Black Box: A Work in Progress

Dr. Catherine Black (center) is played by Kelly Reilly - © Nicole Rivelli / ABC

When the pilot episode of ABC’s Black Box aired on April 24 (in the network’s coveted Thursday night Scandal spot), the show took some hard hits from critics and viewers alike. Some people found the main character—Dr. Catherine Black, a successful neurologist who lives with bipolar disorder—hard to connect with, or at least believe. Some completely identified with her portrayal of a manic episode—a hallmark symptom of untreated bipolar illness—and others found the entire show over-the-top. Dr. Black’s intentional skipping of her medication angered a lot of people who take medication themselves, while some completely empathized because they personally have felt the positive effects of mania.

The only person who can truly address what’s really going on in Catherine’s head is the show’s creator, Amy Holden Jones. Jones has a long history of producing and directing in Hollywood, but her main craft is screenwriting. You can see her handiwork in films such as Beethoven, Mystic Pizza and Indecent Proposal. The show taps two resources as medical consultants: staff writer Michael Madden, M.D., who attended the George Washington University School of Medicine, interned at New York Presbyterian - Weill Cornell Medical Center and practiced trauma and burn surgery for 20 years in New York City, and Roshan Sethi, who will graduate from Harvard Medical School this spring and enters his first year of residency there in the fall.

And Jones is no stranger to bipolar disorder herself. She grew up with a father who had his first manic episode in his early 40s when she was 9 years old. She bore witness to the highs and lows—the mania and the depression—that are the trademarks of bipolar disorder. He was medicated for his illness well into his 60s. NAMI recently spoke with Jones—and Dr. Madden and Roshan Sethi—to explore the responsibility of portraying mental illness in the public eye.

What inspired you to create Black Box?

AHJ: I’ve always wanted to get into the world of the brain, having personally lived in a family dealing with mental illness for a long time—I was 43 when my father finally died. In my era, with my father, there was so much secrecy. I never even had a conversation with him about his illness. We would live through his episodes and we’d never talk about them. He was very brilliant, high-achieving, worked 24/7 when he was younger. Then he had his first big breakdown at around 40. He finally began taking lithium and it made such a difference in our lives—but there are a lot of things I don’t understand. Looking back, I assume he had something like high-cycling mania. When I read Kay Jamison’s An Unquiet Mind, I suspected maybe he sometimes stopped taking his medication. And I know, as a doctor, he often experimented with self-medicating.

In Kay’s book, I saw someone that had a full life, success and had mental illness. Black Box is not a show about bipolar; I only saw it as an opportunity to have a character that lived with it who had a full and interesting life. Because of my father, I did an enormous amount of reading about the brain always, people like VS Ramachandran, Steven Pinker, and Oliver Sacks, who was a big influence. What I took in most of all is that behavior is not the result of how your mother raised you, but the biology of brain you are born with. Our brains our built by our genes, just like our hair and our eyes and everything else.

In TV dramas, characters who don’t have challenges aren’t that interesting. You lead must have a problem to overcome, quirks, strengths and weaknesses. I decided to create a neuroscientist who deals with non-psychiatric illnesses and studies the brain, but has a psychiatric illness herself. The first episode of Black Box exists to show the challenge that she lives with—she doesn’t have manic episodes on every show. But let’s face it, people don’t stand around the water cooler talking about the “happy, well-adjusted family.” In television, you see a lot of lead characters who are alcoholics or addicts—networks and the public want to see a challenge in a character that needs to be overcome. With Catherine, I don’t want bipolar to define her. Sherlock Holmes has an addiction, but it is just one part of who he is. He’s Sherlock Holmes, not “an addict.” Similarly, Catherine is a very complete human being who happens to be bipolar.

I read that your father lived with bipolar and would sometimes stop taking his lithium, which exposed you to the flashes of brilliance that are sometimes associated with mania. What would happen? Was this a main point of inspiration for Dr. Black?

AHJ: I believe his early or pre-mania only benefited him in the years before he was fully bipolar. At that point he had great focus and energy. When he was truly sick, I don’t believe mania imparted any kind of genius. My voice is that of Hartramph, the psychiatrist who says in our first episode that you must normalize to do your best work. I do not romanticize this condition. It was tragic to watch my father’s struggle. I would not wish this on anyone—but I also wouldn’t stigmatize or devalue anyone for having this condition.

I recently spoke to a Huffington Post blogger who has bipolar disorder and is a mother. She asked me: What was it like to be the child of a bipolar parent? I told her that through it all, I knew my father loved me, and that took away a lot of the bad. The thing that did the most harm was the secrecy—we couldn’t talk to anyone about it. I could not have sleepovers. Nobody knew what my life was like. There was this horrible coming out at my high school graduation that occurred during one of my father’s breakdowns. We were trying to get him into a hospital and my mother felt he needed to come to the award ceremony and he made a scene there. Everybody found out all right—and not in the way I wanted it to happen. It wasn’t nice, that feeling that you had to be ashamed. In later years, out of my five best friends from those days, I discovered that one’s mother had bipolar and multiple suicide attempts, another had a father with OCD who they said was a teacher but really stayed home all day polishing doorknobs. Secrecy and the shaming is a terrible, terrible thing. It’s one of the biggest themes the show addresses.

The way my father presented was classic bipolar when I think back to my childhood—moving into drinking and self-medicating and ending in a big breakdown. He absolutely had mania and depression—the grandiosity. Once he was convinced he had the cure for aging. He bought a drug stock, which we could not afford, because he believed he’d sold them his magic cure so it would go up and he’d make a fortune, and of course it crashed and we lost money. After his first big breakdown, he was in a mental hospital for a year, then luckily got another great job doing leukemia research, mainly treating children. He still wasn’t well—he still drank, but later began taking lithium and he stopped drinking. Then our lives completely changed, at least for a while. The problem with doctors is that they can self-medicate. His arc was very tragic. He developed tardive dyskinesia and liver damage and eventually had to stop his medication. The result was catastrophic and ultimately ended in his death. So clearly I am not an advocate of refusing medication.

NAMI had a strong reaction on our Facebook page after the show aired—both positive and negative. How do you handle any possible backlash or perceptions that the show could be “glamorizing” going off medication?

AHJ: Dr. Black’s reaction wasn’t exaggerated, but that doesn’t happen to everybody. There are many people with bipolar who won’t recognize themselves in her manic episode, but some people will recognize all of it. I’ve had people berate me for “stealing their life” and others thank me for my honesty, and still others say I have no idea what bipolar is and I don’t know what I’m doing. There’s nothing to do but listen to it all and go forward with my vision. With Black Box, we try to show experiences from the inside—not just the outside. For example, Catherine tells her therapist she thought she was flying, but in reality she was standing on a balcony and almost fell to her death. She experienced a form of ecstasy, but the reality is her delusion nearly killed her. To me this shows why she is tempted to go off the meds, but also how dangerous and destructive it is.

How can you see the journey as glamorized by the show when you she ends up screaming in an ambulance, having alienated and shocked her fiancé , finishing finally on the beach contemplating suicide? And after this first episode, you will see her life as a bipolar patient who is on medication. Then she is fine and a brilliant, responsible doctor. If you follow her to episode 12, when she becomes intolerant to her meds, you’ll see in that episode when she has goes into mania again, there’s nothing glamorous about it. I hope people will come back and give it the time to see the full picture. You have to see where it goes. There wasn’t any other way to do it without that first episode, and, if you keep watching, you’ll see subtext of the show should be dear to NAMI—to bury Freud and quit blaming mothers.

Catherine’s brother is empathic and loving. His line, "It could have been me," was our medical director’s favorite part of the episode. Siblings can be incredibly protective with a parent or another sibling who has bipolar. Is that a possible theme going forward?

AHJ: The brother is speaking as me there—that’s an actual conversation my own brother and I have had many times about our father. The stuff with the brother, with all Catherine’s family, is intensely personal to me and breaks my heart. The role of the relatives who must try to help those they love is the one my brother and I both lived, trying to help and save our father.

What’s your process for medical fact-checking, or judging whether something is offensive?

Michael Madden, M.D.: We try to make things as accurate as possible within the confines of a TV show. There are things, like time lapses, that are hard to translate into a one-hour show—such as when Catherine goes off her meds and how long it takes before it manifests into a manic state. We don’t have the luxury of seeing it over a matter of days. There are some things that are compressed, but the essential truth is maintained—if you have the correct meds and stick with it, you’re highly functional and if you’re not compliant with that, there are dire consequences. We stick to the essential truths.

Roshan Sethi: Also, we source every major psychiatric question that comes up with psychiatrists in the Harvard system. Even the little things, like her exact medication regimen and pill bottle, which may not survive a final cut of the episode, getting all those small details right. [Dr. Madden, Amy and myself] talk about stigma all the time—any time she’s manic it’s a long conversation about how to show it and how it will come off, not just the medical questions that come along with it.

Do you find it hard to balance entertainment value and portraying mental illness?

AHJ: I have to entertain people, but I have to make this point: If you have an alteration to a part of your brain, it can change who you are—because who you are is in the biology of your brain. You can’t just will yourself “better,” and blaming and shaming are not appropriate. I sure hope people come back and keep watching Black Box. They should come back to see fascinating brain cases Catherine treats, like the music episode when a man becomes a savant after being struck by lightning, and the make-up artist who loses color vision.

I’m open to the criticism and always want to make the show better, but we’re trying to do something hard here that TV doesn’t want to do—TV wants to see cars exploding and zombies and vampires—so I hope people cut us a little slack. Let the show grow and watch where it takes Dr. Catherine Black, and you might discover that we do better than you think.

Black Box airs tonight at 10 p.m. ET on ABC.