Aesthetic Representation of Antisocial Personality Disorder in British Coming-of-Age TV Series

Abstract

TV series’ depictions of mental disorders have received considerable scholarly attention. However, few studies have considered the role of aesthetic elements in representing mental disorders. Therefore, in this study, we analysed how aesthetic features influence the representation of “psychopathy” in British coming-of-age TV series through the case study of The End of the F***ing World. We chose to analyse psychopathy due to its over-representation in the media and its often-mistaken conflation with the actual mental disorder of antisocial personality disorder (ASPD). We applied an aesthetic methodology in our analysis. We analysed the series in terms of language, appearance, behaviour, music and sound, technical devices, and intertextuality, closely observing three sequences of various episodes that correspond to the character’s symptoms, diagnosis, medication, and treatment. Our findings show that the aesthetic characteristics, characters, and events of the plot can act as expressive means through which the experience of living with a mental disorder can be accurately represented and simultaneously entertain viewers with drama and suspense. The series challenges the reductionist perspective and previous stereotypes of audio–visual pieces related to ASPD, suggesting that future TV series can better represent mental disorders with the correct use of television aesthetics and cinematic devices.

1. Introduction

Since the early 2000s, scholars have analysed representations of mental disorders in TV series due to their social and cultural commentary being worthy of critical attention (Chapman 2020, p. 2). The tools of narrative and discourse analysis have been used to study elements such as character development, plot structure, filmic space, and aspects related to mental disorders. The majority of television studies seek to deconstruct stigmatising discourses while reversing harmful stereotypes and misconceptions. However, representations of mental disorders in popular TV series have seldom been analysed from an aesthetic vantage point, in comparison to film studies. Some filmmakers have been commended for their use of film devices to portray characters suffering from mental disorders. For example, Clean Shaven (Kerrigan 1995) “allowed viewers to ‘get inside the head’ of people with schizophrenia by the use of continual sound distortion and radio ‘fuzz’ that simulate auditory hallucinations’’ (Rosenstock 2003, p. 119). Film techniques, stylistic choices, and characters can be employed by filmmakers to translate the experience of mental disorders into the language of film (Middleton 2013; Stadler 2017). Consequently, while focusing on television studies, we took film aesthetics as a reference because they have paved the way for television studies, particularly in the representation of mental disorders. Films’ portrayal of mental disorders has led to cultural awareness. Movies such as Rain Man (Levinson 1988) are still being quoted more than 30 years later to frame characters, as seen in current TV series such as The Good Doctor (ABC 2017–current) (McMahon-Coleman and Weaver 2020, p. 21). Furthermore, contemporary serial TV has been defined as cinematic for its scale of production, lush cinematography, and significant budget, although it does not exactly replicate film (Wadia 2021, p. 2); hence, it can improve its portrayals by shifting previous mishaps, but it is undeniable that certain aesthetic qualities of film are comparable to those of TV series. Cinematic and television aesthetics constitute a “core component of our experiences of it, and viewer’s pleasures are not reduced to social or narrative concerns alone” (McElroy 2017, p. 11). Aesthetics and visual imagery can allow “a stronger familiarity with the characters, which in return influences the degree of sympathy that spectators feel towards them; this can even affect the moral judgements placed upon their actions” (García Fanlo 2011, p. 7). Accordingly, TV series’ narratives can positively influence the moral capacities of viewers, preventing them from considering how “madness” can be used metaphorically as an expression of political and social protests. In this study, we aimed to analyse the aesthetic representation of antisocial personality disorder (ASPD), commonly mistaken as “psychopathy” in the British and coming-of-age TV series The End of the F***ing World (E4 and Netflix 2017–2019).

1.1. Common Narratives of Psychopathy

Mental disorders on TV series can be depicted through four medical framings: diagnosis, symptomatology, treatment, and medication based on the Diagnostic and Statistical Manual of Mental Disorders (DSM-5) (Cambra-Badii and Baños 2018, p. 277). Many leading characters are presented as undiagnosed or self-diagnosed, such as Sherlock (BBC 2010–current). Others may be diagnosed by a fellow character or even by audiences, e.g., Sheldon Cooper from Big Bang Theory (CBS 2008–2018), whereas others are diagnosed by a character with medical legitimacy, such as Sam Gardner from Atypical (Netflix 2017–2021). Regardless of these diagnostics’ accuracy, TV acts as one of the primary sources of information about mental disorders for individuals (Klin and Lemish 2008). Productions do not have a legal compromise to label a clinically proven diagnosis, although some media can perceive an identical mental disorder differently and contribute to its depiction bias (Klin and Lemish 2008, p. 439). Nonetheless, if a diagnosis is accurate and aligns with its symptomatology, audiences can identify, recognise, and empathise with the character and seek help for themselves or those around them who might be living with mental and neurodevelopmental disorders. As Nussbaum (2008, p. 148) argued, “narrative imagination is an essential precursor to moral interaction. The habits of empathy and conjecture lead to a certain type of citizenship and a certain form of community”. Hence, those involved in production may feel compelled to create socially responsible representations, but they are not obligated to do so. TV practitioners need to consider the commercial interests that often lead to distorted depictions that do not conform to clinical reality, but that provoke fascination to audiences. This likely contributes to the misrecognition of ASPD as psychopathy,1 which is “greatly overrepresented among the media mentally ill” (Harris and Sanborn 2014, p. 114). On occasion, this aspect has the effect of aestheticising violence (García Martínez 2019). Thus, if a misdiagnosis, overdiagnosis, or a nonexplicit diagnosis occurs without medical legitimacy on-screen, it can create incorrect imagery of the symptomatology and treatment. In the case of ASPD, it tends to be shown related to aggressiveness, criminality, violence, etc., which is an over-representation compared to real life (Byrne 2009) or pathologies that do not correspond with the disorder, which can lead to a rejection by the audience of people that might suffer from ASPD. This rejection can prompt to an “otherness phenomenon” (Han 2015): an invisible line can be created between the “audience” and “the mentally ill”, which distinguishes between “mental disorders’’ and “normal/standard” being, conforming to a pathologisation that shapes an identity that is fragmented (Cross 2004).

