NOTEBOOKS Esteve Foundation 42 Television fiction viewed from the perspective Medicine in Television Series of medical professionals House and Medical Diagnosis. Lisa Sanders Editor: Toni de la Torre The Knick and Surgical Techniques. Leire Losa The Sopranos and Psychoanalysis. Oriol Estrada Rangil The Big Bang Theory and Asperger’s Syndrome. Ramon Cererols Breaking Bad and Methamphetamine Addiction. Patricia Robledo Mad Men and Tobacco Addiction. Joan R. Villalbí The Walking Dead and Epidemics in the Collective Imagination. Josep M. Comelles and Enrique Perdiguero Gil Angels in America, The Normal Heart and Positius: HIV and AIDS in Television Series. Aina Clotet and Marc Clotet, under the supervision of Bonaventura Clotet Nip/Tuck, Grey’s Anatomy and Plastic Surgery. María del Mar Vaquero Pérez Masters of Sex and Sexology. Helena Boadas CSI and Forensic Medicine. Adriana Farré, Marta Torrens, Josep-Eladi Baños and Magí Farré Homeland and the Emotional Sphere. Liana Vehil and Luis Lalucat Series Medicine in Television Olive Kitteridge and Depression. Oriol Estrada Rangil True Detective and the Attraction of Evil. Luis Lalucat and Liana Vehil Polseres vermelles and Cancer. Pere Gascón i Vilaplana ISBN: 978-84-945061-9-2 9 788494 506192 42 NOTEBOOKS OF THE ESTEVE Foundation Nº 42 Homeland and the Emotional Sphere Liana Vehil and Luis Lalucat The producers of the action-packed 24, Howard Gordon and Alex Gansa, have at last earned critical praise on this adaptation of the Israeli series Hatufim, first broadcast on the cable network Showtime in 2011 and still on air. What began as a game of suspense and ambiguity between a CIA agent suffering from bipolar disorder (Claire Danes) and a US marine recently freed from captivity at Al-Qaeda’s hands (Damian Lewis), has developed into a fascinating spy fiction. Year after year it is ranked among the favor- ites at the Emmy Awards (it harvested six trophies in its premier year), and has even “hooked” President Obama himself. Its different emotional states, as well as its an- sions taken at lightning speed, it represents the guish, have generated a great deal of interest supremacy of action over introspection. Though among the different narrative arts. The history of the series’ main aim does not lie in describing its literature lets us see into the lives and passions characters’ mental functioning, the scriptwriters of fascinating characters. We could mention offer viewers elements to identify with them by Madame Bovary’s day-dreaming and emotional showing how continued exposure to situations of deception in Gustave Flaubert’s masterpiece, or risk can affect one’s mind and emotional states. the affective sufferings of the characters in Fy- The storyline focuses particularly on the main odor Dostoyevsky’s novels, held captive by their character, Carrie Mathison, a CIA agent who has emotional development and a heightened intro- been diagnosed with bipolar disorder. spective view of their life experiences. Film in par- Bipolar disorder is considered one of the ticular has explored the human personality and most significant psycho-pathological disorders helped us to experience the reactions of fictional affecting mood. This name is given to disorders characters as our own. Firstly films, and more that are characterized by mood swings. One’s recently TV series, have fascinated us with the mood consists of a range of emotions that differ- lives of their everyday heroes, showing us their ent experiences evoke in one. These emotional likenesses and revealing our own fears and de- states and resulting behaviors are considered sires. The treatment given the emotional states healthy and within the norm when they adapt to constitutes, in fact, the cohesive core of any film the context in which they are expressed. Gener- genre such as melodrama, which from Douglas ally, at the risk of oversimplifying for clarification’s Sirk to Pedro Almodóvar, and including Rainer W. sake, within the range of reactions appropriate to Fassbinder and recently David O. Russell’s Silver their setting we would include annoyance at an Linings Playbook, submerges us in the depths of injustice, sadness when facing loss, or happiness the most extreme human emotions. at good news. Losing control in expressing one’s Homeland is an action series that centers on feelings would also be considered acceptable as the coverage of international conflicts and the would exaggerated annoyance at highly stressful fight against terrorism. Fast-paced, with deci- situations if they occurred momentarily. On the -97- Homeland and the Emotional Sphere contrary, in assessing a disorder one should con- lucinations. Sometimes they require psychiatric sider whether these reactions occur repeatedly hospitalization. or in an exaggerated