Okay, just finished Hannibal Season One.

My name is Jeremy, these are my Hannibal credentials: I read Red Dragon and Silence before the movie was made. I read Hannibal and Hannibal Rising in hardcover (!), and liked them both for what they were–love story and backstory. I even mostly enjoyed those films.

So last week, when an insect bite laid me out for the week, I queued up Neflix with a Hannibal marathon.

There is some great stuff. It’s beautifully shot–the cooking especially. I like Mads, but Hugh Dancy was really the star of the show–just a believably understated performance in what could have become campy. The arc of the season is nicely plotted, the murderer-of-the-week is moderately interesting.

BUT (and yes, capital but, here) could they not have hired a psychiatric consultant? The show was written as if we should be drinking every time the word psychopath is spoken. The endless prattling on in psychobabble is so tedious and banal, I had to grit my teeth every time Gillian Anderson or poor Caroline Dhavernas were onscreen.

“I haven’t practiced medicine in years,” said the PSYCHIATRIST!
“Dementia is a symptom. What is the disease?!” Huh?
“She’s killing people because she thinks she’s dead.” Wait, what now?

Delirium versus dementia. Sociopath versus psychopath. Cotard’s Syndrome. Anti-NMDA Receptor encephalitis. This is a show that thrives on the intricacies of mental phenomena and yet the ability to make these abstract ideas interesting and nuanced (and worthy of armchair diagnostic fetishism with which they are endowed) is next to nil.

What the Starling-Lecter dialog succeed at was the absence of jargon. Conversation as metaphor as window into psychology. This season went the other direction–metaphor as jargon as power as jargon as plot.

Still, a show like Hannibal gets me jazzed up. It encourages me to find some way to get the real intricacies and challenges of psychiatry onscreen. When psychiatrists get together we don’t talk jargon. We talk stories, the surprises, the predictable surprises, the Gordian knots of helping someone. The dance, the breakthrough, the failure, the risk.

Okay, back to work.


There is a bias in modern mental health toward pharmacology. A diagnostic term is a lifejacket on the Titanic. Bipolar Disorder is salvation. Schizophrenia? Thank the Lord! Post-traumatic Stress Disorder!?! Hallelujah!

Label implies treatment, implies excision, implies happiness.

Unfortunately, diagnoses portray a level of remission that mental health treatment rarely achieves. Hope turns to disappointment. Disappointment turns to anger…Yoda would have more to say.

When the DSM took over nomenclature and reduced psychiatric diagnoses to an Internet Chinese menu (for better and for worse), human experience and psychiatric labels were placed in conflict.


“I have Anger Management issues.”

“I’m totally ADD. Like, totally.”

“My boyfriend tells me I’m Bipolar.”

The language of emotion has been subsumed by the vernacular of diagnosis or treatment as if it’s only pathology. One can’t be angry or inattentive or reactive or vengeful or ambitious without a label, or the popular acceptance of a term.

Anger can be appropriate. Inattention, too. 

Most of my day is spent as a translator; I am Fezzik in The Princess Bride.

Personality is the general term for stable traits. Those that are recurrent, predictable. It is not a derogatory term, it might be everything.

Fiction often captures more about personality than the DSM. Reading a novel, you will learn more about the trajectory of personality, of sadness, of anger than a psychiatric diagnosis.

Inherent in psychiatry are the concepts of. baseline and change. Inherent in fiction are the concepts of flaw and motivationThe goal of psychotherapy is to make the inherent articulated, the inchoate communicated. Fiction celebrates “flaws” as interesting.

Don’t tell me a diagnosis. Tell me what pisses ya off.


I don’t write much here about being a psychiatrist.  The reason is entirely self-preservative—as much as I yearn to self-indulge, I fear that anything I write could be used against me in a  court of law.

And so, until courts of law are done with me, a brief word about cliche. The hallmark of cliche is predictability—the lack of surprise, the expected outcome, the ordinary, the banal.

As a shrink, there are too many days where I’m confronted by the banality and stereo typicality of human dynamics. Labels are legion and well distributed in pop psychology:  the hysteric, the borderline, the psychopath, the narcissist. Or, if you prefer others, GAD, OCD, ODD, BD II, MDD, and PD NOS.  

I sit in my chair, ask my questions, get my answers, and the brain I’ve been granted does its best to squeeze the answers into categories, diagnoses, labels. It does so, so effectively, that many days I am left with little pleasure in human encounters.

But, I am by no means alone. I could be writing this as a salesman, a stripper, a front desk worker at a cheesy motel, a former Goldman Sachs manager, a cashier, a hostess.  Each has a paradigm, a situation, a set of questions, and to each, the interaction can be squeezed into a number of labels, dealt with, and abandoned.

I think the danger in any job is to know when the labels define interaction, and when they define the limitations of experience.  That may be conjecture, but I hope not.