As mentioned above, characters with ASPD traits have often been depicted as sadistic, violent, unstable, sex-deprived, and untrustworthy. Moreover, they have displayed bizarre mannerisms, and they choose their victims either completely at random or with great intention (García Fanlo 2011; Leistedt and Linkowski 2013, p. 2). Portrayals of characters with ASPD came to include elements of grave robbing, necrophilia, cannibalism, and collecting “victim trophies”, such as human organs, photographs, bones, and clothing. Depictions were loosely characterised into two groups. The first type included socially functional misfits who (often) harbour a sexual compulsion to kill, such as in the films Peeping Tom (Powell 1960) and Psycho (Hitchcock 1960). The other type of “psychotic” character included extremely violent, deranged mass murderers with a distinctive appearance and idiosyncratic behaviours (Leistedt and Linkowski 2013, p. 5).

During the 1960s and 1970s, many high-profile cases involved “psychopaths” and serial killers, such as Ed Kemper, Ed Gein, Ted Bundy, and Charles Manson, who appeared regularly in the news. These high-profile psychopaths and sensationalised depictions of their ritualised practices inspired the imagery and mythos of the psychopath in popular media. That is, these cases laid the foundation for the highly marketable “monster narrative” (García Fanlo 2011; Swart 2016), as seen in recent TV series such as Mindhunter (Netflix 2017–2019). Moreover, many characters displayed behaviours that closely resemble the symptoms of obsessive–compulsive disorder (OCD) (Coyne et al. 2010, p. 288). Its visual appearance was a “distinctive mask”, and graphic on-screen kills as a result of special effects, makeup, and latex prosthetics enhanced the slasher film subgenre that would “come to dominate the tone and design of the psychopathic model for decades” (Leistedt and Linkowski 2013, p. 5). Two new stereotypes emerged in the 1980s and 1990s: “ideal villains” and “superhumans”. Their characteristics were:

(1)

High intelligence and a preference for intellectual stimulation;

(2)

Somewhat vain, stylish, almost “cat-like” demeanour;

(3)

Prestige or a successful career or position;

(4)

A calm, calculating, and always-in-control attitude; and

(5)

Unrealistic, exceptional skill at killing people, especially with blades or household objects (Leistedt and Linkowski 2013, p. 5).

In real life, according to the DSM-5, ASPD patients seldom display any of these traits and particularly not in this combination (Leistedt and Linkowski 2013, p. 5). Current television serial fictions about psychopaths have proliferated on-screen that are inclined to clinical reality, but are still inaccurate. A certain democratisation of the figure of the “psychopath” has occurred, resulting in increased empathy toward them, inaugurating a new discourse that can be closely associated with the post-modern fascination for anti-heroes that portray our insecurities in times of economic crises and aligning with the morally care-free neoliberal horizon (Martínez-Lucena 2020, pp. 54–57). Ongoing character representations can be loosely categorised into six different types. The “elite psychopath” is defined by a lack of empathy, callousness, disinterestedness, and cruel behaviour (Leistedt and Linkowski 2013, p. 6; Swart 2016). The “corporate psychopath” (Leistedt and Linkowski 2013) can function in society and holds a position of power while also having an affectless, remorseless, and ruthless attitude, and tends to excel in a capitalistic society and often works as a teacher, stock broker, or lawyer (Coyne et al. 2010, p. 288; Leistedt and Linkowski 2013, p. 7), e.g., Jordan Belfort in The Wolf of Wall Street (Scorsese 2013), Frank Underwood in House of Cards (Netflix 2013–2018), and Tyrell Wellick in Mr. Robot (USA Network 2015–2019). The “average-man-on-the-street” is a lonely character who passes unnoticed by neighbours; they are often shown living in mansions, cabins, and atypical dwellings with dark interiors and antique decorations. These characters are often intended to impart a sinister or haunting aura. Some are also shown working alongside police investigators, e.g., Dexter (Showtime 2006–2013). In these instances, psychopathic characters often act innocent while playing mind games with other characters by presenting clues in the form of riddles (García Fanlo 2011). The “successful psychopath” lacks remorse, empathy, and a conscience, and behaves in a cruel and heartless manner (García Fanlo 2011; Swart 2016). These characters are depicted as everyday citizens constantly plotting to harm those around them for their pleasure, such as George Harvey in The Lovely Bones (Jackson 2009). The “realistic psychopath” is charming, sophisticated, and manipulative, while remaining calm in all situations (Coyne et al. 2010, p. 288). Such characters “arose from the same sources but different genres with varying levels of success depending on the actor’s portrayal” (Leistedt and Linkowski 2013, p. 6). Finally, the “disorganised” or “sexually impulsive” (Stone 2009) psychopathic character is depicted as violent, confrontational, impulsive, and sexually deprived; it is often implied that their torture and murder of others is due to being intellectually deficient (Stone 2009).

