Midsommar's Portrayal Of Bipolar: Why Do Horror Films Always Get Mental Health Wrong?

Cinema-goers, charities and campaigners have raised concerns about the link between violence and mental illness in the film's opening scenes.

Warning: this article contains spoilers regarding the film’s opening scenes.

Midsommar might be the horror hit of the summer, but for some viewers, the first 15 minutes have proved unsettling for all the wrong reasons – thanks to the film’s graphic depiction of a character with bipolar disorder.

Director Ari Aster’s follow-up to his terrifying 2018 thriller Hereditary is about a group of millennials attending a cult-like summer solstice festival in Sweden. The film has divided HuffPost UK’s entertainment team, who can’t agree if it’s “nightmarish” or “predictable” – while fans are furiously debating hidden details in its dark and twisted turns.

The film’s main “shroom-fuelled” storyline is prefaced with a short backstory in which Dani (played by Florence Pugh) receives a “goodbye” email from her sister who we’re explicitly told has bipolar disorder. We learn that Dani’s sister has died by suicide and has murdered their parents, too – before Aster shows us the aftermath of these events in shocking detail.

Alice Boyd, 23, an English teacher from Reading who lives with bipolar disorder, says she found the portrayal “unsettling” and that such depictions lead to “massive stigmatisation” of an illness that is already misunderstood.

After five years of misdiagnosis and poor mental health, Boyd was diagnosed two years ago with bipolar disorder type 1 (like the character in Midsommar). She is open about her illness with friends, family and colleagues, but worries how the film might impact people’s opinions, particularly among her students.

“If you didn’t know much about bipolar, you’d go away and if someone told you they had bipolar you’d be afraid of them because you’ve seen a film where someone killed loads of people,” she says. Midsommar is rated 18 in the UK, but Boyd worries that her younger students might find a way to watch it and come away feeling frightened of her. “That’s not really the first impression a person should have of such a serious disability,” she says.

Despite enjoying the rest of the film, Boyd was “disappointed” by its opening scenes because, in her view, the filmmakers didn’t need to specify that Dani’s sister had bipolar disorder. “It’s so easy to make an equivalence of violence with a mental health problem,” she says.

Since Midsommar’s UK release on 5 July, dozens of viewers have taken to Twitter to complain that it vilifies mental illness – commenting that the sister storyline has little or no bearing on the rest of the movie and is not properly contextualised. The inclusion of a physically disabled character called Reuben, who is used to evoke fear and shock, prompted cries of ableism, too.

“Hollywood has villainized bipolar to the point where people think 90% of us will snap and kill ourselves or others. It’s not OK.”

- @Maliciousduck on Twitter

“Do yourselves a favour if you want to watch Midsommar,” tweeted one cinema goer. “Just don’t. It’s got a bullshit representation of bipolar disorder and is 100% why sufferers have to deal with so much stigma. Hollywood and other forms of media have villainized bipolar to the point where people think 90% of us will snap and kill ourselves or others. It’s not OK. It needs to stop.”

Another woman tweeted that she was also “incredibly disappointed” by the first 15 minutes. “There was some seriously damaging treatment of people with mental illnesses, particularly the bipolar diagnosis,” she wrote. “I know it’s a horror film but I expected better from this director.”

Around 2% of the population fit the criteria for a bipolar diagnosis, according to mental health awareness campaign Time To Change. People with bipolar disorder will often fluctuate from one extreme mood to another, experiencing periods of mania, followed by periods of depression. It’s a very serious illness – living with bipolar increases the risk of suicide by 20 times.

With the more severe type 1, people tend towards manic episodes that last at least seven days and sometimes require hospital care, followed by shorter depressive episodes; while people with type 2 bipolar experience highs that rarely develop into a full blown manic episode, as well as the depression.

Therapist Maureen Brumby, who has bipolar disorder herself, says some people with type 1 can also experience psychotic episodes, which might go some way to explaining Midsommar’s opening scenes, but the lack of explanation makes this hard to call. “In the context of the film and in the context of the murders being carried out, I would be estimating that that individual would be in an extremely psychotic state to be able to go into those behaviours,” she says.

A 2010 study of 3,700 people in Sweden showed people with bipolar disorder were no more likely to be violent than anyone else – unless they abused drugs or alcohol. In fact, people with mental health problems are more likely to be victims of violent crime, rather than perpetrators, according to Jo Loughran, director of Time to Change, who tells HuffPost UK: “Linking mental illness to violence for dramatic effect perpetuates the problem, widening the gap of understanding and reinforcing outdated misconceptions.”

“Film and TV can be a huge force for good in mental health but there is also potential to harm, and that must be recognised and addressed.”

- Chris O’Sullivan, Mental Health Foundation

Films, particularly horror films, have often veered towards extreme depictions of mental illness – think Psycho and Halloween, both popular classics of the genre. But Chris O’Sullivan at the Mental Health Foundation urges people who are vulnerable to think twice about seeing Midsommar at the cinema.

“Mental health charities can’t be the arbiters of what is entertainment, but we do have two major concerns about Midsommar,” he explains. The first, he says, is the link made between mental illness and violence; the second is the graphic depiction of the suicide method. “The film opens with a mental health crisis leading to violent death by homicide and suicide,” says O’Sullivan. “We can’t escape the fact that sometimes tragedies of this nature occur, but associating mental illness and violence in entertainment increases stigma.”

