The Alien Says Don’t Take Your Meds: Neurodiversity and Mental Health Treatment in TV SF/F

Mental health and neurodiversity are both complicated issues. A whole world of complicated. Treatments and results vary wildly, and society can still be deeply unsympathetic to those whose chronic illness is not immediately visible. As someone who has many friends and family members affected by conditions such as (but not limited to) depression, bi–polar disorder, schitzo–affective disorder, brain damage, anxiety, and PTSD, raising neurodiversity awareness is a topic very close to my heart.

When you’re trying to explain a specific medical disorder or condition to a layperson, it can help sometimes to have TV shows or films to point to as examples with built–in sympathy. But depictions of mental health on television are often more damaging than helpful, especially if they emphasize outdated or wrong ideas, if they treat neurodiversity as a joke, or if they replicate harmful patterns unthinkingly. Let’s not even get started on how many times the character with a psychological illness gets a tragic ending…

This can happen in any genre, across any media. But for a long time now, I’ve been thinking about the depiction of mental illness in SF, fantasy, and horror, and one trope in particular: what the TV Tropes site refers to as Neurodiversity is Supernatural.

I have a problem with any story in which mental disorders, traumatic response, or other forms of neurodiversity are presented as non–existent because Aliens! Or magic! This doesn’t mean it’s impossible to tell ethical stories about screwy brain chemistry in a supernatural universe, only that the subject needs to be approached with more depth and sensitivity. Let’s start from the premise that the existence of aliens, magic, or other supernatural tropes does not automatically negate everybody’s health issues.

If you can have broken legs and hangovers in a world with magic or alien science, you can have realistic depictions of psychiatric disorders. Even stories where symptoms of neurodiversity are caused or triggered by the supernatural, you can have realism, complexity, and far more interesting complications than merely “fixing” the “problem” through an otherworldly reveal.

The Series 8 Doctor Who episode “In the Forest of the Night” revolves around a little girl, Maebh, whose neurodiversity (including hallucinations and ongoing mental distress) is explained as a side effect of alien communication rather than, as previously believed, emotional fallout from the traumatic loss of her sister. In one scene, the Doctor dismisses the genuine concerns of Maebh’s teacher and fellow students, all of whom are supportive of her usual medication routine. He declares, as part of his grand reveal about aliens and telepathic trees, that she doesn’t need her tablets.

This made me uncomfortable on a number of levels. The Doctor is a figure of great authority to the many children around Maebh’s age who watch the show. More to the point, he is not Maebh’s medical doctor, who prescribed her medication. How many kids watching might have to take regular medication, for one health reason or another?

The idea that a fictional stranger can come and re–diagnose a child with aliens, and cheerfully order everyone not to medicate her, is not just highly irresponsible, but actively harmful. The story strongly implies that Maebh never had a mental disorder at all, and that this is something the Doctor is qualified to decide. Not only is it harmful because of the potential that kids might think their own prescribed medication is optional, but it’s harmful because it promotes the idea that mental illness is “all in the mind” and therefore not real.

I suspect that if a script called for a fictional hero to order a child to throw away prescribed medication for their heart complaint, or to eat a food they have been previously diagnosed as allergic to, the editors would have pulled it before it reached the screen.

Another example from Doctor Who, the Series 5 episode “Vincent and the Doctor,” written by Richard Curtis, is based on the idea that Vincent Van Gogh has the ability to see beyond the “real” and that this explains his artistic vision as well as his isolation and some of his mental distress. However, Vincent’s depression is presented as a genuine medical complaint. The narrative goes out of its way to show that even with the key causes or triggers of his depression removed (his lack of artistic recognition, the fact that he sees invisible aliens), his brain chemistry cannot be “cured.”

Sadly “Vincent and the Doctor” is also one of a multitude of “neurodiverse person dies at the end” narratives, so it’s not an overwhelmingly positive example (let’s imagine what might have happened if the Doctor had taken him to a hospital offering 21st century medication for his depression, rather than an art gallery), but “Vincent and the Doctor” still presents a far more realistic and sensitive take on mental illness within a science fictional context than we see several years later with “In the Forest of the Night.”

As an added bonus, while “Vincent and the Doctor” skirts a trope I loathe, of the [male, always male] tortured artistic genius who “needs” his mental illness in order to be creative, it doesn’t romanticize Vincent’s neurodiversity. I really appreciated that while the story suggested that Vincent’s brain chemistry was tied to his artistic vision in positive ways, there were also days when he couldn’t get out of bed in the morning.

It’s so rare to find fictional narratives that respect the sheer effort it can take for a neurodiverse individual to deal with what seem like everyday challenges to others – not just the initial concerns of diagnosis and treatment, but balancing their health needs against other priorities: social, professional, and personal, even before you throw in the supernatural. Science fiction and fantasy TV shows often romanticize self–destructive protagonists, but many people with a diagnosed mental psychological disorder (as with any chronic illness) can’t afford to push themselves to the edge, as their edge is a lot rockier underfoot than that of the neurotypical hero. They need to consider coping mechanisms, self–awareness, avoiding triggers, not to mention the question of how “out” they want to be about their condition.

Characters facing personal challenges are what the best stories are all about—which is why a greater variety of neurodiverse protagonists would make science fiction and fantasy more interesting as a genre. If we can have as many stories as we do about alcoholics with commitment issues, why can’t we have bipolar aliens and witches with anxiety disorders?

The most ethical and layered TV example I can think of that explores neurodiversity in a science fictional universe is the portrayal of Walter Bishop in Fringe. Walter’s original psychotic break, his long period of isolation in mental hospitals, and his ongoing patterns of behavior all emerge from a series of traumatic events connected to his work in “fringe science.” However, the various explanations behind his mental collapse and his ongoing state of mind (including deliberate brain damage) do not make his condition any less real.

