Legion‘s pilot episode premiered on FX last week and while much of the talk thereafter was focused on the show’s stunning visuals, there has been some back and forth regarding the portrayal of mental illness and psychiatric institutions. One of my colleagues here at GeekMom felt that Legion‘s portrayal of mental illness did a disservice to those living with mental health concerns, that it was stereotypical and packed with tropes that glossed over accuracy in favor of drama.
I respectfully disagree and I’d like to offer a counter argument: Legion, fantastical and psychedelic aspects aside (it is an X-Men show after all), is actually a careful and considered portrayal of mental illness.
I come at this analysis from two different angles: as someone who has worked in the mental health field in different settings and as someone who has long wrestled with her own mental illness. Earlier in my nursing career, I worked at both the Oregon State Psychiatric Hospital and in the clinic at a youth correctional facility where there was a high incidence of psychiatric illness.
As to my story? I’ve been living with anxiety and depression since age eleven. That, for anyone eyeing a calendar, is twenty-seven years. Twenty-seven years of fighting my own brain, of trying, sometimes with the help of medication, sometimes with the assistance of therapy, and sometimes on my own, to wrestle a chemical imbalance into submission so I can function, hold down a job, be a decent parent, and enjoy my life. So I can keep living, period. And before you ask, yes, I am on medication currently and I have been continuously since my daughter had to be switched to formula due to some sensitivities. I take Paxil. 40mg every day. Likely for the rest of my life.
I’m okay with that. I’m treating an illness. If I were diabetic, no one would tell me I didn’t need my insulin. If I had a thyroid dysfunction, no one would tell me to power through, suck it up, be strong.
There’s a misperception in our society that mental illness is something else. Something other.
It’s not.
If you want to talk neurotransmitters and pharmacology, let me know. I’d be happy to write that article.
But that’s not what we’re talking about right now.
We’re talking about Legion and its portrayal of mental illness.
David Haller, alias Legion, was created by Chris Claremont and Bill Sienkiewicz, first appearing in New Mutants #25 (March, 1985). Before David’s mutant abilities were recognized, he was diagnosed as having developed “multiple personality disorder” (now renamed Dissociative Identity Disorder) after a trauma (characteristic of the condition). He was also, at various times, labeled as autistic.
On the show, David has been diagnosed as having “paranoid schizophrenia,” an entirely different condition. Some reviews have expressed concern the switch is a casual “conflation” of David’s various diagnoses and is, therefore, misleading and insensitive. I disagree for a couple of reasons.
First, true, persistent dissociative identity disorder is extremely rare (some psychiatrists feel it’s a symptom or feature of another condition rather than a standalone diagnosis though it does have an accepted criteria list) and does not involve hallucinations or delusions; an individual’s different identities are a fractured but real presentation of a complete psyche. The only treatment for DID is intensive therapy. Schizophrenia, in contrast, often features both hallucinations and delusions, with those diagnosed often reporting hearing voices that are “other,” rather than elements of the individual’s mind and are, most often, terrible and cruel. Schizophrenia is treated with both medication and therapy, though medication is the greater part, intended to balance neurotransmitters, thereby reducing symptoms (according to the patients I worked with, those symptoms rarely dissipate entirely). As portrayed on the show, David definitely fits the criteria for paranoid schizophrenia and not dissociative identity disorder; autism is never mentioned. It’s a change, as often occurs when a property is updated and translated for a different form of media, but it is far from a conflation or dismissal of what David is experiencing.
There seems to be some concern that the portrayal of David as schizophrenic is “stereotypical” or “trope,” especially as regards violence; again, I disagree. Does David Haller have violent outbursts? Yes, he does. Do all schizophrenic patients experience such episodes? No, not all. But, having worked in an inpatient setting, having been one of the providers attempting to assist someone in the throes of such an episode, many, especially those with a “paranoid” component to their illness, do. The important bit of Dan Steven’s portrayal is not that the episodes happen but why they happen. David only becomes violent when he is frightened, when he is threatened, when he is under attack and the same is true for the schizophrenic patients with whom I interacted. The impetus may be internal or external, real or the product of delusion, but the common factor is terror and never have I seen that more carefully emphasized in a media property than in Legion.
