The Culture of Mental Illness: Better Call Saul and American Psychiatry Kara Callahan

Home , Better Call Saul, Chuck McGill, Howard Hamlin

SATURA VOL. 2

Psychiatry has not always been there. This popular view of mental a science which relies on cultural illness dictates how the character heritage. In fact, in many practices called Chuck develops throughout the across the world, psychiatry is seen as program, thus giving a valuable pers- medicinal and broken down into pective on the cultural influence on symptoms, labels, and treatments. psychiatric treatment in the US. For instance, the Diagnostic and Sta- Cultural aspects of mental tistical Manual of Mental Disorders, 5th illness are rooted in implications of edition (DSM-5), is a tool used by specific terminology that are used to medical professionals to define and describe mental illnesses and their classify mental disorders in order to symptoms. The terms used to describe improve diagnoses, treatment, and a mental medical condition—for research. Although including con- example, illness, sickness, or dis- tributions from an international co- ease—already imply discussions of mmunity, this tool is framed by a US- distinct features from the beginning American view on mental illness. It of treatment seeking. The choice of often neglects the patients’ emotions one term over another has different and experience with the disease and implications of meaning: (1) illness is may lead to an incomplete picture of the human experience of symptoms the patient’s illness with problematic and suffering in general, (2) sickness consequences regarding both the is the concern a medical practitioner diagnosis and treatment (Gray 1). would address to treat, and (3) disease There has been an increased effort on is a term denoting feeling unwell the part of many anthropologists and without any local or medical conno- psychiatrists alike to work toward a tations (Kleinman 3-6). The under- more comprehensive understanding standings of the terms and the of the cultural influences on mental associations individuals have with illness. These influences are depicted them are based on our individual in the filmic work Better Call Saul cultural backgrounds. The way symp- (2015 & 2017) which takes place within toms are discussed is influenced by the US and strongly represent how culture because their meanings be- mental illness is popularly viewed

79 SATURA VOL. 2

come truths and natural occurrences culture relevant to the practice of di- through a cultural system projecting agnosing and treating patients in a them onto the world (Kleinman 10). healthcare environment, but it is also For example, if I wake up with a essential to forming the social inter- headache I may contribute that symp- pretation and representation of men- tom to be the result of dehydration tal illnesses. To elaborate on this and drink some water, whereas some- point, a discussion of how the por- one who grew up in a culture where a trayal of mental illness in popular me- headache was a symptom of poor dia contributes to psychiatry’s de- circulation may address the symptom pendence on cultural influence is of with a heart medication instead. the utmost importance.

These conventional terms and For such a discussion, selected associations we have for illnesses scenes are taken from the American manifest themselves in certain idioms Movie Classics (AMC) series titled of distress which are also culturally Better Call Saul, which follows the life influenced and demonstrate know- of lawyer Jimmy McGill. Mental illness ledge of the body and self in relation to in this series is presented through the each other in our lifeworlds (Kleinman character Chuck, who, at the be- 11). In addition to the symptoms, ginning of the series, is deemed to be emotions are also cultural knowledge, of sound mind as his illness is purely and the way a person interprets their physical, but whose reception is body is culturally influenced because transformed as a result of his illness our bodily experiences are informed being irrefutably categorized as men- and molded by social meanings which tal, a dichotomy common in the US then become internalized; therefore, (Mehta 14). The shift in his reception culture is a part of the mental faculties among other characters in the series which may be altered due to a physical brings out essential facets of the US- or mental illness. Health care profes- American psychiatric view. sionals, specifically Dr. Samrat (2016) Better Call Saul takes place in and Dr. Jadhav (2016), who have taken New Mexico, US. Next to James (Jim- these cultural facets into account, my) McGill, many other of its main have found that addressing them and characters are lawyers, such as his including them in the diagnosis and brother Charles (Chuck) McGill and treatment of mentally ill patients can Chuck’s law partner Howard Hamlin. impact the patient-doctor relation- Chuck suffers from electromagnetic ship and improve the treatment and hypersensitivity (EHS), which in- experience of the patient. Not only is creasingly impacts his life throughout