way, with no apparent quali- In the above descriptions, it is easy to recog- tative or quantitative link to outside stimuli, and nize some of the moments and behaviors Carrie whether they determine the individual’s relation- experiences: she seems to fall into a hypomanic ship with surrounding reality. state when she makes decisions following her im- Considered to be a serious mental disorder, pulses without considering the risks associated bipolar disorder, formerly called manic depres- with them, or shows signs of an exaggerated sion, is characterized by changing moods. These self-esteem that does not seem congruent with swing between two opposite poles: the mania, or her context. Yet at the same time, she maintains phase in which the subject appears exalted, eu- a high level of competence. She is capable of phoric and harbors grandiose delusions on one establishing a significant personal relationship hand; and on the other, depression, the phase to which she remains emotionally faithful, and where sadness, inhibition and thoughts of death of modulating her irritability. Nevertheless, she predominate. Such fluctuations can be observed also displays a more serious clinical presenta- in Carrie’s character when at times she gets into tion at such times as those behaviors escape situations of great risk from solely following her her control, she loses her capacity for empathy, impulses, disregarding her colleagues’ warnings, becomes submerged in her emotions and even or else the opposite when, discouraged, she has distorted perceptions and invents delirious shuts herself away, and is wracked by sobbing, conspiracy ideas. This is when she needs to be even attempting suicide. hospitalized. This initial schema of cyclical alternation be- Carrie likewise shows symptoms typical of the tween mania and depression does not occur depressive phases when overwhelming feelings evenly in all individuals suffering from this dis- of sadness and despair, tiredness, anxiety and a order. Cases occur in which the alternation be- marked alteration in her vital rhythms, such as in- tween euphoric and depressive states are com- somnia and appetite loss, appear. bined with more or less prolonged phases of full The information provided by the series might stability and functional restitution, with a good also bring to mind a mixed episode; in other response to treatment, absence of associated words, one simultaneously combining manic and problems and a return to a fully independent life. depressive symptoms. So symptoms of hyperac- Even so, most people tend to face more of a tivity, worry, feeling down, a tendency to cry and torpid evolution, with frequent relapses and the feelings of guilt can be associated. As the series manifestation of other associated clinical features reflects, such variability of the mixed episode like anxiety, substance abuse and some degree hugely complicates diagnosis and treatment, and of functional deterioration. has the more negative consequence of increas- During manic phases, patients can also mani- ing the risk of suicide. fest contrasting states. On one hand is hypo- Given the variability of clinical presentations, mania, a euphoric state in which individuals ap- bipolar disorder has been subdivided into two pear to be in a buoyant and expansive mood, conditions: bipolar I disorder (BP-I), is character- alongside irritability and impulsiveness, disquiet, ized by alternation between depressive and man- agitation, uninhibitedness and verbosity, which ic episodes; and bipolar II disorder (BP-II), by de- nevertheless does not significantly interfere with pressive and hypomanic symptoms. In our case, daily activities. On the other hand is a marked Carrie’s behavior rather resembles BP-II disorder. state of mania in which manic symptoms of a Investigations developed around the etiologi- more invalidating nature predominate. The latter cal hypotheses of the disorder show the impor- seriously interferes with the individual’s functional tance of the genetic load, which points to greater performance, going as far in certain cases as de- personal vulnerability and seems to confirm that veloping psychotic symptoms like delirium or hal- the presence of a disorder on the bipolar spec- -98- NOTEBOOKS OF THE ESTEVE Foundation Nº 42 MEDICINE IN TELEVISION SERIES trum in a parent increases the chance that de- may involve an evolution toward chronicity. In scendants will suffer from it. As occurs with other fact, the frequency of critical episodes gradually complex mental states, the causes tend to be increases, until two episodes occur in a very brief due to multiple factors and consequently the in- interval of time. fluence of other aspects linked to development The quality of therapy plays a large role in the are highlighted.