Watching "Pretty Little Liars"… as a Psychologist

Between sanitariums and straight jackets, a dire image is painted.

Posted Dec 20, 2018

Note: Spoilers present in text

At last, seven seasons and 160 episodes later, I can finally Google all those lingering questions regarding the show, Pretty Little Liars, without fear of accidentally finding out who A was all along.  After all, when a quick IMDB search of Ian Hastings led to a wedding photo of his character with Aria (who begin a romance from the very first season) shot from the final season I quickly learned spoilers are everywhere. 

I consider myself one who would have proudly passed the famous marshmallow test of Walter Mischel had I been one of those kindergartners being tested for delay of gratification.  Although many a time I wanted to give in from the suspense and look up who A was, I persisted, painfully.  Literally, that is, as I often watched the show when I was exercising on the elliptical.

While the show began innocently enough and was intriguing (I guessed Alison to be alive from the first episode and Jenna to miraculously regain sight), over time they pulled out more and more of the stops, with many nods to thrillers such as Psycho (shower scene) and Hitchcock-esque elements complete a Rear View Brew.  Everything ever considered creepy from clowns to dolls, teddy bears, deserted lake cabins and masks were somehow integrated into a teen drama turned horror film. 

Including that is, the ubiquity of the worst of mental health—sanitariums, straight jackets, that human muzzle from Silence of the Lambs (whose terrifying movie cover image kept me from ever watching the film in the first place), and even a disturbing dance number from Maddie Ziegler, known for her performance in Sia’s Chandelier music video.

In watching the series, the theme of mental illness is clearly a prevalent one.  Mona ends up in a mental institute called Radley Sanitarium (sanitariums having been replaced by psychiatric wards in hospitals long ago, and certainly not looking like what is sensationalized on the show) at the end of season one the moment when the missing psychologist Dr. Sullivan returns with a “diagnosis” (if you can call it that) which explains Mona’s terrorizing of the girls.  Something about extremely high intelligence paired with being bullied and not accepted somehow morphing into a multiple personality disorder (a term which the mental health community stopped using when the disorder was replaced with Dissociative Identity Disorder). 

From there, Spencer ends up locked up after she abuses stimulant medications and finds out about Toby’s apparent death.  We see her in various states of consciousness as well as locked up in a room that looks like a dungeon with no medical equipment in sight as one might assume a hospital might have (although anyone who has watched the series knows nearly every character ends up with IV fluids at some point during the series whether from being run over by a car, shot by a gun, or burned by a fireplace bursting in flames). 

Of course, Spencer still manages to find game boards, puzzle pieces, abandoned rooms and there seems to be a level of roaming about the facility which again, doesn’t happen in real psychiatric facilities.  While I am certainly not an expert in every form of psychiatric long-term facility in existence, I can tell you with certainty that the patients I have sent to the hospital have very structured group therapy, individual therapy, and activities hour to hour that keep them more than occupied and not roaming around aimlessly in underground basements.

After Spencer is eventually released from the hospital, Aria goes in as a volunteer and of course, there is Mona who is repeatedly sneaking in and out of the sanitarium.  Later, uber-A, CeCe Drake, is revealed as a transgender male to female patient who was born to Mary Drake, Jessica DiLaurentis’ twin sister (yes, this is indeed sounding like the stuff of soap operas you’d expect from Days of Our Lives) who was also institutionalized (Mary, not Jessica).  Apparently, Mary manages to get pregnant (twice) and delivers twins in the sanitarium, one of whom we learn in the final season is Spencer (bringing full circle that she was born in a sanitarium only to return to the same one 16 or so years later).  CeCe Drake (the first of Mary’s children and non-twin), is meanwhile also a brilliant mastermind who manages an ivy league degree at the University of Pennsylvania. 

You might say the Pretty Little Liars creators are very fascinated by that famous saying about the line between genius and insanity.  Mona and CeCe (basically the first two out of the three A’s we encounter) are all described as highly intelligent.  It seems the narrative then is that these are all sociopathic deviants.  Except that many things don’t add up (not that we expect them to).  This is notwithstanding the fact that two of the main leading men have the hacking skills of what you’d expect out of CIA hopefuls but are just your average high schooler and English teacher.

There are of course many logical flaws that make for fantastic drama—as my husband once astutely asked, “Why don’t they have alarms or guard dogs in their homes with all the frequent break-ins?”  Regarding mental health, however, it is not only the inaccurate portrayal of psychiatric care facilities but also the idea that brilliant masterminds are plagued by mental illness.  I’d argue that in fact the severely mentally ill are actually just trying to hold onto hope and deal with life one day at a time.  The energy expenditure required for a severely depressed patient to exercise let alone plan some scheme is essentially nonexistent. 

Even if we are talking about the personality disorder category, we’d be looking at individuals with histories of abuse and traumatic upbringings.  The percentage of children in the “deviant” category who torture animals is extremely low and they are typically not parading around suburban Pennsylvania towns in heels toting shopping bags.  No, I am not a criminal expert or forensic psychologist.  But as a psychologist in practice not unlike the show’s Dr. Sullivan (although I certainly do not see groups of 4-5 teens in therapy!), I can tell you some major liberties are taken with the portrayal of mental health in the show. 

In fact, the use of mental health facilities was not really necessary to tell any of the stories at all.  Mona could have just been a jealous cyber-bully.  Mary could have been a woman on the Autism-spectrum scale, and CeCe could have had narcissistic personality disorder (she makes the transition from boy to girl look seamless and glamorous, which is a far cry from the reality of true trans teens).  No sanitarium in sight.  But of course, in Hollywood, it’s all about the backdrop and the hospital was featured in some of the scariest scenes.  Perhaps as spin-offs of the show come out or there are reunions, we get a fairer and ultimately more respectful portrayal of mental illness.