Written into Reality: Mental Health Stigma in Literature

Representations of mental health in literature can contribute to negative stereotypes that stigmatize real people—or they can combat those very stigmas.

Author's Corner Book Culture Diverse Voices Opinions
On a pale yellow background sits a multi-colored image of a brain hovering over an open, multicolored book. Dark blue swirls branch out from the gap between the brain the the book on each side.

Whether we realize it or not, literature shapes the way we interact with the world and the people around us. Sometimes, literature’s effects on us are obvious—every bookworm has at least one book that changed their life. But at other times, these impacts are more subtle. The more certain stereotypes are normalized in the media we read and watch, the blinder we grow to them. That’s why it’s important that we take the time to look critically at the representations the literary world gives us. So, let’s talk about mental health and the stigmas that can arise from poor representation.

Numbers Don’t Lie

According to Mental Health America, nearly 20% of adults in the US deal with at least one mental illness. In younger generations, as understandings of a broad spectrum of mental health issues grow, so do diagnoses. Johns Hopkins Bloomberg School of Public Health has found that 21.8% of American children experience just the most common mental health disorders. That percentage grows with the inclusion of less common disorders. With these numbers, chances are that we all know at least a few people with diagnosed mental illnesses—and that could include ourselves!

It’s therefore vital that authors get mental illness representation right, and even more so that we as readers ask ourselves: what stereotypes do I see in this book? What assumptions do I make about mental illnesses because of what I’ve read? How can these assumptions impact people in real life? And most importantly, what can I do to combat stigmas surrounding mental illness?

Through the Looking Glass


Dr. Rudine Sims Bishop teaches that when it comes to representation, readers need windows and mirrors. Windows offer glimpses into the experiences of people who are not like us, while mirrors allow us to see ourselves represented in our favorite stories. But what happens when the glass is warped?

The horror genre boasts some of the most prevalent depictions of mental illness, with thrillers and murder mysteries not far behind. The result: mental illness becomes synonymous with violence in popular culture. Some of the most targeted conditions in these types of representations are schizophrenia, dissociative identity disorder (DID), and antisocial personality disorder (ASPD). When readers who internalize these stereotypes only see violence and negativity associated with these disorders, they may not be able to see anything else.

On a pale yellow background, a short-haired, light-skinned person stands with their back to the viewer, facing a mirror. In the mirror is a silhouette of a demon's head and shoulders.
IMAGE VIA BOOKSTR / ALEXA QUEZADA

Another common portrayal of mental health disorders is the manic pixie dream girl trope. The manic pixie dream girl can be ditzy, disorganized, quirky, and haunted by her past in a way that’s just this side of endearing. Because these traits are associated with women in stories with male protagonists, they become romanticized or sexualized. Manic pixie dream girls often fall into the categories of obsessive-compulsive disorder (OCD), attention-deficit/hyperactivity disorder (ADHD), generalized anxiety disorder, or post-traumatic stress disorder (PTSD). Like with violent stereotypes, the romanticized quirky stereotype can leave these kinds of characters one dimensional, with nothing else to define them except their mental illnesses.

In real life, people with mental health disorders are more than just their diagnoses—though their disorders may greatly affect them. These people are family members, friends, coworkers, classmates, and neighbors, and their lives are just as rich and multifaceted as anyone else’s.

Beyond the Page


The mental health stigmas that pervade through literature don’t stay fictional. They affect real people: the way they’re viewed by the people around them, the treatment they receive from doctors, even their own self-image, and the likelihood they’ll seek diagnosis and treatment that could help them.

But how can we oppose these stigmas? Begin with your own bookshelf: read books with positive representations. You can find these books by reading reviews and seeking recommendations from sites just like Bookstr! Own Voices books are also generally great for accurately representing all types of experiences, not just mental health. Most importantly, keep an open mind and think critically about the representations you see in literature and the messages they send.


Find recommendations for mental health representation here.

For more reading recs, check out Mindscapes: Diverse Narratives of Neurodiversity in Literature on Bookshop.

FEATURED IMAGE VIA BOOKSTR / ALEXA QUEZADA