As the 2008-09 television season ends and networks begin to reveal plans for their 2009-10 schedules, a surprising pattern emerges.
Pilots in contention for the upcoming season include NBC's Legally Mad, with Kristin Chenoweth as an attorney with flashes of psychosis, and FOX's Maggie Hill, whose title character is a heart surgeon with schizophrenia. Canada’s Showcase recently ordered Shattered, a 13-episode series starring Callum Keith Rennie as an ex-detective with dissociative identity disorder.
Renewed freshmen series Fringe and 90210 feature main characters coping with psychiatric conditions. And among the more senior series, House led up to Monday's season finale with a storyline involving suicide and Hugh Laurie's dysfunctional doctor questioning his sanity after confronting his inner Cutthroat Bitch: Wilson's dead girlfriend Amber appeared to him as a facet of his tormented psyche.
More than ever, writers and networks seem to be embracing the idea that compelling stories can be mined from complex psychological issues. As mental health organizations work to reduce the stigma and more people open up about their own struggles with mental health, today's audiences tend to expect better than simplistic or offensive depictions. In other (simplistic) words: psychotic killers are out, protagonists dealing with psychoses are in.
"Audiences are definitely more sophisticated now. We know stigma has gone down — we've studied that," said Dr. Nada Stotland, M.D., president of the American Psychiatric Association.
"You know a TV program is a TV program, but the closer it gets to looking like reality, the more you believe it," she added. That worries her when it comes to how dramas represent mental health issues — "even people with some sophistication can be swayed by depictions on television" — but it should also cause writers to worry about inaccuracy in their scripts. After all, if it doesn't feel real, a show risks losing its bond with the audience.
"I think it's much more difficult nowadays for programs to get away with extremely inaccurate, damaging portrayals of mental illness, partly because the general public is more sensitive and informed and partly because the advocacy groups won't stand for it," Stotland said.
"I agree that we are seeing television shows address mental health issues more than ever," is the opinion of Dr. Deborah Serani, Psy.D., a psychologist and psychoanalyst who has worked as a technical advisor for Law & Order: Special Victims Unit. "For a long time, mental health issues were characterized inaccurately. However, now more than ever, the mental health community and professional organizations watchdog television media. I think sensationalism has been replaced with realism in the entertainment industry as a result."
House has been lauded for its portrayal of drug addiction and mental illness by some of those organizations: Hugh Laurie has been nominated for PRISM awards, and the season three episode "Resignation" won a Voice Award, for example.
The latest episode, "Under My Skin," was searingly emotional in its portrait of a man reluctantly accepting his need for help, terrified to face the cause, and apprehensive the treatment might mean the loss of his career and his gifted mind.
Psychosis was one possible cause of House's hallucinations. For House though, it isn't even the worst-case scenario, that would be detoxing from Vicodin. "I've been popping pills for years," House reminds Wilson when protesting the apparently final solution. "What changed?" If we accept answers proposed in prior episodes, his crisis may have been triggered by grief, insomnia, or guilt following the abrupt suicide of Kutner (Kal Penn). That death shocked, angered, and saddened many fans — exactly the emotions Kutner's fictional colleagues faced.
"All the characters went through very normal reactions to Kutner's suicide," confirmed Serani, who specializes in trauma and depression. "Anger, confusion, guilt, isolation, and numbness were seen, just to name a few. With House, in particular, his reaction of denial was spot-on."
While the character's exit was prompted by an exceptional excuse (actor Penn took a job with the Obama administration), the writers could very well have provided clues to his mental state in the episodes leading up to it. Instead, the unsolvable mystery set up the dramatic events that followed.
"Out of every ten suicides, two show no outward signs of their internal struggles, so their suicide comes as a surprise," explained Serani. "Any sudden death presses deeply on our psyche. But suicide adds layers that complicate bereavement. Making sense of loss helps us recover. If we know someone died because the road was icy and the accident was unavoidable, we can somehow move on. If a medical illness or a tangible reason can explain a death, a sense of closure will eventually occur. But suicide leaves many questions, none of which can or ever will be readily answered. So there is a legacy of a loved one's death not making sense. There is no closure."
For a man who needs to solve a medical mystery even if the answer can no longer help his patient, a lack of closure might be kryptonite. House has already relinquished his superman status; his unexpected admission of misery to already-dead Amber in the season four finale has cast a shadow across season five. He's tried methadone, psychiatry, and tentative steps towards a relationship with Cuddy, even as he sabotages every opportunity for meaningful change. Then Kutner's suicide and the hallucinations threatened his true superpower — his reason.
Making internal conflict visible can be a challenge for television. House frequently uses CGI effects to allow viewers inside the damaged bodies of patients; it used the reappearance of a dead woman to allow us entrance into the damaged mind of House.
"I think using Amber is a terrific way to highlight House's struggle," said Serani. She pointed out the audience had been as much in the dark as House about the cause of his hallucination: "Is it a grief reaction? Is it a psychotic break? Is she a fundamental side effect from the years of pain medication he has taken?"
The American Psychiatric Association's Stotland more reluctantly accepts that dramatic shows take dramatic license. "I wish they wouldn't, but I have to accept that you don't always get what you want. It's entertainment. That's why people are watching. I'm not about to write to the people who do Monk, for example, and say 'this isn't a completely accurate portrayal.' As long as it's sympathetic. When it's unsympathetic and perpetrates stigma, that's more problematic."
Despite entering deep waters lately, House has managed to plumb them with its characteristic humour. After all, the show is primarily a piece of entertainment. But some of the most resonant viewing experiences occur when entertainment intersects with meaningful issues. With the prevalence of mental health conditions, most audience members can't help but have a profoundly personal reaction to those stories.
More than 25 years later, Serani still grieves for a friend lost to suicide, and I will always regret missing signs prior to the attempted suicide of someone close to me over a decade ago, making the "Simple Explanation" episode of House painfully poignant.
Even beyond that, "Television is a powerful media platform that can help educate viewers about mental health facts and fictions," Serani acknowledged. "In doing so, the television show offers something greater than its entertainment value. It becomes part of a teachable moment, helping to take away distorted and stigmatizing views of psychological and psychiatric issues."
The small screen picture's not all rosy. Serani isn't pleased with how Showtime's United States of Tara treats its main character's dissociative identity disorder, and both Serani and Stotland brought up Wonderland, the short-lived ABC series recently rerun on DirecTV, as a particularly egregious example of stigmatization. In Stotland's words: "That indicates that in fairly recent years, the networks are willing to put on something really bad."
The current climate would indicate that they are more interested in putting on something really good, however. HBO's In Treatment was singled out by Stotland and Serani as an excellent representation not only of mental illness but of the treatment process, and Serani added shows such as Grey's Anatomy, Private Practice, Law and Order, and Without a Trace. It's perhaps not so surprising after all to see so many stories related to mental health; you can't get much more complex than the inner workings of the irrational mind.
From Wilson's brother's schizophrenia, to Kutner's suicide, to House grappling with his sanity, House has certainly tackled those issues in a big way lately. But even before then, the show offered its own humourous, de-stigmatizing philosophy succinctly, in a line that now appears on a t-shirt to raise funds for the National Alliance on Mental Illness: "Normal's overrated."Powered by Sidelines