Although mental illness has a high prevalence rate, the prevalence rate of obsessive-compulsive and related disorders is relatively low. Because media, such as films and television shows, is the greatest informer of the public today, characterizations of the mentally ill, such as those suffering from obsessive-compulsive or a related disorder, can create or negate stigma and stereotypes. In an attempt to reduce stigma around mental disorders and encourage the mentally ill to seek help, visual media’s portrayals of the mentally ill must be evaluated for accurate depictions. The Aviator is one such film that characterizes a mental illness, obsessive-compulsive disorder in particular. The main character, Howard Hughes, is analyzed to determine if he meets the criteria for obsessive-compulsive disorder and if his portrayal de-stigmatizes or further stigmatizes mental illness.
Although the lifetime prevalence of any mental disorder is 50%, and the one-year prevalence is 25%, the prevalence of different mental illness varies within these statistics (Sue, Sue, Sue, Sue, 2013). For example, Obsessive-compulsive Disorder (OCD), which is characterized by anxiety-producing obsessions and anxiety-reducing compulsions, has a one-year prevalence of 1% in American adults, an estimated number of 2.2 million people (“Facts & statistics”). Approximately 50.6% of these cases are labeled as severe, with the average age of symptom onset being 19 years (“Obsessive compulsive disorder among adults”). According to the Anxiety and Depression Association of America, the classification of disorders to which Obsessive-compulsive disorder belongs, anxiety disorders, is the most common mental disorder in America. Those who have an anxiety disorder are 6 times more likely to be hospitalized for a psychiatric illness as well. Anxiety disorders can be comorbid with bipolar disorder, eating disorders, headaches, irritable bowel syndrome, sleep disorders, substance abuse, adult attention deficit/hyperactivity disorder, body dysmorphic disorder, chronic pain, and fibromyalgia (“Facts & statistics”). Although Obsessive-compulsive disorder has a low prevalence rate, the term “OCD” can be heard in common conversation. However, the growing recognition of this mental illness may not entirely be due to the large number of people affected by this disorder, but instead through its introduction by various media forms. Although mental disorders as a whole have a high prevalence rate, OCD’s relatively low prevalence rate (1.6% lifetime prevalence) means that many people obtain information from media, especially films and television shows. However, digital media consumers not only acquire whatever information about mental disorders is presented, but the stigma and positive or negative associations related to the disorder as well. Because a community’s perceptions of a mental disorder can impact an affected individual’s pursuit of treatment, in order to reduce stigma of various mental disorders, the accuracy in depicting a mental disorder in media portrayals of persons with mental illnesses must be evaluated in in order to correctly inform public perception of mental illness in a de-stigmatizing manner.
An example of media portrayal of mental illnesses is the depiction of obsessive-compulsive disorder in The Aviator. This film was directed by Martin Scorsese and was released in the United States on December 24, 2004. Leonardo DiCaprio stars as Howard Hughes, Cate Blanchett as Katharine Hepburn, John C. Reilly as Noah Dietrich, and Kate Beckinsale as Ava Gardner (“The Aviator (2004)”).
This film is a biographical movie of the life of director and aviator Howard Hughes from the late 1920’s to mid-1940’s. The Aviator relates Howard Hughes’s great achievements, such as the production of the movie, Hell’s Angels, breaking aviation records, flying around the world in record time, the flight of Hercules, and the creation Trans World Airlines, amidst his increasing anxiety, fears, and compulsions. The movie depicts both Hughes’s public life, including public perception of him, and his private life, containing his relationships with Katharine Hepburn and Ava Gardner. The film had an estimated $110,000,000 budget, but only made $858,021 in the United States during its opening weekend. Nevertheless, The Aviator has won 5 Oscar awards, 3 Golden Globes, 4 BAFTA awards, 1 Screen Actors Guild Award, and 1 Movie of the Year AFI award (“The Aviator (2004)”).
Impact on Critics and Audiences and Public Reception
The Aviator currently has 7.5 out of 10 stars on the Internet Movie Database and 4 out of 5 stars on Amazon. Although reviews on the Internet Movie Database praised the cinematic artistry of the film and the actors’ performance, a common criticism of the film is summarized in a review titled “Falling Short of Greatness…Again,” which was published near the movie’s 2004 release date. According to this reviewer, whose review is ranked as the most helpful, The Aviator does not completely satisfy the audience because the film appears to have no unifying theme. The author emphasizes the absence of a true emotional journey. The only reference to obsessive-compulsive disorder is Hughes’ indulgence of “personal obsessions” (“The Aviator (2004)”). Similarly, Amazon reviews pointedly praise the art direction and acting, marveling over the depiction of Howard Hughes himself, rather than obsessive-compulsive disorder. The one obvious review that addresses the portrayal of a mental illness was a 2-star Amazon review entitled “A great life – a mediocre movie.” This particular review described Howard Hughes as a Jekyll and Hyde character, “paralyzed by madness one moment…and in another moment fighting for his business.” This review highlighted some of the discrepancies in the portrayal of obsessive-compulsive disorder in the film and called for explanations for Hughes’ paranoia about disease. Nevertheless, the review still states the movie is worth watching despite his or her 2-star rating (Ujnat).
Manohla Dargis’s article in The New York Times describes The Aviator as a “disappointingly hollow account of Hughes’s early life,” (Dargis). Although the review does not mention the depiction of obsessive-compulsive disorder, it praises the film’s use of camera movements and scene cuts to portray characters’ thoughts. Roger Ebert’s review, which gave the film 4 out of 5 stars, also has no mention of obsessive-compulsive disorder, but commends the use of special effects and cinematography.
Because The Aviator is a biographical film whose director is known for the superb use of editing, art direction, and narration, the reviews largely focused on the historical accuracy and cinematography, rather than the portrayal of obsessive-compulsive disorder, in the film.
Just as the majority of reviews praise Martin Scorsese’s cinematography, any person, with or without a basic knowledge of filming, can appreciate the crafting of The Aviator. Although there is a general consensus on the cinematographic success of the film, the main concern is the depiction of obsessive-compulsive disorder: how the editing attempts to explain the causes and effects of the disorder in a real and de-stigmatizing manner, devoid of stereotypes. In that respect, reviewers, such as Carlo Cavagna, state that Scorsese “has once again made a film about man versus himself,” implying that the film successfully captured the internal struggle related to mental disorders (Cavagna).
Throughout the film, cause-effect editing is distinctly used in an attempt to illustrate possible explanations for Howard Hughes’s obsessive-compulsive disorder. The opening scene of the movie attempts to present an etiological view of the disorder by illustrating social, psychological, and biological factors that may have contributed to Hughes’ expression of OCD symptoms. The movie begins with Howard Hughes’ mother bathing him as a young boy, with the first image being her use of soap, a typical and widely known association with OCD (1:50). She demonstrates aspects of social and psychological factors, such as cognitive distortions, controlling parenting, and modeling, which affect the development of obsessive-compulsive disorder. For example, Hughes’ mother verbalizes her fear of diseases, such as cholera and typhus. She instills fear by asking questions, such as, “Do you know what they can do to you?” and stating, “You’re not safe,” (2:10). She models coping with these obsessive thoughts by bathing, washing, and spelling words, such as “quarantine.” The effects of these early experiences are displayed later in the film, through parallel shots that demonstrate the increasing severity of Howard Hughes’ hand washing and spelling of words such as “quarantine” and verbal repetition of phrases. The audience is able to gain a cursory etiological view of obsessive-compulsive disorder by visualizing the pairing between early teachings and later obsessive-compulsive responses to stress, hopefully reducing the stereotype that a mental illness is controlled choice of an individual.
