In Britain this week, the TV soap opera Eastenders has stirred up controversy because of the way it portrayed a woman giving birth to a baby with Down's syndrome. The Royal College of Midwives complained that the plot was unrealistic and would worry couples unduly. The producers replied that the storyline had been meticulously researched and though it did not represent best practice, it was realistic.
But should this have been an issue at all? A soap opera is fiction. Its aim is to entertain. The impetus for the plot is drama not realism. Surely it is up to documentaries, news programs and public health campaigns to inform us, or does fiction also have a duty to tell the truth?
The way television and film portray illness and disability has caused much debate in the last decade. Programs like Eastenders have a massive audience, and surveys have shown that they have a tremendous impact on how the public understands disease, particularly young people. Eastenders itself was groundbreaking with respect to HIV and AIDS. For thirteen years, yes thirteen years, we saw the character of Mark Fowler first contract the virus, then come to terms with his condition and the reactions of others toward it, struggle with the drugs and treatment that kept him healthy until eventually - and campaigners argue he was killed off too soon as life expectancy for people who are HIV positive in developed countries is now much longer than thirteen years - become ill with AIDS and die.
We learnt much more from seeing Mark Fowler on our screens every week than from reading hundreds of leaflets or seeing a public information film. Partly this is because when we are entertained, we are stimulated and this makes us more open to respond to what we are shown. Good fiction leads us to respond both emotionally and intellectually; there is a sense of intimacy. Particularly in long-running fiction like a soap opera, we feel involved, we don't feel informed: We understand.
Fiction is undoubtedly powerful in conveying a message to its audience. The first HIV awareness campaigns in Britain failed miserably because they were stark and scary and because they lacked intrusive detail. Later campaigns were more successful because they dealt with the subject with frankness and humor. Something that was embarrassing - buying a condom - became ordinary. In using realistic scenarios and using narrative rather than data to convey information, the later campaigns were much more successful in conveying the safe sex message in Britain.
Television and film have become reference points. When we think about cancer for instance, much of the images that come to mind are from films, unless of course you have suffered first-hand experience of this disease. I remember clearly my own terror when my father was about to undergo his first chemotherapy treatment. The nurse wheeled in a trolley with the bag of innocuous-looking clear liquid that was about to be pumped into his bloodstream. I looked at it picturing the worst. Images of people with their heads shaven, bent double with violent sickness, their bodies shivering and sweating in convulsions - innumerable images from books, films and television programs I had seen over the years came to my mind merged into one. The reality was quite different. Not nearly so violent, it did not have the dramatic punch of the story-teller; it was much more debilitating, the kind of slow suffering that sucks life out breath by breath.
That's the thing about fiction, it needs to be dramatic. It's aim is not to inform the public but to entertain, any portrayal of illness is a servant to the plot and not vice-versa. How often do we see a character conveniently clutch his chest and die of a heart attack at a critical moment? How often is a character murdered by a psychopath on the loose?
That is where the campaigners for responsibility in filmmaking have a point. If fiction becomes a reference point yet gives us portrayals that are consistently skewed, it essentially misinforms us. No more is this more apparent than in portrayals of mental illness. Think of schizophrenia. I bet many of you immediately thought of split personalities and conjured up images of frenetic violence. That psychopath on the loose in other words. Yet schizophrenia has nothing to do with split personalities, that is an entirely different mental disorder. Nor is the image of the schizophrenic as murderer accurate: Those who suffer from this debilitating illness are rarely a danger to others.
Clearly television and film provides a phenomenal platform for public information as propagandists all over the world have long known, but that is where the danger lies. Fiction should not be a vehicle for a message, not even a public health message. The moment the viewer or the reader feels that she is being lectured or manipulated into thinking in a particular way trust is lost and the very link between writer and reader or filmmaker and viewer is lost.
I once heard someone ask why writers such as Arundhati Roy have such impact when they make statements about matters outside the realm of fiction like international relations - why are people more inclined to believe a fiction writer than a politician or a company executive? I am not convinced that they do but I think we live at a time when people do not know who to trust and where they are fearful of information they are being spoon-fed. Consequently we search for individuals we can trust and part of the reason we trust them is because they speak from the deeply personal and what they say resonates.
We shouldn't be surprised that programs like Eastenders have more impact on public perception than information from official sources. One of the most significant trends of recent years has been the erosion of authority: We no longer trust authority in the same way that we did. We have become much more cynical and question anything which comes from an official source. This may have been par for the course in politics - after all who ever believed a politician's words? - but it has had a knock-on effect on how we view health issues. Think of bird flu for instance, how many people stopped eating chicken despite official assurances that it was safe to do so? Or the controversy over the MMR vaccine in Britain where many parents refused to have their children vaccinated despite assurances from the government that the MMR vaccine was not associated with autism.
We live in interesting times, as the Chinese like to say. We want to witness everything first hand in order to believe it; yet we wish to be constantly entertained. The result is an increasingly blurred line between fact and fiction. We learn more from experience by proxy than by direct contact with other individuals, relying more and more on film, television and the Internet to inform us of what the lives of other people are really like.
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