Earlier this month, Crazy Ex-Girlfriend went where few stories about “crazy” characters have gone before: Not only did it give its mentally ill heroine, Rebecca Bunch, an actual diagnosis, but it gave her a diagnosis and a song about the importance of being diagnosed.

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While realistic mental health diagnoses are rare on TV—which tends to prefer the drama of a tragic, raving Ophelia figure over medical precision—they really shouldn’t be. The DSM-V manual, which clinicians use to diagnose psychiatric patients, lists around 265 mental illnesses; odds are, you or someone you know is described therein, since 46.5 percent of Americans will have a diagnosable mental illness in their lifetimes. And yet, most storytellers give their mentally ill characters a generic “craziness” that functions mainly as a plot device, turning their personalities and struggles into a grab-bag of randomly assigned quirks. In many popular entertainments, mental illness functions less as a medical phenomenon than as a superpower—think of all the magic mentally ill detectives out there, from Benedict Cumberbatch as “high-functioning sociopath” Sherlock to Tony Shalhoub as the obsessive-compulsive Monk. And then there's the sexy, non-sequitur-spouting “crazy” babes of genre fiction: Joss Whedon’s Drusilla and River Tam, Suicide Squad’s Harley Quinn, or the cavalcade of wacky, quirky homicidal violence that is Helena on Orphan Black.

In a TV landscape littered with Manic Pixie Disordered Girls, there’s something admirable in the simple fact that Rebecca Bunch has a real illness—with a name and a treatment regimen. But then, there’s the disorder itself. It’s progressive to humanize a mentally ill character. It’s a damn revolution to do so with Rebecca’s illness: Borderline Personality Disorder.

From the title on down, Crazy Ex-Girlfriend has always explored and redeemed nasty female stereotypes. In the show’s first season’s theme music, Rebecca herself informs us that “[crazy ex-girlfriend] is a sexist term.” And it forced us to examine how we evaluate our female leads, characterizing Rebecca in large part by her obsession with her on-again-off-again boyfriend, Josh Chan. In many ways, she seemed like the exact opposite of a “strong” role model—emotionally fragile, incomplete without a man, and sometimes (as when Rebecca sabotages her best friend’s professional ambitions to further a vendetta or spread lies about Josh to keep him from communicating with their mutual friend group) just plain toxic. Yet, as the show never stopped reminding us, Rebecca was also brilliant, good at her job, a surprisingly ardent feminist, and, above all, a fundamentally likable person whose addiction to rom-com narratives in general, and Josh Chan in particular, was rooted in deep pain.

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Crazy Ex-Girlfriend excavated the “crazy ex” stereotype in order to complicate it—which is an important task in a world where the fear of being or sounding “crazy” keeps too many women quiet in their struggles. It wanted us to take Rebecca’s emotions seriously no matter how messy they became and to think about how extremely lonely a woman would have to be in order to believe her entire life hinged on making one man like her.

By giving its lead character borderline personality disorder, the show is taking on an even more formidable and cruel set of stereotypes. BPD, which is characterized by tumultuous relationships, an intense fear of abandonment, and disproportionately huge emotions, is one of the most intensely stigmatized disorders in the world of mental health—and, not coincidentally, one of the most stereotypically feminine disorders as well. Around 75 percent of the people diagnosed with BPD are women. Accordingly, people with the disease are stereotyped as, well, “crazy ex-girlfriends.” Before Rebecca Bunch, the most famous fictional case of BPD was Glenn Close’s character in Fatal Attraction. People with this illness are often treated like ticking time bombs—which can seriously limit their ability to get psychiatric help. According to the National Alliance on Mental Illness, “studies show that even some mental health professionals have more stigmatizing views about BPD than any other mental health condition.” Crazy Ex-Girlfriend actually alludes to this when Rebecca googles her diagnosis, against her doctor’s advice, and finds out that many psychiatrists refuse to treat patients with BPD.

In recent years, borderline personality disorder has been a flashpoint for questions of gender bias in mental health treatment, with some going so far as to argue the diagnosis should be permanently retired; writing in the Independent, psychologist Jay Watts argues that personality disorders are a product of “gendered norms” and social conformity with no scientific basis and notes that women “who have not fitted contemporary ideas of how women should behave have been slurred with the idea that they might have BPD.”

Most mental health professionals disagree with Watts’ assessment; after much debate, the disorder has been retained in the most recent revision of the DSM. Yet even psychiatrists who believe the validity of the diagnosis have noted that the criteria of the disorder are written so that it’s much, much more likely it’ll be diagnosed in female patients. For instance, inappropriate anger is a symptom—but we, as a culture, are more likely to view women’s anger as inappropriate. “Sexual impulsivity” is on the checklist, but a woman who has a lot of casual sex may seem “impulsive” where a man merely seems popular. The evidence suggests that men and women with the same manifestations of the illness are being given different diagnoses: If a man and a woman both present with temper outbursts, a feeling of emptiness, and self-destructive binge drinking, a woman might get a BPD diagnosis immediately, whereas a man might just be referred for substance abuse counseling. We tend to assume that men’s problems are a result of what they do, and that women’s problems arise from who they are; as Rebecca says of her own BPD, “it’s not something I have, it’s something I am.”

It’s too early to say whether Crazy Ex-Girlfriend is going to dive head-on into the feminist controversy surrounding BPD. But what is clear is that what we’re seeing on screen is unprecedented. Co-creators Aline Brosh McKenna and Rachel Bloom have been exceptionally responsible, doing research and making sure the depiction of Rebecca’s illness is as medically accurate as possible. They even arrived at the BPD diagnosis by treating their character like an actual patient, inviting a panel of doctors to watch the show and make their assessments: “We didn’t tell them that we thought it was borderline; we just said, ‘Watch these episodes of the show,’” Bloom told Vanity Fair. Nor does it seem that they intend to transform the lead character of their show into a horror-movie villain (with the exception of a few episodes ago, when she literally transformed herself into a horror-movie villain). In the same Vanity Fair interview, Brosh McKenna said that their goal was to be “humane” and “to make sure that we were being as kind as possible—to Rebecca and about the situation.”

Instead of treating Rebecca’s illness as a plot device, the show is foregrounding her own experience of being sick. That experience, which includes a suicide attempt and hospitalization, has been frightening—but we’re scared for Rebecca, not of her. The phrase “borderline personality” no longer calls to mind an unlovable, violent monster, simply because it now applies to a character we know and like, and we can see she hasn’t changed much since getting the diagnosis. She’s not a spectacle; she’s coming to terms with the news that she has a severe and potentially fatal illness. We’re invited to bear witness to how frightening that is and how much it hurts to believe a given disease means that a person is, as Rebecca puts it, “broken.”

That’s heavy stuff, especially for a comedy about a woman who visualizes her dating problems as elaborate musical numbers. But Crazy Ex-Girlfriend has proved it can handle it.

And it’s a worthwhile pursuit, not just for people with mental illness. Every day, women’s very real pain and anger is dismissed as “crazy,” which gives us permission to put those women in the box labeled People We Can Ignore. If we can empathize with someone who really is “crazy,” then we will have done something to broaden our definitions of women who deserve to be seen and heard.



Sady Doyle Sady Doyle is the author of 'Trainwreck: The Women We Love to Hate, Mock, and Fear ...

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