Other concerns raised as regards the portrayal of mental illness in Legion include: the presence of a catatonic patient, the presence of a hypersexual character, and a moment during which Syd submits to having her mouth checked after taking her medication. As to the first, yes, it was a little over the top and it did bother me a bit to see it played for humor but the fact of the matter is, adjusting psychiatric medications is a delicate process and it is an ongoing one. Patients often arrive so ill that, in order to assist them effectively, providers must prescribe an intensive medication regime and then, as providers get to know individuals and have a chance to speak with them, the regime is adjusted. As regards the second: hypersexuality is actually a prominent “symptom” of several different disorders, most notably the manic phase of bipolar disorder. I appreciated that, on Legion, no one took advantage of Lenny’s manifestation of her illness. As to the last: psych providers do med checks. I understand how it may seem like a violation of privacy or as though staff is treating grown patients in a childish fashion. Neither is the intention of such checks. It is a “competent” adult’s right to refuse medication; if someone is admitted to a psych facility, however, there is a concern his judgment is impaired to the point of being dangerous to the patient or others. Medications are administered to assist that person in recovering baseline function. Patients reject their medication for a variety of legitimate reasons: unpleasant side effects, the aforementioned impaired judgment, an attempt to assert control in a life which feels out of control. Safety, however, is the number one priority on an inpatient unit and medications are an integral part of that safety. So yes. We check.
Another aspect of the show I felt was extremely well done was the fact none of the patients at Clockwork were referred to by their diagnoses, nor at any point were they dehumanized. David, Lenny, Syd and the others were allowed to express themselves, provided safety was maintained. Their therapist (if he was real) was respectful, always addressing each individual by name and giving everyone an opportunity to speak in the group setting. While there was a patient uniform of sorts, each character was allowed to alter it to express their personality and to add accessories (reality: Syd would never have been allowed a cloth headband like the one she wore in an actual facility). Was it difficult to watch those moments when staff physically restrained David? Yes. Did they do so appropriately? Yes. David was restrained only when he was endangering himself or others. Did we try to avoid restraining patients on my unit? Absolutely. But there were times when it is necessary. If I recall correctly, at no point was David hit or abused, nor was he ever taken down face-first. Chemical restraint replaced physical restraint as quickly as was reasonable and safe. Did I hate having to call codes when I knew a patient might have to be restrained? Yes. I hated it with everything I am and every bit of empathy in my body. It is gut wrenching to watch such moments in fiction and it was gut wrenching in reality. As it should be because another human is suffering and there is so little we can do to help other than buy him time to stabilize and prevent him from injury in the interim.
Finally, there is concern Legion detracts from the normalization of mental illness.
Well, hell, I hope so.
Normalization is the wrong word to use in such cases as David Haller’s and as regards the patients I’ve worked with. I would never use it in considering my own mental illness. To discuss “normalization” is to discount the struggle those with mental illness face every day. It suggests they should accept their own mind torturing them every waking moment moment and sometimes in their sleep despite medication with serious side effects, despite talk therapy, despite other treatments such as electroconvulsive therapy. To “normalize” is to discount the exhausting, demoralizing, painful, endless battle some of us fight to complete the most simple of tasks on any given Tuesday.
It diminishes how hard we have to fight to survive.
Cancer is natural but no one would claim it’s “normal.” Those who fight cancer are warriors. The same is true of the who do battle with mental illness. I say that as someone who has advocated for patients, who has led therapy groups, who has sat one on one with those warriors.
I say that as a warrior myself.
It is vitally important we de-stigmatize mental illness, that we seek to understand it, to promote awareness. We must teach empathy for the difficulties those with mental illness face and put aside our discomfort, reach out, offer assistance and understanding and kindness. Those of us who understand that its essence is in the name, “mental illness,” must spread that word. We must shout it until we’re hoarse, until we don’t have any breath left.
Legion is adding to that collective surge. And for that, I thank Noah Hawley and everyone else involved in the production because for each voice added, each warrior is relieved of a little bit of our burden.
Still holding my shield, though. It belongs to all of you.
Speaking as a person with a great many mentally ill relatives, that definitely sounds like a very solid portrayal of Type II schizophrenia (paranoid delusional form).