Could Psychiatry Have Worked?

I am not exactly a TV medical-drama junkie, even though I went to medical school.  But I do watch some of them and have over the years.  I can't tell you what makes me watch one and not another, and for the purpose of this piece it really doesn't matter, but I watch some and have over the years.

The other night there was an interesting episode of one that I do indeed tape and later watch.  That would be "Chicago Med", which is a pretty typical hospital drama with a new set of patients each week and lots of romantic interactions between the staff members, mostly centered around the hospital's ER.

Now, this is, after all, network TV, which means that you get lectured at quite regularly, whether you want to be or not.  The lectures, of course, are politically correct, so businessmen are bad and need to die, the leftists are good and conservatives and religious people are bad, unless they are Muslims.  You get the idea.  And I do find myself shouting "Stop lecturing!" at the screen.

I shout that often, or at least think it often, so I know that we are being lectured every episode.  And that is what made this particular episode curious, because I couldn't quite figure out what I was supposed to take away from it.

In this case, a white man in his 50s was admitted to the ER after a fall, with serious other symptoms that the doctors quickly diagnosed as advanced throat cancer.  This would require aggressive treatment, but was treatable -- except that the patient wanted to die.

You see, he was a pedophile, but one who had never touched a child in his life because he had the moral strength to resist the urges he had.  So he wanted to die, because those urges were so strong, and the outcome of acting on them so awful, that he felt it better to leave the planet without having ever acted on them.

So follow this, because it is important ... there is good and bad, and there is sick and well.  This man, to me, was a sick, good man.  He was psychologically ill because he was moved to prey on children, but he was a good man because he resisted the urge to do evil -- yet the show never dealt with that!

The drama involves the ER doctor, who is committed, at least until the end, to trying to save his life and convince him to take the medical treatment for his cancer, and a judgmental nurse, who clearly does not want to help save him -- even though, again, he never actually did anything.  Eventually, he has a severe episode, the doctor accedes to the patient's wishes and does no heroic treatment to save him, and he dies.  The nurse questions her ethics, we roll credits, and all is well, I guess.

But here's the thing.  This show has not one but two characters who are psychiatrists in the cast, and both are seen frequently.  The patient, remember, was not a criminal, since he had not actually done anything with his urges and was ready to die to avoid any such action.  So why was no psychiatric treatment for his pedophilia ever once suggested?

I'm not even saying there is such a treatment; I don't really know about psychiatry and how successful it can actually be in different cases.  And they do seem to lead the entire medical profession in trying to normalize certain behaviors that I might choose to disagree with.

But in this case, no such treatment was proposed; no alternative offered, even though psychiatric efforts are a significant part of the show's premise.  Forget the cancer; suppose that a 55-year-old man had walked in, perfectly healthy, no cancer, to the same ER and announced that he had overwhelming urges to pedophilia and had managed not to act on them.  What would they have done with him then?

What if he had been (gasp) black?

From a dramatic standpoint, that might have made the show a lot better, regardless of the availability of a treatment for him.  After all, that character -- a non-functioning, ethical pedophile -- well that is not something we know about, so the dramatic tension would have been something.

It is fiction, I know.  But the show clearly, intentionally missed a fascinating plot evolution they could have explored.  Since they are such lecturers, we have to suspect that they did not want to go that route, possibly because it would have had to have raised the question about whether things like homosexuality could be addressed by psychiatry.  But with two psychiatrists in principal roles, how did they not look at that approach?  Were they lecturing us somehow, and we missed the lecture?

I don't know, but I'd sure like the writers to ask themselves that.

Copyright 2018 by Robert Sutton
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