MedicalPhysician Q&A

Q&A With Physician-Author Vasilis K. Pozios, Forensic Psychiatrist

Dr. Vasilis K. Pozios is a board-certified physician in forensic and general psychiatry, mental health advocate, entertainment consultant, and author. He graduated with a medical degree from Tufts University before completing a general psychiatry residency at the University of Michigan, a forensic psychiatry fellowship at Case Western Reserve University, and a  Jeanne Spurlock, MD Congressional Fellowship. But before all of that, he was just a six-year-old boy who picked up a copy of  Detective Comics #540, read about Batman’s battle with Scarecrow, and fell in love with pop culture. That love of pop culture permeates his work today. Dr. Pozios is a co-founder of  Broadcast Thought, where he provides expert consultation to the entertainment industry on mental health issues and has appeared in the  New York Times,  WIRED, and  much more. He also authored Aura, a comic book story about a superheroine living with bipolar disorder and migraines, published in the anthology  RISE: Comics Against Bullying. After listening to Dr. Pozios speak about mental health and pop culture at the 2016 New York Comic Con, he graciously agreed to answer my questions about his unique career path. This interview has been edited and condensed:
Can you tell us a little more about yourself and your career path?
I’m a forensic psychiatrist, which means that I completed psychiatry residency and a fellowship in forensic psychiatry. Back in 2008, I had initial conversations with a couple of colleagues of mine who were [child] psychiatry residents thinking about careers in forensic psychiatry. We got together at the American Academy of Psychiatry and Law Annual Meeting and we just started talking about how we were really disappointed in how mental health issues were portrayed in media, particularly entertainment media. We talked about our shared interest in “geeky things” – comic books, anime cartoons, fantasy – and trying to do something where we combined those interests, where we could get involved in reaching out to the entertainment industry to encourage more accurate, less stigmatizing representations of people with mental illnesses.
The first foray into that was doing a presentation at San Diego Comic Con back in 2009. From there, we continued to present at San Diego Comic Con, New York Comic Con, and a couple of other conventions. Also, we began to write pieces on representation of people with mental illnesses in entertainment media. We did a  piece for the New York Times  back in 2011, in which we discuss how people with mental illnesses are portrayed in the Batman series of comics and related franchises, how the villains in the Batman comics are often portrayed as having mental health issues. And then a couple years after that, we began to do some regular features for  The Walking Dead magazine, an official publication related to  Robert Kirkman, using pop culture as a hook to discuss mental health related issues.
One of the things that I’ve always wanted to do was get involved in writing comics and that’s something I did a couple of years ago with my short story in  RISE: Comics Against Bullying. I wanted to portray a character who has a mental disorder who is – first of all – not a villain, but is also a fully realized three-dimensional character with a mental illness.
I’d like to continue doing all three of those things – reaching out to the public, whether it be through popular arts conventions like Comic Con or in other ways, to use pop culture as a means to discuss mental health issues; to write opinion pieces and other works discussing how the larger issues regarding representation of people with mental illnesses really needs to change; and work in a more creative fashion and continue to write comic books and other forms of fiction in which we really practice what we preach in terms of the representation of people with mental illnesses.
You have a lot of dimensions in your career. When it comes to consulting, what was your biggest break there? It’s very difficult to go from an idea that’s germinating at a conference to something where you get regular gigs.
That break has its origins back in 2008, when I was a  Jeanne Spurlock Fellow  with the American Psychiatric Association. The Jeanne Spurlock Fellows are congressional fellows and they work in an office of either a representative or senator in Washington, D.C. I met an executive from the entertainment industry’s council who was there to present on mental health and substance abuse representation in entertainment. We hit it off and that was what got our foot in the door in terms of doing some consulting work. We went on to consult with some comic books, plays, some television series. We consulted on a series by  ABC Family  about the depiction of autism spectrum disorder,  “Bates Motel” on A&E  for a depiction of what we saw as psychopathy.
