Forensic Psychiatrist Gets Too Close ==================================== * Susan Hatters Friedman * Karen B. Rosenbaum * forensic psychiatry * boundary violations * evaluations * fiction * film * stigma *Too Close* is a best-selling 2018 psychological thriller novel which recently became a popular 2021 BBC miniseries (available on AMC+). The protagonist is Dr. Emma Robinson (Dr. Robertson in the miniseries), a female forensic psychiatrist. As is often seen in fiction, she appears to have only one case at a time and the case that is the focus of the series is of a mother who we learn attempted to kill her child and her romantic rival’s child. The perspective of the defendant, Connie Mortensen, is interspersed with Dr. Robinson’s perspective in the novel. As early as Chapter 1 in the novel, there are misconceptions of the role of forensic psychiatrists. Connie believes that the forensic psychiatrist evaluator “is here *to help me,* so she said last time, *to get to the root of it all*” (p 16, emphasis in the original). Also as early as Chapter 1, the meaning of the title becomes apparent. Dr. Robinson has major problems with boundaries, and over-identification with the defendant. Among forensic psychiatrists in fiction, Dr. Robinson easily falls into the category of The Activist, a crusader who rationalizes boundary violations.1 For example, “When Emma saw that she had a new document in her work inbox she felt strangely excited, as if she were opening a love letter. Connie had called the file ‘The Beginning of It All’. Emma’s heart skipped a beat or two as she nervously clicked on it” (p 27). In the BBC miniseries, many of the same problems with boundaries are seen, albeit in a different order. Unlike what is allowed in most forensic facilities, Emma seems to always have her purse with her. She carelessly allows the hospitalized defendant to glance at her transport pass, learning her neighborhood, and observe a text message or call on her phone from “Si Hubby.” Throughout the interviews or “sessions” (as the forensic psychiatrist refers to them) the defendant asks the psychiatrist questions about her own life, especially regarding “Si Hubby.” At one point the increasingly over-invested forensic psychiatrist yells at the defendant “Connie, you have *got* to remember! None of us want to remember these things but we have to!” (p 261, emphasis in original), then begins crying. She even reveals to the defendant that her own young daughter had been killed in an accident, reminding us that those at risk of boundary problems include those with relationship problems, grief, and loneliness.2 In the BBC miniseries, the fictional forensic hospital “Tatchwell” where Connie is sent for observation appears more similar to correctional facilities than a hospital. Painting a concerning portrait of forensic hospitals, we learn in the novel that hospitalized patients are not allowed access to the news, phone calls, or scents. Detective Sergeant Allen and Dr. Robinson question the defendant in a special room of the hospital, implying that forensic psychiatrists are involved in police questioning. And unfortunately, as occurs often in crime fiction,3 as well as in real life, Connie variously refers to Dr. Robinson as a psychologist and her psychiatrist. This perpetuates the public’s confusion of the roles of a clinical psychiatrist and an independent forensic evaluator, as well as the confusion between a psychiatrist and psychologist. There is also a confusion as to whether Dr. Robinson is a treating psychiatrist working at the forensic facility, or if she is an independent evaluator for the courts. It seems she is both. In addition, different types of forensic evaluations are confused, such as the insanity defense and fitness to stand trial. This misunderstanding was also pointed out in our review of the crime drama series, *The Sinner.*4 In what Dr. Robinson refers to as a “session” of her evaluation, she meets with Connie in her bedroom at the forensic hospital. A hung-over, sick Dr. Robinson vomits in the patient’s toilet and lies down in Connie’s bed. Whereas any reader would be aware that police officers do not see defendants in their private jail cell and would never fall asleep there themselves, forensic psychiatrists remain a mystery to readers and viewers, and as such this portrayal does a disservice to our profession. The two most realistic parts of the book are when the media nicknamed the attractive defendant in a high-profile case “Yummy Monster,” and when the forensic psychiatrist attended a party and others were asking her opinion of the defendant. Fortunately, at the party, the psychiatrist evidenced some boundaries with the help of her attorney husband who shut down the conversation. Though later, when she went on a date alone with her old high-school crush, she did not. In fact, the crush specifically questions her attachment to the defendant. The forensic psychiatrist even visits the defendant’s father. She explains “dissociative amnesia” (p 153). She explains to him