Why Is Medication for Mental Health Still Stigmatized on TV?

Here's the truth behind all those troubled geniuses you see on TV argues Jeff Gentile

(As originally published on August 24, 2018 by TVGUIDE.com) 

During the third episode of Dietland a remarkable scene transpires. After meeting a wealthy benefactor, Plum Kettle (Joy Nash) is offered $20,000 to quit her medication, a fictional pill named "Y", which she takes for depression, anxiety and other body image issues stemming from her weight which is constantly demonized by those around her. She does so cold turkey. Over a weekend of withdrawal, her behavior becomes increasingly erratic. She sends uncharacteristically inappropriate work emails, experiences brain zaps and hallucinations, which include conversations with an anthropomorphic tiger voiced by a detective and current potential love interest. As distressing as these symptoms may seem, she emerges from this 48 hour haze with a major life epiphany. As a woman who has been struggling with weight issues and low self-esteem all her life, she comes to this ultimate conclusion:

"I don't hate myself. The world hates me. They act like I'm a stain ... Worst of all, they tell me I have a pretty face and they lecture me on how to fix my body."

It's a powerful assertion. One made all the more troubling by how it was reached. A character's journey from self-loathing to self-actualization is always a welcome one, especially when it comes to those in marginalized spaces. (I'm hard pressed to think of a fat woman on television who doesn't hate her body, let alone actively loves herself other. Donna Meagle — played by Rhetta — from Parks and Recreation may be the lone exception that comes to mind.) However, the fact that this profound honesty is facilitated by withdrawal from medication, without the assistance of a medical professional no less, is deeply dangerous — yet it shouldn't come as unexpected. 

A refreshingly well-adjusted, confident Donna seen encouraging self-love

As is the norm on TV, a character that's seen as noble, gifted or otherwise different from the status quo in terms of their worldview, possesses some sort of mental health issue, one that must go untreated for fear that their unique perspective will disappear.

We see mental health fetishized as a near super power time and time again. Think the asperberger-like quirks of forensic anthropologist Temperance Brennan (Emily Deschanel) from Bones and the genius diagnosis of addict Gregory House (Hugh Laurie) from the eponymous House. Even in more nuanced examples like Carrie Matheson, a bipolar FBI agent played by Claire Danes on Homeland, we still see a professional who is exceptionally capable, because of, not despite of her condition. Season 3 of Monk takes the idea even further: rather than simply self-medicating his condition like Carrie, the titular detective played by Tony Shalhoub goes off his OCD medication completely, leaving him unable to manage his symptoms but able to solve crimes again. 

Brilliant detective Adrian Monk faces his psychiatrist (the late Stanley Kamel)

This stigmatization of medication is pushed even on shows where our beleaguered protagonists reach out for professional help willingly. In thankfully short-lived ABC drama Black Box (which only ran for one season in 2014), the show's main protagonist, Catherine Black (Kelly Reilly), is a medical director of neurological center and, you guessed it, her psychological issues are treated as an asset in communicating with patients. When she decides to go off her meds, she tells her psychiatrist that, "Hemingway. Sylvia Plath. Billie Holiday. Dickens. Melville. These are just a few of the great minds that suffered from a fine madness. Should they be medicated into mediocrity?"

The doctor on Black Box then amplifies this faulty line of thinking by saying, "Do you want to be exceptional and dead?" as if that was the only alternative to mediocrity, implying there's no balance to be struck. There is never any discussion of the spectrum of positive experiences that can be lived when mental illness is medically treated. In all these examples (even when a medical professional is giving the prognosis) the bottom line remains the same: one must endure mental anguish in order for them to retain and be recognized as special in the first place. Health wise, nothing can change at the risk of losing these gifts which are romanticized as rare, precious and enviable.

Delightfully colorful incarnations of tricyclic antidepressant (TCA) Clomipramine

On TV, pills are a tool used by those who wish to smother your specialness, your otherness, whatever is it about you that makes you different. In reality they have often the opposite effect, and work as necessary ways to balance chemical deficiencies. This hasn't stopped television from portraying them in incredibly negative ways. 

With pop culture prompting a heavy churn of anti-medication narratives, it's easy to figure out why Americans still cling to damaging stereotypes of mental health to the extent that keeps them from reaching out for help. Nearly 43 million Americans are believed to have some sort of mental health issue. However an estimated 56 percent of adults within that demographic do not receive professional treatment. It's ironic that the era of self-care only extends to facemasks and not professional medical intervention.

Debilitating depression can be spotted explains Mohammed Al-Mosaiwi

In reality millions of Americans wouldn't be unable to function at all if it wasn't for medication that keeps symptoms of depression, anxiety, PTSD and other mental health issues at bay. SSRIs, the most commonly used medications, work to help balance feel-good neurotransmitters like serotonin. Those brain chemicals have a huge impact mood and emotions and their regulation is often imperative to mental stability. If an individual quits cold turkey a vast array of damaging mental and physical repercussions may occur. Everything from insomnia to stomach aches, paranoia, headaches and an inevitable upswing in anxiety, and depression may emerge.

A model mapping acupuncture points for anxiety and depression

So if SSRI medication helps 15 million Americans on a daily basis, then where are those positive narratives on television? Very few shows have portrayed how vital these medications are in the lives of those who rely on them. But the rare ones that do, have done so by showing the dire consequences that characters face when treatment is stopped without the aid of medical professional. 