When it comes to suicide, he adds, there is evidence to suggest that showing suicide methods in close detail leads to increased suicide attempts using those methods. Indeed, it is this link that has led to the Samaritans’ widely accepted media guidelines on how to report stories that involve suicide.

“Film and TV production professionals should be as mindful as news journalists in how they depict suicide,” argues O’Sullivan. “Film and TV can be a huge force for good in mental health but there is also potential to harm, and that must be recognised and addressed.”

In the past year, Bradley Cooper’s A Star Is Born and the Netflix series 13 Reasons Why have both been criticised for depicting a character’s suicide in upsetting and graphic ways, while Bird Box, starring Sandra Bullock, faced a backlash for its “negative depiction of mental health”. This week, the criticism of 13 Reasons Why led the show’s producers to remove the suicide scene from season one, two years after it first aired.

Bradley Cooper and Lady Gaga in A Star Is Born.
Bradley Cooper and Lady Gaga in A Star Is Born.

Sophie Robinson-Matthews, a psychotherapist based in Wolverhampton and a member of the Counselling Directory, believes the media is particularly “unkind” to people with bipolar disorder and schizophrenia – and also nods to criticism of M. Night Shyamalan’s 2016 film Split, in which James McAvoy plays a character with dissociative identity disorder who abducts and torments three teenage girls.

A 2016 study of films featuring a protagonist with schizophrenia found there was a high frequency of violent behaviour, implying that individuals “are overwhelmingly dangerous and to be feared”. The author concluded that filmmakers are “presenting audiences with crude and monstrous characters that contribute substantially to the discrimination and stigma attached to individuals living with the disease” – and called on the film industry to do better.

Robinson-Matthews often works with patients who have bipolar disorder and raises two concerns about Midsommar: that it will “make people fear those with bipolar” but also, for her clients, that it will “reinforce the isolation and stigma surrounding the illness”. There was no need for Midsommar to mention bipolar, she argues – the film’s creators could have very easily not referenced a mental illness at all.

HuffPost UK approached director Ari Aster to ask about the rationale behind his opening scenes, but has yet to receive a response. Aster told GameSpot the movie was originally three hours and 45 mins long, but he cut it down to two and a half hours – which might account for a lack of context surrounding the suicide and homicide at the start.

The backlash to Midsommar prompts a key question for audiences and the industry: can we ask the same of film makers as of journalists when it comes to treating mental health with care and sensitivity?

Rhianna Dhillon, a broadcaster and film critic, argues not. While she agrees that it was “unnecessary” to put a label on Dani’s sister’s condition, she says cinematically the opening scene is “spectacular and incredibly effective, setting the tone for the rest of the film, which is incredibly unsettling and jarring.”

Laying a horrific crime at the door of someone suffering with severe mental illness is “less stigmatising for the people suffering with these conditions and more laziness on the writer’s part”, she suggests – adding that while Aster doesn’t delve into what it means to have bipolar disorder, he does explore grief and the intricacies of being in a controlling relationship.

Dhillon believes we veer into “dangerous territory” if we start issuing edicts on what filmmakers can and can’t cover. “A huge part of cinema is debating the content of the film you’ve just seen, that’s what makes it exciting,” she says. “It’s vital that cinema maintains a balance when it comes to representation of anything and anyone, otherwise stories become stale, predictable and pedestrian.”

For each film that plays into stereotypes of mental health, there can be films that portray the issues “from a more knowledgeable perspective”, Dhillon adds, and if the backlash against Midsommar sparks appetite to make or support films that portray bipolar disorder in a different way, “that can only be a good thing”.

Acknowledging the graphic suicide scene, Dhillon thinks it might be useful for cinema or booking websites to flag there are triggering events in the film. A parallel debate is currently playing out in UK theatre, with the recent introduction of content advisory warnings by London’s Donmar Warehouse on its shows.

At the time of writing, Midsommar had an 82% approval rating on the Rotten Tomatoes movie review aggregator – arguably, even more reason to get this right. For Alice Boyd, who enjoyed the film’s overall story arc, particularly the notion of a horror movie set in broad daylight, she would like to see filmmakers like Ari Aster considering the impact of their work on audiences in future.

“The director has really big potential and has obviously got a lot of talent,” she says of Aster, “but I feel like perhaps he needs to be more understanding of the implications of using these mental health diagnoses as quips.”

Useful websites and helplines:

  • Mind, open Monday to Friday, 9am-6pm on 0300 123 3393
  • Bipolar UK offers practical information, advice and support by phone and email. Find support on its website or, to arrange a call back, leave a message on 0333 323 3880 or email info@bipolaruk.org.
  • Samaritans offers a listening service which is open 24 hours a day, on 116 123 (UK and ROI - this number is FREE to call and will not appear on your phone bill.)
  • The Mix is a free support service for people under 25. Call 0808 808 4994 or email: help@themix.org.uk
  • Rethink Mental Illness offers practical help through its advice line which can be reached on 0300 5000 927 (open Monday to Friday 10am-4pm). More info can be found on www.rethink.org.