Pop culture loves an ambiguous mental health diagnosis. All those anxieties to exploit around agency in treatment, the nebulous boundaries where illness ends and the self begins. In Steven Soderbergh’s film Unsane, a young woman is committed involuntarily to a psychiatric facility—but is she ill, or punished for speaking out against a stalker? In Ari Aster’s film Hereditary, a family is suffering the symptoms of inherited mental illness—or are they haunted by a supernatural curse?
While it lacks the gothic tones of these 2018 films, the recent Netflix mini-series Maniac, the work of director Cary Joji Fukunaga and writer Patrick Somerville, also has a disputed diagnosis at its heart. A young man, Owen Milgrim, is taking medication to treat paranoid schizophrenia. But is he really ill, or just alienated?
Hailing from a clan of bourgeois Manhattan bullies who neglect to include him in their family portrait, mild-mannered Owen Milgrim (Jonah Hill) is a poster-boy for this view. In the first episode, he is being pressured by his father to provide a false alibi for his brother, who has been accused of sexual harassment. Owen is reluctant, but vulnerable to their coercion. Displaying the slightest flicker of free will, such as declining to play a board-game, is enough to prompt their angry outcry: ‘has he gone off his meds?’ Informed by debates between Somerville’s father, a neurologist, and his psychotherapist wife, a consultant on the show, it’s not hard to guess which camp Maniac pitches its tent in. RD Laing, a prominent figure in the ‘anti-psychiatry’ movement of the late 1960s, questioned the genetic or neurological basis of mental illness and instead privileged social factors, particularly familial dysfunction.
At the beginning of the series, Owen’s just lost his job and, being hesitant to join the family business, has signed up for a pharmaceutical trial. The trial has been designed by Dr James K. Mantleray (Justin Theroux), a quack with a toupee, who explains how, using ‘powerful microwave technology’, he will ‘cure’ mental illness and eliminate the need for talk therapy forever: ‘Sorry, Sigmund!’ The premises of Neberdine Pharmaceutical borrow from the future-retro stylings of Wes Anderson (IBM technology, bonsais and sleep pods). Outside of the Pharmaceutical, the streets are laden with advertising, reminiscent of Blade Runner.
Maniac presents less a dystopic future than the present day on steroids: Russian tourists trail past a super-sized Statue of Extra Liberty; in a nod to the gig economy, citizens supplement their income with AdBuddy, a service that pays them to be trailed by someone reading copy; an average 87 percent of income is spent on rent. Financial precarity, the encroachment of advertising. Somerville diligently maps out his thesis. Is it any wonder people are sick?
As Laing once had it, insanity is a ‘perfectly rational adjustment to an insane world.’
Accordingly, psychiatric treatment is mocked as perfunctory and dehumanising. A machine scans the trial participants’ eyeballs and spits out verdicts that read like a DSM His and Hers—paranoid Schizophrenia for Owen and Borderline Personality Disorder for Annie (Emma Stone), a young woman who, to gain access to the pharmaceutical pill which she is addicted to, has blackmailed her way onto the trial. Maniac evidently doesn’t place much stock in diagnoses: the pair are merely a Sad Guy and an Unorthodox Girl embarking on a trial that promises to eliminate pain forever (so far, so Eternal Sunshine of the Spotless Mind). After being administered a series of pills, both their heads are placed between ominous metal plates designed to monitor their dreams.
Due to a computer error—or cosmic rebellion—Annie and Owen’s dreams keep merging. The series begins to resemble a Netflix sampler menu, the pair hopping through genres. In a 1980s Long Island heist caper, Annie has Owen riding shotgun in a plot to kidnap a lemur; in a Scandinavian thriller she is a sleeper agent saving him with her gun-skills. With her husky suffer-no-fools sarcasm and impetuous disregard for The Law, Annie is a Manic Pixie Dream Girl reboot: here to enliven the sensitive, subdued Owen, to teach him how to be fearless.
Maniac’s narrative is emblematic of a distinct, cultural type of ghosting: a reluctance to acknowledge the symptoms of mental illness. Instead, it treats sufferers as though they are merely experiencing a spiritual or political malaise. It’s not long before we come banging into that old pop-cultural chestnut—mental illness is just a Big Pharma conspiracy, and meds—much like binge watching!—turn people into soulless zombies. Owen and Annie are in danger of becoming McMurphys, à la the lobotomised protagonist of One Flew Over the Cuckoo’s Nest, their minds left behind in the computer’s mainframe.
