Diagnosis: Fiction

Mental health care and the crisis of narrative

When I was researching The Method, I spent a lot of time reading transcribed lectures by both Lee Strasberg and Stella Adler. Both were compulsive recorders of their own voices, and the heart of both of their methodologies really lies in these recordings rather than in anything they wrote. I kept coming upon this idea Stella Adler had about a major shift in how drama is constructed that began taking place in the 19th century. It’s an idea I think about—well, not once a day, but at least weekly.

I’m paraphrasing here, but the point that she made is that the difference between what she called Modern Drama and everything that came before it is that in modern drama the character’s problems cannot be solved by the play’s narrative, because their real problem is the human condition under modernity. She would often illustrate this by comparing Hamlet and A Doll’s House. At the end of Hamlet, everything is resolved because everyone is dead. Hamlet is revenged. Laertes is revenged. The succession crisis prompted by Claudius seizing the throne is resolved because Fortinbras has conquered Denmark, etc. We may feel a way about this resolution, but it is most assuredly resolved.

The ending of A Doll’s House solves very little. I mean, sure, it has solved the immediate problems of the play: Nora’s dishonest marriage to Torvald, the blackmail campaign, etc. But the actual problem Nora confronts in A Doll’s House is being a woman in 19th century Norway. That problem has not been resolved, because it cannot be resolved by an individual. And thus she will confront a whole host of new problems after the door slam heard around the world. (For some thoughts on what those problems might be, you can read Lucas Hnaith’s delightful A Doll’s House, Part 2). This in turn leads to what might be called impossible characters. Characters who cannot be solved, whose parts don’t always cohere in comfortable ways.

Anyway, I think Stella’s point is pretty brilliant. When I first stumbled upon it while watching videos of her lectures at the Random Center, I had one of those epiphanic moments where you literally feel the swell of strings accompaning your own thoughts. But I realized that, in the decades since she started saying this, there has also been a major shift in how human beings approach the world: widespread use of talk therapy and adoption of increasingly effective psychoactive medication. Both of these have created a kind of crisis for narrative art that is under-discussed.

The crisis takes two forms. The first is the diagnostic approach in both creation and criticism. This is where the author has created a character that feels more ripped from the pages of the DSM than actually alive. They have a set of traumas that neatly explain their behavior, or they have the exact symptoms of a particular set of disorders, and because of this the character comes to feel schematic. This is a way of rejecting the mystery of being alive, of reducing the complexity of the human experience to a kind of familiar checklist. Freud actually semi-endorsed this approach to character in his piece “Psychopathic Characters on the Stage” in which he argued that the main use of neurotic characters (like Hamlet) was helping to demonstrate for neurotic audience members how their neuroses worked in the relatively safe space of the theater. Authors and psychoanalysts aren’t the only culprits here, however. Critics can fall into the diagnostic fallacy as well, looking at a character and thinking “oh, they’re clearly manic depressive” or whatever, and thus reducing the impossibility of the character to something easier to swallow and deal with.

But the other form this problem takes is the creation of characters whose actual problem is not modernity or the society in which they find themselves, but rather that they desperately need treatment and medication. This would not solve all of their issues— as anyone who has had therapy or been on medication knows, this is when a whole new kind of work begins. But it would resolve many of the major issues within the narrative itself. This in turn invites the kind of diagnostic reading I’m talking about above, it creates the circumstances for its own defanging. To take it out of the mental health sphere for a moment: it would be a bit like writing a play in which a character has a severe cough and this is their main problem throughout the play, and no one ever tells them they should probably see a doctor and get some antibiotics. Mental health is more complicated than this, of course, but there’s a good reason why no one tries to write the modern equivalent of Ibsen’s Ghosts— there is no physical disease that neatly represents the sins of an elder generation that can be passed through the shared use of a pipe, and we all know this now. Yet we also know all sorts of things about mental health and often cheat this knowledge in the pursuit of particular narratives.

The rise of therapy has not eliminated impossible characters and unresolvable conflicts. Recent films like Nomadland and The Lost Daughter both focus on women who are unable to fully know themselves, and thus to understand or handle the world around them. I’m teaching a course on new American plays of the 21st century this semester, and there’s plenty of works in there ([sic], God’s Ear, The Flick, etc.) that focus on these kinds of people. But I believe this crisis for narrative art is real and underdiscussed.

I was thinking about this with two narrative works I encountered last week, Kingsley Amis’s The Green Man and Mike Leigh’s Hard Truths. Other than being English, and both taking place over a week, these two projects probably couldn’t be much less alike. The Green Man is a novel, a mashup of horror and bedroom farce about a scabrous, alcoholic innkeeper who begins encountering ghosts while trying to manipulate his wife and mistress into a threesome. Hard Truths is a film from 2024, about a woman named Pansy and her family, and is a slice of life drama about the little indignities of being alive. Yet both of these works confront, and in one case, fall victim to the therapeutic crisis.

Maurice, the narrator of The Green Man posseseses easily diagnosable problems. He’s an alcoholic— there’s a passage of the book in which he details how much he drinks in a day and it includes an entire bottle of scotch and an entire bottle of wine— and, as is slowly hinted at over the course of the novel, probably obsessive compulsive. So far so pigeonholed. And yet Amis does a few clever things to avoid simply reducing him to these problems. The first is that Maurice is self-aware. He knows he’s an alcoholic, and if he ever forgot it, one of his only friends is his doctor, who keeps popping around the inn Maurice runs to tell him he’s an alcoholic. He also cannot quit drinking—having drunk so much for so long, doing so would likely kill him. And thus he must remain an active alcoholic, meaning this problem cannot be resolved. But also, as my friends who’ve gone through treatment have told me, the problem with an alcoholic is never really that they’re an alcoholic, it’s the stuff going on that drove them to drink in the first place, the stuff that cannot be fully looked at until they stop drinking.