Sitcoms like One Day at a Time and You're the Worst have both dedicated episodes to characters who have gone off medications to disastrous and highly realistic results. On ODAT, nurse, mom, and veteran Penelope Alvarez (Justina Machado) decides to stop going to therapy ands stops taking antidepressants for her PTSD because she is embarrassed to disclose this condition to her new boyfriend, given its perceived social stigma — which for Alvarez is layered with the piousness of her immigrant mother, and the expectation for her to be superhuman as a single, Latino mother. As a result she is rendered impotent, unable to leave her bed, or fulfill any of her personal or professional duties. She doesn't go to work, refuses her mother's cooking (a huge red flag in a tight-knight Cuban family), and even misses out on an important date she had been looking forward to all week. Even her religious mother, played by the legendary Rita Moreno, who previously was opposed to discussing her mental health issues insists she resume treatment upon encountering her daughter in such a helpless position. 

Family acceptance and support on Netflix's "One Day At A Time" (Season 2, Episode 9)

During the episode's climax, Penelope unleashes a tearful plea. She's worried she's failing her children, given her severe depression and inability unable to feel and appreciate life in her current state. "What's the point of living if you can't feel anything?," she asks. It's a very raw, and very revealing question, one she eventually discusses with her neighbor and confidant Schneider (Todd Grinnell). "I don't want to have to be on a drug for the rest of my life. I shouldn't have to need it," she confides to him. As a recovering addict with mental health issues of his own, he's able to offer a healthy and necessary perspective. Having to be on a pill for the rest of your life may not be desirable, but it's a hell of a lot better than the alternative, which would entail a lifetime of needless anxiety, trauma and all the physical and mental symptoms that come with it. In the aftermath of this breakdown she resumes treatment and medication, having come to this necessary, if brutal, realization.

A "no signal" TV pattern of long-past eras. broadcast when daily content concluded

You're the Worst presents a similarly devastating portrayal of withdrawal. Edgar Quintero (Desmin Borges), who also happens to be a Latino veteran and suffers from PTSD, experiences a similar episode as Penelope. When he stops taking his medication, he undergoes severe anxiety, paranoia and insomnia. An entire episode is told from his disassociated viewpoint. Some plot points from the previous episode are retraced, however this time they're shown from his hazy perspective. Scenes are blurred, the voices of other characters frequently trail off. Edgar is so trapped in his own head, overwhelmed by the world around him that he's able to perform tasks as a mundane as washing the dishes or buying groceries. He literally perceives his fellow shoppers as enemies out to get him. He lashes out at those around him including his girlfriend who refuses his advances until he agrees to go back on medication, and a Veterans Affairs consultant who offers him several specialized treatment options that can only be considered if he goes back on his antidepressants.

Edgar faces a cabinet of ubiquitous amber pill bottles in You're The Worst Season 3

Nevertheless he refuses to give in to a "one-size-fits all chemical cocktail" given the stigma and embarrassing sexual side-effects. At his lowest he considers wandering into traffic. It isn't until a stranger stops, not only to talk with him, but to listen. While a random pep-talk doesn't cure him, it does inspire him to resume treatment. Subsequent episodes find him experimenting with exposure-based therapy and medical marijuana, as well as more traditional methods. 

For both Penelope and Edgar, the journey to clarity is long and rarely linear. These raw depictions of withdrawal and recovery show just how necessary medication is to their ability to live full and meaningful lives. More importantly, their respective sitcoms treat their process as lifetime commitments, not something that can be cured in thirty minutes.

The 2016 etching "Shades of Night" by abstract artist Lorena Herrero

And luckily they're not alone. As a whole, TV is getting better at representing the realities of people suffering from common mental health issues, but slowly, and in unexpected arenas, with comedies clearly leading the way. A host of sad-coms, from Bojack Horseman to Crazy Ex-Girlfriend are finally treating medicated mental health issues with the respect they deserve and as a result have become critical darlings with devoted fandoms. Even comedies that aren't centered around trauma, such as Broad City have throwaway lines about the positive impact of SSRIs. Humor obviously helps in the delivery of such tricky subject matter, proving that even laughter can be found during life's darkest moments. 

Rachel Bloom's titular Crazy Ex-Girlfriend contemplates medication

But the biggest way these comedies differ from their dramatic counterparts — with perhaps the exception of This Is Us-- is that they vehemently resist romanticization of their character's mental state. Comedies like ODAT and You're the Worst never fall prey to the trope that their character's mental state elevates them as noble, enlightened individuals. Penelope and Edgar's withdrawal is anything but idealized. They can barely manage to do household chores, let alone solve crimes or diagnose fatally ill patients in their hazy, anxious states. The only epiphanies they're able to come to is that resuming treatment is necessary for their own self-preservation, and that comes well after their suffering is made known to themselves and the audience in raw and realistic ways. 

Joy Nash gets clinically assessed on AMC's Dietland

Television clearly needs to move in this direction as whole if it wants to help erase the cultural shame and stigma that it's helped perpetuate for so long. Dietland in particular could learn a lot from this representation. Imagine how much easier Plum's life could be if she continued treatment, medication and all, and learned to rid her life of her toxic job and discount harmful social attitudes without the tumult, brain zaps, and imaginary tigers she endured.