The shot reverse shot editing sequence is used later in the film to contrast the interactions of Howard Hughes and his competitor, Juan Trippe. A door separates the two men in every shot to demonstrate how Howard has isolated himself from the world due to his increasing distress (135:05). This editing sequence illustrates how impactful Hughes’ symptoms have become on his life. The contrast between Trippe and Hughes also serves in providing a sense of the degree to which Hughes’ life has changed: in the prime of his life, Hughes was Tripp, well dressed, confident, and a serious competitor. His mental disorder has contributed to his isolation and impairment in the social and business aspects of his life. These scenes help illustrate how pervasive a mental disorder can be. Audiences know that they would not choose to live the lifestyle Hughes does, unclothed, urinating in bottles, and unclean. This combats the stereotype of mental illness as a “choice.” Although this depiction of obsessive-compulsive disorder combats stereotypes, it may not entirely de-stigmatize this particular mental illness because of the viewers’ inability to relate to the main character, Howard Hughes.
Two components of art direction, light and sound, were utilized in the chronicling of Howard Hughes’s obsessive-compulsive disorder. During the opening of the film, when Howard Hughes’s mother is modeling obsessive-compulsive behaviors, the light is soft, low, and an amber color. This may represent Hughes’ immersive beginnings in obsessive-compulsive behaviors. The soft, warm light reflects the motherly comfort and stress-relief associated in performing compulsions. Throughout the film, light intensity and color will symbolize the pervasiveness of Howard’s OCD symptoms. During this initial scene, the obsessions and compulsions do not influence Howard to the extent that they influence his mother. The obsessions and compulsions are external at this point.
Throughout the middle of the film, during Hughes’s success as a director, the light becomes hard, glaring, and bright white. When walking the red carpet after his release of Hell’s Angels, the bright, white light bulb flashes of cameras and reporters represent Hughes’ distress (23:00). Hughes’ increasing discomfort on the red carpet is paralleled throughout the film to highlight the progression of his obsessive-compulsive disorder (54:22). During these scenes, Howard Hughes’s inappropriate responses in conversations and hand washing rituals are magnified. The harsh, white light is not only paired with red carpet scenes, however; when prompted to make decisions concerning airplane designs, Hughes must retreat to his car where he repeated spells the word “quarantine,” (100:37). A searing, white light, indicating the intensity of his disorder, illuminates his face.
Towards the end of the film, once Hughes has isolated himself, his obsessive-compulsive disorder is represented by a red light that is not quite soft, but almost. This light represents how encompassing Hughes’ mental illness has become. Instead of flashes of light, each scene is lit with red. His obsessive-compulsive disorder affects every aspect of his life, just as the brown light represented the impact of OCD on his mother. The red color represents his feeling the need to perform his compulsions and the disorder’s complete hold on his life.
Therefore, The Aviator uses light to record Howard Hughes’ struggle with obsessive-compulsive disorder. Soft, brown light accompanies maladaptive learning in childhood. Harsh, white light in an increasing frequency documents his struggle with OCD symptoms, while remaining largely functional. The constant, red light depicts Hughes’ complete capitulation to obsessive-compulsive disorder, to the point where he is unable to function in all areas of his life.
The Aviator has many perspectives, one for each character and how she or he views and is affected by Hughes’ mental illness. Although these points of view inform the viewers’ own take on mental illness, an interesting form of narration employed by the film are the voice-overs of newscasters. The voice of a newscaster overlies scenes and provides public perception of Howard. Audiences will tend to adopt the same point of view of the newscaster; although the newscaster does not comment on Hughes’ expression of obsessive-compulsive behaviors, the public and audience’s feelings towards Hughes may generalize to their feelings toward the disorder he represents. When the media is against him continuing to spend money on his film after the stock market crash and the death of three pilots, the audience is against him as well (22:00). However, when the media supports his release of Hell’s Angels, saying, “It cost four million dollars and has four million thrills,” the audience is somewhat swayed towards his character (26:20). Nevertheless, the most impactful perspective is that of Hughes’ two lovers, Kate Hepburn and Ava Gardner. Kate Hepburn’s initial support and maintenance of a relationship with Hughes, illustrated by her reassurance that she will “take the wheel,” contends with the stereotype that the mentally ill cannot have healthy, working relationships (51:18). However, this stereotype is later reinforced when both Hepburn and Gardner leave Hughes, and Gardner’s statement of, “You’re too crazy for me,” (141:30). The points of view in The Aviator encompass and portray many aspects of mental illness; however, the film attempts to use different perspective to combat stereotypes and stigma of mental illness and is successful in some instances, while failing in others.
