By Randy Withers, MA, NCC, LCMHC
Post-Traumatic Stress Disorder (PTSD) is a complicated mental illness that develops in response to a real or perceived threat of death or gross bodily harm. The condition is typically marked by hypervigilance, nightmares or flashbacks, mood reactivity, adverse reactions to triggers, avoidance, intrusive thoughts and overwhelming feelings of guilt and shame. Due to its complex nature, PTSD presents in varied ways, and people who live with the condition are often masters of concealing its effects.
We exist in a culture that celebrates — or is, at the very least, fascinated by — violence, and Hollywood is no exception. Dozens of films and television shows feature characters who show signs of PTSD. As the entertainment industry is known for taking poetic license, it’s not surprising that many of these depictions miss the mark.
As a therapist, I appreciate accurate and engaging depictions of mental illness, whether the illness renders the character sympathetic or not. What I look for in media portrayals of mental health conditions is believability. What I want is to be moved.
More specifically, I value depictions of PTSD in film and television shows where the condition itself is not necessarily the focus; instead, it simply adds dimension and humanity to the characters. Mental illness doesn’t define people, nor does it have to be the main focus of a movie to be an accurate and successful depiction of it.
Here are six portrayals that I believe are both accurate and powerful.
The U.S. has a history of mistreating and overlooking veterans from the Vietnam War Era. In its own way, “First Blood” is a movie about the mental health consequences of these failures.
While the name “Rambo” has been synonymous with action movie clichés for decades, Stallone’s performance as a traumatized Vietnam veteran is an iconic representation of combat-related post-traumatic stress. He is hypervigilant, emotionally reactive, avoidant and he often suffers from flashbacks. The raw final scene, in which an emotionally overwhelmed John Rambo breaks down recalling the death of a fellow soldier, is worthy of an Oscar.
In 1984’s “The Terminator,” Hamilton portrayed a 19-year-old Sarah Connor, a carefree waitress targeted by a futuristic cyborg. In the 1991 sequel, however, Connor is both physically and emotionally unrecognizable.
Traumatized by the events in “The Terminator,” Connor is paranoid, hypervigilant, angry and cynical. Plagued by nightmares and visions of a nuclear apocalypse, she is relentlessly cold and focused only on the survival of her son.
Not only does Hamilton capture the essence of PTSD, she demonstrates an admirable resilience that people with PTSD often have to channel. Despite her trauma, she remains determined, driven and resolute. She is, in a word, inspiring.
“NCIS” is one of the most popular shows ever made, drawing in 10.35 million viewers for its season 18 premiere in 2020. The show’s continued renewal and success is due, in no small part, to Harmon’s portrayal of Leroy Jethro Gibbs, a former Marine sniper-turned-NCIS special agent whose wife and daughter were murdered by a drug cartel.
Gibbs is a stoic character, making it difficult to see many of his symptoms, but he does suffer from irritability, flashbacks and insomnia. He avoids relationships and, from time to time, he even suffers from psychotic breaks — specifically, hallucinations of dead NCIS agents. Additionally, the show strongly hints that these symptoms emerged after his family’s murder. In the show’s 13th season, Gibbs even seeks help from a clinician, and becomes an advocate for therapy.
While some of these symptoms are not necessarily textbook criteria for PTSD, they are nonetheless the behaviors you could expect to see in a person living with the condition.
Accurate film depictions of children with PTSD are harder to come by, but one that stands out is Gus Lewis playing an eight-year-old Bruce Wayne.
In “Batman Begins,” Wayne’s PTSD begins when he falls down a well, breaks his leg and is terrorized by hundreds of cave-dwelling bats. Lewis appears for only a few scenes in the movie, but one, in particular, highlights the painful reality for children with the condition: Wayne and his parents are at the opera “Mefistofele,” which at one point depicts a slew of characters dressed as bats. As the scene unfolds, a visibly triggered Wayne begins trembling and is forced to leave the show.
What makes this scene even more powerful is that his decision to leave ultimately proves fatal to his parents; they leave the opera from a rear exit where they are robbed at gunpoint and shot in cold blood. His PTSD becomes complex at this point, serving as the driving force behind Bruce’s decision to become a masked vigilante. Not only are Bruce’s behaviors consistent with how a child might react to certain triggers, but their long-term impact can be seriously damaging without proper help.
Based on the life of Navy SEAL Chris Kyle, “American Sniper” is one of the best depictions of combat-related PTSD of the past decade. Cooper’s thousand-yard stare is haunting, as is his body language and interaction with others. Watching Kyle navigate his extreme discomfort and mask his symptoms is especially jarring — and, unfortunately, reflects how many people with PTSD feel they must act as if nothing is wrong. In one particularly powerful scene, Kyle is at a family barbecue, sitting with his wife and watching his son play with the family dog. When the dog appears to attack the child, Kyle is triggered and almost kills the dog before his wife intervenes. The look of humiliation on his face is haunting.
In real life, Kyle worked through his own PTSD by helping fellow veterans who also struggled with the condition before his death in 2013.
Playing detective Olivia Benson, Hargitay gives an outstanding performance of a strong woman who both counsels victims who suffer from PTSD while living with it herself. Benson’s exposure to all manner of horrific crimes is easily enough to form the foundation of her PTSD, but it is her kidnapping by the notorious serial killer William Lewis that proves to be the cause of her mental health struggles. Over a period of three days, Benson is beaten, threatened with a pistol and told repeatedly that she will be raped. The threat of bodily harm, including rape, is a common cause of PTSD. Nobody, not even a strong character, is immune from PTSD.
Perhaps the most accurate and moving aspect of this show is Benson’s repeated visits to her therapist, Dr. Peter Lindstrom. As a therapist, I pay close attention to depictions of therapy and practitioners — and this character is first-rate, as are his sessions with Benson. In every scene, he presents as ethical, composed and compassionate. Benson is an imposing force, and Lindstrom’s mild-but-firm manner works as an excellent counterbalance in their sessions.
Given the show’s popularity, this portrayal of someone seeking help is particularly important. I imagine that some of those scenes encouraged survivors of sexual assault to seek help.
While this is certainly not an all-inclusive list by any means, these depictions move and empower me — as a therapist and as someone who has struggled with PTSD. Of course, trauma is an intensely personal experience, as is our relationship with film and television. We may have a different reactions to these portrayals; not every individual with mental illness interprets media in the same way.
However, these characters resonate with me because all they persevere in extraordinarily difficult circumstances. They simply carry on with their lives in the best way they know how. I encourage anyone who struggles with PTSD to seek treatment, and to carry on as best they can, too.
Randy Withers, MA, NCC, LCMHC, is a therapist and author of Therapists Share Their Thoughts on Suicide. He earned his Master’s degree in Counseling from Lenoir-Rhyne University and is the Founder of Blunt Therapy, a blog about mental health.
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