With its mainline to the asylum horror genre, which grew out of the anti-psychiatry movement in the 1970s, Maniac moves the anxieties around agency outside the hospital. The show instead appeals to a popular notion that doctors are one-stop shops these days, who dispense medication like ‘candies’. It depicts Annie self-medicating, crushing up pills to sniff, and Owen flicking his own prescribed medication away. If the show fails to depict any responsible use of psychiatric medication, it’s because it doesn’t imagine there is one.
We are a culture of the quick fix, sounds the lament, overmedicated and under-extended. There’s a reason for this attitude: globally, rates of antidepressant use are up, prompting concerns that we are failing to address social and political dimensions of mental health. While these discussions are important, in an age of hot takes nuance is often the first casualty. Are all mental illnesses reducible to social or existential woes? What is stunning is how nimbly the creators of Maniac brand this myth to appeal to a hipster ethos of authenticity.
Annie and Owen’s quest to escape the pharmaceutical matrix is all about acquitting themselves of being like those other, more obsequious millennials (complicit in taking meds to maintain the status quo). Cycling through past eras and fashions, Annie and Owen embark on their adventures with the requisite irony that allows them to remain aloof from a world of fakes and phonies. At a 1940s séance, ectoplasms and tarot cards distract the guileless punters while they are a pair of discerning grifters, hunting down the final, lost chapter of Cervantes’ Don Quixote. When they find it, it is housed in a vintage matchbox. Whether it’s a VHS or a floppy disk, the pair are never far from an analogue talisman. Shots of New York signify nostalgia for the city pre-gentrification. Annie eats at a retro diner called Cup and Saucer; the camera lingers over a 70s chic night-scape, decorated with overflowing piles of rubbish, shady folk and neon Girls XXX signs. The show’s conviction is given by Annie’s father, an eccentric recluse, by way of Spinoza: ‘all things excellent are as difficult as they are rare.’
Series creator Somerville describes the show’s ethos as ‘anti-easiness’. (Meds are for cheats; Ayahuasca vision quest anyone?) Annie and Owen’s surreal adventures are hardly of the blister pack variety. The trial owes more to the infamous community-based experiments of Laing, who took his patients off their regular medication so they could experience the delusions that, he believed, offered insight into the family dynamics that were the ‘real’ problem. As a ‘spiritual laxative’ to help along the process, he administered some patients LSD.
In Maniac, the twist is that the ideas of Mantleray’s therapist mother have laced the experiment. In one adventure, Owen is seen reading a book about ‘emotional poltergeists’—a reference to the psychoanalytic theory, pioneered by Nandor Fodor, that hallucinations are externalised manifestations of repressed traumas. The idea is that Owen and Annie are working through their traumas with a bit of innovative cosplay. It’s all a bit tongue-in-cheek, but watching Dream-Owen, in Snoop Dog braids, turn informant on his oppressive mob family, I began to wonder if the show’s creators actually believe in schizophrenia. Owen’s hallucinations—which involve him sitting on NY benches, looking askance as popcorn pops on the sidewalk—are little more distressing than Kaufman-whimsy. Is Owen—like the other trial participants, referred to as Odds—down with little more than an invigorating dose of alienation? Or perhaps he’s contracted Integrity©; the condition of suffering from an ideological purity that treatment puts at risk. The show’s failure to distinguish between different types and severities of mental illness smacks of privilege. While it’s a fact that psychiatry has a dire history of pathologising ‘difference’—until 1987, for instance, homosexuality, was still in the DSM—the most pressing injustice that these kids face is that they are just too complex for a diagnosis. As Annie brags: ‘I’ve never had a therapist that could figure me out.’
Ironic, given how extensively the show’s creative direction was deferred to Netflix’s extensive viewing data; as Fukunaga shrugged, ‘the algorithm’s argument is gonna win at the end of the day’. While Netflix keeps its data under close wraps, it’s fair to surmise that Maniac appeals to a young demographic, who are more vulnerable to the tough-it-out, not-ill-just-misunderstood approach to mental health.
Here is some data we do have access to: suicide is the second leading cause of death for young Australians aged 15-24; the leading cause for those aged 25-44. Men are at the greatest risk, and are the least likely to see help. Other groups at high risk, according to the Black Dog Institute, are Indigenous Australians ‘who experience an overall rate of suicide more than double that of non-Indigenous Australians’ and the LGBTI community, ‘who experience a rate of attempted suicide 4 times that of those identifying as straight.’