As outlined above, the depictions of psychopaths are widely different. However, they often share the common trope of depicting the character as having been physically and psychologically abused and exposed to drugs, trauma, and alcohol as a child (Stone 2009); this is shown to cause post-traumatic stress disorder (PTSD) in many characters. Furthermore, although psychopathic characters are still primarily featured in the thriller, slasher, and horror genres (García Fanlo 2011; Swart 2016), they also appear in comedies where they function as a tool of social and political commentaries (Harper 2009), e.g., Sideshow Bob from The Simpsons (FOX 1989–current). Furthermore, the most recent problematic portrayal of psychopaths is the phenomenon of the “young psychopath”, such as Norman Bates from Bates Motel (A&E 2013–2017), Campbell from The Society (Netflix 2019), and Joffrey Baratheon from Game of Thrones (HBO 2011–2019). Despite being fictional representations, “the labelling of youth as psychopaths, both from a developmental and ethical perspectives, can cause a great deal of controversy” (Swart 2016, p. 89). Representations of young psychopaths can also traumatise children with this particular mental disorder, exacerbate their symptoms, and, most alarmingly, decrease children’s willingness to seek treatment (García Fanlo 2011). They are often depicted as possessing superior intelligence and having grown up with loving, affluent, and caring parents. Empirical studies, however, prove that the opposite is true. These children often suffer from physical and emotional abuse and are raised separated from their parents, such as in foster care situations (Swart 2016, p. 90). Moreover, we find psychopathic characters in the healthcare industry that are usually classified into two groups: the “evil psychiatrist” who sexually or emotionally abuses and/or sometimes even kills patients (Leistedt and Linkowski 2013), such as Hannibal in Hannibal (NBC 2013–2015); and the “death angel” (Stone 2009), who is either a nurse or doctor who kills patients.

Concerning gender, a bias exists when portraying mental disorders (Lopera-Mármol 2020): in terms of fictional psychopaths, men are represented far more than women (Klin and Lemish 2008, p. 6; Swart 2016, p. 87). Although female psychopath characters have many of the same traits as their male counterparts, they are often also hypersexual and promiscuous and display symptoms of erotomania. Hence, they “often serve as scheming manipulators whose main weapons are sexual” (Leistedt and Linkowski 2013, p. 6) and display a need for attention and admiration to compensate for their underlying insecurities. In this context, their hostility and manipulative nature can be interpreted as a safety mechanism that hides their fragile egos (Swart 2016, p. 88), such as Oksana in Killing Eve (BBC America 2018). Unfortunately, representations of female psychopaths are often “rife with violent antifeminism” (Middleton 2013).

Medication is almost never mentioned in TV series when depicting psychopaths; this is likely explained by the fact that there is no specific medication2 or treatment for ASPD. Regarding treatment, many depictions often portray nonconventional and unethical forms that are no longer accepted practice, such as straitjackets, lobotomies, and overdoses. These treatments are administered by uncaring professionals3 in unconventional spaces such as prisons, dark places, and inside cages. Most of the time, the only thing that can protect victims of antisocial personality disorder is the criminal justice system; however, “in rare instances, corrections systems provide opportunities for treatment or rehabilitation and instead tend to promote antisocial behaviour” (Harvard Health Publishing 2019). Consequently, treatment is usually guided by each person’s specific circumstances.4 Therefore, although popular depictions of “psychopathy” onscreen approximate the symptomatology and treatment of ASPD in actual healthcare settings, they do not resemble ASPD. Unlike fictional psychopathic characters, people diagnosed with ASPD are not murderers. Hence, it is fundamental to break away from traditionalist media stereotypes of the “psychopath”. As mentioned, it can not only help people to break with their own self-stigma,5 but also with the social stigma6 rooted in misconceptions that are far from the clinical reality. These misconceptions can create negative or false expectations; instead, they could opt for empathetic, sympathetic, and accurate portrayals that positively help influence public perception.

1.2. Psychopathy in British TV

In this study, we focused on the British coming-of-age TV series The End of the F***ing World (E4 and Netflix 2017–2019), hereinafter referred as TEOTFW (Appendix A), for its visually spectacular representation that has gained and sustained the imagination of the public and quickly became a worldwide cult phenomenon, receiving high ratings. E4 gained 1.1 million viewers in its first season, and with the second season, it successfully gathered 1.4 million. Clerkenwell Films stated that it was the “most-binged boxset ever” through cross-platform viewing (Farber 2019). Concerning Netflix’s case, although transparent data are not made available to the public, Ted Sarandos, Netflix’s chief content officer, and Cindy Holland, Netflix’s vice president of original content, admitted that they did not expect the high success of the TV series and that their data studies surprised them (Sharf 2018). The series also gained praise from academics beyond the British territory for its particular aesthetic style and breaking with the conventions of earlier crime, drama, and horror shows, as well as for the implications, as previously mentioned, that youth depictions can have on audiences and sufferers. The show is based on a graphic novel by Charles Forsman (2013) and depicts a road-trip TV series across England. The TV series displays a keen awareness of the moral dilemmas faced by youth and celebrates a rebellious counter-culture indie aesthetic. The show also contains ambiguous and disturbing imagery that emulates classic heist films. As implied in the first episode, the main character diagnoses himself as a psychopath, which is an unusual statement; for this reason, we chose to analyse the first season, as such a diagnosis deserves attention.

