Over the past decade, the legitimacy of advertising prescription drugs to the lay public has been vigorously debated. Proponents argue that such “direct-to-consumer” or DTC advertising plays an important role in enhancing public health by providing information to sufferers and encouraging help-seeking. Rejecting such arguments, critics contend that DTC advertising provokes unnecessary prescribing, strains doctor-patient relations, and misappropriates healthcare dollars. This is an important debate. While I make no pretext to be neutral, it is not my purpose here to make a pro or con argument. Rather, I want to explore one feature of DTC ads, spe- cifically those for psychoactive medications, that is surprisingly overlooked. I want to ask how mental illness is visually represented in print ads and commercials, what such images signify about suffering, and what response they are designed to elicit. Visual representations of mental illness did not begin with pharmaceutical advertising; such representations have a long history in psychiatry. That history provides some clues to the dynamics of DTC advertising.