Mistresses, Part 2: Mental Health Professional Analysis and Scorecard

SPOILER ALERT: This post contains information from Season 1, Episodes 1-13 of Mistresses (US).
TRIGGER WARNING: This post briefly describes mild sexual violence, and references rape culture. 

Sorry for the hiatus, folks! I'm back, and am jumping back in to pop culture analysis and deconstruction with  Mistresses' portrayal of psychiatrist Dr. Karen Kim, (played by Yunjin Kim).

First, some background. As discussed in the Mental Health Profession 101 post, a psychiatrist is someone with a medical degree [such as a D.O. (doctor of osteopathy) or M.D. (medical doctor)] who has completed post-doc training in assessing and treating psychological distress (things like anxiety, depression, bipolar disorder, trauma, etc.). Most psychiatrists prescribe psychotropic medicine, and some also provide psychotherapy. Mistresses Dr. Kim is one of the latter. In the show, she is co-partner at a psychiatric private practice with former medical school colleague Jacob Pollack (played by Matthew del Negro).

There are a fair number of pros, and unfortunately, even more cons in Mistresses' portrayal of Dr. Kim. Let's start with the pros, shall we?

For starters, it absolutely rocks this doctor's socks that Dr. Kim's character is an immigrant South Korean woman of color in a high-ranking professional position. Popular media predominantly cast men and white people in high-ranking professional roles such as doctors, lawyers, executives, etc., and thereby reinforce racist and sexist cultural beliefs that these professions are for men and white folks, only. Though Dr. Kim doesn't always make fabulous decisions in her role as psychiatrist, it is clear that the show aims to portray her as a humanized protagonist with whom the audience can relate and empathize--who also happens to be an East Asian woman of color. Moreover, Dr. Kim is co-partner and co-owner of a psychiatric private practice--therefore, she and her partner, Dr. Pollack, are their own bosses. Get it, Dr. Kim!

Dr. Pollack and Dr. Kim in Kim's office

Furthermore, in the fictional world of Mistresses, Dr. Kim developed a program to increase Koreans and Korean-Americans' access to mental health services, and said model was so successful, it was used by other agencies as a prototype for outreach to other non-English-speaking groups. Additionally, in episode 5, Dr. Kim is recognized by her professional peers and nominated for a prestigious award due to this program.

Dr. Jacob Pollack and support staff Lila sharing the award news with Dr. Kim

 

Mistresses also develops Dr. Kim's character as a real person, with friends, relationships, emotions and dreams, her own practice, home, etc.--which is not always the case with media portrayals of mental health professionals. Viewers observe Dr. Kim interacting with friends, colleagues, acquaintances, and patients' relatives :/ in a variety of social contexts, averaging about 4 different social settings per episode (yup, I counted). Additionally, in numerous cases, exemplifications of her professional expertise enhance overall character and plot development, averaging about 1.5 exemplifications per episode (yup, counted that, too). Happily, her character balances using clinical skills to inform her relationships and provision of support to friends, while simultaneously refraining from becoming her friends' therapist.

Dr. (Karen) Kim celebrating Savi's birthday with friends Savi, Joss, and April

Finally, Mistresses presents a fairly contemporary depiction of therapy and psychotherapists, and primarily refrains from making the easy and stereotypical psych jokes often present in any popular medium with a mental health theme. Which makes this doc quite pleased. :)

However, when it comes to upholding relevant professional and ethical standards, Mistresses' Dr. Kim crashes and burns.

"Wait, there's an ethics code I'm supposed to be following?!"

The audience learns in the very first episode that after he disclosed his attraction to her, Dr. Kim had an affair with Thomas Grey, one of her (married) patients. Of all the ethical infractions mental health professionals can commit, sleeping with a client is probably the worst, and can do a TON of harm to said client. Dr. Kim has the affair, anyway.

Dr. Karen Kim and Thomas Grey

Though the circumstances are not clearly explained, it appears that Thomas has a form of cancer that is not responding to treatment, and does not expect to live much longer. After their affair begins, Thomas asks Dr. Kim to "help" him when the pain becomes too severe, and his quality of life has significantly diminished. (The ableist messages in his request will be further discussed in the next post). Dr. