How ‘The End of the F***ing World’ cautions against the mental health medicalization of fiction

Alyssa looking a little distressed via the season 2 trailer. Netflix spells it with those *** so whatever, I will too. I also wish I had a brighter image, but it’s a dark show…

Netflix’s The End of the F***ing World got a sequel season! Who could have guessed after the ambiguous dead-end from the original series? And I liked the original for having the audacity to resist profit-seeking seasonitis and end…

But with that initial gripe out of the way, I liked the second season. Though it lost the unrelenting forward energy of the teenage-runaway road-trip from the first season, it still works well as a thoughtful examination of love and other adolescent delusions, this time from a more mature perspective now that James and Alyssa, the lead couple, have aged out of their aborted Romeo-and-Juliet fantasy. If nothing else, I enjoyed it for another chance to hear Alyssa say “fuck” and “shit” in her adorable Yorkshire accent (and beyond Alyssa, the whole cast imbues just one impassive word — “okay” — with so many meaningful, implicative tones that they could craft an entire language).

No, I don’t have any serious problems with the second season or even much to say.

Rather, I’ve been more interested in the way people have discussed the series after the fact. With few exceptions, most of the reviews I have read describe the characters in psychiatric terms: depression, PTSD, autism, social anxiety, borderline and antisocial personality disorders. To be fair, those professional writers do cover other varied themes like The End of the F***ing World’s unique trope-busting crush on teenage romance stories. But good luck finding a fan discussion on social media covering any thematic topic other than mental health while armchair psychiatrists on Quora and Reddit argue over where James falls on the autism or antisocial spectrums.

The experience reading through so many other’s thoughts on The End of the F***ing World left me wondering: when did fiction become so heavily medicalized? Why has it become a default impulse to diagnose characters, not with basic emotions like sadness or loneliness or more lofty literary problems like ennui or alienation, but with specific psychiatric pathologies like depression and PTSD?

To be clear, I don’t necessarily consider those psychiatric readings wrong – James, Alyssa, and newcomer Bonnie from the second season all have serious problems. But I just find them ironic because I think such interpretations oppose one of the The End of the F***ing World’s consistent messages about confronting the messy nuances of human tragedy instead of straight-jacketing those issues into narrow clinical categories.

James exemplifies the problem of relying on diagnoses (though for her part, Alyssa probably needs real help). He begins the first season by explaining that he has antisocial personality disorder (i.e., in popular parlance, psychopathy) because the shock of witnessing his mother’s suicide as a child gave him a precocious obsession with death. In his opening monologue, James introduces himself as if reporting his case history to a psychiatrist:

  • “I was eight when I realized I didn’t have a sense of humor.”
  • “When I was nine, I put my hand in [a deep fryer]. I wanted to make myself feel something.”
  • “When I was 15, I put my neighbor’s cat in a box [and killed it].”

However, James isn’t “really” a psychopath. Instead, he forces himself to fit the pop-culture definition of the condition to avoid confronting his grief over his mother’s death. He doesn’t stick his hand in the deep fryer because he wants to feel something – he does so so that he won’t have to feel anything at all. But when he meets a real psychopathic serial rapist partway through the adventure, James realizes that he had only pretended to want to kill people in an extreme case of youthful self-delusion.

James demonstrates one of the follies of self-diagnosis: how, seeking assurance from the authoritative power of psychiatric science, people can delve into DSM-V diagnostic checklists and read them like a horoscope, exaggerating symptoms here and discounting them there until they’ve fit themselves into a snug category that can explain all of their problems. In James case then, his false “psychopath” self-identity functions as a sort of absolution that allows him to avoid confronting his grief. The label protects him from the challenge of genuine introspection.

By analogy, I think that diagnosing a fictional character with a psychiatric disorder has a certain attractive ease that allows the audience bypass more fundamental social or philosophical messages in a work while still claiming to have done a “deep” read.

To move beyond The End of the F***ing World for a moment with two examples from literature, I think readings of The Cather in the Rye that cast Holden as a victim of depression, PTSD, and maybe-even sexual abuse sometimes use those diagnoses as a dodge to avoid discussing the book’s more literary points about youthful innocence succumbing to cruel time (and worse, those who dismiss Holden as a whinny case of teenage angst afflicted by narcissistic personality disorder). Or, think how badly Anna Karenina would have ended if – after over 300,00 words — Tolstoy had reduced Anna’s troubles to a mere matter of imbalanced dopamine!

Anna Karenina itself famously opens with the line “All happy families are alike; each unhappy family is unhappy in its own way.” But with the medicalization of fiction, all those unhappinesses begin to look the same, running down a checklist of DSM-V diagnostic criteria to the implied interpretive conclusion – hmm, if Anna and Alyssa had just taken a lithium pill or an SSRI, maybe they wouldn’t have suffered so. But what did Anna Karenina, and The End of the F***ing World, have to say about the nature of love?

Though they perhaps have power in destigmatizing mental illness and creating relatable representations of certain disorders, I don’t think that psychiatric interpretations of fiction can answer those sorts of messy, literary questions, the very questions that art exists to answer. And if nothing else, well — isn’t it a little boring to reduce fictional characters to a single diagnostic label? Medicalization maybe makes fiction less fun. Does Alyssa have bipolar disorder, does James have autism? I don’t care! — I love to watch their love unfold all the same.

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