That stuff, for Maurice, gets us back to Stella’s territory of the unresolvable, impossible nature of being alive in the contemporary moment. And, because we are absolutely locked into Maurice’s limited POV, that stuff cannot even be fully articulated within the novel, it can only be felt through the prose, like the ghostly presences in Maurice’s inn being felt through the walls. He is a kind of double haunted character, both by the ghost of a serial killing occultist madman, and by the secret pains he carries with him. The closest the book can get to seeing those pains is Maurice’s simple acknowledgment at the end that they exist. The epiphanic moment does not solve anything, it merely holds out a little bit of hope that things could possibly get better. Maurice, in other words, is both self-aware and blinkered, and what awareness he possesses does not actually help him in any meaningful way when it comes to the deeper problems he confronts.

Mike Leigh’s Hard Truths on the other hand is the story of Pansy, a woman in late middle age who cannot abide the world. The action of the film takes place over the week marking the anniversary of her mother’s death, and the major question of the plot (such as it is, this is not a movie about plot) is whether or not she will join her sister in visiting her mother’s grave. Meanwhile, we get little snippets of the day-to-day life of various members of her family: her mostly silent husband, Curtley, and even more mostly silent son Moses, both of whom take her for granted, her vivacious sister Chantelle and her daughter Alisha and Savannah, their co-workers etc.

But for most of the film, we are watching Pansy, and it is here that the therapeutic crisis can be felt most strongly. Pansy’s abrasiveness to the rest of the world is so dialed up, it becomes a series of textbook pathologies. While the film is a drama, Pansy’s list of symptoms is not too dissimilar from Bill Murray’s in What About Bob?. She’s afraid to leave the house. She’s obsessed with the possibility of catching illnesses and thus compulsively cleans. She verbally abuses anyone who gets within ten feet of her. She’s a hypochondriac. By the end of the film, she expresses the desire to end her life multiple times. Meanwhile, Moses, her twenty two year old son, seems obviously mentally delayed (his actions over the course of the film consist of walking around his neighborhood, playing with model planes, playing video games, and reading a chidlrens’ book about aviation).

But the film appears to take place in a universe in which mental health care doesn’t exist. Pansy has an appointment with a doctor at the NHS who never asks her the standard questions about mental health one faces during a check up. No one in Pansy’s family brings up— even privately, outside of her earshot when they discuss her— mental health. No one in the film acknowledges Moses’s obvious delays. There’s even a moment of high emotional confrontation in which Chantelle asks Pansy why she can’t enjoy life in a tone that indicates they have never had this conversation before in their lives. Pansy responds “i don’t know!”

Her behavior is so extreme, however, that the viewer knows. At least some of her inability to enjoy life is because she is clearly chemically imbalanced and needs help. Or, as I couldn’t help but think about halfway through the movie, “this is the harrowing story of a woman who needs lexapro.” The film instead supplies two reasons for her behavior: a traumatic past essentially raising Chantelle after their father left them, and her terrible marriage to Curtley, which includes ample criticism of Moses for lacking in the normal filial duties of a son. Again, no characters ever acknowledge that Moses is clearly developmentally delayed, and thus the film’s insistence that he is part of the problem feel, frankly, cruel.

Hard Truths wants to present us with the suffering of the human condition in the present moment, but Pansy’s behavior is so dialed up and so pathologized that it invites a diagnostic reading, which in turn defangs the film. In a way it is a mirror image of Leigh’s Happy-Go-Lucky, in which Sally Hawkins’s optimistic Poppy (note the names!) is the anti-Pansy: happy, bright, and aggravatingly cheerful no matter what happens. But Happy-Go-Lucky is a comedy, and Hawkins’s performance is purposefully broad in a way that lets us understand that Poppy is not necessarily a realistic character. There is, thank Hashem, no one on Earth who is that cheerful.

There are, however, lots of people on Earth who are like Pansy, and lots of families that have to arrange themselves around a parent’s stubborn refusal to change, which in turn comes to be a demand that everyone organize their lives around them. The film at times moves towards a portrait of this, a portrait of how emotional abuse shapes all who come into contact with it, but then it shies away from this. It comes instead to feel like a film about denial on both the family’s part and the filmmaker.

It is a dangerous critical exercise to imagine how one would “fix” the problems in the piece, but I started to imagine over the days since I’ve seen it what I would do were I revising Hard Truths as a kind of creative putting my money where my mouth is. One common way these problems are solved is to relegate characters like Pansy to a secondary or antagonistic character, like the matriarch in August: Osage County. Another would be to simply include a scene of the two sisters preparing the lunch they serve the family after the graveside visit, and have them talk about their aunt. Or have the doctor raise therapy with Pansy and have her chew the doctor out. It’s not that I want to a movie in which Pansy gets better (or seeks treatment)— I don’t even think, joking aside, this would “solve” all of her problems. Instead, I want a movie that, if it’s purporting to exist in the real world, at least has one mention ever that mental health care exists. Especially as doing so can actually be a way of making the character’s irresolvable nature—her impossible, contradictory self, one that speaks to our own impossibility—more vibrant, alive, and true.