“The Patient” and My Patients (by Dennis Palumbo, M.A., MFT)
Dennis Palumbo, M.A., MFT is a writer and licensed psychotherapist in private practice, specializing in creative issues, primarily in the entertainment industry. His award-winning series of mystery thrillers—Mirror Image, Fever Dream, Night Terrors, Phantom Limb, Head Wounds and the latest, Panic Attack—feature psychologist and trauma expert Daniel Rinaldi. He’s also the author of Writing From the Inside Out, as well as a collection of mystery short stories, From Crime to Crime. Recently he served as Consulting Producer on the Hulu limited series The Patient, and here (in an article first published in the journal Capital Psychiatry) he tells us about how the play out of the television crime drama affected his real-life patients.
After seventeen years as a Hollywood screenwriter (the film My Favorite Year; the sitcom Welcome Back, Kotter, etc.), I retired from show business and have been a licensed psychotherapist in private practice for over thirty years. During this time, my writing has been confined to articles and reviews, as well as a series of mystery novels whose protagonist is a psychologist. My point is, it’s been so long since I was a dues-paying member of the Hollywood industry that I was quite surprised to hear from the team of Joel Fields and Joe Weisberg. Writers of the award-winning TV series The Americans, they’d reached out to me to act as advisor on a new show they were developing. Called The Patient, it was about a serial killer who kidnaps and holds hostage a well-known therapist, in hopes that he can “cure” the killer of his homicidal urges.
Apparently, my former career as a script writer and my current one as a therapist prompted them to see me as a reasonable person to act as consultant on the new series. Essentially, what they wanted was for me to vet each episode’s scripts for clinical accuracy and to “make sure the therapist sounded like a therapist”—or as much like one as possible given the bizarre circumstances of the show’s premise.
Over the coming months, I did my best to keep the narrative within the range of plausibility, including suggesting the occasional line of dialogue or therapeutic interpretation. Just as we were finishing the script for the last episode, it was announced that Steve Carell had been cast as the therapist. A wonderful actor, he’d been given a salt-and-pepper beard and glasses. Whether or not it was conscious on the writers’ part, he looked somewhat like me. Which, at the time, I just found amusing.
My working relationship with Fields and Weisberg was one of the most pleasant professional experiences of my life. Moreover, the two writers were very gracious about my contribution when doing PR interviews leading up to the series premiere. During one such interview, when writing up the story for Newsweek, the reporter off-handedly mentioned that Carell’s character looked like me.
It wasn’t until the series began airing on Hulu that the ramifications of this became apparent in my therapy practice. A number of patients who’d begun watching the show pointed out that Carell’s therapist character looked a lot like me, and on occasion even sounded like me. (No surprise, since I’d suggested some of the therapeutic comments the therapist made.) Naturally, I had to process this with these patients, some of whom were quite upset at seeing the therapist chained to a bed, helpless. More than one half-jokingly worried that the series’ premise would give “some crazy person” the idea of kidnapping me. Did I feel I was in danger? they asked. I answered honestly that I didn’t, while privately wondering why I’d never even entertained that idea when working on the show.
Moreover, had I been unforgivably clueless in not anticipating this reaction from my patients? I reminded myself that Steve Carell hadn’t been cast until the series’ scripts were almost finished, that I had no idea he’d be playing the therapist, and certainly no idea how they were going to make him look. Yet I still felt pangs of remorse for the distress the show’s depiction of the therapist was causing for some of my patients.
As the weeks went on, and episode after episode aired, it became obvious that seeing an avatar of their therapist was upsetting to a number of my patients. Of equal interest during sessions was the reaction of those patients who found the whole thing amusing, or at least presented it as such. They even joked with me about the series’ story-telling: why didn’t the therapist try harder to escape? Why didn’t he just refuse to talk to the serial killer? Is this how you would react in this situation, Dennis?
Of course, the narrative choices displayed on-screen were made by the show’s writers, not me. I was merely the consultant. But this didn’t matter. What did matter, and what ended up being of real clinical interest (and value) was what some patients’ transferential connection to the therapist character and the story revealed about both their own core issues and their relationship with me. As Robert Stolorow has reiterated, there is only subjectivity and context; in this unusual situation, there was a patient’s subjective experience of me in the context of our therapeutic relationship, and then a kind of meta-subjectivity/context experience through the narrative of a TV series.
(SPOILER ALERT: I’m going to discuss the series’ final episode)
For a select few of my patients, as I’d expected, it was the series’ final episode that elicited the strongest reaction. Not only does the therapist fail to escape, he’s strangled to death on-screen by the serial-killer patient. This horrible murder is hardly ameliorated by the killer’s decision to send an anonymous letter to the therapist’s family, telling them where they can find the body so it can have a proper funeral. The last time we see the serial killer, he’s the one chained to the bed, his mother holding the key to the chain’s lock. Since she’s known all along about her son’s activities, we’re left to wonder if/when she’ll release him to potentially kill again.
A couple patients revealed that they’d cried at the end, one of them pointing an accusing finger at me and saying, “You better not fucking die!” Again, said half-jokingly. And yet, not. The few others who’d stayed with the show all the way to the end were angry at both the series’ writers and at me. Their reactions ranged from disbelief (“How could they end a show like that? How come the killer gets away with it?”) to frustration (“That’s not fair to the viewers. We deserved a better ending.”) to simple creative criticism (“I hate ambiguous endings.”).
As difficult as the sessions were with these patients over the course of the series’ run (including my own guilt at having put them through it), some of the clinical work that arose from our discussions was quite beneficial. A greater understanding of the contextual nature of our therapist/patient relationship undoubtably occurred. Moreover, we often reached a deeper understanding of the dependency/resentment dynamic at work in the therapeutic dyad. And, in one or two cases, the discussion regarding the show was a springboard to a more energized, proactive engagement on the patient’s part.
Still, I have somewhat mixed feelings about my participation in the series. It was often an exhilarating experience, due primarily to the talent, receptivity and warmth of both Joel Fields and Joe Weisberg. And while I regret the distress that the lead character’s words and looks evoked in a few of my patients, I also felt this similarity led to real forward progress in our work together. A potential disjunction becoming a fruitful conjunction.
That said, if I’m ever asked to consult on another series, my only hope is that the lead character looks like someone else.
