BoJack Horseman's fourth season starts with this line, spoken by a protagonist about himself: "Piece of shit."

The Netflix series has never shied away from the realities of BoJack's issues. He's a narcissistic, multi-substance abuser who can't be trusted and sabotages all his close relationships, alienating anyone who cares about him. We saw him at what appeared to be rock bottom last season, after he went on a bender with his former child co-star Sarah Lynn, who dies of an overdose next to him. The show never absolves him of blame for his actions—he's an unlikable lead who keeps failing to get better or to fix the problems he causes—but in the sixth episode of its new season, the show tries something new: letting us inside of BoJack's head.

Of course, the viewers have always known BoJack doesn't think highly of himself. Although he's propped up by his artificially inflated ego, it's clear he uses it (and his faded '90s fame) as a coping mechanism. The show has also shown the roots of some of his worst problems in its run: his family life, his falling out with former best friend Herb, etc. But this episode shows us two things—first, that BoJack Horseman is a very sick man, and second, exactly how it feels to be that sick.

You're a real stupid piece of shit, he thinks the moment he opens his eyes. And thus begins his day spent battling with the voice inside his head: Breakfast. Oh, I don't deserve breakfast. Shut up! Go make yourself breakfast, you stupid fat ass. Then, eating a sleeve of cookies: Stop it. Stop eating cookies, go make yourself breakfast, he tells himself. I can't believe you ate that cookie!

But the episode shines most when it breaks away from its standard animation and we see the illustrations of BoJack's mental gymnastics: When his daughter, Hollyhock, who he has newly met, says the house needs more milk, a mundane request for his car evolves into a manic spiral of self-loathing and paranoia as the camera cuts away to shaky drawings of the characters surrounded by a void. There, BoJack spins out of control: He doesn't want her to drive his car and get her "grubby little hands" all over it, but she's not grubby, she's his daughter, so wow, he's a real piece of shit, but if she drives, he's trapped at home with his dementia-stricken abusive mother, but if he drives, his mother might poison his daughter against him. Then we see a little scribbled BoJack surrounded by floating, watchful eyes, as he thinks Oh, shit. They're looking. Say something! Open your idiot dumbass mouth! Finally, he says he'll get the milk.

I've struggled for years to explain to other people the way my feelings can spiral out of control when I'm depressed, and how my own analysis of those thoughts often just becomes internal bickering that ends in a generous dose of shame. In high school, after I broke up with a long-term boyfriend, I was sad—and then I just kept being sad for months. The sympathy I got from friends for my hurt eventually dissipated and turned to frustration. I didn't know what to say; my months-long reaction was entirely disproportionate to what had happened, and I couldn't explain it myself. Nine months post-breakup, I didn't have a reason for still being so sad. The message we all believed, erroneously, was that pain without a visible cause must be chosen. If the reason is not external, then it must be internal. I told myself to suck it up and kicked myself when I couldn't. Suddenly, I was watching BoJack go through the same thing.

Nadine Kaslow, a professor and chief psychologist at Emory University School of Medicine, says that the show's characterization of depression as a "voice in one's head" is correct. She says that people with depression often have low self-esteem and often get caught in loops of "negative self-talk" like the kind BoJack presents throughout the episode, and the negativity pushes self-esteem lower and lower in a spiral that can be hard to break out of.

The episode's asides show just how mundane these moments of intense self-flagellation have become for its title character. Everything he encounters is a new trigger for the depressive voice in his head to tell him how terrible he is. It's more than just overthinking; this is the way mental illness works—by presenting small things as evidence for one's innate worthlessness and making those leaps of spiraling logic seem both reasonable and normal. It's no wonder BoJack forgets about the milk and gets drunk. When he shows up on his doorstep later that night, stumbling drunk, his family looks at him with anger and disgust. But the series has never juxtaposed the reactions of BoJack's family and friends with his internal monologue before, and it adds a new element. Everything he hears from other people he's already heard from himself.

The episode's treatment of BoJack's obvious depression is one of the most accurate on television today. BoJack isn't just trying to fight off something he can clearly separate and identify as "depression"; instead, he's wrestling with all the parts of himself as he simultaneously berates himself for being so depressed in the first place. He can't focus on anything without invasive thoughts telling him he's garbage. He's constantly second-guessing and arguing with himself. He sits parked on the side of the road, alone for hours, but even that doesn't help, as he thinks about how stupid it is to do that at all. The episode nails how it feels to both hate that you need help but also desperately look for it.

That's depression in a nutshell: You despise yourself for needing help, but can't stop yourself from seeking it—and then you feel pathetic all over again. Possibly my favorite line illustrating this comes soon after, when BoJack silently muses What if I killed myself by throwing myself off my deck into Felicity Huffman's backyard? If she found my dead body, that'd show her. Suicide isn't a selfish act, and neither is depression, but that kind of thought—suicide or self-harm as a joint revenge fantasy and cry for help—struck a deep chord in me. Those thoughts, ugly as they are, are real. Of course, those thoughts then make you feel worse for wanting any kind of revenge at all. Too often, says Kaslow, thoughts of suicide motivated by revenge are ignored or brushed off by others who dismiss them as not serious.

BoJack isn't actively making a suicide plan, but his thought spirals remind him that everything might be better if he were dead. Suicidality occurs on a continuum, Kaslow says, and BoJack is presenting towards the "ideation" end, as opposed to the actual "attempt" end, but that doesn't mean it's not serious. Ironically, it's his depression itself that stops him from acting, as we see in an early scene where he thinks, Why don't you do the world a favor and swerve into oncoming traffic? No, you don't deserve to die young, only the greats die young. Oh, now you think you're young all of a sudden? His inability to focus, plan or make decisions, plus his constant self-doubt and self-hatred, step in and stop him. This, too, is extremely consistent with depression, per Kaslow; many people die by suicide when they start feeling a little better, not worse. Suicide takes energy and planning that many depressed people can't manage at their lowest, and when they're buoyed, their risk of death increases. In "Piece of Shit," BoJack's too depressed to even kill himself.

The episode's most poignant moment comes at the end, where BoJack tries to remind Hollyhock it's not her fault when he acts cruelly towards her. "I know," she says. "I mean, I know, but I don't always know, you know? Like, sometimes I have this tiny voice in the back of my head that goes, like, 'Hey! Everyone hates you! And they're not wrong to feel that way!'" It's particularly arresting after watching her biological father walk around battling the same voice for half an hour—and because, according to Kaslow, there's "no question" that research shows depression can have a genetic component. Quietly, Hollyhock asks him, "It goes away, right? It's just, like, a dumb teenage girl thing, but then it goes away?" "Yeah," he says.

BoJack thinks he's lying. But what he hasn't figured out yet is that while it may not be a "dumb teenage" thing that everyone goes through, it does go away. One of the most dangerous lies depression tells you is that everyone else is responding to the same events with the same thoughts and feelings, just handling them better, and you're the one who can't hack it. That's depression. It can go away with the right combination of therapy, medication and other mental health treatment. Hopefully, BoJack Horseman will let its title character realize that before it's too late.