and to the reader, conflating evaluation types and her role, “I have to assess her mental state at the time of the offense and whether she is fit to stand trial. At some stage, Mr. de Cadenet, she has to be held accountable. If Connie doesn’t acknowledge her actions, how can there ever be recovery?” (p 153). She then holds the defendant’s father’s “old mottled hand” (p 154) and tells him that the defendant likely had a psychotic episode, while he blames these events on prescriptions from her general practitioner who also had boundary problems long before the defendant met the forensic psychiatrist. Misunderstandings about amnesia and mental illness abound as well and can perpetuate the general public’s misunderstandings.3,5 The defendant had claimed not to recall the attempted murder. The forensic psychiatrist later explains that the defendant is not malingering, had amnesia of “sudden onset” (p 269), but, and rather remarkably, after these many hours of evaluation and boundary violating, the forensic psychiatrist was “undecided about her fitness to stand trial” (p 269). She also describes that the crime was a “family annihilation” (p 269), a misuse of the term since she had only attempted to kill her daughter and a neighbor girl, sparing her other child, her husband, and his live-in paramour. The forensic psychiatrist asserts that there was a “psychotic episode” and “serious questions to be raised concerning the benzodiazepine prescriptions from her GP and particularly the Clonazepam…” (p 269). It is quite unclear to us as readers what the “psychotic episode” refers to, other than visual hallucinations which were also attributed to benzodiazepine withdrawal. Finally, appropriately, Tom, Emma Robinson’s supervisor calls her in the office to talk about her personal bereavement and complaints about her by two staff members. She reeks of alcohol and videos were found of her sleeping and vomiting in the patient’s bedroom. She said, “She needs me, Tom. I’m all she has right now” (p 271), further highlighting her massive boundary violations. She is encouraged to take a sabbatical and to turn in her pass. Then in her *pièce de résistance*, she sneaks off to hypnotize the defendant. (A forensic psychiatrist is also seen engaging in hypnotism in the series *The Sinner*.)4 Most outrageously, at the close of the novel, another patient is pretending to be a dog. Connie’s children play fetch with this patient as if the patient is a dog. This interaction further stigmatizes mental illness. Both the novel and the series, *Too Close*, raise questions of why fictional misrepresentations should interest us as real-life forensic psychiatrists. It is important that forensic psychiatrists, our population of defendants with mental illness, and forensic hospitals are portrayed fairly in fiction. Otherwise, there is the risk of increased stigmatization of psychiatric populations and increased misunderstandings from members of the public who are potential jurors. In considering stories and being advocates for the proper depiction of these themes, we should consider whether stories can be told without so many misrepresentations, and whether these distortions are in service of the story being told or whether they are merely fear-mongering about mental illness and violence. In the case of *Too Close*, the portrayal of misconceptions about mental illness, the confusion of the role of the forensic psychiatrist, and conflating psychosis, amnesia, medication side effects, and violence unfortunately all serve only to perpetuate the stigmatization of mental illness. ## Footnotes * Disclosures of financial or other potential conflicts of interest: None. * © 2022 American Academy of Psychiatry and the Law ## References 1. 1.Friedman SH, Cerny CA, Soliman S, West SG. Reel forensic experts: Forensic psychiatrists as portrayed on screen. J Am Acad Psychiatry Law. 2011 Sep; 39(3):412–7 2. 2.Friedman SH, Martinez RP. Boundaries, professionalism, and malpractice in psychiatry. Focus. 2019; 17(4):365–71 3. 3.Friedman SH. Forensic psychiatrists and crime fiction: Top 10 myths corrected. Crime File UK [Internet]; 2020. Available from: [https://www.crimefiles.co.uk/author-post/2020/08/06/forensic-psychiatrists-and-crime-fiction-top-ten-myths-corrected-by-susan-hatters-friedman-md/](https://www.crimefiles.co.uk/author-post/2020/08/06/forensic-psychiatrists-and-crime-fiction-top-ten-myths-corrected-by-susan-hatters-friedman-md/). Accessed January 22, 2022 4. 4.Hicks C, Friedman SH, Rosenbaum KB. Trauma versus immorality: A review of *The Sinner*. J Am Acad Psychiatry Law. 2020 Sep; 48(3):418–9 5. 5.Baxendale S. Memories aren't made of this: Amnesia at the movies. BMJ. 2004; 329(7480):1480–3 [FREE Full Text](http://jaapl.org/lookup/ijlink/YTozOntzOjQ6InBhdGgiO3M6MTQ6Ii9sb29rdXAvaWpsaW5rIjtzOjU6InF1ZXJ5IjthOjQ6e3M6ODoibGlua1R5cGUiO3M6NDoiRlVMTCI7czoxMToiam91cm5hbENvZGUiO3M6MzoiYm1qIjtzOjU6InJlc2lkIjtzOjEzOiIzMjkvNzQ4MC8xNDgwIjtzOjQ6ImF0b20iO3M6MjA6Ii9qYWFwbC81MC8xLzE2NC5hdG9tIjt9czo4OiJmcmFnbWVudCI7czowOiIiO30=)