The actor has taken on her toughest part yet, playing a mentally ill mother in new true crime show The Act. Here, she talks about ageing, activism and midwifery

Patricia Arquette’s new US television true crime series, The Act, is as unsettling as it is fascinating. She portrays Dee Dee Blanchard, a mother now understood to have been suffering from Munchausen syndrome by proxy, who faked her daughter Gypsy’s serious ailments, confining her to a wheelchair and subjecting her to unnecessary procedures and medications for more than 20 years. In real life, Dee Dee was murdered by Gypsy’s boyfriend and co-conspirator, Nicholas Godejohn, in 2015. Joey King (Gypsy) and Chloë Sevigny (neighbour Mel) are excellent in The Act, but it’s Arquette’s Dee Dee who holds the eye – one moment, a “devoted” mother, the next, brooding and calculating.

“I’d always been fascinated by Munchausen by proxy,” says Arquette, 51, when we meet at a central London hotel. “It was terrifying to me that parents would do this to their kids. I didn’t know this specific case, though. My kids did. They went: “No, don’t play that lady!” I said: ‘Guys, I’m just an actor. I’m not going to start coming home and giving you medication.’”

What does she make of criticisms that the increasingly popular true crime genre is exploitative?

“If you read the Bible, there’s some true crime right there… Callousness, intrigue, craziness, it’s part of human nature. These stories are fascinating because they’re our species. Why are people making these choices?”

Facebook Twitter Pinterest ‘As unsettling as it is fascinating’: Patricia Arquette and Joey King in The Act. Photograph: Brownie Harris/Hulu/Kobal/Rex/Shutterstock

Direct and outspoken, Arquette radiates “tough cookie”, though this isn’t always how she’s been interpreted. “I’d do early interviews, and the way they’d write about me – ‘kooky’, blah, blah, blah… It was a convenient cartoon version of me; kind of frustrating. My work is about being authentic.” Her chic cream suit and sleek blond hair are in stark contrast to her on-screen transformation into heavy, frumpy Dee Dee. Arquette has portrayed everyone from a sex worker in Tony Scott’s True Romance to an empathetic girlfriend in Tim Burton’s Ed Wood to a battling mother in Richard Linklater’s Boyhood. In another true crime drama, Escape at Dannemora, she played prison worker Tilly Mitchell – a woman, like Dee Dee, who didn’t subscribe to Hollywood’s beauty ideal.

“It’s really liberating,” she says. “I feel like my whole career, I’ve had to operate within boundaries of what’s a likable woman? What’s attractive to society? There were a lot of people before I did Escape at Dannemora who said: ‘Oh my God, don’t gain weight for that, don’t let them make you look like that or you won’t be able to get jobs.’ I was like: ‘I’m an actor, just let me act!’… I don’t feel that we put that on males and I don’t want to carry it around any more.

“I don’t want to be the ingenue for ever – you can’t,” she continues. “We see people my age still trying to be ingenues, and at a certain point, you look… otherworldly. How are you going to play a 50-year-old woman in the real world?” Arquette isn’t judgmental about plastic surgery (“It’s your face; you get to look like whatever you want to look like”). She just feels that it affects on-screen credibility. “If some dude who looks like he works out four hours a day plays some regular dad, I have a hard time believing that too. You’ve got to look realistic for a part like that.”

Arquette is known for her activism, and around the time we meet, anti-abortion legislation is being passed in the US. “We’re the only country with a rising maternity mortality rate. These are the same people who talk about sanctity of life,” she says.

Helping people through birth and death, it’s very similar… I think you give birth to yourself when you die

Is it difficult for someone with her outlook to live in America at the time of Trump?

“For me, it’s very difficult – I’m very worried about America.” When Arquette accepted her best supporting actress Oscar for Boyhood in 2015, she spoke about equal pay for women across all industries. “I was afraid of doing it,” she recalls. “Would there be a backlash for being political?” While Arquette doesn’t regret speaking up, she still seems exasperated with the “stupid” media for depicting her as a spoiled Hollywood actress whingeing about her own pay. “I think [equal pay] is something some people don’t want to talk about, so they’ll get pissed off if it’s an actor talking about it, or a model, whoever… Too fucking bad! Guess what? Fix it, so we don’t have to talk about it.”

Her sister, the actor Rosanna, was among the first to speak out about Harvey Weinstein: “People like my sister, who was really brave and came forward, started these [#MeToo] conversations and again there was a backlash, because they were actresses, spoiled, blah blah blah… But it started such conversations.” Arquette also felt that her younger sister, trans actor Alexis (who died of HIV complications), should have featured in the Oscars In Memoriam section. “That was a horrible misstep. It wasn’t just Alexis – they never recognise any trans people in those things. I know she was an inspiration to a lot of trans people everywhere and they were grateful to her.”

Is this what Arquette feels fame is good for – highlighting issues she cares about? “I do. I was raised by activists so it’s a part of my DNA. And it’s part of the fabric of me being an actor – looking at the human condition.”

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Would she want her children working in Hollywood?

“I don’t think you can say to your kid: ‘You can’t be an actor’. You arm them with knowledge and teach them how to be careful and who to be careful of.”

Arquette was first married to musician Paul Rossi (father to her son, Enzo), then actors Nicolas Cage and Thomas Jane (father to her daughter, Harlow). She is now with artist Eric White. Is it important for her to be in relationships with creative people?

“If my boyfriend, who he is as a person, was an investment banker, plumber, whatever, I couldn’t love him any more – he’s perfect for me. But I love watching his art, being with somebody who’s a master of their form.”

Arquette feels that when she started acting, Rosanna’s success in films such as Desperately Seeking Susan helped her. “I don’t know if I could have broken in so easily had my sister not been a star. I had the opportunity to have more auditions. Then they were: ‘Oh, you’re totally different to your sister.’” The Arquette family background was unconventional (creative, activist, living in communes). Growing up, she was drawn to male actors (James Cagney, Gregory Peck), plus Gena Rowlands in A Woman Under the Influence and Jessica Lange in Frances. First, though, she considered being a midwife.

“Sometimes I think, one day, I’ll still be a midwife. I’ve been present at a lot of births. I had my daughter at home. I also helped a lot of people through their death. That’s very intimate. Helping people through birth and death, it’s very similar… I think you give birth to yourself when you die. It’s very hard, but also incredibly beautiful, a sacred thing. To care for my mom when she was dying, or for Alexis, it’s an honour.”

Arquette’s next project is Otherhood, a comedy directed by Cindy Chupack, also starring Angela Bassett. “I play a normal mom and I really needed that.” Highly self-critical, she only watches herself once in anything. “I’ve never ever thought that I did a great job. Though I’ve thought, that’s all right, yeah, I’m feeling that right there.” Other than that, she’s busy finishing her memoirs. “The last chapters are about [Alexis’s] death and it’s been pretty hard.” Arquette is also dyslexic. “I find writing to be the hardest thing on earth. I’m moved by writers, but I’d almost rather swim with sharks.” She laughs. “It’s a love/hate thing. For me, not being able to be held back by my own inner critic is an important thing. But I’ve always found through acting, activism, everything, if it’s a beautiful thing and it terrifies you, push through – see what you can learn.”

The Act will be available from 14 June via Starzplay on Amazon Prime and Virgin Media