COMMENTARY

'After Life' and Before Good Treatment

Portrayal of Psychiatry in Netflix Series Could Deter People From Getting Help

Susan Hatters Friedman, MD, and Karen B. Rosenbaum, MD

Disclosures

June 02, 2020

While many across the world who have access to Netflix and other streaming services have been on lockdown, the second season of Ricky Gervais's dark comedy series, "After Life," was released. The show will also return for a third season.

The setup of the show is that Lisa, the wife of Gervais's protagonist, Tony, has died of breast cancer. Knowing that he would need help after, she made him a video guide to life without her, ranging from the mundane of a garbage day or house alarm to feeding their dog Brandy, tidying the house, and constantly reminding him to take care of himself.

When we first see Tony, he is not doing great on self-care, and he has turned his grief into a "super power" allowing himself to do or say whatever he wants to – from pretending to reprimand his dog for calling a man (who had just told him his dog should be on a lead) a "fat hairy nosy !#$%&" to getting into a name-calling exchange with a primary school child. He later (jokingly) threatens this same child with a hammer, so that the child will stop bullying his nephew.

Tony works as the head of features for the Tambury Gazette, the free local paper. The comedy is full of the hometown charm with Tony and the photographer, Lenny, visiting the homes of the interesting personalities who have called into the paper with their small-town newsworthy stories.

Colorful characters abound in his town, including Postman Pat, who pops in and helps himself to a bath. Tony develops an unlikely friendship with a sex worker whom he hires to clean his house – since she said that she would do "anything for 50 quid."

Tony, in the midst of an existential crisis, visits his wife's grave frequently. While there, he meets an older widow, Anne, who befriends him and offers good advice. (Anne is played by Penelope Wilton of The Best Exotic Marigold Hotel and Downton Abbey.)

Tony also dutifully visits his father daily at the Autumnal Leaves Care Home. His father has dementia and keeps asking about Lisa, forgetting that she is dead. Tony comments that if his father were a dog, he would euthanize him. In actuality, Tony's dog, Brandy, stops Tony's potential suicide throughout the series.

Matt, who is Tony's brother-in-law (and boss at the paper) describes Tony as "devastated, suicidal." Tony explains that he can do and say what he wants, and "then when it all gets too much, I can always kill myself." By season 2, Matt's wife has left him, and he, too, needs to see the psychiatrist.

The problem is the Tambury psychiatrist (played by Paul Kaye). General psychiatrists in film have been described in various ways by the late Irving Schneider, MD, including Dr. Evil, Dr. Wonderful, and Dr. Dippy types. "Dr. Dippy's Sanitarium" was a 1906 silent film in which Dr. Dippy is seen lacking in common sense but being harmless overall. Based on the behaviors displayed in and out of therapy, the Tambury psychiatrist could never be described as Dr. Wonderful, leading to the Dr. Evil or the Dr. Dippy options. He is certainly using patients for his own personal gratification (like a Dr. Evil might) and is certainly lacking in common sense and acting "crazier or more foolish than his patients"1 (like a Dr. Dippy). However, this psychiatrist may need a category all to himself.

Tony sought out the psychiatrist at a desperate time in his life. The dark but comical way he expresses himself: "A good day is one where I don't go around wanting to shoot random strangers in the face and then turn the gun on myself" is not met with compassion, but unfortunately by inappropriate chuckles. Instead of offering solace, the psychiatrist revealed confidential doctor-patient information about other patients. When pressed, the psychiatrist insists, "I didn't say his name." The psychiatrist also explains he is telling Tony privileged information to "let you know you're not … the only mental case out there." The psychiatrist is also blatantly tweeting on his phone during the session. He tells his patient that it is ridiculous to want a soul mate and explains that other species might rape their sexual conquest. He yawns loudly in a session with Tony. When Tony fires the psychiatrist, the psychiatrist tells him that his brother-in-law "told me about you." These are just some of the many cringe-worthy behaviors displayed by this (unnamed) fictional embarrassment to our field.

By season 2, the psychiatrist begins seeing Tony's brother-in-law, Matt, in treatment, the first of his boundary violations with Matt since Matt is Tony's close friend and relative. The psychiatrist soon makes the crass self-disclosure to Matt that, "I was bleeding from the anus for a month last year, and I never went to the doctor," implying Matt is a wimp for coming in. The psychiatrist invites him to go out with him and his friends, and gives him a beer in a session. The psychiatrist tells Matt stories of his sex life and complains about why people are bothered about toxic masculinity. When there is no way it can get worse, Tony and Matt run into the psychiatrist and his mates in a pub. The psychiatrist tells his comrades: "That's the suicidal one with the dead wife I was telling you about." When asked about confidentiality, he again protests: "I didn't say your name mate," Gestures are made, and the patients are mocked and laughed at. Unfathomably, Matt still returns for therapy, but is told by the psychiatrist to "lie, cheat, just be a man," and about lesbians using dildos. The psychiatrist complains to Matt he is "sick of this @#!&, hearing people winge all day."

Dr. Dippy or Dr. Evil – or somewhere in between – Tambury's psychiatrist is not anyone who should be seeing humans, let alone a vulnerable population seeking help. These satirical behaviors and comments perhaps suggest worries of the general population about what happens behind the closed doors of psychotherapy and the concern that there may not be such a thing as a "safe space." Even though this character is meant to be funny, there is a concern that, in this difficult time, this portrayal could deter even one person from getting the help that they need.

In spite of this unfortunate characterization of psychiatry, "After Life" is a brilliant, dark portrayal of grief after loss, the comfort of pets, grief while losing someone to dementia, and even growth after loss. The theme of grief is especially poignant during this time of collective grief.

The difficulty is the portrayal of psychiatry and therapy – released at a time when in the real world, we are coping with a pandemic and expecting massive mental health fallout. Negative portrayals of psychiatry and therapy in this and other shows could potentially deter people from taking care of their own mental health in this traumatic time in our collective history when we all need to be vigilant about mental health.

Reference

1. Schneider I. Am J Psychiatry. 1987 Aug;144(8):966-1002.

This story originally appeared on MDedge.com.

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