Review of Fox TV show “Mental”

Fox TV Program MENTAL about a  psychiatrist is not an authentic  portrayal of a real shrink

As someone who wants to see the public educated about  psychiatry and mental health, I was hopeful that Fox’s new TV series MENTAL would achieve   the impact and success that Fox’s other series HOUSE has accomplished. Unfortunately after viewing the first 4 out of the projected summer series of 13 episodes, I am quite disappointed.

Actor Chris Vance

The star of the series is Dr. Jack Gallagher (played by Chris Vance). He is a young, likeable, very smart doctor who is the new Director of Mental Health Services at a Los Angeles hospital ( so far so good ). However, his method of operating doesn’t resemble any real psychiatrist I have ever known or heard about. For example, we are introduced to the main character when he walks into the Emergency Room of his new job and sees a psychotic paranoid man without any clothes menacing everyone. Dr. Gallagher takes off all his own clothes in order to better relate to the patient and talks him down. Not only would a real psychiatrist never do this but even a first year resident should know that such behavior would be viewed as an extremely frightening threat by a patient in this situation.  In one episode Dr. Gallagher is treating a celebrity patient with a Narcissistic Personality and some breaks with reality. The doctor invites a good friend of the patient to view the therapy sessions with the patient through a one way mirror breaking all ethics of confidentiality which are important in all of medicine, especially in psychiatry. In still another episode, a women prosecutor is racked with guilt about people she has convicted. The treatment consists of the hospital staff pretending to be players in a court room drama which the patient thinks is really happening. They plan on reenacting the drama until the patient has somehow worked through her problem. The twists and turns of the various plots appear to be those that people might fantasize that a brilliant psychiatrist in this setting might do, but lack authenticity which would make it much more interesting.

I understand that a successful TV program has to use imagination and take poetic license in its writing. The long-running show ER certainly had complicated character developments and some fanciful plots. However the medical aspects of the program were quite realistic which was an important part of the great appeal of the program. In fact, I believe that one of the reasons that medical students over the past several years have been increasingly choosing emergency medicine as their specialty is because these doctor characters became role models for them. The popular TV show HOUSE showed an eccentric physician with his own quirks but nevertheless just about all the cases were based on scientific thinking and good medicine which also was riveting TV.

It appears to me that the producers and writers of MENTAL either did not have psychiatric consultants or were not listening to them. I know of medical students or medical residents being assigned viewing of ER or HOUSE episodes whereas I can’t imagine asking a trainee to view MENTAL unless it is to see what they should not do. Truth can be more interesting than fiction and there are plenty of clinical books and articles which describe case histories which will make great material for a television shown such as MENTAL.

The National Alliance on Mental Illness (NAMI ) has this show on it’s StigmaBusters alert which means members of this group will be watching and making judgments as to how this program depicts mental illness. Thus far their few comments are mixed. . I certainly share their hope that television shows such as this one will give truthful awareness of mental illness and the battle that patients, families and healthcare providers are going through on the road to recovery. I will be following future episodes to see if they get it right.

Addendum:

I caught some additional programs and I regret to say, in my opinion, the program is not on track to depict mental illness or psychiatry in any where near a realistic or interesting manner. For example one program suggested that a patient’s belief in reincarnation and past lives has somehow connected him to a man who was the lone survivor of a mine disaster almost 100 years ago. Although the psychiatrist in the show says he doesn’t believe in such things, the patient’s belief somehow gave him knowledge of factual things he otherwise couldn’t have known and leads to him having physical symptoms including an episode of a fever of 106 degrees. Even as a far fetched fanciful tale, the story fell flat and it certainly is a big disappointment if it is trying to demonstrate how modern day psychiatrists practice. I can only hope that if this show is renewed and given a second chance next season, the writers will take a close look at some real case histories, which are readily available in textbooks and journals, although perhaps disguised for confidentiality reasons. They will find that truth is stranger and more fascinating that totally made up fiction and that may even help with the all important ratings.

Second Addendum- Program Still Out of Touch with Reality

Since I was a little delayed in launching this first edition of the PsychiatryTalk blog I can report on the season’s two hour finale. Jack hospitalizes his long lost schizophrenic sister and makes the unorthodox and usually unethical decision to try to treat her himself.  He realizes that he was emotionally too involved to be objective and takes the advice given to him and gets some therapy for himself. During a therapy session we  get a glimpse that  one of his problems is that he is afraid of having a psychotic episode himself although he acknowledges that the onset of this condition at his age would be unusual. After a few therapy sessions where we only heard the voice of his therapist, we finally see that his therapist was actually himself . He was really just privately reflecting on things! During the  two hour finale we are also shown two patients with very rare but quite interesting real psychiatric conditions which I will give the program credit for introducing to the audience. One is a man who since childhood has had an intense desire to ampute his own hand. He does it and ends up in the hospital,  Jack recognizes the condition and distinguishes it from the more common type of psychosis. The second patient believes that he has been transformed into a werewolf and is about to kill others seeking blood when the moon comes up. He is holding Jack and some staff members hostage with a gun. Jack convinces the man to bite his arm so they both can face the moonrise together and whatever it will bring. The first season ends with Jack having quit his job at the hospital and is basically going off into the sunset with his guitar case on his back.If this program is renewed, it is hard for me to believe that they will top this season in so far as showing a more unrealistic picture as to what the treatment of mental illness is about . If they should have a second chance,  I sincerely hope that they will give Chris Vance, the talented actor who plays Dr. Gallagher, some better scripts. But of course first they will have to rehire the good doctor.