The Representation of Pain in Adolescent Media: What You See Isn’t Always What You Get

A new study reveals that although pain is often portrayed in popular adolescent media, it is commonly depicted in a narrow and biased fashion, which could further enhance pain-related stigma and inequities among young people. 

Pain is frequently depicted in movies and television shows. Considering how influential media consumption is on the way young people view themselves and interact with others, it’s quite possible that these depictions could influence how youngsters understand and react to their own painful experiences. Previous research has shown that is exactly the case with media designed for young children. But whether the same applies to portrayals of pain in media targeted to adolescents is unclear.

Now, a new study from investigators at the University of Calgary, Canada, tackles this question. The research team, including first author Allison Cormier, senior author Melanie Noel, and colleagues, analyzed depictions of pain in a number of popular movies and television shows available on Canadian Netflix – and the results are discouraging.

The researchers found an overrepresentation of pain from violence and injuries compared to everyday, chronic, or medical/procedural pain. There was also an underrepresentation of pain in characters with racialized, female, or gender-diverse identities, and a general lack of empathy and support shown toward characters in pain.

“[This study] is important, as it indicates what value our society gives to pain and how we expect people to behave when they are in pain. Often these cultural expectations stigmatize having pain (we idolize stoicism in face of pain) and how we respond to pain,” according to Miranda van Tilburg, Cape Fear Valley Medical Center, Fayetteville, North Carolina, US, in an email to Migraine Science Collaborative. Van Tilburg, a pediatric pain researcher, was not involved with the current study.

The research appeared online ahead of print in the journal PAIN on March 27, 2024.

Representation of pain in media for young children
Noel told MSC that the current line of research came from a desire to understand societal and cultural stories about pain after observing that parents did not talk to their young children about painful experiences in the same way they spoke about sad or scary experiences.

“When they talked about pain, they weren’t talking about it in ways we know are helpful for a child’s development, such as talking about emotions, or being open and elaborative. We were fascinated by why this might be,” Noel wrote in an email.

This finding inspired Noel and her team to understand how pain and suffering are portrayed in the media, as well as if and how other people or characters respond to painful situations. In 2021, they published results from a study of how movies and television shows designed for young children aged four to six years depicted pain.

That initial study had three key findings. First, pain arising from intentional (violent) injuries was more frequently observed than everyday, procedural, or chronic pain. Second, boy characters experienced a greater number of pain instances than girl characters did. Third, observers of characters in pain did not frequently respond to this pain in others, and when they did, it was with a distinct lack of empathy.

Noel was keen to determine whether adolescent media represented pain in a similar fashion, as media is one of the most powerful influences on how young people learn.

“Youths learn by watching – they learn by others modeling how to react and respond to pain. Children tell us they relate more to their favorite movie or TV characters than people they don’t know in real life. So we should hope those characters are teaching them well about how to live in the world and, in this case, what to expect for themselves and others when they are hurt and suffering,” Noel explained.

Setting up a new study
As in the previous study, co-author Kendra Mueri watched 10 movies and the first season of six TV shows aimed at adolescents, based on the trending/popular list on Canadian Netflix – adding up to just over 60 hours of screen time.  The idea was to identify the number and nature of pain instances in each piece of media, including characteristics of the sufferer, the painful event, and any observer responses.

As they did for their study in young children, the researchers systematically characterized the demographic features of the pain sufferer, including gender, race, and the type of pain the characters experienced (everyday pain, violent pain, chronic pain such as headache, stomachache or backache, or procedural/medical pain).

Also of interest was the body part affected by pain, what caused the incident, how severe the pain was, how distressed the sufferer was after the incident, whether the sufferer displayed any protective behaviors, and if/how any observers responded to the sufferer’s pain. The team defined instances of pain as any situational event that could have led to a pain response, regardless of its potential severity.

A disappointing showing
The investigators identified 616 pain instances in the selected media, which included shows like 13 Reasons Why, Riverdale, and Stranger Things, and movies such as Enola Homes, Spider-man: Homecoming, and To All the Boys I’ve Loved Before – equating to 10.2 pain instances per hour of media.

One of the key findings was that pain of the chronic type was hardly represented.

“Even though one in five youths lives with chronic pain in the real world, chronic pain was not seen in popular media – less than 1% of pain portrayals in the media depicted chronic pain,” she told MSC.

This lack of focus on pain specifically of the chronic variety has important adverse consequences, including stigma.

“Acute pain usually is a good indicator for harm (e.g., burning your hand when touching a hot stove or a broken foot). However, chronic pain in many cases is not an indicator of bodily harm. Most headaches do not mean you have brain cancer or you got hit in the head by a falling branch. Because there is no bodily harm, chronic pain is often stigmatized as ‘not real’ or ‘all in your head.’ This is far from the truth. In addition, chronic pain requires a different approach to how to manage it than acute pain,” van Tilburg said.

Further, pain in popular adolescent media was portrayed in a consistently narrow fashion: Most frequently violent pain (57% of all pain instances), pain in White characters (78%), and pain in boy characters (77%), all of which perpetuates stereotypes and bias.

“The finding that women and minorities were less likely to be depicted to have pain communicates that pain is even less likely to be encountered in them,” van Tilburg said. “Not too long ago it was assumed that people who are Black cannot feel pain at all, or feel less pain. The fact that they are still not included in our depictions of pain is worrisome and can reinforce these racial biases.”

The head was the second most common body location of pain (26% of characters), trailing only the arms (29% of characters). There were no differences in the proportion of head pain portrayals between boy and girl characters, nor was there a difference between White characters and characters with a racialized identity.

It is unlikely that many (if any) of the head pain portrayals were of headache or migraine, simply due to the tiny percentage of chronic pain instances in the selected media.

How observers responded
Although 85% of pain instances were witnessed by at least one observer, there was a stark lack of empathic or prosocial responses (such as helping, providing physical comfort, or expressing sympathy), regardless of observed gender or race. Observers most commonly responded by verbally criticizing (24%) or taunting/mocking the character (9%). The observer responded verbally with sympathy in only 7% of pain instances, and with reassurance in just 2% of pain instances.

Non-verbal responses told a similar story: Only 8% of pain instances involved the observer helping the character, for example, by rubbing the injured area, and only 8% offered physical comfort.

“This shows we discount pain in others who now are left to cope by themselves without social support. For example, we know from multiple studies that one of the best things parents can do to help their kids with pain is to distract them by talking about something else or doing another fun activity together. How many parents know to do this, if it is never shown to them to be helpful/expected behavior?” van Tilburg wrote.

Taking Netflix to task
Noel, along with her international colleagues and partners, is continuing to research the (mis)representation of pain in marginalized and minoritized populations, and has plans to work with media creators and people with lived experience of pain to transform how pain is portrayed in the media.

“We are committed to understanding why, when, and for whom empathy fails (or doesn’t) and to shining a bigger spotlight on the power of cultural and societal stories about pain,” Noel wrote.

Noel has a strong message for streaming services like Netflix and movie/television creators.

“Take this research seriously. Get excited and inspired to directly influence millions of children around the world. Fictional stories matter – in some cases they matter more than real-life stories.”

Noel continued, “You have a monumental opportunity to influence the compassion and humanity we see in our children and our future world. So let’s create stories to reflect the world we want to see: A humane, diverse, inclusive, equitable, compassionate, and caring world.”

Lincoln Tracy, PhD, is a researcher and freelance writer based in Melbourne, Australia. Follow him on X (formerly known as Twitter) @lincolntracy.

Image credit: 123RF Stock Photo.

References
The sociocultural context of adolescent pain: portrayals of pain in popular adolescent media.
Cormier et al.
PAIN. 2024 March 27 [online ahead of print]

The sociocultural context of pediatric pain: an examination of the portrayal of pain in children’s popular media.
Mueri et al.
PAIN. 2021 Mar;162(3):967-75.