Alias Grace – Psychiatry in television

Alias Grace is a six-part drama series adaptation of the award-winning Margaret Atwood novel of the same name, currently available on the streaming media service Netflix, and first released in 2017. Upon completing Alias Grace, I was struck by the variety of topics relevant to our speciality that the narrative touches upon, and the notably tense relationship psychiatry can have with popular culture.

The series triggered reflection on the portrayal of psychopathology in television and literature. It grapples with complex themes such as the depiction of illness and psychiatrists in the Victorian era, and how this may filter into unconscious public feeling and stigmatisation of both patients and the profession. It probes the treatment of women and those from marginalised groups, and the challenge of differential and multiple diagnoses or possible pathologising and medicalising appropriate human responses. The surfacing of erotic feelings and transference in the doctor–patient relationship and abuse built around an uneven power dynamic by those with formal authority and expert power feature uncomfortably.

Both the series and novel are based on the true story of Grace Marks, a poor, young, beautiful, Irish female immigrant in 19th century Canada who may have suffered with a severe mental disorder. Whilst working as a domestic servant and aged just 16, she and her 20-year-old colleague James McDermott were charged with the brutal double murder of their employer and his housekeeper. The murder trial was sensationally reported in Canada, the UK and the USA, the degree of interest alone being cause for consideration of our attitude to mental illness and its sufferers. McDermott was convicted of first-degree murder and hanged, and although Grace was initially sentenced to death as an accessory, this was reduced to life imprisonment. She was incarcerated for nearly 30 years, spending most of this time in Kingston Penitentiary, but for a period of around 15 months was committed to the Provincial Lunatic Asylum before returning to prison. Grace was pardoned and released in 1872.

The story centres around fictional interviews between our central character and a psychiatrist, Dr Jordan, who is trialling new psychological evaluation techniques. At this time, many women accused of committing crimes or simply not conforming to social norms were detained in asylums and labelled as insane. There was a culturally growing interest in the relationships between mental condition and criminality, particularly if female. Through early attempts to use psychodynamic psychotherapy, Dr Jordan seeks to understand if and how a humble maid could have participated in violent and murderous acts. Meanwhile, Grace claims amnesia of key events and we are under no illusion of her ability to be relied upon as an accurate personal historian.

We are, however, privy to multiple significant traumas in Grace's young life, starting with an alcoholic and abusive father, and the harrowing death of her mother on the voyage from Ireland. We are given glimpses of the discrimination and challenges of a deprived daughter lacking any social support, disdained for being an immigrant and living on the fringes of society. The story discloses the suffering of Grace's sole female friend, followed by our protagonist suffering third-person auditory hallucinations and a significant dissociative amnesic episode upon her friend's demise. A theme of unprotected women vulnerable to sexual abuse, including from relatives and male figures of authority, exploitation, adultification and the impact this could have on mental health, runs through the series.

The audience are ultimately given a suggestion Grace suffers with what can be interpreted as a dissociative identity disorder, revealing a second persona with distinct patterns of perception and personality taking control of her behaviour, accompanied by retrospective memory gaps. However, neither the novel nor the series give a firm conclusion as to if or what psychopathology is present, or whether our protagonist is guilty of any crime. And in the end, this doesn't matter. The adaptation highlights uncomfortable truths in the treatment of exposed young employees, the uneducated, those socioeconomically disadvantaged and those with possible mental disorders. It touches on the significant traumas sidelined individuals may be exposed to, their vulnerabilities and risk factors for developing mental illness, their overlooked suffering and our responsibility to reflect upon historical conduct and challenge attitudes in modern society.