Television depictions about dermatology and skin diseases in Seinfeld
1. Department of Dermatology
The iconic television situation comedy Seinfeld frequently referenced dermatologists and topics involving the integument, using satire for comedic effect. However, selecting satire to portray an already misunderstood and unknown subject matter may perpetuate incorrect public beliefs and stereotypes about those with skin diseases and diminish cultural sensitivity towards people who have dermatologic conditions and their caregivers.
Oscar Wilde’s famous aphorism challenged traditional belief that art and its foci inherently follow and mimic real life events. Instead, life is molded by and mimics art. Film was in its infancy during Wilde’s lifetime and television was in the future. Filmmaker Woody Allen humorously altered Wilde’s insight by observing, “Life doesn’t imitate art, it imitates bad television .” Health care is a popular topic for film and television. How might life imitate art, with respect to medicine in general and dermatology in particular, as depicted on television?
During the pre-penicillin era, the practice of dermatology was stigmatized by church and state because of its historic emphasis on the care of patients with cutaneous manifestations of syphilis and other venereal diseases. Rosoff and Leone’s analysis about the relative social prestige of various medical specialties showed that dermatology consistently ranked as one of the least prestigious by the public . Respondents in the study ranked dermatology lowest in three of four parameters used for comparison, including perceived income, social value, and personal esteem afforded . From where do these opinions stem and why does the public view dermatology this way? Negative public misconceptions about skin diseases have a potential adverse impact on future funding for dermatology research, education and public health programs. Despite being universal and widespread, skin diseases and skin conditions are frequently misunderstood; the general public remains largely unaware about the many physical, emotional, and financial burdens encountered by those with skin diseases. In order to better understand the public’s negative perception and misconceptions about dermatology and skin diseases, dermatologists should investigate the possible origins of these beliefs. This study examined the popular television situation comedy, Seinfeld, for its potential impact on current public perceptions about skin diseases and dermatology.
Seinfeld’s 180 episodes over its nine seasons were viewed (JLV) from commercially available DVDs and a log of all health-related references was recorded. No IRB approval was required for this retrospective media analysis. An internet website with transcriptions of all 180 episodes was used as an aid in completing the reference log . In order to divide health references into groups that could be compared, each reference was assigned a clinical category based on the medical topic depicted. The references that did not belong to any specific category were labeled as “unspecified.” Frequency tables were created for all categories and reported as percentages of the total number of references.
After all references were recorded, all dermatology references were classified a second time for the type(s) of humor used, based on definitions adapted from two separate sources that provide descriptions and explanations of types of humor in various contexts [5, 6]. References within four more esteemed  non-dermatology specialties (ophthalmology, surgery, neurology, and cardiology) were combined and also classified by types of humor used. Lastly, all psychiatry references were classified for types of humor used. A frequency table was created for each of the three categories depicting the frequency with which each type of humor was used and reported as percentages of the total number of humor references.
Distributions of types of humor across the three categories of dermatology, non-dermatology, and psychiatry were assessed using the Pearson chi-square test for homogeneity. Eleven types of humor, each that had total count less than 10 across the three categories, were grouped together as “Others” for statistical analysis. The chi-square test was assessed at the 0.05 level of significance. Data analyses were carried out using PROC FREQ in the SAS® system, release 9.1 .
A total of 1,638 health-related references were recorded (Table 1). Dermatology had the highest frequency of references with 240 (240/1638, 14.7%). Psychiatry had the second highest frequency of references with 162 (162/1638, 9.9%). Dermatology was referenced more in the last season with 54 depictions (54/240, 22.5%, Figure 1) when compared to earlier seasons.
Distributions of types of humor across the three categories were significantly different from each other (p<0.0001, Table 2). The three most frequent humor types for dermatology were satire (65/201, 32.3%), exaggeration (28/201, 13.9%), and nonsensism (25/201, 12.4% of 201). Satire was also the most frequent type of humor for psychiatric topics (66/127, 52%) on Seinfeld, followed by exaggeration (14/127, 11%) and understatement (12/127, 9.4%). In the non-dermatology category, nonsensism (37/170, 21.8%), sarcasm (31/170, 18.2%), exaggeration (29/170, 17.1%), silliness (26/170, 15.3%) and understatement (20/170, 11.8%) were used most frequently. Exaggeration was more frequently used in non-dermatology (29/170, 17.1%) than in dermatology (28/201, 13.9%) and psychiatry (14/127, 11%). Although satire was the most frequent type of humor found for psychiatry and dermatology, it tied for seventh (6/170, 3.5%) with irony in non-dermatology. Caricature was used more frequently for dermatology (9/201, 4.5%) but only once for non-dermatology (1/170, 0.6%), and was absent for psychiatry (0/127, 0%). Nonsensism (25/201, 12.4%) and silliness (14/201, 7%) were used less frequently for dermatology than non-dermatology (137/170, 21.8% and 26/170, 15.3% respectively), and were infrequent for psychiatry (7/127, 5.5% and 0/127, 0% respectively). Sarcasm and understatement were used often for non-dermatology (31/170, 18.2% and 201/170, 11.8% respectively) and psychiatry (10/127, 7.9% and 12/127, 9.4% respectively), but were used less frequently for dermatology (9/201, 4.5% and 2/201, 1% respectively).
Media can exert a profound impact on how we view the world and may influence the decisions we make. Television, in particular, can be particularly influential because of its ubiquity. We are often unaware of the impact that television has on our attitudes and behaviors. The television sitcom, Seinfeld, was broadcast from 1989 to 1998 and continues to occupy high-profile time slots in syndication on leading television stations in more than 200 markets around the United States . In the current era of readily accessible enduring media, all episodes are available for purchase, rental, or lending through media libraries. Commercial advertisers certainly understood the value of product exposure on this popular television program. Seinfeld’s 1997 finale commanded 1.5 to 1.7 million dollars for each 30 second slot, surpassing the 1996 Super Bowl XXXIII advertising costs . Illustrative of Seinfeld’s commercial impact was the program’s 31st episode, entitled “The Pez Dispenser.” Following its 1992 broadcast, with a subplot featuring a Tweety Bird Pez dispenser, Pez® Candy sales spiked so dramatically that the company eventually had to expand their Connecticut plant to accommodate the overwhelming renewed interest in their product . Seinfeld’s remarkable broad and continuing sociological impact has generated several books and academic papers and is comparable in impact to earlier iconic television depictions of American life such as The Honeymooners and I Love Lucy. Seinfeld’s longevity, breadth of airtime, and record-breaking popularity afforded it influence on current public attitudes and behaviors.
Media depictions may color our attitudes about disease. When Wahl et al showed subjects a film that depicted a character with mental illness as being dangerous, they found that viewers had significantly more negative attitudes toward people with mental illness than another group that saw the control film . The authors postulated that the emotional and visual impact of the target film could not be overcome by the inclusion of an informational trailer . Similar outcomes may be occurring with dermatologic and psychiatric depictions in Seinfeld. Limited public exposure to true and authentic depictions of skin disease and mental illness may bring them to the forefront of the “public brain” without accuracy or understanding. The sitcom’s frequent, erroneous, and often negative depictions of these entities may persuade the viewer that these depictions are accurate, with ensuing public stigmatization of patients with these disorders.
Understanding humorous media portrayals of skin diseases and dermatology may illuminate one possible origin of the public’s misconceptions. The type of humor selected to depict health topics may have some bearing on public opinion and perception. Depending on the type of humor used, its portrayal of health topics could communicate medical conditions unrealistically and in an insensitive or ridiculing manner. Satire, a type of critical humor usually reserved to “…expose and discredit vice or folly ” was used with greater frequency in Seinfeld for dermatology and psychiatry compared to the four higher ranked non-dermatology specialties. Griffin, an expert on satire, recognized the subversive power of satire through its political consequences . An example of satire is seen in the portrayals of George and the frequent references to his baldness. Throughout the sitcom, George was repeatedly teased for his hair loss; his failures in life, love, and physical appearance were often presented in an entertaining and comical manner. In this way, Seinfeld regularly used schadenfreude, the German concept of taking delight in the misfortunes of others  as means of amusement. Schadenfreude’s application to health-related issues as frequently observed in the program, compromises sensitivity and empathy. In specialties such as dermatology and psychiatry in which related conditions are often misunderstood and diminished, schadenfreude’s effect can be even more pronounced. It has been estimated that 30 percent of patients with dermatological disorders suffer from some kind of psychiatric disturbance or psychosocial impairment [14, 15]. The repeated mockery and satire that is applied to dermatologic and psychiatric conditions in Seinfeld is an example of how television and the media could contribute to these effects.
Stereotypes of medical disorders, procedures, and professionals that have been portrayed in films have been reviewed in several areas of health care including psychiatry, dentistry, and transfusion medicine [16, 17, 18, 19]. The mentally ill are often portrayed as dangerous, violent, and mentally inferior. Wilson et al analyzed 14 television dramas that included one character with mental illness shown in prime-time during a one year period . This study showed that characters were overwhelmingly depicted as “lost, unpredictable, unproductive, asocial, vulnerable, dangerous to self and others because of incompetent behaviors, untrustworthy, and socially outcast .” These results were consistent with television media contributing to stigmatizing stereotypes of psychiatric patients that are neither true nor accurate. Similarly, for dermatology, characters with albinism, alopecia or facial scars are often stereotypically depicted in evil or villainous roles .
Of particular concern in Seinfeld is the potential for the public to model their behavior after Seinfeld characters. In “The Conversion” during Season 5, Jerry was shocked and disgusted to the point that he broke up with his girlfriend after finding fungicide in her medicine cabinet. Although cutaneous fungal infection is a common disease in the United States and does not reflect an affected person’s hygiene, it is stereotypically presented as unclean and disgusting by the media. It has been estimated that up to 20 percent of people in the United States have at least one type of dermatophytic infection . Although anyone is subject to contracting a superficial fungal infection, we are hypocritical in believing that people who have an infection should be avoided socially. We laugh because we see our own hypocrisy in the comedic representation. However, portraying people who have dermatophytic infections as being dirty or undesirable disseminates an unnecessary and unfair stigma that could discourage affected individuals from seeking treatment out of embarrassment or shame, or may lead to social isolation and depression. Although these stereotypes are used as seemingly harmless derivations of humor, this representation presents the causality dilemma of whether these depictions reinforce the public’s misperceptions and result in an expansion of these stereotypes. In this respect, the media may be making life for people with skin diseases more difficult.
Future research on this topic might examine media portrayal of dermatology and other health topics within additional popular television programs. Additional research could also aim to test or measure the public’s opinion about dermatology and dermatology-related topics and then examine the interrelations between public opinion and media portrayal. Dermatologists and patient advocacy groups could organize timely responses to misconceptions propagated by the media about skin diseases. Broadcast media recommendations could be formulated to require time for rebuttal when medical conditions are inaccurately depicted or presented in a stigmatizing manner.
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