‘Mad Men’ and the Trouble With Mental Illness as a Plotline

Alert: Major spoilers ahead.

Last Sunday’s Mad Men took a walk on the weird side, and we’re not just referring to Don Draper’s awkward threesome. The episode, cowritten by Mad Men creator Matthew Weiner, showed the neurotic but lovable copywriter Michael Ginsberg enduring a mental breakdown of epic—and pretty unfair—proportions.

The unhinging starts when Ginsberg becomes agitated by the constant hum of Sterling Cooper & Partners’ gigantic new computer, which recently usurped the creatives’ lounge. Convinced that “that machine makes men do unnatural things,” (aka turns them gay), Ginsberg frantically makes a failed pass at Peggy Olson to tamp down his uncomfortable feelings toward a male coworker.

The next workday, he appears in Peggy’s office, lucid and bearing a small box as a token of gratitude. Inside it: his right nipple, freshly sliced from his chest. (Cue millions of viewers desperately trying to unsee that image for life.) He calmly explains that “the waves of data were filling me up. I had to find a release.” In our last glimpse of poor Ginzo, he’s leaving the office strapped to a stretcher, wailing, “Get out while you can!” to stunned coworkers.

Unsettling as it was, the scene didn’t surprise viewers paying close attention to Ginsberg’s trajectory. Mad Men writers seeded his character with delusions, paranoia, and anxiety from the start. Not that other SC&P workers didn’t suffer the same symptoms—theirs were just usually tied to ego. The intensely lonely Ginsberg set himself apart by claiming to be from Mars, when in fact he was born in a concentration camp during World War II. In another troubling scene in which he melts down before a Manischewitz meeting, he says, “I can’t turn off the transmissions to do harm. They’re beaming ’em right into my head.”

A 20-something male like Ginsberg with such symptoms would lead a lot of people to presume he’s experiencing the onset of schizophrenia or schizoaffective disorder. “[Weiner] is not off in terms of the epidemiology or even in the self-mutilatory factor with the nipple,” said Steve Schlozman, assistant professor of psychiatry at Harvard Medical School and associate director of the Clay Center for Young Healthy Minds. Schlozman conceded that cutting off a nipple is pretty common among people with mental illnesses who remove extremities. “But hardly anybody with schizophrenia cuts things off,” Schlozman said. “It’s extremely rare, and this depiction probably didn’t do anybody any favors in terms of how people perceive psychiatric illness.”

In reality, the majority of people with severe mental illness decompensate in much less dramatic ways, such as shutting down emotionally and withdrawing from society. Even if their turmoil involves others, it’s not likely to be violent. “Ginsberg could have put a million more ordinary things in that package that would have been more representative of somebody who was suffering what we might call a psychotic break,” said Schlozman.

But that wouldn’t have been as dramatic, would it? Instead of staying true to real-life symptoms, Weiner likely exaggerated Ginsberg’s psychosis to serve as a metaphor for the violence of the late ’60s. Or, with only nine episodes left in the series, maybe Weiner wanted to quickly neutralize the biggest creative threat to Don’s potential comeback. If we’re being really cynical, sending Ginsberg to the funny farm was also an expedient way to cull a character played by a guy who just landed a lead role on another series. (Congrats, Ben Feldman, on getting your rom-com, A to Z, picked up by NBC!)

Whatever the reason, this ghastly nip clip did a disservice to the sympathetic character Weiner and Company built with Ginsberg—and to the millions of people who live with mental illness. (About 1 percent of Americans have schizophrenia, according to the National Institute of Mental Health.) “In highlighting the sensationalism of the disease, we lose the humanness of this character,” says Patricia Owen, professor of psychology at St. Mary’s University and a clinical psychologist who studies the portrayal of schizophrenia in film.

Ginsberg’s demise is just one more example of the entertainment industry’s tendency to reduce characters with mental illness to cartoons or monsters. The critically acclaimed Homeland also flubs basic facts. In its first season, the bipolar protagonist, Carrie Mathison, takes Clozaril, a drug that’s typically prescribed only in the most severe cases and causes significant weight gain. Never mind that the character is in the upper echelon of the CIA and actor Claire Danes has a willowy frame. “All [Homeland writers] had to do was make one phone call to know they chose the most dangerous and highly regulated medicine,” says Schlozman.

While it beefs up the fact-checking, Hollywood could also stand to lay off the clichés. Ginsberg, for example, was a white male whose genius was tied to insanity. You might recall that trope from A Beautiful Mind, Proof, and about a billion other movies. And if the Mad Men writers meant to suggest that Ginsberg’s experience as a Holocaust survivor caused his nascent schizophrenia, they were way, way off. “The idea that a trauma can cause schizophrenia has been completely debunked,” says Owen.

No one expects Weiner to create characters who are paper dolls cut from the DSM-5 or do a Very Special Episode for National Mental Health Awareness Month. But it’s reasonable to demand more from a guy who’s notorious for obsessing over details, down to the brand of cigarettes characters smoke. The mental health gaffe could just be a blind spot—he’s had it for race—though it’s a curious slip from a guy who worked on The Sopranos, the mother of all psych dramas. Perhaps his next series will ground complex characters like Ginsberg in the reality of mental illness. “At the very least, filmmakers could show that people with serious mental illness are more likely to be the victims of crime and brutal acts, not the perpetrators,” suggests Owen.