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Critics have given mixed reviews of Netflix's new series, "Maniac," which is set in a retro-futuristic present that at times feels more like a dystopia.
The show presents a wild and fascinating world where the story unfolds over 10 episodes of an experimental pharmaceutical trial to test whether a course of three pills can replace cognitive-behavioral therapy for people experiencing psychological trauma.
The show plays with theoretical and fantastical science; its style and tone falling somewhere between the films "Inception" and "Eternal Sunshine of the Spotless Mind," with more than a little influence taken from the television series "Black Mirror."
But "Maniac" does actually incorporate many facets of current psychology. A lot of the technology and science used in the show, like ink-blot tests and brain monitors, exist in real life.
And the show’s central technology, a supercomputer capable of interfacing with and subsequently curing the patient’s brains, is exactly what many current companies like Neuralink are working to create right now.
Potential spoilers lie ahead, so tread carefully.
Mental Illness Screening
In the show, participants in the trial get tested for defense mechanisms. Those tests are actually used to screen for mental illness. In fact, many psychology concepts in the show come from real research by psychologists like Sigmund Freud and Carl Jung.
A defense mechanism, for example, is a real term in modern psychology. These mechanisms are the ego's way to protect the mind from feelings of anxiety, depression, guilt, and shame. The major defense mechanisms as defined by Freud are repression, reaction formation, projection, regression, sublimation, denial, and rationalization.
Prior to admission to the pharmaceutical trial depicted in the show, the subjects (including the two main characters, Annie and Owen) undergo a pre-screening test for such defense mechanisms.
The three tests in the pre-screening are all really used by psychologists to scan for mental abnormalities or signs of PTSD in patients. They are:
1) The inkblot test, also known as the Rorschach Test:
This test was invented by psychiatrist Hermann Rorschach in 1917 to study the mind's interpretation of the splattered paint. While there are no wrong answers, highly unusual responses tend to be an indicator of potential psychological issues.
For example, Rorschach found that schizophrenic patients displayed more abnormal eye movement and deviation in image perception in this test compared to normal people.
Later research showed similar findings. In 2013, the American Psychological Association deemed the test effective at diagnosing mental illness. The test has historically been used to test defense mechanisms as well.
2) Picture-word association:
In these free-association tests, subjects are asked to say the first word that comes to mind when they see an ambiguous image. A similar test was used by psychologist Carl Jung to see into the mind of patients. The idea is that patients are likely to project their own ideas, thoughts, and emotions onto the simple images they're shown.
3) Maintaining direct eye contact:
Direct eye contact is used to assess social anxiety levels in individuals since fear is associated with avoidance of eye contact. The test is also administered to assess if individuals have PTSD, since those patients may perceive direct eye contact as threatening.
Cognitive-Behavioral Therapy
In the show, the three pills are designed to replace cognitive-behavioral therapy. In real life, cognitive-behavioral therapy (CBT) is often used to relieve symptoms of trauma, grief, or PTSD by helping patients understand their experiences and coping mechanisms.
CBT can be used on its own or in conjunction with medication, and the aim is to return a sense of control, confidence, and predictability to patients' lives.
In the show, the characters' experiences when taking the pills parallels that process.
The first pill, A, stands for agonia, which means struggle in Greek. It's supposed to reveal and uncover a person's tragic experiences, making the patient relive them. Immersion therapy and gradual exposure to traumatic memory is usually the first step in trauma-focused cognitive-behavioral therapy.
The B pill stands for behavioral, and it's supposed to identify blind spots, tear down defense mechanisms and expose lies created by the mind. This mirrors a step in CBT that educates patients about their reaction to trauma exposure. The goal is to get someone to realize their true feelings and shed coping mechanisms.
The C pill stands for confrontation, and it's supposed to get the patient to come to terms with the truth. Here, they must accept their own shortcomings and the consequences of their behavior.
From this point of catharsis, they can start to change, move on, and connect with others. This mirrors the step in CBT in which caregivers help patients process trauma-related thoughts and beliefs and help patients reassert control over their situation.
Psychedelic Psychotherapy
Research into psychedelics seeks to answer whether a drug could act as a catalyst to getting patients through serious trauma.
"The mind can be solved. Pain can be destroyed," Dr. James K. Mantleray promises in the show. But could a real drug replace therapy and erase trauma by altering patients' minds?
Besides antidepressants and other mood-stabilizing medications, psychedelic drugs may be the closest thing we have right now to the pills in the show.
Research has suggested that psilocybin (the hallucinogenic agent in mushrooms), ayahuasca, and LSD may help patients with anxiety and depression rewire connections in the brain. Such drugs have the potential to kill the ego, which is responsible for erecting defense mechanisms.
"In the depressed brain, in the addicted brain, in the obsessed brain, it gets locked into a pattern of thinking or processing that's driven by the frontal lobe, the control center, and they cannot un-depress themselves," David Nutt, director of the neuropsychopharmacology unit at Imperial College London, has said.
"Psychedelics disrupt that process so people can escape." In fact, the FDA granted a special designation that could fast-track several psychedelics for approval for the treatment of PTSD. Of course, these kinds of drugs have plenty of side effects and dangers on their own, so much more research is needed before they could regularly be used in a clinical setting.
A computer interface as a cure:
The entire drug trial in the show revolves around a computer that relays patients' brain activities to doctors. In reality, there are machines we use today can perform the same functions.
During the trial in the show, researchers monitored the subjects' progress via a futuristic brain scan. Although different than the technology depicted in "Maniac," functional magnetic resonance imaging (better known as fMRI scans) can be used for a similar purpose.
The technology has been able to measure dream activity as well as activity in brain areas associated with emotion, movement, and decision-making.
So theoretically, it could be possible to use one of these machines to track a patient's mental journey.
The researchers in the show also use a computer program called GRTA to guide patients through their experience on the pills, kind of like an artificially intelligent therapist.
The closest real-life version of that may be AI therapy chatbots. But those algorithms are based on fairly simple computer codes, and they don't contain an "empathy program" like GRTA, so wouldn't become sentient… or psychotic.
But perhaps the closest real-world parallel is Elon Musk’s secretive side-business, Neuralink.
Neuralink is his secretive company with the goal of someday connecting human brains to machines.
Musk has said, “The long-term aspiration with neural networks would be to achieve a symbiosis with artificial intelligence, and to achieve a democratization of intelligence such that it is not monopolistically held in a purely digital form by governments and large corporations…if we have billions of people with the high-bandwidth link to the A.I. extension of themselves, it would actually make everyone hyper smart.”
In other words, Neuralink is aiming to harness the limitless power of AI to make our own brains better. Not only would this help cure mental disorders and trauma in record time, but it would also help us to avoid a future where artificial intelligence decides it no longer needs humans and simply gets rid of us. Still better than Maniac’s psycho AI, if you ask me.