British and U.S. television series have frequently been marked by a transnational Anglo-Saxon axis and have mutual influences. Because of their wide international distribution, ostensibly wider than any other audio–visual industry, they have settled a serial canon, notorious in various television spaces beyond its frontiers (Thussu 2006). TEOTFW was produced by E4 and distributed globally through Netflix, “placing British TV culture in a broader international context” (Bignell 2010, p. 181). TV series’ success often depends on their achievements in international markets. Therefore, British TV series and those of other countries, particularly European, must internalise the aesthetics of the “cosmopolitanism nationalism”, which does “not necessarily mark a break from distinctly national cultures as much as a complex reworking of them” (Savage et al. 2010, p. 599). TEOTFW illustrates this through the inclusion of popular American cultural forms such as food, fashion, and music. As one of the main characters states, “If this were a film, we would probably be American” (1 × 02). These types of references to “quirky” American culture evoke a nostalgic, reimagined British national space (Savage et al. 2010, p. 601). In this context, British TV “has to deal with the belief that it is doomed to eventual colonisation and subservience to U.S. programme formats, imports and funding models” (Bignell 2010, p. 185). However, in recent years, it has been slightly diluted by other contra-flows in global media and television spaces (Ribke 2017). Hence, to engage a wider audience, British television shows must submit to a certain level of hybridisation. Such hybrid forms that reflect the trends in “national cosmopolitanism” now constitute the dominant form of “post-national” identity in British TV series. This cultural identification can be associated with other drama formats, particularly those imported from the U.S. (Chapman 2020, p. 65). In other words, British nationality is bound in global cultural flows, fragmenting it in the process. These circulations and movements provoke intensified geopolitical tensions. Simultaneously, this hybridity provides a multicultural space where people, signs, artefacts, and identities are able to challenge white Britishness (Savage et al. 2010, pp. 598–99). Such global cultural flows have become intertwined with narratives of British identity, allowing for new symbolic imagery of nationhood, “global cultural flows might be remaking Britain’s national cultural referents” (Savage et al. 2010, p. 600). Both British and American dramas have dealt with medical narratives and mental disorders (Cambra-Badii and Martínez-Lucena 2020). However, contemporary “British social realism” has focused on the relationship between the depoliticisation of the working class and issues related to unemployment, drug addiction, mental disorders, criminality, alcohol abuse, etc. (Lay 2002). Thus, they show a more local, geopolitical component than the universalism of some U.S. narratives in this genre, who generally favoured broader industry demands with less socioeconomic references, although both expand upon the healthcare deficiencies of the system and the triumph of the neoliberal regime of self-exploitation (Han 2015) in which “one directs aggression towards oneself instead of doubting the society or system” (Bauman 1999, p. 16). Brit-grit drama series centre the responsibility of mental disorders in private and personal spaces, as if it were an individual or family matter undermining any sense of the social and economic reasons (Lay 2002, p. 112), although mental disorders are affected by social, political, and economic inequalities (Harper 2009). For instance, in Nil by Mouth (Olman 1997), Olman’s subjacent criticism is how addiction and alcoholism are portrayed as a family disease rather than a societal one, showing how cycles of abuses are perpetuated over time. Furthermore, partially because of the predominant anodyne day-to-day lifestyle of its soap operas, British social coming-of-age texts in comparison to U.S. narratives focus more on the everyday realities of a young person living in a truthful, non-glamourised way. Hence, youth is described as grittier and more realistic (Buckingham 2021, p. 145). Finally, in terms of aesthetics, contemporary British social realism employs “a plurality of stylistic approaches ranging from the naturalistic, observational style of Ken Loach to the poetic, even hypnotic style of relative newcomers like Ramsay and Pawlikowski” (Lay 2002, p. 110), which can be explored in an analysis in a more detailed manner than the same genre produced by other national industries.

Moreover, although TEOFTW is a postmodern television series, it also appeals to viewers’ nostalgia, evoking the narrative certainties of the past but structuring them around certain cultural myths and stereotypes. TEOFTW also draws heavily on British popular culture, alluding to fashion, music, and other references.

The TV series begins with a 17-year-old named James who has self-diagnosed himself as a psychopath. James suffers from childhood trauma after seeing his mother commit suicide as a child, implying that he has a genetic predisposition to a mental disorder. The TV series starts with his desire to kill a fellow human. He chooses his new classmate, Alyssa, to be his victim. Alyssa is a rebellious 17-year-old from a dysfunctional family who appears to suffer from borderline personality disorder (BPD), but this is unconfirmed by the series. Alyssa suggests that they run away together to escape their dysfunctional families and search for her biological father, who abandoned her. At first, James agrees, as he sees it as an opportunity to kill her. Nonetheless, after time and many inevitable misadventures, they begin to develop a somewhat loving relationship. Therefore, the series thematises the embodied imagination and the elicitation of ASPD at the narrative and characterization levels as well as through character engagement and screen aesthetics.

The characters in TEOTFW are reminiscent of social realist Brit-grit films and are characterised by “cosmopolitan nationality”. Initially, Alyssa and James are repeatedly depicted as criminals who commit theft, robbery, and blackmail. As with many other British TV series, TEOTFW projects the image of the criminal as the antithesis of “corporate capitalism and its sympathy for dissidents and outsiders” (Chapman 2020, p. 41).

2. Materials and Methods

In our study, we aimed to analyse and reveal how stylistic and aesthetic choices frame characters suffering from ASPD. To do so, we adopted the methodology proposed by Camp et al. (2010) in their analysis of the character of the Joker from the film The Dark Knight (Nolan 2008). We adopted this methodology from film studies to study a TV series for two main reasons. First, the so-called “British quality television” adopts numerous cinematographic techniques common to film (Chapman 2020). Second, there is a long history of “psychopathic” characters in film, which serve as an important reference point for later depictions on TV. The emergence of such characters in TV series may offer a new methodological approach to the study of ASPD or other mental disorders and may allow for a more in-depth analysis due to their serial nature. Moreover, we adapted this methodology to analyse the aesthetic qualities of TV shows without neglecting the cultural, political, and ideological questions raised by critical and appreciative practices.