Over several seasons, we see Walter make choices about his treatment, some sensible and some highly risky. We see him self–medicate, develop various coping strategies, and harness his neurodiversity in all manner of creative and positive ways—as well as being challenged and often hampered by his brain chemistry. His condition changes and shifts over time, sometimes in startling or jarring ways, and sometimes more gradually. He has good and bad days. The repeated use of alternate universes, timelines, and experimental storylines also means that the writers (and actors) can explore different takes on Walter’s mental health based on his situation, his carers, and his lifestyle.

There’s no magical fix, no hand–waving. It becomes clear over the course of several seasons that the fragile, erratic, highly neurodiverse version of Walter is his best self: more compassionate and empathetic than he was in his prior life when he presented as neurotypical. Through his son Peter, we also get to explore the pressures and challenges of a family carer—a nurturing role rarely given to men in television at all, let alone in science fiction.

Fringe provides a rare example of fictional neurodiversity with a sense of narrative responsibility—Walter is often the comic relief, and/or a tragic figure, but he is a complex and rich character who isn’t always right, or good, and has a fascinating journey.

A common and highly problematic fictional cousin of the Neurodiversity is Supernatural trope is the use of a nightmarish Bedlam–style asylum or mental hospital as a nightmare scenario to be inflicted upon a neurotypical hero as a punishment for believing in the magical/science fictional.

I have to say, dipping into the “how pop culture affects real life” topic, this trope is particularly unhelpful when you’re trying to convince a beloved friend or family member that seeing a doctor is a really good idea. Being hospitalized is rarely a barrel of laughs for anyone involved, but there are times when it is the safest and most responsible option (as is taking prescribed medication and following the advice of doctors).

The “Bedlam House/Mental Inhospitable” trope is based on the historical reality of the horrific ways in which those with mental disorders (and in many cases, those who defied other societal norms) were treated in the 19th and early 20th centuries. Common elements to this particular narrative tradition include a righteous hero/heroine, cruel doctors, sadistic doctors, physical torture, and a fetishized use of electro–shock therapy.

From Dorothy in Return to Oz (1985) all the way through to Alice in Once Upon a Time in Wonderland (2013), the idea of a portal fantasy hero being treated as if they are insane as a result telling the truth about their magical adventures has been a highly popular one. It plays on neurotypicals’ fear of being misdiagnosed as “insane,” and carries the uncomfortable message that the grotesque treatment of inmates in Victorian–era asylums was not equally awful for those with legitimate medical reasons for their incarceration.

But how does this translate to stories set in the present day?

For Walter Bishop in Fringe, the idea of returning to the mental hospital in which he spent seventeen years of his life is horrific – not because he was treated badly or because it is a place full of evil alien doctors, but because he spent that time isolated in his own misery, unable to work or to connect with his son. Remaining functional enough to be part of Fringe Division, to maintain borderline healthy relationships, and to indulge freely in personal whims rather than conforming to a hospital timetable, is an ongoing priority for him.

The hospital itself, however, is not actively maligned—its function as a symbol of his condition overwhelming him is horror enough.

In the infamous Buffy the Vampire Slayer episode, “Normal Again,” (2002) Buffy awakes in a hospital where she is told the entire last six seasons of her life has been a series of hallucinations. The nightmare here is not the fact of the mental institution so much as the idea that her friends and her accomplishments were imaginary—Buffy losing faith in herself and believing what the doctors are telling her is presented as the real horror.

Another take on the idea of “mental hospital as worst thing that can happen to you” comes from Season 5 of Supernatural, and the episode “Sam, Interrupted.” Dean and Sam get themselves fake–institutionalized in a psychiatric hospital to investigate a series of apparent suicides—of course, all they have to do to convince the doctors they are “crazy” is to narrate the highlights of their show so far, with an emphasis on all the demon–hunting and angel–possession.

Despite this jokey start, there are several things that this episode does well: the central premise is that a monstrous wraith is feeding upon the emotional distress of the patients, which exacerbates their symptoms—but the story does not erase the reality of mental illness in its various treatable forms. Also, instead of following the traditional narrative of neurotypical heroes overcoming the threat of Institutionalised While Sane, both Dean and Sam use this exposure to psychiatric care to question how well they are coping with the high stress nature of their work, and the tragedies they have suffered. Given how often mental health is presented in television narratives as a binary concept (you’re either 100 percent sane or the exact opposite) I appreciated the acknowledgement of grey areas.

It’s worth noting that both Buffy and Supernatural also had episodes that presented hospitals generally as places of horror and fear, so it wasn’t a concept they reserved for psychiatric hospitals.

Television—and science fiction/fantasy television in particular—has always had a reputation for over–simplifying concepts, for the casual viewer. But these days, we have higher expectations of our entertainment, across all media. The Neurodiversity is Supernatural trope has a great deal of story potential, but the more interesting and inventive takes on that trope are the ones that do not erase the lived experience of actual humans.

You can totally have a diagnosed psychiatric disorder and still see ghosts, learn magic, talk to aliens, and/or save the world from monsters.

As long as you check with your doctor before ditching your meds.*

*As opposed to The Doctor, whose official medical credentials remain a matter of informal debate.


Tansy Rayner Roberts

Tansy Rayner Roberts is the author of the Creature Court trilogy, and a series of cozy gaslamp fantasy novellas including Tea & Sympathetic Magic. She is a co-host on the marvelous Verity! Doctor Who podcast. Find her on Twitter, Instagram and Patreon as @tansyrr

Leave a Reply

You must be logged in to post a comment. You can register here.