Stereotyping and stigmatising attitudes towards psychiatric patients are maintained and periodically reinforced by the ‘bad press’ that psychiatry receives (Reference Angermeyer and MatschingerAngermeyer & Mattschinger, 1996, Reference HammondHammond, 1996; Reference PhiloPhilo, 1996).Numerous recent examples testify to the concern that this arouses in the general public (Reference PhiloPhilo, 1996), but media coverage of psychiatric disorders has probably always been selective, negative, misinforming and melodramatic (Reference NunnallyNunnally, 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.

The study

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.

Findings

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.

Table 1 Examples of positive, neutral and negative newspaper headlines about medicine and psychiatry

Category	Examples
Psychiatry
Positive	Radical policies to end the failure of community care
	Measles jab suspected in autism cases
Neutral	Peace of mind
	Don't worry, it's just your genes
	Is the Duchess really a suicidal type?
Negative	Psychiatric bed cuts ‘could lead to more murders’
	‘Why was schizophrenic freed to kill my father?’
	Victim's agony as senile sex beast is freed
	Judge warns of mentally ill nightmare
	Health shake-up after ‘care in community’ fails
	Inquiry after mentally ill man was set free to kill
Medicine
Positive	BSE epidemic ‘could be over by mid-1998’
	Polio and measles ‘to be erased by 2010’
	Treatment offers hope for ‘human vegetables’
Neutral	Sex ‘can ward off stomach ulcers’
	Protests lead to rabies rethink
Negative	Food poisoning reaches epidemic level
	Doctor questioned over woman she pronounced dead
	Wicked nurse suspected of over 30 sabotage incidents
	Fake doctor gave two injections to patients

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).

Comment

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 (Reference Day and PageDay & 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 (Reference Day and PageDay & Page, 1986). The recent College survey found that 54% of 1292 reports in the British press over one year were negative (Reference Hart and PhillipsonHart & 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 (Reference Barnes and EarnshawBarnes & Earnshaw, 1993; Reference HammondHammond, 1996; Reference PhiloPhilo, 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.