Substance Use Disorder and "Nurse Jackie"
Season Five of Showtime Channel’s darkly comic “Nurse Jackie” proves my contention that “if you deal with the behavior without confronting the underlying issues, you’re just switching chairs on a sinking ship.” I was referring to substance abuse in the quote, but it really holds true for the behavioral approach to all psychological problems. Yet another post about TV, you ask? As I learned in grad school, it’s easier to see a book, movie, or TV character’s issues and learn from them than to see our own.
Substance use disorder and the behavioral approach
In the TV show we watched ER nurse Jackie Peyton go through years (or at least seasons!) of prescription drug misuse, and spin a web of lies that even she couldn’t maintain. She had an affair with her co-worker, the hospital pharmacist, primarily to get drugs from him. She never told him she was married and had kids. When the pharmacist followed her and saw her with her husband, the situation took a particularly dark dramatic turn. Her marriage was irreparably damaged, and Jackie finally went to detox and rehab and began a recovery process that focused on staying away from drug use.This is the conventional, behavioral approach to substance use disorder: detox, followed by rehab or outpatient substance abuse treatment and 12-step meetings. And it can be a great start for many, but not the whole story.Viewers who don’t understand psychology were probably cheering for Jackie and thinking everything would work out for her. But her recovery process didn’t include ongoing therapy, and she blew off outpatient substance use disorder treatment and 12-step meetings for a long time, so while she managed to stay drug free, she continued to do things her way, avoiding her underlying issues, such as working on managing her anxiety with experienced anxiety therapy.The “chair” she’s switched to is drama and lying to the men she is working with, dating, sleeping with—three different guys—as well as to her ex-husband. She lies to everyone in her life, including herself, but this has been her character for years.Hey, but she’s not using drugs, so it’s a victory, right? Depends how you define victory. If you define it only in behavioral terms, restricted to drug use or abstinence from drug use, it’s a victory. If you define victory as handling yourself well in daily life, living in a way you want your kids to emulate—in short, living with integrity—Jackie is far from victorious. And in the season finale, she pops a pill before going to her one-year anniversary celebration at her 12-step meeting—and doesn’t tell anyone.
Problematic life equals great TV
And Jackie’s character, which we’ll define as how a person habitually deals with things, is coming back to “bite” her. Grace, her 14-y.o. daughter, is lying to her, sneaking around with an older boy, and experimenting with drugs. This is not going to end well, unless Jackie commits to getting lots of good therapy, rather than looking at her daughters’ problems as separate from hers, and starts modeling a more reasonable orientation toward life for her daughters.Of course, then we’d have a very boring show, because who wants to watch a show without drama? Jackie would turn the channel in a heartbeat!Where do you stand on the drama in everyday life, versus the joy in everyday life? If the drama-to-joy ratio is high, good therapy can make a dig difference. If you'd like to learn more, please reach out to me. I look forward to speaking with you.
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