80 SATURA VOL. 2

the series. He lives in a house with no Chuck’s room. The doctor, Dr. Cruz, electrical components or batteries, all wants to commit Chuck to the hospital visitors must remove their watches for 30 days of psychiatric observation. and other battery-powered devices Because Jimmy is Chuck’s brother, she when visiting him, and he seldom claims that Jimmy can make that deci- leaves his house. Chuck is accommo- sion on behalf of his brother, with or dated at work by all lights and electri- without Chuck’s consent. At that cal devices being turned off and re- point in the conversation, Chuck moved from colleagues and offices emerges from his unresponsive state where he will be working. He also has by reacting to the doctor’s suggestion. tailor-made suits which are lined with He then proceeds to explain his condi- so-called “space blankets”; their use tion to Dr. Cruz stating that “it’s not a being to insulate Chuck from the elec- situation, it’s a condition” (00:23:45- tromagnetic waves interfering with 00:23:48). When prompted about the his body. In one of the first scenes of symptoms he experiences, Chuck lists the series in which his condition is a burning sensation on his skin, sharp discussed, Season 1 Episode 5: Alpine cold pain in his bones, muscle fatigue, Shepherd Boy, Chuck has been admit- blurred vision, and nausea, among ted to the hospital after a neighbor- others. He also explains that his first hood altercation. He is surrounded by experience of the symptoms took and attached to electric devices, as is place about two years ago, which leads normal in an emergency setting, and to the following conversation: unresponsive to all external stimuli. Dr. Cruz: “Two years, that’s a long time to His eyes and mouth remain open; he is live with discomfort.” ‘locked in’ his body. Jimmy begins Chuck: “Oh, there it is. You think I’m shutting things off and tries to explain crazy.” his brother’s condition to the doctor Dr. Cruz: “I never said that.” who comes into the room with a secu- Chuck: “No, you didn’t, because you’re very rity officer: polite. But you think it, otherwise you “He’s allergic to electricity!. . . All these wouldn’t be talking about commitment.” lights and machines, you might as well Dr. Cruz: “You find that idea distressing.” throw him into a microwave. . . Look, I know how it sounds. It’s real. . . anything with a Jimmy: “Who the hell wouldn’t.” battery in it, he can’t have it near him.” Chuck: “I find it inappropriate for a person (“Alpine Shepherd Boy” 00:21:04- suffering from a physical condition. Anyone 00:21:50). who’s spent more than a few minutes with Jimmy is successful in removing or me knows that this isn’t some sort of delu- turning off all electric devices in sion. . . Have you ever seen me exhibit any

81 SATURA VOL. 2

sign, any sign whatsoever, of mental ill- mind-body dualism: Chuck is ada- ness? (She shakes her head, no) See? If I mant from the start that his condition thought for one second that you could cure is purely physical. To consider his me, believe me, I’d jump at the chance. But, with all due respect, psychiatry doesn’t mental state as relevant to or influ- have the answers.” encing the situation he finds himself

(00:24:47-00:25:43) in is a misguided assumption. Indeed, this view is put forth by Jimmy, who Meanwhile, Dr. Cruz walks to the foot remains unconvinced after Dr. Cruz end of Chuck’s bed and turns on an re-starts the bed’s electricity and also electric panel. Both she and Jimmy see by Howard and the D.A. for their firm. it, but Chuck does not, nor does he re- They have even gone so far as to refuse act to the electric stimulus in any way. Chuck’s commitment without visiting She asks to speak with Jimmy outside him first because they know his con- the room and attempts to convince dition is purely physical. Within this him to have Chuck admitted for psy- scene, all of these individuals act chiatric evaluation by trying to prove within the mind-body dichotomy, that Chuck is a danger to himself presupposing that the mind and the and/or others. Jimmy refuses Dr. body are two separate entities with Cruz’s pleas, saying “untie him, I’m different principle natures—the body getting him out of here” (00:28:47- to control physical manifestations and 00:28:50). The scene concludes when the mind to remain independent of Chuck’s partner at the law firm, How- the physical (Mehta 14). This dichot- ard Hamlin shows up at the hospital. omy is also practiced in medicine, par- He tells Jimmy, with whom he does ticularly in the US, where disease is not have a good relationship, that he seen as a biological change or devia- has “talked to the D.A. [Defense At- tion caused by a physical or chemical torney for the firm], and he absolutely event and with physical and/or chem- will not sign off on any commitment ical manifestations (Mehta 14). The papers. This is a physical condition, portrayal of the characters in this not a mental one. Chuck is of sound scene and their adherence to this pro- mind, I think we can all agree on that” cess of thought is reflective of the cul- (00:29:26-00:29:36). ture it is meant to display: US-Ameri- This scene brings up two essen- can. This mind-body dualism is per- tial points when considering mental petuated through the use of the DSM- illness from a US-American societal, 5, which prescribes to this notion medical, and legal perspective. Firstly, (Raese 1), and is also extended to the and most obviously, it points to the US-American medical consciousness through many media outlets, such as

