Numerous musical theatre productions, television programs and movies vividly portray characters experiencing mental illness, including issues of depression, social anxiety and suicide. While some media offers content warnings, viewers may be surprised and triggered by intense portrayals of emotionally laden topics. Since about one in five Americans experience mental illness annually, and even more people care about someone living with mental illness, the potential impact on audiences is considerable. For actors, authentically portraying characters with serious mental health issues can also take a toll. 

“When you really get into character, your blood pressure goes up, your heart rate increases and your mind and body can’t differentiate between reality and acting,” said Michelle Sherman, PhD, professor in the University of Minnesota Medical School’s Department of Family Medicine and Community Health. “Your body goes through this emotional experience in intense ways, and that’s hard to just turn off.”

Dr. Sherman, a clinical psychologist, and colleagues Robert Levy, MD, assistant professor in the Department of Family Medicine and Community Health, and Jessica Larsen, PhD, recently published the paper, “Shining a spotlight on issues of mental health in musical theatre and ways psychologists can help: Perspectives of theatre professionals,” in the journal Professional Psychology: Research and Practice. Their research explores the portrayal of mental illness in theatre from the perspective of professional actors, directors and choreographers, along with how a behavioral health consultant (BHC) might help both performers and the audience deal with psychological themes.

“As a psychologist, choreographer and long-time fan of musical theater, the opportunity to merge my passions and engage in robust discussions with theater professionals has been meaningful and enjoyable,” Dr. Sherman said. 

A Spotlight on Mental Health

Dr. Sherman’s unique study involved in-depth interviews with 15 professional theatre actors and directors to better understand how psychological themes can impact the production team and audience, along with the potential benefits and roles of a BHC.

“Theoretically, theater has the potential to help both the actors and audience by providing information about mental illness, challenging stereotypes, reducing stigma, decreasing the sense of isolation, providing role models and instilling hope,” Dr. Sherman said. “It’s possible that the addition of a BHC could help theatre companies achieve these goals.”  

Study participants shared that audience members who struggle with mental health concerns can feel less alone when seeing mental illness portrayed on stage. Theater can also spark discussion and personal reflection about mental illness, decrease stigma, build empathy for people living with mental illness and even encourage activism.

On the other hand, about two-thirds of research participants shared that viewing mental illness in the media or on stage has the potential to be distressing. For instance, after the release of the Netflix series 13 Reasons Why, there was a significant uptick in teen suicide. Consequently, Dr. Sherman recommends having some form of a trigger warning in marketing materials to indicate that the program contains content depicting mental health topics.

Research participants also reflected on their emotional challenges as actors portraying these intense characters on stage and noted numerous roles a BHC could play to help both the audience (e.g. post-show discussions) and actors (e.g. self-care skills, portrayal of mental illness in an authentic and non-stigmatizing way, setting boundaries between their character and personal life).

“I think having a behavioral health consultant can certainly make it safer for the actors in terms of their own mental health,” Dr. Sherman said. “Acting is tough – you’re asked to go to dark, difficult places within yourself. It’s important to manage that without getting burned out or too overwhelmed.”

The Role of a Behavioral Health Consultant

Shortly before the pandemic, Dr. Sherman served as a BHC with a local theatre company that produced “Next to Normal,” a musical with themes of bipolar disorder and suicide. Early on in the rehearsal process, she met with the actors and production team and provided education about bipolar disorder and its impact on the family. She also facilitated discussions about the personal relevance of the show for the actors, many of whom had family members living with mental illness. 

“Then, I would go to rehearsals to observe and provide feedback to help the actors craft their characters,” Dr. Sherman said. “I also taught self-care skills to help actors turn off the role and set boundaries with themselves.”

In addition, she facilitated a post-show discussion and wrote a section in the program focused on the mental health topics covered in the show, as well as a list of community resources.

The Future of Theatre and Mental Health

While live theatre productions have the luxury of offering in-person, post-show discussions, the public may experience similar themes on television and in movies without any support. The popular stage musical, “Dear Evan Hansen,” will be released in movie theaters in September, giving the general public access to this powerful production which vividly portrays topics of suicide, depression and social anxiety. The musical’s movie release is an opportunity to shape the discussion and public understanding about mental illness. 

“In my mind, it’s important for the community – clergy, educators, journalists, mental health professionals and nonprofit organizations, such as the National Alliance on Mental Illness (NAMI) – to take a community-based approach,” Dr. Sherman said. “They can proactively open the dialogue about ‘Dear Evan Hansen’ and its messages, provide accurate and destigmatizing information about mental illness, encourage people who are triggered by the show to seek professional help and offer local resources.” 

Dr. Sherman hopes to find more theatre companies in the Twin Cities willing to try out the BHC concept to further examine the feasibility and usefulness of this role. She’s also hoping to get audience feedback on how a BHC can be useful.

“There’s really not much research around theatre and mental health,” Dr. Sherman said. “I’m hopeful this area will really grow, as I see considerable benefits for both audience members and performers.”