Now, what’s interesting is obviously we’re approaching these characters from a different perspective than writers are. Some writers do have a background in mental health, either through personal, family, or professional experience. But the majority I would say do not. They oftentimes will write a character not with any classic disorder in mind per se. So it’ll be a constellation of behaviors, symptoms, etcetera that we are often then asked to offer an opinion on what that character might be diagnosed with and how that character might be treated, how they might behave, what their childhoods might have been like in order to elicit the symptoms that they’re experiencing at the time of the writing of the script. So it’s really interesting stuff.
Certainly, there’s a need for more mental health professionals to be involved in this sort of effort. At the end of the day, even though there’s a lot of misrepresentation of people with mental illnesses, I really don’t think it’s volitional on the part of writers. I think it just comes from either a misunderstanding of mental disorders and people with mental illnesses and possibly not knowing where to go to kind of seek that information out. The worst case is the lack of effort to seek that information out. But I think that it’s a really worthwhile thing and I encourage other mental health professionals who have an interest in this to get involved.
When it comes to your consulting, what’s been the most interesting consulting job you’ve had through  Broadcast Thought
“Bates Motel” was the most interesting because they weren’t really thinking of the character Norman from necessarily a diagnostic perspective. It was beneficial for us to think about that character and how they might exist in the real world, and have that kind of back and forth with the writers. One of the challenges about consulting in general is [that] there’s an overrepresentation of more extreme disorders, rare disorders, violence because there needs to be “action” on the screen. People often say, “Oh, you can’t portray depression in a film or television series because it’s boring.” I disagree with that. I think that there’s a lot you can do with depression, actually. But there’s a tendency to portray things that are outrageous and violent and so forth. I can understand that, but at the same time, we need to think about how that affects our perceptions about mental health. One of the things that we try to say is that this character, if he’s seen as somebody who’s psychopathic, is an outlier and not representative of the community of people with mental illnesses at large.
What would you say that the biggest challenge [in media representation of mental health] is?
One of the biggest pitfalls is trying to incorporate mental health into a show as a “very special episode” where it’s not something that’s really incorporated into the character, but is treated superficially and in a one shot kind of way where one episode is about suicide and it’s never really discussed again. What we’re really trying to advocate for is making mental health issues really tied into the DNA of the show or the character that you’re writing about – not dealing with it as a surface-level “very special episode” kind of thing, but really helping writers understand that there is a lot of entertainment value so to speak in psychiatric disorders. Mental disorders are inherently interesting and there’s a lot of dramatic conflict that can be exploited through the depiction of mental health disorders. But it can also be done in a responsible way where it’s not stigmatizing and it’s portrayed accurately. Helping writers understand that as opposed to doing a public service [episode] is really a challenge. But I think there’s obviously more openness to it now. It’s being portrayed much more frequently than it has been in the past. Progress is being made there.
It seems like you tackle a lot of those themes in  Aura. There’s a role in telling people how to have better depictions, but in  Aura  you really show people how to do it. Can you tell us a bit more about that comic book character?
Well, you said showing is important rather than telling and that’s what I really wanted to do. I wanted to – in four pages, which is what I was allotted – try to get across why common tropes regarding mental health might be damaging to someone on an individual level. Somebody who is experiencing, in this case, bipolar disorder themselves. So what I wanted to show is the reality of having a mental disorder – that it’s not romantic necessarily, it can be tough, it can be a real challenge especially in terms of finding the right treatment, not responding well to medication or having side effects to medication, how people around you respond to learning when you have a mental disorder, the stigma that’s involved in mental health and mental health treatment – but also being able to rise above that and be somebody who is heroic and inspiring. Again, something that’s not really depicted that often in entertainment, especially in comics. So that’s really what my goal was. And again, I only really had four pages to do it.
But I’m really looking forward to doing more with this character because I think that the audience is ready for a character like this. The past couple years we’ve been doing these panels in which we more concretely talk about mental health representation in comics, there’s been a growing interest in it. And  Aura  has gotten really, really good reception from those who’ve read it.
What I’m hoping for next is a mini-series. I’ve plotted out a four issue mini-series that I am going to pitch to comic book publishers and also graphic novel publishers as soon as I find a suitable artist. Unfortunately, the artist that worked with me on  Aura, they’ve kind of blown up now and they’re working for DC Comics, for Marvel Comics, and for other big publishers. Comics is a really time intensive process and it’s sometimes challenging from a scheduling standpoint to find people whose schedules match your own. That’s the thing I’m struggling with right now, but hopefully we can get that squared away and get to work.
At the New York Comic Con panel [you spoke on,] someone asked, “Do you have any experiences with mental illness?” and everyone [on the panel] rose their hands. It’s obvious that you have experiences from a professional perspective, but I was wondering if you had any personal experiences that are really informing your work that you do now. 
I have an anxiety disorder – panic disorder. I know what it’s like to have a mental disorder and to feel stigmatized because of it and feel like you have to keep it from your peers. In residency, I had a panic attack while I was on one of my clinical rotations and it was just a very scary experience, but also an unnecessarily shameful one. I felt like I had to keep it from my attendings and so forth. So yeah, I know what it’s like but I don’t pretend to have the same experience as the other panelists or other folks who have different mental disorders. But the bottom line is that anyone can have one of these mental disorders. And the other truism is that treatment does work. It’s just being able to get yourself to treatment that’s difficult for a lot of people because they don’t want to be labeled as having a mental disorder and they don’t want to be viewed differently from other people. That’s what I’m really trying to break down with my comic in a small way and [encourage] other people to…more accurately represent people with mental illnesses. You normalize having a mental disorder, you lessen the stigma associated with it. In that way, we actually will save lives. A lot of people don’t get treatment and unfortunately end up dying because of that.
I think there’s also a lot of concern about disclosing mental illness, especially among medical students and residents. And I was wondering if you could speak to that or if you had any advice for medical students, residents, or trainees who are struggling with mental illness and how to deal with it in their professional lives.
Medical school is extremely stressful and it can often trigger underlying mental disorders in medical students. And you’re right. There’s a heightened stigma in the medical community. There’s a stigma in general about having a mental disorder, but there’s also the added dimension of when you’re a medical student, you’re kind of expected to be healthy. You’re expected not to have an illness because you have to be there for those who are ill. Then there’s another dimension of professional stigma, of non-psychiatric physicians stigmatizing psychiatrists. And even within psychiatry, I think we have to admit that we’re not always as stigma-free as we like to pretend. So yeah, there are a lot of challenges for medical students and residents. I don’t think I have any particularly sage advice, but I just want to encourage people to seek help if they need it and to recognize that we need to practice what we preach if we’re saying that having a mental disorder is no different than having a physical disorder, that having depression is no different than having cancer. We need to live by that code. We need to support people in our own profession who need psychiatric help and make them feel that that’s okay.
What sparked your interest in comic books? And who is your favorite comic book character and why?
Batman, hands down. I’ve been a comic book fan for as long as I can remember and Batman has always been there. I don’t exactly remember when I first got into Batman, but I can certainly remember when I bought my first comic book on my own. It was a Batman comic book. As I grew up and went to medical school and psychiatry residency and really when I was a fourth year medical student, I knew I wanted to go into forensic psychiatry. When you start to learn about mental disorders, you start to recognize patterns of people you’ve known in the past. Whether they be family members or just people you see on the street, you start to recognize or speculate, “Do they have a mental disorder? Do they have schizophrenia? Do they have bipolar?” That’s, I think, a common phenomenon for people who go into psychiatry.
But what I started to realize is I started to look back at the comics I read and I realized, “My God! Basically everything that I’ve been reading has had to do with psychiatry in the Batman comics,” because of Arkham Asylum and because the villains are all considered to be “criminally insane.” And so I really started to think about what that meant and contrasted that with the experiences that I had with actual patients and patients who were involved in the criminal justice system, who were found not guilty by reason of insanity or incompetent to stand trial, and were actually in a forensic hospital. You know, like a real world equivalent of Arkham Asylum. And I just realized just how stigmatizing that is to people with mental illnesses, but also how depictions like Arkham Asylum influenced jury perceptions of people with mental illnesses and how that potentially affects adjudication.
So it’s a really complex picture and it all kind of goes back to negative stereotypes that are really hard to combat. You can tell somebody about what the facts are about mental illness, but we form our beliefs from a larger body of experiences that include cultural experiences, and I would argue that those are the most important aspects that inform our beliefs about things – especially as they come to mental illnesses. So that kind of firms up my belief that “yes, you can educate the public about mental illnesses all day long” and “yes, you might increase their knowledge base,” [but] that doesn’t necessarily diminish stigma – and research backs this up. What I think is a much more compelling way to decrease stigma is to change the culture. And that’s a big task. And it’s something that happens usually at a glacial pace. But we have to do something about it.
There’s precedent for it – changing public perception of the LGBTQ community, for example. A lot of the changing perception has really been helped by, at first, less villainized media depictions and, after that, more accurate media depictions. And I think the same can be said of different minority groups too. They’re first ridiculed by media and then kind of lampooned and then are presented in a more accurate way. We’re starting to see that with mental health. But for some reason in comics it seems to be lagging a bit behind. Aside from my personal interest in comics, I think that’s another reason why I’m focusing my efforts in comics because there seems to be a little bit of a gap between comics and the rest of entertainment media.
And we can talk about the reasons for that. One of them is, undeniably, there’s a lot of money tied up in stigmatizing representations. With Arkham Asylum – I mean, this is a multibillion dollar franchise between movies, video games, television, etcetera. So there’s an impetus for that stigma to continue. But it doesn’t have to be that way. That’s hopefully what I’m able to convey and other people are open to incorporate into their writing.
Are there some pieces of media – comic books, television, movies – that are getting it more right than others? Or are particularly more accurate than others?
Even the films and television series that “get it right” – mental health professionals and psychiatrists can still pick it apart. The film in recent years that’s gotten it mostly right is “Silver Linings Playbook.” Again, not perfect. Still tropes there. But a generally positive representation of what it’s like to have bipolar disorder and I think that the other character – I don’t know if they gave a diagnosis, but it seems like borderline personality disorder maybe. And also a fairly accurate depiction of how someone with a mental illness might get involved in the criminal justice system as opposed to being a “serial killer.” So I think that was positive. Demonstrating that treatment works and medication compliance…is important, and portrayed positively.
A lot has been said of “Homeland” of being a positive representation of mental illness. When you have a character that’s considered heroic that has a mental disorder, I think that’s always a good thing [but] we have to be careful about potentially romanticizing disorders. And also again there are some inaccuracies – the one that sticks out in my mind is overplaying the memory side effects of ECT. That can have unintended consequences. But by and large, I think that’s moving in the right direction.
Do you use any comics or popular media in your own practice of psychiatry? If so, what do you tend to use them for?
I don’t necessarily use comics per se, but one of the things that I’m going to be doing with my patients who are prisoners in a state department of corrections is, in a therapeutic way, have the patients incorporate comics into narrative therapy in which they discuss and contextualize the traumatic events that have occurred in their lives. A lot of the prisoners I’ve worked with are fans of comics and especially all of the superhero movies that have come out in recent years. They’re very excited to start work on doing that. Again, comics are really a universal language. Comics as a medium are really great for conveying somebody’s story in written form, but also in pictoral form. And you don’t have to be a writer or an artist to be a comic. You just need a pencil and paper and have an interest in doing so. It could be a very cathartic experience and it can also help to contextualize events in your own life if you’re doing an autobiographical comic. So I’m really interested in seeing what my patients put forth.

About the Ads
Christy Duan, MD is an award-winning writer and a psychiatry resident physician at Zucker Hillside Hospital in New York City. Read more of her work at Christy Duan, MD is an award-winning writer and a psychiatry resident physician at Zucker Hillside Hospital in New York City. Read more of her work at...