What the Grey's Anatomy Premiere Got Wrong About Mental Health, According to a Psychiatrist
I was eager to catch the Grey's Anatomy season 16 premiere last night — not because I was awaiting updates on the several romantic storylines, or wanted to see if anything crashed or blew up, but because I am a psychiatrist, and the last season ended with one of the main characters, Jo (Camilla Luddington), checking herself into a psychiatric hospital. I tuned in to see if the show would handle that delicate topic with care, or if it would somehow portray it negatively, potentially scaring viewers away from seeking treatment they might need in the future (see: One Flew Over The Cuckoo's Nest). After watching, I feel mixed.
Jo's part starts with her solemnly entering the psychiatric ward. No one talks throughout the entire scene and, as is often the case with Grey's, there is dramatic music instead of dialog, which certainly adds intensity. At first we see a male character (we see his badge, but he is not named) have Jo remove her wedding ring. Through the only opening in a metal gate, her ring is then handed to someone who puts it in a plastic bag. Next the same man pats her down. Someone removes the string from her jacket, and we later see Jo take off her belt. This is all before she goes into her room and finally lays down to cry.
While I felt empathy for Jo and understood the need to portray her fear of entering a psychiatric hospital for the first time, as the scene progressed, I felt myself becoming angry. From my experience on a psychiatric ward, many of these images were wrong, and even if the intent behind them was taking some creative license, getting it wrong can be harmful. Here's a slight fact-checking of the episode, from a professional's point of view — the good news is, it isn't all bad.
What the episode got wrong about Jo's mental health treatment:
Psychiatric care doesn't look or feel like jail.
I have never seen a divider like that in a hospital. Glass, yes, but metal? Not even in a community psychiatry ER (which, to be sure, can be less glamorous than some of the mental-health stays that celebrities go for.). Metal evokes a big barrier and a prison feel. I have also never seen someone be pat down when entering treatment. While we typically have new patients change clothes, and the clothes themselves may be searched, it is not typical for a patient to be touched. It is especially unlikely that a male would be the one touching a female patient. This imagery adds an extra layer of violation that did not need to be present, particularly for a traumatized female, in a storyline that focuses on her PTSD following domestic violence and rape. The "pat-down" again evokes an image of prison. While in a psychiatric hospital, Jo may have fewer rights than if she were out of it, if viewers think psychiatric hospitals are like prison, why would they ever go there for help?
Some key dialog never happened.
Jo never says, "why are you patting me down?" or "why do you need my belt?" or "can I have a female pat me down, instead?" No staff member explains what is happening to her and why, either. Any and all of these questions or unprompted explanations by staff would have created a safe environment for Jo and an educational one for viewers — which the show did so well in the "Silent All These Years" episode that tackled the subject of rape. For example, explaining that they are removing her personal items that they feel could be used to endanger herself or others (laces, belt, sharp objects), makes the decision to take her wedding ring or remove a jacket string feel less invasive and punitive. But, the characters were silent and viewers were left to draw their own, likely stigmatized, conclusions.
Residential facilities, again, are not like jails.
A week passes and when the story is back on Jo, we see Alex drive her to her residential facility where he says she will be spending 30 days. The facility has a guard out front and a metal, garage-door like security gate which made it seem like entering the grounds of a prison or some other highly classified government facility. The guard tells them to say goodbye, and Jo has to walk into the facility on foot, presumably alone. Given that residential facilities are much less restrictive than a psychiatric ward, it is unlikely that family members or support person would not be allowed to at least walk the patient to the door. This detail is odd, and makes the fact of residential care seem arbitrarily cold. Even though I know this experience is not the truth of most psychiatric treatment facilities, I found myself saying in my head "What? He can't even walk her to the door? WHAT IS THIS PLACE." Imagine what people who have never seen a psychiatric treatment facility are thinking.
It's not a presto-change-o kind of thing, either.
Time lapses week by week and as viewers we see very little of the inside of the treatment center or of her Jo's care there. To me, this is another missed opportunity, as few shows or films have ever shown that experience well. The weekly time lapse also gives an unrealistic sense of ease and speed to psychiatric treatment and recovery that frankly does not exist. It takes time. A lot of it.
What the episode got right:
Alex and Jo's Dynamic in Therapy
The episode was not all missed opportunities and stigmatizing images of treatment facilities. In the one scene we do see of Jo in residential treatment, she and Alex are doing "I messages" homework for couples counseling. That's filling in the blanks of sentences like, "When you [blank] I felt [blank]." This is a common therapy technique used to get people to take responsibility for their own feelings, and understand the impacts of their actions. The therapist (played by Debra Jo Rupp, or as my brain remembers her, the mom in That 70s Show) even calls out Alex for saying "it made me feel" instead of "I felt" — "no one made you feel, those are your feelings."
The Definition of Strength
Both characters are raw and honest about how they feel to each other. Jo says to Alex, "you have had enough pain and crazy to last a lifetime. You deserve someone who doesn't break like glass and need to be swept up and shipped off to places like this."
Instead of Alex answering, the therapist steps in and says: "Do you think that person exists?" Jo tearfully replies: "I think some are stronger than others." To which, poignantly and importantly, her therapist reminds her she is in a depressive episode caused by intense trauma. She says, "Even though our society tells us places like this mean we are broken, I think, the truth is, coming to a place like this makes you stronger than most."
This is the best scene in the whole episode about mental illness. It is validating not just for Jo, but for Alex as her loved one, and for anyone at home watching who has ever asked for help or has a loved one who has. Asking for help is a strength, not a weakness.
It also helps to counter the stigma surrounding mental illness and puts into better context some of their word choices ("crazy," "insane") throughout the episode. "Crazy" is used in the script, not because they think people with mental illness are "crazy," but because Jo and Alex use those words due to their own harbored misconceptions about mental illness. With this one conversation, we are made aware that Jo and Alex have been wrong the whole time. Even if name calling is normalized in television, according to USC Annenberg research, to discuss characters with mental illness, with one study finding uses of the word "crazy," "nutso," and "scumbag," among others, this episode is different. With her statement, the therapist not only names the societal stigma that exists, she helps make strides to correct it for them (and anyone else watching) without any judgment.
An Imperfect Ending
In the end, Jo leaves the facility and Alex picks her up (he somehow is magically allowed to walk near the entrance for pick up). She is visibly brighter, and points out the reality of living with mental illness that a patient hopefully would have come to understand in treatment. She says to Alex, "I did the work here but I am not magically fixed, I can't promise that it won't happen again."
As a viewer, I have to say I hope that it does. Currently, only 7% of characters on television have a mental illness compared to 18.9% in the general population; 12% of the time the characters that do have mental illness on television, conceal it. To see what living with mental illness is really like, out in the open, with all of its ups and downs, is a complicated narrative but one we need to see.
This episode serves as a first try. It had hits and misses, and some room for improvement. I hope to see Grey's Anatomy to continue delving into the nuance of Jo's recovery this season — if her story ends on a high note when the series wraps, it wouldn't just be satisfying to watch, it would be a public service to any viewers who have struggled, and need to know that help, and treatment, can work.