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This post was co-authored by Gowri Aragam, MD.
Has your child ever watched a TV show and then been excited to get mental health treatment? Probably not, and that’s a problem. Representations of children’s mental health on television have left something to be desired. At best, they paint child psychiatrists as stiff and uptight. At worst, they neglect guidelines on mental health reporting and may increase suicide rates.
As psychiatrists, we’ve finally found the TV mental health representation we’ve been looking for in Mindy Kaling’s new Netflix’s show Never Have I Ever. For the first time, we have something that will show young people representations of what mental health can look like, and how mental health treatment can help them. The show also tackles some of psychiatry's hardest topics in a way we never thought we’d see on TV, ranging from accurate psychodynamic portrayals of adolescents’ sex lives to “psychosomatic weakness” (formally called a functional neurologic disorder), the impact of grief, and the importance of cultural humility in mental health treatment.
Psychiatrists aren’t all weird and uptight.
Most people think of psychiatrists as old white men wearing bow ties and talking about Freud. This couldn’t be further from the truth, particularly in child psychiatry. Good child psychiatrists are playful and meet patients where they are.
Never Have I Ever introduces us to the caring yet irreverent Dr. Ryan. She seems like a real child psychiatrist. Child mental health providers don’t sit with a kid and read them Melanie Klein. They sit with them and have real conversations, sometimes over Legos or board games.
Pediatric psychiatrists know that adolescents don’t like it when they act uptight and fake. A real child psychiatrist may even give an adolescent some side-eye, like Dr. Ryan frequently does. This kind of representation is important. Kids need to know that a child psychiatrist isn’t a scary distant robot. What kid would want to subject themselves to that? Once they realize that a child psychiatrist can be like a wise friend (who by law can’t share their secrets), and even understand high school drama, they may be more open to getting help.
Dr. Ryan’s therapist also breaks the common notion that child psychiatry is all about pathologizing the child. She brings in Devi’s mother and acknowledges that children’s mental health is all about family dynamics. It’s never about blaming a person; it’s about figuring out what could be working better in a whole family system. Most kids want their families to be happy, and they can get behind therapy when they know they aren’t being blamed.
Some patients have limb paralysis due to a psychiatric condition, and they aren’t “faking it.”
The show opens with a story about Devi developing weakness in both legs following the death of her father. For months, she requires a wheelchair, even though doctors cannot find any medical cause for her weakness. In medicine, we call this condition a “functional neurologic disorder,” and it is one of the most common reasons patients show up to a neurologist. For a simplistic conceptualization, the body shuts down due to intense psychiatric distress. Because blood tests and imaging are normal, many people think that these kids are “faking it.”
But they aren’t. “Patients with functional neurological disorder have a condition that is real, common, and brain-based. I like to emphasize that this condition is at the interface of neurology and psychiatry; the brain doesn't separate into 'neurologic' and 'psychiatric' circuits,” says David Perez, director of the functional neurologic disorders clinic at Massachusetts General Hospital. Children with functional neurologic disorders are often teased by peers and sometimes, sadly, even their doctors. The show captures this reality, as other students tease Devi and bully her in school.
The treatment for functional neurologic disorders is physical therapy and psychotherapy. As patients’ mental health improves, their weakness may improve as well, as happens with Devi. Though the show skips over the long and difficult treatment these patients often face, it is a huge step to have this stigmatized condition represented on TV. Devi beautifully highlights what most patients with this condition say about their symptoms not being taken seriously: “Yeah, why would I choose to be in a wheelchair and have my life ruined?”
Kids' sex lives are complicated, and psychiatrists get that.
Kids have sex and sexual interests, and we do them a disservice if we ignore this. Their inner lives, as it relates to this, are also complicated. Dr. Ryan does an incredible job showing how a child psychiatrist can help a kid understand their sex life (even though most think they would be mortified to ever talk to an adult about this). The show also doesn’t sugarcoat that adolescent sex and romance are awkward. When Devi tries to have sex in Paxton’s garage, she makes a joke about polio, runs into a table, and starts bleeding.
It becomes clear fairly quickly that Devi’s efforts to fit in serve as a way to avoid her grief about her father, and her struggles with self-esteem. With wit and humor, Dr. Ryan playfully acknowledges that Paxton is attractive ("Is this kid taking HGH!?”) while helping Devi explore what else may be going on and how else she can fulfill her emotional needs in a way that may be more successful. She later highlights the same avoidance in Devi’s mother when she tried to move the family to India in the hopes that this will take away her grief around her husband’s death. The show reminds us that adults and kids can have very similar defense mechanisms, and that psychiatrists can understand and help.
Kids' grief may show up differently.
Kids may not always know that what they are feeling is grief. Devi unexpectedly and traumatically loses her father to a heart attack. Without consciously realizing it, she avoids these feelings with a series of destructive behaviors—drinking, lashing out at her friends, and breaking a window. Her psychiatrist gently helps her to gain insight into how this avoidance is hurting her.
Devi experiences painful flashbacks to the night of his death throughout the series. Her therapist takes a trauma-informed approach of letting Devi explore her grief slowly on her own terms. When Devi believes her father is reincarnated as a coyote, she encourages her to talk to the coyote to explore her emotions. This gentle approach allows Devi to ultimately move past her avoidance of activities that remind her of her father’s death (like playing the harp) and gets her past her self-destructive behaviors.
Despite what kids think, psychiatry recognizes that culture is a vital aspect of mental health.
Many kids of diverse backgrounds can feel like their cultural identity is at odds with their social “American” identity. They can also feel like a mental health professional could never understand or help. But good psychiatrists are trained to understand the cultural context of a kid’s life as a way to understand their emotional reactions, assumptions, and behaviors. They also help kids navigate these tensions around identity that can impact their self-esteem, sense of self, and ultimately their mental health
The context for Devi’s adolescent experiences is her relationship to her Indian culture. We see this through her family and her community. Devi and her mother have a contentious relationship. While Devi wants to fit in at school, her mother expects Devi to stay away from boys, to get into Princeton, and to engage in all religious and cultural norms. However when Devi attends the Hindu religious festival (Ganesh Puja) at her school, she doesn’t feel like she fits in. She makes fun of the traditional dances, and is frustrated by having to wear a sari.
In approaching this tension, Dr. Ryan doesn’t make any assumptions about Devi’s culture. She instead gets curious and makes room for Devi and her family to explore their unique experiences and viewpoints. For example, when Devi’s mom shares with Dr. Ryan that “therapy is for white people,” immediately followed by, “I mean clearly there are some exceptions” while pointing at Dr. Ryan, who is Black, it serves a playful and ironic dig at the assumptions many cultures make about the legitimacy of psychological treatment. By gently and nonjudgmentally challenging these assumptions and encouraging Nalini to express her grief to Devi, Dr. Ryan helps Nalini and Devi find their way back to each other, and helps Devi build a bridge between these seemingly opposing cultural identities.
Adolescents rarely want to go to see a therapist. The vast majority of the time, they’re there because their parents made them go. We suspect that a huge part of this is the media’s inaccurate portrayal of mental health treatment. We are beyond grateful for this show and hope it inspires more adolescents to seek out or help. We promise we won’t be weird or talk about Freud.
Gowri Aragam MD (@gowriaragam) is a psychiatrist at Massachusetts General Hospital and co-founder of Stanford Brainstorm Lab for Mental Health Innovation.
