Mental illness remains highly stigmatized in society. Cinematography is a potent source of psychiatric images. Research has concentrated on mental illness portrayals in Hollywood; neglecting European cinematic perspectives.

We systematically examined European cinematic depictions of psychiatric illness and treatment. Award-winning European films were screened for psychiatric content using the International Movie Database. Two assessors independently viewed shortlisted films and compared findings. Stigma markers were derived from Link. Attributes, affective responses, attitudes and behaviours towards designated mentally-ill characters were identified through content and dramatic character analysis.

40 films between 1964 and 2009 were identified. Psychopathologies included schizophrenia, delusional disorder, epileptiform psychosis, depression, somnambulism, learning difficulties, autism, sado-masochism and transsexualism. Frequent attributions were ‘odd’, ‘inappropriate’, ‘dangerous’, ‘unstable’, ‘frightening’ or ‘perverted’. Core affective responses comprised a cluster of ‘shame’, ‘pity’, ‘disgust’ and ‘fear’. Attitudes and corresponding behaviours occurred on a spectrum of ‘benevolent’, ‘ambivalent’, ‘distant’ and ‘hostile’. Stigmatisation of psychiatric treatment included portraying home treatment within traditional societies as misguided; institutional confinement as common; and medication as dominating daily routine. Religious dimensions to psychiatric illness and care were depicted positively and negatively. Anti-stigma themes included redemptive sacrifice or artistic genius in madness; madness as a natural manifestation of industrial alienation; and madness as unjust political labelling. Stigmatising reactions were depicted as cruel; even driving sufferers to gain sympathy through faking suicide. Psychiatrists were often characterized as empathic. One film charted humane Italian psychiatric reforms.

European cinematic psychiatric perspectives are complex; both propagating and deconstructing stigmatising stereotypes.