I recently re-watched the series Fleishman Is in Trouble to confirm if my initial visceral response was fair and valid. After a painful re-viewing, I realized it was. By the end, I was again left with an intense urge to yell at the protagonist “Shame on you, Dr. Fleishman!”
The show depicts a marriage falling apart, and since it is mostly shown from Dr. Toby Fleishman’s point of view, it’s easy to initially blame his wife Rachel for the demise. But things are often not as they seem, especially when told from a one-sided perspective.
Halfway through this series, we learn that Rachel had a traumatic delivery with her first child, and this precipitated severe postpartum depression (PPD). As a Perinatal Psychiatrist for over 2 decades, I have treated many women who developed Post Traumatic Stress Disorder (PTSD) and subsequent PPD after a traumatic birth, mostly related to having no control over their labour and delivery. In the series, Rachel’s delivery is depicted in a cringe-worthy, horrific induction scene where her paternalistic obstetrician abuses his power by failing to obtain informed consent for a procedure and Rachel is left feeling disempowered and victimized. The result is a new mother lying helplessly in the hospital bed, dissociated from the birth experience and detached from the baby who amplifies her guilt as a maternal failure.
As for Dr. Toby Fleishman, portrayed as a respected liver expert who prides himself on being an excellent clinician and diagnostician, it seems as if he skipped any sensitivity training in medical school and is completely lacking in empathy for what his wife had just endured. He is clueless to the severity of Rachel’s mental anguish, never offers sound medical advice (like calling on a Psychiatry colleague), or never takes the time to just listen to his wife, who is so obviously suffering. He hypocritically quotes Dr. William Osler while teaching his MD residents, stating, “Listen to the patient, she will tell you the diagnosis,” yet he ignores all the glaring signs in the mother of his children. Toby is complicit in Rachel’s mental health decompensation. He may be an exceptional doctor, but as a husband, he doesn’t abide by one of the main Hippocratic adages: first do no harm. Doing nothing is doing harm.
Some may say Toby tries to help Rachel, but she is resistant. He yells at the obstetrician for not treating her with respect as a “patient” (but does not defend her as his wife). When it’s obvious that she is suffering from PPD, we see his hesitation at leaving her alone, his vague attempts at getting her to speak to a therapist, and satisfaction when she finally agrees to attend group therapy, stating, “I’m glad it worked.” But it doesn’t work, and Rachel continues to suffer in silence. In one of the most harrowing scenes of the series, a screaming, sobbing Rachel is comforted by a group of strangers— women who share the common bond of trauma— gathering around her and providing the safety to freely emote without judgement or repercussion.
Rachel is left to survive on her own in a world of competitive mothers, no family support, and a partner who criticizes the way she parents. Even when it appears she is happier upon her return to work, she never actually gets the proper help she needs; she remains isolated and under continuous scrutiny by her husband, until anger, resentment and, ultimately, divorce ensues.
So, what could Fleishman have done differently? He could have shown his wife empathy— the empathy he prides himself on showing his patients.
In the postpartum period, I understand that many partners walk on eggshells or worse, get angry when they think their spouse is not participating as an equal partner. Some men may feel resentful with the added responsibilities of caring for the kids and picking up the slack at home while also working in their day job. Others will try to fix the problem by offering practical tips on how to feel better. But it’s important to understand why a new mother is distant, avoidant, despondent, or wearing the same grubby clothes every day. The best thing is to be honest with a new mom and talk to her in a loving and supportive way. Ask her “How can I help you?”, make empathic statements like “I’m worried about you, you are not your usual self” or “I miss you”, and most of all, take action when there are concerning red flags that she is unwell. Remember that most women with PPD have difficulty making decisions or they worry about every potential negative consequence, so help her by making an appointment with her primary care provider, and go with her to show your support and share your concerns.
It was not surprising to me when Rachel has another major depressive episode, this time so severe that she becomes psychotic. What was shocking to me was how harshly Fleishman reacts towards her, offering no sympathy when he finds out why she disappeared. Even when his friend repeats— 5 times! — that “Rachel had a nervous breakdown,” he is still too angry to really comprehend what happened. He could not appreciate that a mental health crisis is an emergency and equivalent to one of his patients with acute liver failure. He is able to show insight, empathy and remorse to his patient’s husband, but not to his own wife.
So, Fleishman is in trouble— first, for failing to really listen to his wife without judgement and not appreciating the severity of her mental illness. Second, for ignoring the urgent need for her to receive appropriate mental healthcare. His inaction perpetuated the worst fears a woman can have: being a failure as a mother, unlovable, and completely alone. PPD is an illness of immense vulnerability which, if left untreated, can lead to more dire consequences. People with mental health struggles often rely on their loved ones to acknowledge their mental anguish and to help them seek out the care they need. So please, partners— do better than Dr. Fleishman!