Analysis of DSM-5 Criteria
The Diagnostic and Statistical Manual of Mental Disorders (Fifth Edition) categorizes obsessive-compulsive and related disorders closely to anxiety disorders. Disorders related to obsessive-compulsive disorder include body dysmorphic disorder, hoarding disorder, trichotillomania (also known as hair-pulling disorder), excoriation (skin-picking) disorder, substance or medication induced obsessive-compulsive and related disorders, and other specified and unspecified obsessive-compulsive and related disorders (American Psychiatric Association, 2013, 235).
The diagnostic criteria for obsessive-compulsive Disorder include the presence of obsessions and/or compulsions. Obsessions are thoughts that occur repeatedly and continually which the individual views as undesired and disruptive and are combatted through other thoughts and actions that cause anxiety and distress. Compulsions are the repeated actions or mental steps the individual feels compelled to perform in response to obsessions. Repeated behaviors include washing of the hands, checking, and ordering, or mental acts, such as praying, counting, repeating words silently. Compulsions are intended to combat anxiety and distress, although they are not realistically related to the obsessions. Although obsessions and compulsions differ among individuals, the most common symptoms include cleaning (obsession with contamination and compulsions of cleaning), symmetry (obsession with symmetry ad compulsively repeating, ordering, and counting), banned or socially undesirable thoughts (obsessions with aggression, sexual actions, or religion and complimentary compulsions), and harm (obsessions with fears of harming oneself or others and associated checking compulsions) (American Psychiatric Association, 2013, 235-236).
The next criterion for obsessive-compulsive disorder is for the obsessions and/or compulsions to be time-consuming (taking an hour or more of each day) or causing distress or dysfunction in social, occupational, or other areas of function. The symptoms cannot be the physiological effect of a substance or some other medical condition. Finally, the symptoms of obsessive-compulsive disorder cannot be better explained by some other disorder (American Psychiatric Association, 2013, 237).
Analysis of Fulfillment of DSM-5 Criteria
The first criterion of an obsessive-compulsive disorder is the presence of obsessions and/or compulsions. Although repeated, distressing thoughts can be difficult to convey in visual media, The Aviator is successful in communicating Hughes’s stressful thoughts to the audience. These obsessions are relayed by Hughes’s mother’s verbalization of her fear of cholera and typhus and her refusal to go to certain places because of the potential of contracting a disease (4:10), Leonardo DiCaprio’s furrowed brow and stressed facial reactions throughout the film (31:00), Hughes’ statements about cleanliness, such as the statement “She’s got to be clean,” when concerning his planes (30:40), his explanation of avoiding the “crap on people’s hands” for the cellophane on the steering wheel (37:50), his expression that he perceives things that may not be there and he fears he is losing his mind (51:18), his indication of his inability to pass a towel in the bathroom (56:00), and his declarations of paranoia (89:35, 98:07, 114:20). The presence of Howard Hughes’ repetitive and distressing thoughts allow him to meet the first criterion of obsessive-compulsive disorder, the presence of obsessions and/or compulsions.
However, Hughes also demonstrates compulsions, repetitive physical actions and mental processes, in response to his obsessions. His compulsions include his rigid separation of peas and meat on his plate and his refusal to eat when his food is disturbed (35:42), his repeated tracing of plane rivets (42:15), his rigorous hand washing, to the point which his hand cuts and bleeds (56:00, 87:00), his burning of clothes (79:21), his repetition of phrases, such as “Show me all the blueprints,” (99:41) and “I need to sleep,” (124:50), his spelling of the words “quarantine” and “llama” (119:40, 130:50), his distress at investigators touching his things (117:07) and a fingerprint on his glass, (120:35), his dictation of his actions (125:30), his counting on his fingers (130:20), and his germ-free zone and use of tissues to open doorknobs (138:15, 139:09). These repeated behaviors in response to stress also fulfill the first criteria of obsessive-compulsive disorder.