While Maniac wants to care, it confuses a compassionate approach with a dangerously sentimental one. At one point Annie coaches an actor she has hired, via the service FriendProxy, to stand in as a substitute for her absent friend Owen: ‘It needs to feel like pain, but not an awful kind of pain. It’s like this low-level sadness that has a lot of caring and sweetness underneath it’. Gentrified melancholy? A boutique kind of blue? When Owen’s family have him committed to a mental health hospital, Annie tries to bust him free in an old jalopy. But I still have visions, Owen protests. So what, Annie bristles, people see aliens, people hear voices, people see ghosts. When Owen insists it’s different, that his mind doesn’t work right, Annie’s response is as emphatic as it is abominable: no-one’s does.
This kind of reckless relativism reminded me of a bit in Maria Bamford’s stand-up comedy which parodies cultural attitudes to mental illness: ‘Apparently Steve has cancer. It’s like, fuck off! We all have cancer!’
The dismissal of mental illness as merely the Human Condition may have its roots in a confused compassion. Fear and misunderstanding have always surrounded mental illness. From Alfred Hitchcock’s Psycho to the latest in the Halloween horror franchise (where serial killer Michael Myers escapes from a psychiatric institution), the mentally ill have been portrayed as volatile and violent, despite the fact that statistically they are no more likely to commit acts of violence (in fact rates of violence against people living with mental illness are higher than for the general population). But in the midst of the anti-psychiatry movement of the 70s, which spot-lit the cruelty of quarantining people indefinitely in psychiatric hospitals, emerged Randle Patrick McMurphy, the anti-hero of One Flew Over the Cuckoo’s Nest. The plight of the wrongfully diagnosed McMurphy, who was only ever in hospital to avoid prison labour, suggested that it’s society that is sick. Ipso facto we’re all sick, which isn’t so different from us all being well. Half a century and a significant movement toward outpatient psychiatric care later, it’s the Hipster who inherits McMurphy’s countercultural cachet: possessor of moral integrity who sees through the ruse. Not ill, just woke, as Annie implies to Owen: a form of gaslighting—now you see it, now you don’t–that evokes the flickering ambiguities of horror. Perhaps this is why contemporary treatments of mental illness continue to reference the genre.
In the new Netflix series Russian Doll, Natasha Lyonne (who co-created the show with Amy Poehler and Leslye Headland) plays a New Yorker who keeps dying on the night of her 36th birthday party, only to reboot and return to the start of the night again. Though the traumatic legacy of her mentally ill mother’s death at the same age seems an obvious clue to this repetition, Nadia investigates the history of the building her party is thrown in (an old Jewish religious school), speculating that it’s haunted. It’s a darkly comic turn on horror narratives like Hereditary, suggesting how in a bid to avoid our own trauma, we appeal to narratives that transform our fear into awe. The spectre of mental illness, and the anxiety that it will subsume our identity, lends itself to a kind of gothic sleuthing—though the reality is that despite neuroscience’s best efforts, and our understanding of genetic and environmental triggers, we may never be able to accurately predict its onset, or pinpoint a finite cause.
When Nadia’s investigations come to a standstill, she remains desperate to avoid being considered mentally ill: it’s not me, and if it’s not me, it’s you, she protests to anyone willing to listen. Or maybe, she wonders, it’s the ketamine-laced joint she’s smoking? Superficially, Russian Doll shares ingredients with Maniac: a self-medicating heroine who is cynically dismissive of ‘mediocres,’ cracking in-jokes about George Plimpton and wryly lamenting the wave of gentrification that she is herself part of (‘remember littering?’). But over eight episodes the show emerges as a witty and compassionate critique of those who imagine they are above the mechanisations, and thus mental health treatments, of regular society. Once quarantined in the asylum, mental illness is now, in Nadia’s milieu, fetishized as quirky. ‘I love crazy,’ a friend assures her. ‘Today I’m helping an artist make blood jelly to suspend over a 13th century mock debtors’ prison’. When Nadia asks her Aunt Ruth (Elizabeth Ashley), a psychologist, to quick-fix her friend Alan’s problems with a dose of ayahuasca, Ruth soberly rebuffs her: ‘I’m a therapist not a shaman’. As the reality that Alan is at risk of suicide dawns on Nadia, she begins to confront her own unacknowledged death wish, and revises her not mentally ill just wacky persona (an impediment to any kind of recovery).