82 SATURA VOL. 2

AMC, which portray characters who ferred treatments, and a general over- believe in this dichotomy as the norm. view to how mental illness takes place Furthermore, it is important to indi- inside the mind and not within the cate that EHS is not an illness recog- body. It also illustrates the cultural nized by the American Psychiatric As- context, similar to US-American psy- sociation, and therefore does not ap- chiatric tradition, without changing pear in the DSM-5. Additionally, sev- Chuck’s own interpretation of what he eral investigations into proving that is himself experiencing and feeling, the symptoms sufferers of EHS expe- both physically and emotionally. rience are triggered by exposure to The second scene takes place electromagnetic fields have been un- when most of the characters still successful (Rubin et al. 1). This could maintain that Chuck’s illness is a be a reason why Dr. Cruz repeatedly physical one; they believe that his pushes Jimmy to reconsider commit- mind has not been affected other than ting his brother for further tests. by having to cope with the manifesta- A second essential point of in- tion of physical symptoms. Jimmy, on terest is the association of EHS as an the other hand, has since adopted the illness with danger, fear, and stress. opinion that his brother’s illness is a This scene establishes that Chuck has mental one with additional physical been out of the office for 18 months, symptoms which Chuck only believes yet he is reluctant to admit the reason to be in his mind, and which he in- for his absence. The reluctance of tends to prove in court, by calling his Chuck, Jimmy, and Howard to discuss brother as a witness in his own disbar- mental illness as a possibility results ment hearing. The scene begins with from the cultural belief in harsh con- everyone in the courtroom turning sequences for those labeled mentally over their electronic and battery- ill. People who are mentally ill are of- powered devices to the court clerk to ten thought to be unstable and dan- accommodate Chuck as he appears on gerous by those who are not, and the the witness stand. Chuck arrives with majority of the US has adopted a “not Howard and collides with a man, Huell in my backyard” response to attempt Babineaux, in the stairwell. Chuck en- to keep the mentally ill far away, both ters the courtroom and is sworn in, af- physically and socially (Link et al. ter which the questions begin with the 1328). This scene thus exposes many attorney representing the state of New features of American views on mental Mexico’s Bar association, Mr. Allen. illness, including popular causes, pre- He asks Chuck about his mental faculties because he sounded “unhinged”

83 SATURA VOL. 2

on the recording presented as evi- Jimmy as to how he can prove to him dence. Chuck responds that he was that his illness is “a physical response play-acting and had exaggerated his to stimuli. It's not a quirk” (00:45:35- illness to make it sound believable. He 00:45:40). Jimmy then lets the entire continues to explain his illness, EHS, courtroom in on his real trick. He had and describes it as an illness that only paid a pickpocket to plant a fully affects him physically, in the form of charged battery on Chuck over an hour discomfort and pain (“Chicanery” and a half previous to his testimony 00:15:06-00:32:25). and all along Chuck had felt nothing. When this is proven to be true to the When the time comes for Jimmy courtroom by Jimmy inserting the to cross-examine him, he asks Chuck battery into his phone and the display about the illness and Mr. Allen objects reading a full charge, Chuck stammers to his line of questioning, arguing no, and his lawyer moves to submit that: “We discussed the physical al- “that Mr. McGill's mental illness is a lergy, not a mental disability” non-issue. If he were schizophrenic, it (00:40:14-00:40:17). Jimmy is allowed wouldn't take away from the fact—” to continue his questioning and pro- which Chuck interrupts, chuckling ceeds to gather details from Chuck “I am not crazy!” (00:46:27- about the symptoms he experiences 00:00:46:35). At this stage, he begins due to his EHS as well as the reasons ranting to himself, raging on about for and forms of his reaction to certain Jimmy ruining different points of his objects. Chuck explains that “[t]he life in excruciating detail for about five farther away it is, the stronger the minutes before he looks to all those source needs to be to have an effect” present in the courtroom and realizes, (00:44:07-00:44:11) and concludes in silent shock, that they are staring at that if something electronic got close him in disbelief for having finally seen to his skin he would feel it. Jimmy that it was, in fact, a mental illness all continues to question him about his along (“Chicanery”). sense of electricity and requests that he points out the spot where he senses This second scene illustrates the highest level of electricity inside several important concepts of mental the room. Chuck inquires as to illness in American society. Again, we whether Jimmy has something in his see that the head-body dichotomy pocket, which he does. Jimmy takes holds strong significance to many of out his cell phone and shows the Chuck’s supporters. They seem to feel, courtroom that it is without a battery so long as the illness manifests itself and merely meant as a trick. The scene in physical symptoms, that his mental continues with Chuck pleading with