The second criteria for obsessive-compulsive disorder is for the obsessions and/or compulsions to be time-consuming, at least one hour of every day, or cause significant impairment in social, occupational, or other areas of life. Howard Hughes fulfills this criterion as well. His compulsions are so time consuming that his media comments on the amount of time needed to finish Hell’s Angels, his inability to produce planes on time, and the amount of screen time dedicated to the manifestation of his obsessions and compulsions. Throughout the film, and particularly towards the end, Hughes is unable to function socially, occupationally, and in many other aspects of his life. His relationships are disrupted by his obsessive-compulsive disorder, he clasps his hand over his mouth repeatedly to stop his repetition of phrases, and the culmination of life impairment is when he isolates himself in his room, not even leaving to relieve himself in a bathroom.
The analysis of Howard Hughes’s character leads to the conclusion that he can be diagnosed with obsessive-compulsive disorder because he fulfills all the criteria for the disorder, including the presence of obsessions and compulsions, their time-consuming nature, and their impairment in all areas of his life, and his symptoms do not appear to be a physiological effect of a substance or some other medical condition.
Although The Aviator’s Howard Hughes clearly meets the criteria of the DSM-5’s classification of obsessive-compulsive disorder, there were still aspects of his personality and his behavior that cannot be explained by his diagnosis. One might conclude that he has a social anxiety disorder or is agoraphobic by his awkward responses in conversations and his discomfort on the red carpet (23:45, 34:45, 58:40, 122:20). He could possibly have Asperger’s because of his fixation on his interests, such as aviation, and his distress at deviance from norms, such as when the investigators are going through his things (61:01, 62:20). There are also unexplained personality traits, such his obsession with milk, which does not appear to be a compulsion in response to an obsessive thought (38:53), and his fear of rare meat (60:30). Because obsessive-compulsive disorder can be comorbid with other mental illnesses, Howard Hughes’s character may not solely depict obsessive-compulsive disorder. The audience may not know about comorbid illnesses and may attribute all symptoms to obsessive-compulsive disorder, the mental illness listed in the summary. Although characters should not be defined only by their mental disorders, the inclusion of symptoms of other disorders can cause confusion and misperception in the public if no clear explanation of indication of a character’s mental health is given.
The Aviator contains both stigmatizing and de-stigmatizing portrayal of mental illness. A few stereotypes were reinforced. For example, the stereotype of a mentally ill person’s inability to have healthy relationships was reinforced through Hughes’s failed relationships with Ava and Kate, although he maintains his relationship with Kate for a significant amount of time. The stereotype that a person with a mental disorder chooses to be mentally ill was reinforced by Hughes’ purposeful drinking from the same bottle as Kate (40:10) and his success at his trial, even after showing severe impairment (155:0). Nevertheless, the film also had a de-stigmatizing effect as well. A very influential example was Hughes’ inability to pass a towel to a man on crutches in the bathroom (56:00). Although this scene can be seen as either stigmatizing, wherein the man on crutches as a “real” illness that prevents him from reaching the towels, this scene can also be viewed as mental illness and physical illness on the same playing field. Both illnesses equally prevented each man from reaching the towel; therefore, each illness is valid. In addition, although Hughes does have a mental illness, he is still extremely successful in aviation, breaking records and creating airlines. This shows that a person can be successful despite a mental disorder. Therefore, this film contains both stigmatizing and de-stigmatizing characterizations of obsessive-compulsive disorder.
Obsessive-compulsive disorder was depicted in a somewhat frightening manner. Although this may be due the director’s attempt to adhere to Howard Hughes’s real life, audiences both at the time of the movie’s release and now were somewhat disappointment by the lack of a cohesive storyline. This portrayal of mental illness may have been an advancement in 2004, but increased access to information on mental illness and obsessive-compulsive disorder would necessitate a more de-stigmatizing and positive characterization today.