Table 1. Aesthetic features and definitions. Source: based on Camp et al. (2010).

Aesthetic Features	Definition
Language	Language relates to how characters themselves or others refer to their mental disorder.
Appearance	Appearance refers to how someone is depicted and presented externally (makeup and costume). For example, the Joker’s painted smile and hospital gown marks him as mentally ill in a healthcare context.
Behaviour	Behaviour refers to how someone acts or conducts themselves, particularly towards others. Behaviour also considers whether a character’s actions conform to clinical reality. For example, it considers whether violent acts (imagined or real) correspond to actual DSM-5 symptoms.
Music and sound	Music and sound observe how vocal and instrumental sounds (or both) combine to produce a specific image or environment. Emotions and feelings expressed through sound can emphasise certain DSM-5 symptoms or recreate specific stereotypes of those suffering from a mental disorder. An example of this is the famous melody in the shower scene in Psycho (Hitchcock 1960).
Intertextuality	Intertextuality refers to the relationship of the text to other texts, including literature, film, and art. Intertextuality refers to the meta-references to other depictions of mental disorders.
Technical devices	Technical devices include how the camera, lighting, and editing are used to create unique atmospheres, feelings, and emotions when framing the mentally ill in terms of symptoms, diagnosis, and recovery.

illustrates the aesthetic features such as language, appearance, behaviour, music and sound (soundtrack), intertextuality, and technical devices; we provide the definitions of each element to avoid bias in the analysis. We all applied the analysis model in this study, which implies that three different researchers watched all of the episodes. Furthermore, to ensure maximum reliability, an external researcher was asked to check the intercoder reliability. Moreover, the medical aspects were analysed by two psychiatrists from two different hospitals.

In this zeitgeist, speech has both an individual and a social side; one without the other cannot be conceived (Saussure 1916). Hence, using specific terminology can substantially impact people’s lives. In the “context of mental illness, mental health, and wellbeing, negative words can be experienced as condescending, isolating, stigmatising whereas positive words can convey dignity, empathy and hope” (Richards 2018, p. 460). Pejorative terms, such as “psycho”, “loony”, “crazy”, “mad”, and “mental”, can stigmatise people with a mental disorder (Pirkis et al. 2006); this type of “disparagement has been normalised in film and TV and has manifested itself in the form of name calling, dehumanising phrases” (Smith et al. 2019, p. 2) and verbal communication designed to demean characters. For this reason, the use of person-centred language, also known as identify-first language, which puts the person before the condition, disorder, or disability, has assumed a considerable role in discourses of mental disorders, e.g., “people with autism” rather than “autistic person”. However, in relation to minorities such as LGBTQ+ characters, when the sufferer uses these terms, it can be empowering rather than debilitating, except if it is self-disparagement or self-stigma. Therefore, to explore the treatment of stigma and the disparagement phenomenon in the series, we applied a quantitative exercise (

Table 2. Terms used in season 1. Source: original.

Terms	Season 1
Kill	23
Murder	13
Knife	10
Gun	9
Mad	5
Weapon	3
Suicide	2
Crime	2
Psychopath	2
Rapist	1
Crazy, nuts, insane, and freak	0

) to all the sequences following the study of Smith et al. (2019). We counted the number of uses of pejorative terms during all of season 1 to determine whether disrespectful terminology was used when referring to mentally ill individuals. If other terms not suggested by us appeared in relation to mental disorders, they were included.

3. Results

The diagnosis of the main character was analysed in episodes 1 × 01 and 1 × 07, as these two episodes mirror each other both aesthetically and narratively. In the pilot episode, James self-diagnoses himself as a “psychopath” in the form of a voice-over monologue. He states: “I’m James. I’m 17, and I’m pretty sure I’m a psychopath”. He explicitly uses the term psychopath, which is followed by rapid cuts to images of him murdering animals and photographing them to achieve a stop-motion effect. However, what is notable about this sequence from the first episode is how the camera follows “his killings”. The audience is first introduced to James’s acts of murder through a flashback (Figure 1 and Figure 2). His body is filmed from behind using unsteady camera movement. Using a low-angle shot, his face is rarely shown while he is killing animals. The combination of the camera angles and the editing style, the language, the replacement of music with sounds of nature, knives, a cat meowing, and gunshots are all employed to exaggerate and dramatise James’s “psychopathic behaviours”. These stylistic choices make James appear cold and calculating, as he appears to lack emotion and remorse. This scene is located in the middle of a forest in daylight, further emphasising his calculated behaviour, apathy, and calmness. Appearance is also relevant, as James is shown with long combed hair and a crisp dress shirt, with a thoughtful, meticulous, and careful look displaying James’s emotional and behavioural shift throughout the entire season. This scene also reveals that James suffers from PTSD as the result of a traumatic childhood event.

