Into The Pitt of Despair: HBO’s The Pitt and Mental Health
Review - Éliott Barnoud
The acclaimed medical drama “The Pitt” takes us into the chaotic world of Emergency Medicine one day at a time. But the darkest corners of the Pittsburgh hospital might just be inside its residents’ heads…
Photo: Glenn Carstens-Peters / Unsplash
Spoilers ahead! This article discusses the first 2 seasons of HBO’s The Pitt!
Content Warning: Discussions of Mental Health, Self-Harm, and Suicide
It is hard to avoid clips of The Pitt if you spend as much time online as I do. That’s precisely how I stumbled across the show, YouTube shorts, and Instagram reels slowly shifted from my Heated Rivalry obsession to nerdy doctors running around and holding the weight of the world on their shoulders. I then decided to give it a try. The state I was in when discovering this show was coincidentally shared by some of those high-functioning surgeons, and I found myself represented in ways I could not have expected.
The Pitt, named after Pittsburgh’s Hospital emergency department and their location in the hospital’s lower level, never sleeps. Each season counts 15 episodes, each representing an hour in the day team’s shift. And a lot of things can happen in 15 hours. Beyond the carefully crafted storylines that give a breathless rhythm to both seasons, the stakes and the characters feel real and genuine. By spending a day with these doctors, students, nurses, and interns, we learn about the patients’ lives, the intricate relationships between everyone in the ER, and institutional issues that end up influencing the quality of care dispensed.
The political
Indeed, the Pitt doesn’t shy away from denouncing the issues hospitals across the world, and specifically in the USA, are facing. Sadly, the doctors trying to save your life are not exempt from answering to management’s increasing demands for productivity and profits. They are short-staffed and working overtime, everything is full and overflowing, but the funds.
This show is a great example of the idea that “the personal is political”. Something as necessary and individual as healthcare is dictated by how many beds need to be freed ASAP. Another gripping example in season 2 is the depiction of ICE agents bringing a detained woman to the ER. The presence of the agents inside the hospital causes many patients to leave and not receive the care they are entitled to. Some nurses also leave despite being under the protection of the hospital. One of the nurses, Jesse, even gets taken into custody after an altercation. This is reminiscent of the sad passing of Alex Pretti, who was an off-duty nurse trying to help a woman being pushed around before being shot repeatedly. The second season also focuses strongly on the life-threatening implications of insurance cuts on American families, medical debts, and Medicaid/Medicare cuts, directly putting people in the ER.
Photo: Etactics Inc / Unsplash
Mental Health
Is it really surprising, then, that many of the doctors we encounter in the show have some sort of mental health issues? The Pitt excels at showing the different ways in which mental health struggles come in. From Abbot, the badass veteran amputee attending, mentioning his therapist and having dark thoughts sometimes, to Collins, the down-to-earth caring doctor, dealing with a miscarriage during her shift, everyone is put through the wringer.
The show also delves into the repercussions of neurodivergence and physical health on mental health. Dr. Langdon struggles with a benzodiazepine addiction after a back injury, but he also jokes about ER doctors having ADHD, and this being a reason they thrive in this fast-paced, high-pressure environment. Dr. McKay is a single mother and a recovering addict; Dr. King is autistic and the primary caretaker of her autistic sister. One very important thing to note is that the characters’ neurodivergences are never used against them; they are judged for the actions that they take and their ability to save lives. Each and every one’s particularities make them capable of caring for different patients; this diversity is not emphasized but rather integrated realistically, and makes for complex interactions.
The show also portrays another form of neurodivergence that is different from developmental disabilities. For instance, PTSD plays a big role in Dr. Robinavitch’s journey in season 1 (and 2 to an extent, but I’ll get back to it later), CPTSD for the intern Santos, and the new attending Dr. Al-Hashimi experiences absence seizures.
Their trauma comes from very different events and has equally different presentations in each of them. Santos is aggressive towards perceived abusers and jumps to defend kids who share her abusive experiences to try and protect them. She also displays a strong and defensive attitude despite struggling with self-harm. Dr. Al-Hashimi (while not yet fully confirmed) experiences dissociative episodes caused by her childhood meningitis, especially prevalent when dealing with young patients, probably due to her experiences in war zones, and therefore seeks medical guidance soon after experiencing her symptoms. And Dr. Robbie breaks down in tears and experiences visual flashbacks when faced with triggering situations (the anniversary of his mentor’s death, failing to save his adoptive son’s girlfriend’s life, hearing about his old mentor, etc).
What’s wrong with Dr. Robbie
Noah Wyle plays Dr. Robinavitch / Photo: HBO / capradio.org
But in Season 2, something is different, Dr. Robbie feels off. The charming yet rugged doctor is not the same man we left in season 1. He has grown distrustful, angry, holds grudges, and keeps talking about how impatient he is about going on a sabbatical. His behavioral change immediately set the alarm bells in action for viewers, especially since the first scene of the new season shows him riding his motorcycle without his helmet.
Let’s use Dr. Robbie’s case to check for potential signs of suicidal ideation and planning to end a life. I will connect the National Institute of Mental Health’s list of concerning behavior with actions the character has taken in this season:
“Making a plan or researching ways to die.” Robbie is planning a motorcycle road trip to some place named “Head-Smashed-In.”
“Withdrawing from friends, saying goodbye, giving away important items, or making a will.” Robbie is obsessed with making sure that the hospital will be fine when he is gone. He asks Whitaker to take care of his house, implying he could keep it later. He insists on getting his friend a health checkup before he leaves
“Taking dangerous risks such as driving extremely fast.” He opens the season by driving recklessly without a helmet
“Displaying extreme mood swings.” Robbie lashes out at multiple characters and has an uncharacteristically short temper this season
“Eating or sleeping more or less,” and “Using drugs or alcohol more often.” Robbie does not display these signs in the show
Everyone is worried about him, and for good reasons. Dr. Robbie is displaying clear signs of being suicidal. He even voiced his death wish in the newest episode (02x13 at the time of writing) by telling his longtime friend and colleague Dana, “What if I don't come back?”
So the main character is suicidal, what now? Beyond the show’s sensitization tactics on drug use and risks of interaction, sexual violence, homelessness, and other social issues, this depiction can serve as an example of what to look for in loved ones. It is never easy to figure out if someone is suicidal because so much of the problem lies in the person feeling like a burden and therefore hiding their pain or trying to cope with it in healthy or unhealthy ways.
A generational problem
The newer generations are struggling with mental health at alarming rates. Part of it is due to increased education and reduced stigma about it. Part of it is due to constant high stress and unreachable goals. According to the WHO, 1 in 7 teens experiences a mental disorder, and Suicide is the third leading cause of death for young adults.
I don’t hold any universal answers, but we need to keep talking about our struggles with people we can trust, recognize that we deserve help when things get rough, and this too shall pass, as painful as it might be. Let’s try to channel our inner Joys, put our mental peace first, and be there for each other.
What to do in case of a Crisis?
Here are some helpful resources to assess your own mental well-being, some easy steps to deal with a crisis, and some European and Norwegian helplines: