May 2014 | International Journal of Social Psychiatry, Vol. 61, No. 1 Volume 62Issue 5 May 2011Pages 565-565 Metrics Acknowledgments and disclosuresThis work was supported in part by a grant to Dr. Dubugras from CAPES, the Brazilian Ministry of Education. Dr. Mari is a I-A-level researcher with the National Research Council (CNPq) in Brazil.The authors report no competing interests. History Published online 1 May 2011 Published in print 1 May 2011