The second scene that we examined was 1 × 07 (Figure 3). Here, James has taken on a new look, similar to Clarence and Alabama in True Romance (Scott 1993). James’s unkempt hair, carefree clothing style, and more cheerful and less groomed appearance can be interpreted as an instance of intertextual reference. Similar to the scene in 1 × 01, this sequence also lacks music. The scenes are accompanied by sounds of nature, James’s crying, and the moans of the tortured cats. This time, the narrative develops alongside Alyssa. Moreover, James’s face is shown using a similar low-angle shot; however, this time, he is crying and incapable of murdering the cat. Here, his actions resemble the typical actions of a confused teenager; that is, he behaves recklessly, dresses sloppily, and is sexually attracted to his female friend, Alyssa. In 1 × 07, James appears to come to understand that there are consequences for his cruel actions. James is no longer able to commit murder, revealing that he is beginning to question his previous conviction that he is a psychopath. Instead, his mental disorder appears more akin to the definition of ASPD defined in the DSM-5.

Moreover, we used a sequence from 1 × 02 to analyse how the symptomatology of psychopathy is presented in the show (Figure 4). It corresponds to the three-second flash forward of James’s vision of killing Alyssa. In this particular scene, Alyssa acts in a way that James has always imagined, but it does not correspond to how Alyssa feels toward him. Alyssa appears scared and her face is covered with blood, which splatters across the entire screen through a series of jump cuts. This cinematic technique visualises James’s desires in the form of a “hallucination” and represents his “malicious” viewpoint in the form of a flash forward in which Alyssa is the victim. The camera uses close-ups to capture the minute detail of the weapons that James will use to murder Alyssa. Before James’s flash forward, a Brit-pop tune from the 1990s can be heard. When the camera cuts to the flash forward, the music ceases to dramatise the cut. The sound of Alyssa gasping and the sound of a knife being sharpened are also inserted to heighten tension, a reference to the thriller genre. Conforming to the overall look of the series, the lighting is dark, cold, and saturated. However, as the narrative develops, James’s desire to kill Alyssa dissipates, as do the horror-film-inspired flash forwards, making the symptomatology of psychopathy not correspond with the narrative elements. Additionally, the image of Alyssa’s bloodied face and body substitutes dialogue.

We also analysed the representation of medical and psychotherapeutic treatment in 1 × 08 to explore James’s story arc and his development of ASPD. As James was self-diagnosed and not diagnosed by a medical professional, the narrative contains no scenes of standardised medical treatment for ASPD. However, James becomes remorseful about his actions as he enters adulthood. Following a romantic montage scene depicting the two, he undergoes a journey of inner discovery as he forms a friendship with Alyssa and falls in love with her. Soon after, he hits her in an attempt to protect her from getting into trouble, thereby demonstrating a personal shift since the first episode and hinting that his self-diagnosis may have been incorrect. As seen in his inner monologue: “I have just turned eighteen, and I think I understand what people mean to each other” (1 × 08). The first season of the series finishes with this dramatic scene, which uses a panoramic shot intercut with medium shots of James and a slowed image of Alyssa being held by the police while he runs. His incognito outfit implies to viewers that he is no longer the James depicted in the first episode. Its saturated colour is symbolic of liberated sexuality, freedom, and modernity as an aspirational living, while also giving the show the appearance of being a contemporary realist drama (Street 2018). Moreover, audiences are able to hear James’s thoughts, as his inner dialogue is the only thing that can be heard due to a rumble that intensifies until a gunshot is heard.

In all three sequences, the location is important, as “background settings offer viewers rich detail about the social strata with an implicit critique of the entrenched inequality of British society” (Bignell 2018, p. 3). Reflecting the influence of “cosmopolitanism nationalism”, the landscape functions to convey a novel conception of Britishness (Savage et al. 2010, p. 610). Inspired by Twin Peaks (ABC and Showtime 1990–1991 and 2017), the producers chose to set this series in Entwistle, a suburban area across from Surrey and the Isle of Sheppey. At the beginning of the series, the colour scheme is defined by gloomy skies, poetic melancholy, and sordid and greyish tones that seek to stress the everydayness of the setting without romanticising industrial Britain. That is, the landscape is coded as muted and desaturated (Brown 2009, p. 29; Street 2018, pp. 469–90). Moreover, “the setting, cinematography and location of the series are both distant from and yet utterly familiar to the British setting” (Savage et al. 2010, p. 612).

Differentiating itself from soap operas, “television has, and continues to be, a vehicle for both the economic and cultural export of Britishness” (Chapman 2020, p. 8). Entwistle states that it could have been set anytime from 1988 to 2006 with the use of single and multiple cameras. The first two sequences are set in an urban crime-type setting to emphasise the “social and geographical remoteness of these communities as a visual expression of the psychological state of their protagonists and as a form of televisual tourism that represents non-metropolitan areas through the lens of a tourist gaze” (Chapman 2020, p. 143). In this “northern” production, the picturesque landscape functions as an existential and psychological space (Chapman 2020, p. 66).

The analysis shows that words such as crazy, nuts, psycho, freak, or mad (5 times or fewer) appear rather infrequently compared to scenes depicting ASPD symptoms such as committing murder and handling the tools needed to commit murder, such as knives and guns (from 15 to 23 times). Most of the pejorative terms are not used to refer to the characters, but instead other terms related to cliché psychopathic situations.