84 SATURA VOL. 2

health remains unaffected and there- convinced that it is, indeed, all inside fore he maintains full mental capaci- his head. ties regarding work and personal life. To conclude, Better Call Saul Chuck having no reaction to a battery exemplifies that many stigmatiza- in close contact with his body until he tions and dichotomies permeate US- is made aware of it is enough to prove American culture within filmic por- to those in the courtroom that his ill- trayals of mental illness. These ele- ness is, indeed, mental in nature. This ments have grown out of Western assumption that there are character- schools of thought and remain rele- istics of physical illnesses entirely vant today through the perpetuation separate from mental illnesses is in- of stereotypes in the diagnosis and correct and helps perpetuate the treatment of patients with mental and stigma associated with mental ill- physical illnesses. The artificial sepa- nesses (Kendell 492). Another stigma- ration of mind and body, which is con- tized mental illness pulled into the sistently demonstrated to be false conversation is schizophrenia, and throughout the series, remains a pow- only after it is mentioned by Mr. Allen erful assumption by many in Ameri- does Chuck appear to become “un- can society (Raese 1) and plays a strong hinged.” The stigmatization of schiz- role in the reception of mental ill- ophrenia is highly prevalent in Amer- nesses in every-day life (5), as can be ican and Western schools of thought seen in the two scenes of the AMC se- (van Zelst 295); it immediately rela- ries Better Call Saul. These observa- bels the individual within the precon- tions are important when considering ceived notions of the disease, such as how culture influences mental illness, odd speech or paranoid reactions, as the two cannot be separated with- throughout all aspects of their profes- out disregarding a patient, their em- sional and social life, whether or not bodiment, and their experience of the the patient has been officially diag- illness they face which are tied to their nosed (van Zelst 293). We see this socialization and cultural background. stigmatization in the digression of Mr. Acknowledging their experience can Allen’s references to Chuck’s condi- greatly increase the psychiatric treat- tion. In the beginning, he refers to it as ment of a mentally ill patient and lead a “physical allergy,” then surrenders to a psychiatric system which recog- to the mounting evidence, calling it nizes the cultural influences illness “Mr. McGill’s mental illness,” before has on patients, their experience, attempting to distance it from schizo- treatment, and overall health. phrenia. In the end, it makes no dif- ference to the audience, as they end up

85 SATURA VOL. 2

Bibliography

“Alpine Shepherd Boy.” Better Call Saul, created by Vince Gilligan and Peter Gould, directed by Nicole Kassell, season 1, episode 5, American Movie Classics, 2 Mar. 2015.

“Chicanery.” Better Call Saul, created by Vince Gilligan and Peter Gould, directed by Daniel Sackhelm, season 3, episode 5, American Movie Classics (AMC), 8 May 2017.

Diagnostic and Statistical Manual of Mental Disorders: DSM-5. American Psychiatric Association, 2017.

Gray, Melvin. “The Limitations of Our Diagnostic Classification: Beyond DSM’s Checklists.” Psychiat- ric Times, 28 July 2012, www.psychiatrictimes.com/articles/limitations-our-diagnostic-classification-beyond-dsm’s-checklists. Accessed 17 Jul. 2017.

Jadhav, Sushrut. The Bloomsbury Cultural Formulation Interview. Performance by Sengupta Samrat, University College London, 10 May 2016, mediacentral.ucl.ac.uk/Play/3081.

Kendell, Robert E. “The Distinction Between Mental and Physical Illness.” British Journal of Psychia- try, vol. 178, no. 6, July 2001, pp. 490-93., doi:10.1192/bjp.178.6.490.

Kleinman, Arthur. The Illness Narratives: Suffering, Healing, and the Human Condition. Basic Books, 1988.

Link, Bruce G, et al. “Public Conceptions of Mental Illness: Labels, Causes, Dangerousness, and Social Distance.” American Journal of Public Health, vol. 89, no. 9, Sept. 1999, pp. 1328-333., doi:10.2105/ajph.89.9.1328.

Mehta, Neeta. “Mind-Body Dualism: A Critique from a Health Perspective.” Mens Sana Monographs, vol. 9, no. 1, Jan. 2011, pp. 202-09., doi:10.4103/0973-1229.77436.

Raese, Joachim. “The Pernicious Effect of Mind/Body Dualism in Psychiatry.” Journal of Psychiatry, vol. 18, no. 1, 2015, doi:10.4172/psychiatry.1000219.

Rubin, G. James, et al. “Idiopathic Environmental Intolerance Attributed to Electromagnetic Fields (Formerly ‘Electromagnetic Hypersensitivity’): An Updated Systematic Review of Provocation Studies.” Bioelectromagnetics, vol. 31, no. 1, Jan. 2010, pp. 1-11., doi:10.1002/bem.20536.

Van Zelst, Catherine. “Stigmatization as an Environmental Risk in Schizophrenia: A User Perspec- tive.” Schizophrenia Bulletin, vol. 35, no. 2, Mar. 2009, pp. 293-96., doi:10.1093/schbul/sbn184.