Rami Malek as Elliot Alderson. Photo: USA

If you haven’t noticed, we like Mr. Robot. Though we’re not quite sure whether to root for its ostensible protagonist, Elliot Alderson (Rami Malek), a sweet but troubled young man with a taste for morphine and a tendency to dialogue with inner voices and outer projections. It also just so happens that his recreational hacking has evolved into sophisticated corporate sabotage, with global — and often deadly — implications. Over the past several weeks, we’ve done our best to delineate Elliot’s delusions and generally outline Mr. Robot’s myriad narrative threads, but perhaps it’s time we turned to a professional. Enter psychiatrist Dr. Paul Puri, who’s previously helped us understand the psyches of complex fan-favorite characters, like Mad Men’s paranoid copywriter Ben Ginsberg. This time, Dr. Puri helps us distinguish between schizophrenia and conversion disorders, in addition to assessing whether Elliot stands a chance at becoming whole, and wholly sympathetic.

So, is it safe to officially say that Elliot’s experiencing delusions?

Yes, you can say he’s experiencing delusions. Delusions are a fixed, false belief. The difference is I would not say he is psychotic in a schizophrenic sense.

Would someone like his adversary Tyrell fit more of a psychotic profile?

He’s more of a psychopathic profile. Psychopaths are somewhere between your con men and your serial killers. They have no particular conscience that we can clearly see, or they have less of one and they’re willing to bend it.

Elliot, however, is guided by a conscience.

Yes. He has clear emotions, and he has them much better-contained in the beginning of the series. They’re slowly revealing as his own psychopathology unravels.

Did Elliot always experience latent psychological dysfunction, or was it more that a singular trauma incited his issues?

That’s going to be up to how they want to write it. In the real world, a single incident doesn’t ever account for something like this. This is fiction in general, so something happening like this in this way is also unlikely. If I had to construct a diagnostic picture that would make this make sense, here’s why people would think he has schizophrenia: He has what seem to be hallucinations, he talks to people who aren’t there, and he [seems to have] paranoia. And that makes sense. The difficulty is that almost no schizophrenics have visual hallucinations. Almost all of them have auditory [ones] only, or they might have other things, like paranoia or magical thinking. Visual hallucinations are some other major problem — often medical, or a drug intoxication or withdrawal — until proven otherwise.

Going beyond the hallucinations, he has essentially forgotten a significant period of his past, so he has retrograde amnesia. He’s essentially seeing things from his past represented in other ways, so if I had to create a story for this, it would be that he has a severe dissociative disorder. Dissociative disorders are something that probably just exist in the general population, and there are all these different forms that can cause problems. A parallel one would be a conversion disorder. A textbook example would be hysterical blindness — a girl sees her boyfriend shot, and then she becomes blind so she doesn’t have to experience the horror of that. It’s not a permanent thing. It’s this disconnect of part of the brain in order to deal with an issue.

People who are subjected to this are often very hypnotizable. In the hypnosis world, there are hypnotic phenomena people can manifest, and they can do things like negative hallucinations: not seeing something that is there. A positive hallucination is seeing something that isn’t there. Buried in the back section of DSM [Diagnostic and Statistical Manual of Mental Disorders], if you have a hallucination that’s fantastical and the person does recognize it’s not real, it’s a symptom of a conversion disorder — they’re called pseudohallucinations. It fits his whole global thing where you have selective forgetting and weird hallucinations that don’t fit a typical schizophrenia picture.

Can you view his dissociative tendencies sympathetically, almost like an ingrained coping mechanism that’s grown to do more harm than good?

Absolutely. The model for this, which has gotten taken out of the most recent DSM, is that this disconnection in a conversion disorder is adaptive. It’s attempting to deal with the trauma. Elliot locking away this history would be because all of these things about his father are too terrible to cope with, so he’s kind of splitting it off, trying to hide it.

It seems as if he’s trying to rewrite his father’s narrative, but he’s so dissociated that he doesn’t even recognize his hallucination as his father.

Yes. These things can fall apart in terms of how the breakdown is and when the reality sets in. It can lead to an emotional breakdown for some people. There are case reports in older literature where you medically force somebody out of a conversion disorder with an Amytal interview. You give them sodium Amytal, and they dissociate so much that all their disconnections break down. So if their arms are paralyzed from a conversion disorder, suddenly they have movement back … but all their memories come back, too. There’s case reports of people suiciding, but that’s from back in the ’70s. Not a lot of people have researched this stuff.

That makes it great material to base a character on, because most people won’t have familiarity with his condition and the writers have a lot of room to explore it respectfully.

Absolutely. Most people will write this off as being pure fiction, because they’ll say it doesn’t look like schizophrenia. Most people are not up on the literature of dissociative disorders in this way.

Assuming he puts himself back together, how does he eventually reconcile the fact that his actions while dissociating contributed to Shayla’s death?

That’s a good question. I think there’s a possibility that he might split it off in some other way, because the new traumas are stacking up now. They’re using a lot of Fight Club references that he’s going to find integration in a different way, like how Tyler Durden killed off his alter ego. If you can do something that is some other way of interacting with the past, he might experiment out of frustration until he finds something that breaks through. It might be saying the right thing to his internalized father figure that he’s now experiencing externally, or it might be killing him off, or it might be some other life experience. It’s also possible that bringing down [Evil Corp] could give him some closure.

Watching the end of last night’s episode, did you want to scream at Darlene and Angela to make sure Elliot gets back on his meds?

That’s a great question. Presuming I’m right, that he has a dissociative disorder, medications, for the most part, aren’t really going to help him. Antipsychotic medications are primarily focused on positive hallucinations, but from a brain pathology related to schizophrenia. And dissociative disorders and conversion disorders are not caused by that. Since people in these circumstances are very suggestible, they might feel a difference because they believe the medications are going to change them, but it’s different than you might expect, which is unfortunate. I think he should definitely be in treatment, but he needs somebody who can outthink him. He has such defensiveness. He’s hiding things from his therapist. He’d need somebody that could actually get through to work on this stuff.