The fetishising of mental illness has become so prevalent that it’s prompted a recent run of satire. In an episode of the fourth season of Broad City, the maître ď (played by RuPaul) at the Manhattan restaurant Ilana Glazer works at tells her that he digs her ‘depression shit’: ‘it’s next level bitchy… I hope you never get better’. In the 2016 TV series Lady Dynamite, Maria Bamford plays Maria, a stand-up comic and actress, who despite a previous psychiatric breakdown and a diagnosis of type II bipolar disorder is persuaded by showbiz types to go off her meds – ‘all the greats are unstable!’ In a sly nod to Audrey Wollen’s Sad Girl Theory, Maria is encouraged to use her ‘sad puss’ to start the revolution for women in Hollywood.
Alienated from the ideal of a successful, ‘empowered’ woman, Wollen argued that expressions of female sadness be recuperated as a form of resistance; the revolution was Instagram-led, favouring a Lana Del Ray–esque despondency. But we can guess how this will all end up for Maria: flashbacks to her previous hospitalisation show her slumped in a hospital wheel-chair. With her lank hair and drawn face, she could not be further from a #prettywhenyoucry selfie; her new boyfriend promises to visit her next time she is hospitalised and shave her medication-induced beard. Based on her own experiences with mental illness, Bamford’s performance denaturalises the trope of the Hot Mess, and calls bluff on the Manic Pixie Dream Girl; manic, in Maria’s world, is not a bit of curated quirkiness but a debilitating acceleration of symptoms. At one point, deep into her delusions, she imagines she is like Neo in The Matrix and embarks on an insensible quest to free ‘Ranlith the hive queen’. Increasingly disorientated, she begins charging around the place, brandishing a sword.
Rather than trivialising symptoms, the sequence is a satire on shows where mental illness is reduced to a metaphor, or a form of resistance to a surveillance state—a trope that continues to be updated and refined. Because you watched Artisanal Sadness Romance Set in a Surveillance State… why not try Asylum Horror for the Me Too generation? Soderbegh’s film Unsane served up a double whammy of conspiracy: a woman committed to a psychiatric facility as part of an insurance racket and as punishment for speaking out against being stalked. Playing on legitimate anxieties concerning agency in the mental health system, depictions like this ultimately perpetuate the stigma of having any contact with it, and romanticise a reluctance to seek help. According to the Black Dog Institute, 75% of people who are admitted to public sector mental health inpatient services in Australia ‘improve notably’. And yet 54% of people with mental illness fail to access any form of treatment (globally, according to WHO, this figure rises to roughly two thirds).
There is a crop of shows that highlight their characters’ uncompromising ideologies as a barrier to treatment. In season five of Bojack Horseman, the series begins to deconstruct the hubris of the show’s depressed lead: a horse who imagines he’s too intelligent for therapy— ‘I’m not someone therapy works on; I might be too smart’—and has to be tricked onto the couch. While Russian Doll is quick to establish its hipster credentials, the show evolves beyond delusions of exceptionalism. One episode, aptly titled “Superiority Complex”, addresses treatment resistance and how it puts people at risk of suicide. Ruth makes a convincing case that, without the mirror of therapy, we are ‘unreliable narrators of our own stories’. Lady Dynamite’s Maria is surrounded by flighty L.A. types who think she should just green-juice her way out of her problems. Instead we see her begin to consolidate her finances in preparation for future relapses, working through therapy books, and, in a nod to responsible medication use, winding down with a non-alcoholic beverage. A riposte to the myth of over-medicated and under-extended, the show highlights just how much work goes in to managing mental illness.
To be seen working at and for something, rather than coming by things ‘organically’—perhaps this is the hipster’s worst nightmare. In Broad City, Ilana lowers her antidepressants and attempts to downplay her symptoms as Seasonal Affective Disorder, scraping through her waitressing shift by making surreptitious visits to the storeroom to bathe in the glow of SAD lamps. But by end of the episode, even the non-conformist Ilana takes a swerve back toward acceptance of her illness, and returns to the treatment that works for it: ‘I was trying to be, like, pure and strong or something, but that’s shame and stigma right there. So I get sick sometimes and need medicine, who cares?’
If you need to talk to someone, please call Lifeline on 13 11 14, or visit www.lifeline.org.au
Katie Dobbs is a writer and critic. Her work has appeared in Overland, Lithub, Review of Australian Fiction and Indigo.