4. Discussion

British TV series are capable of offering compelling and complex depictions of the human psyche through the combinations of audio–visual aesthetics and psychiatry. At the same time, as McElroy (2017, p. 1) stated, “British TV dramas are not only entertaining but also provide our culture with a place to explore social anxieties and new social relationships and often deeply troubling instances of social breakdown and violence”. As shown in our analysis, aesthetic features play an important role in the representations and framings of ASPD. Factors related to language and discourse are helpful in understanding the development of a character. However, such terms can also be misleading, as seen in how James’s self-diagnosis turns out to be incorrect. For this reason, the combination of narrative elements with aesthetic elements plays a considerable role. Moreover, voice is used liberally rather than formally (Bignell 2018, p. 5). Notably, although the language used to describe characters with ASPD has shifted, the depictions of acts associated with ASPD have not changed. The language terminology no longer focuses on negatively framing the characters; rather, the use of language for murdering tools shows a connection between crime, violence, and ASPD. This is partially a positive development regarding character framing, but it still proves that a discursive link exists between “psychopathy” and violence.

The show also makes the audience question the reliability of the dialogue and whether it is occurring between characters or is an inner voice. Several TV series play with the narrative reliability of the mentally ill, such as My Mad Fat Diary (E4 2015–2017) and Mr. Robot (USA Network 2015–2019). A character’s appearance was connected with behaviour, as appearance is able to emphasise the changes in attitude and behaviour of the main characters, especially James. James’s wardrobe changed from cold colours associated with a calmer and contained character to warmer and more saturated colours, which signify multiculturalism, abundance, saturation, youth, and adventure (Street 2018, p. 473). Therefore, we can observe the emotional implications it had on James in the murderous act against Alyssa’s sex attacker.

Regarding filmic devices, one of the most used techniques was the flash forward, which was enhanced through repetition, structured jump-cutting, and syncopated editing. This aspect enabled the audiences to enter into the psyche of James, or what seems to be, at first glance, his psyche, since it could be, in fact, his own representation of it because just as he confuses his diagnosis and makes the audience believe that he is a psychopath, he could also confuse audiences by allowing them to enter “his” psyche. Many TV series characters play with the narrator’s reliability in this postmodern context. It “renders the spectator unable to determine who holds information on the story or whether that information is accurate or not” (Sorolla-Romero et al. 2021, p. 161). In the case of mental disorders, the solipsistic narrative characteristic of postmodernism allows bringing drama, aesthetics, and socioeconomic and political commentary onto the screen, as seen with TV series such as Mr. Robot (USA Network 2015–2019).

The aesthetic depictions of the background settings are important. They are seemingly unattractive and unsightly, located in the suburbs. They are photographed with a critical eye, highlighting the desaturated colours (Street 2018, p. 472), striving for Brit-grit aesthetics. At the beginning, the colour is naturalistic, but by the end, it changes, and the chromatism is enhanced by the vivid looks of James and Alyssa. For this reason, the film uses colour as an expressive form of life aspiration, youth, and the adventure expectations of the characters. This strengthens the coming-of-age nature of the genre. The camera shots showing the emotions of the main character are usually close up and suffocating. This aspect allows the viewer to enter his feelings and mind; they also enhance the inner monologue. By applying these techniques, audiences tend to forgive the unethical, immoral, and offensive behaviour that James displays at the beginning of the series toward Alyssa and his murder of animals.

TEOTFW uses an original soundtrack for various reasons. The sounds that are most important for the narrative are those of animals, as they mark the before and after of James’s self-diagnosis. The combination of music and sound highlights the suspense and, consequently, allows an extended period in which James’s character displays a more perverse and paradoxical morality. A significant correlation exists between music and the coming-of-age genre. Similar to previous Brit-grit productions from E4, such as Skins (2007–2013), Misfits (2009–2013), and My Mad Fat Diary (2013–2015), the series opts for retro-indie music to intensify the coming-of-age genre aesthetic. The leading artists featured are Blur, Fleetwood Mac, The Black Angels, Mazzy Star, Shuggie Otis, etc. These artists are also featured in the series mentioned above. The music acts to illustrate a road trip series of two particular teenagers in a nostalgic form that resembles the 1970s without being out of place, achieving a perfect balance that conforms to Netflix trends. The reality is that this type of style aligns with the 1960s sexual revolution and the coming-of-age self-discovery journey; unsurprisingly, sex plays a huge role in the narrative.

Intertextuality in the series appears in references to other media forms, as many other quality British television dramas are usually associated with other types of art forms, as they add creativity, authenticity, and relevance (Bignell 2010, p. 194). This TV series is based on a graphic novel. This particular aspect of our methodology is linked to the tradition of semiotics and the literature of Bajtín, Todorov, and Kristeva, among others. One of the intertextual aspects is determined by the genre, with films that refer to Tarantino’s imagination for the use of music, that allows audiences to map James’s adventures, mishaps, despair, and disorder. In addition, Alyssa, as with Mia in Pulp Fiction (Tarantino 1994), likes to dance without apprehension. Therefore, in a sense, the genre of gore violence is appropriate through humour. However, intertextually, the “use of pastiche episodes is replete with references to other characters and stories” (Chapman 2020, p. 123) that are audience-pleasing and a more sophisticated mobilisation of popular film and TV than most other postmodern television series have integrated into the narrative fabric of the series (Chapman 2020, p. 59). Thus, the postmodern TV drama is characterised by its awareness of its own status as drama.

It is no coincidence that TEOTFW reminds audiences of other movies, primarily, Bonnie and Clyde (Penn 1967), as it explores not only the narrative of two fugitive lovers and their crimes, but also the connection they both had until their tragic deaths, similar to James’s shot at the end of the first season. This loving dependence in James’s case allows us to observe how his self-diagnosis cannot be sustained throughout the narrative, which also can be interpreted as a reference to Sid and Nancy (Cox 1986), mostly for their self-destructive pattern. The coming-of-age genre and how James’s ASPD and probably Alyssa’s BPD remind us of those interactions of Sam and Suzy in Moonrise Kingdom (Anderson 2012) from their runaway scene from home to their love scene at the beach when they realise their true feelings for one another. Both of these audio–visual elements present similarities in the role, place, and how they express it. Alyssa and James’s childhood traumas remind the viewer of the act portrayed in Natural Born Killers (Stone 1994). Stone aimed at emphasising the sensational way in which the press describes crimes and the way the media extols the murderers. The film is similar to the underlying critique of TEOFTW, how ASPD is represented in TV series, and the action that people tend to associate with that disorder. The combination of all of these aesthetic features can minimise the disgust audiences might feel toward violent images, instead enhancing humorous scenes, breaking with structural cliché repetitions, letting the intertextual references emerge, and adding more layers of narrative attention. Thus, the visual fascination is not only another part of each episode, but also its appeal. The dramedy and coming-of-age genres only add to the certainty and reliability of the ASPD diagnosis.

5. Conclusions

It is not by chance that these cultural products focused on mental disorders appear in these specific contexts. Scholarly works on TV series are attempting to trace the evolution of representations of crime and justice and outline how these representations align with the current political, economic, and cultural notions. TEOTFW is a depiction of how psychopathy can be inaccurately and problematically depicted in a TV series. It dares to speak the language of TV by putting together sophisticated devices such as montage and jump cuts, with the urgency of the story soundtrack creating a story from selected details. This series is highly manipulative, “dazzling us with its glossy aesthetic and narrational tricks that serve to distract our attention from questioning the ambivalence of our identification” (Chapman 2020, p. 61). James’s presentation of a mental disorder perfectly conforms to the definition of ASPD given in the DSM-5. The visual aesthetics of the series, linked with historical and medical contexts, exposes the palpable contradictions and nuances within the character, revealing the self-diagnosis of psychopathy to be incorrect.

As our results suggest, aesthetic features strongly impacting the framing of ASPD can help to more realistically represent the symptoms of ASPD, providing viewers with a more accurate understanding of the symptomatology previously presented. The series considers the variability and intersectionality of each character’s struggle and gives space to examine how ASPD affects the daily lives of the characters. The show also vaguely hints at other narratives of mental disorders such as BPD. Not only do the aesthetic characteristics help to either confirm or refute the diagnosis presented in a TV series, they also become a vast and unexplored field of expression for the depiction of the mentally ill. TEOTFW generates audiences’ positive reactions over the understanding and comprehension of the character’s representation of his own psyche and mental disorder. Therefore, the advantage of this is the possibility that the series, through the use of intertextual resources, can create a liminal space in which the mental patient’s dysfunctional behaviour is found halfway between his own reaction and the mimicry action the viewer has seen in psychopath movies. In this context, this detailed study of the aesthetic features and the underlying narrative aspects reveals that filmic devices, particularly structured jump-cutting, voice-over, and syncopated editing, were used to translate the internal state of the character into a language understandable by the audience. The show’s aim is to challenge a reductive perspective of ASPD by mocking stereotypes, clichés, and common misconceptions, thereby denying any connection with the term “psychopath”. Consequently, by accurately depicting the symptoms and experiences of people with ASPD, the series presents a sharp social commentary on the depiction of “psychopathy” in TV series. For this reason, TEOTFW plays on not wanting to provide a realistic representation of this aspect and prioritises the narrative expressiveness of the genre over realism. The seamless interplay between the technical devices that were used to portray James as a psychopath function to deconstruct this initial diagnosis, which proves that media professionals should be aware of how TV series frame our understandings of mental disorders. Television practitioners should understand they have a social responsibility, which is essential. In particular, the audio–visual field in all its senses, narratively and aesthetically, allows as many nuances as mental disorders themselves. Nonetheless, as Middleton (2013, p. 187) suggested, a “more profound knowledge of these aspects would enable anti-stigma writers and academics with a higher capacity to recognise, evaluate and counterattack stigmatising portrayals”.

In summary, TV series treat psychopathy as a source of violence and tragedy or as a target of ridicule. Although it is understandable that productions need to consider commercial interest, our findings revealed that shows can be suspenseful and entertaining without relying on stereotyped and harmful depictions of people with mental disorders. Our results demonstrated that it is possible to create realistic characters and show their struggles. Consequently, TEOTFW assertively thematises the embodied imagination and the elicitation of ASPD by focusing on the narration, characterisation, character engagement, and screen aesthetics. That is, accurate depictions of mental disorders are not incompatible with commercial success. The supposed dichotomy that a series must be either an accurate portrayal of a mental disorder or a visually exciting and compelling narrative is a fabrication, as the two are not mutually exclusive. Accurate depictions of mental disorders are not mutually incompatible with engaging character development, intricate plotlines, and unique storytelling (Swart 2016, p. 73). However, TV series continue to reinforce misconceptions about mental disorders and fail to produce realistic representations (Harper 2009). As Buckingham (2021, p. 94) noted, boyhood in British TV series primarily centres around crime and violence and girlhood around emergent sexuality. Finally, we argue that this study showed that the representation of ASPD in TV series has improved, particularly in TEOTFW, adding new literature to the field and providing evidence that the analysis of Camp et al. (2010) can be applied to the field of television. Nonetheless, as with the majority of studies, the design of the current study is subject to limitations, mainly the focus on a case study, although it is a cult TV series; hence, future research can continue to explore how television aesthetics portray mental disorders, because it might allow the extension of the accuracy and faithfulness of representations with the better use of resources, and so less stigmatised portrayals may be encouraged.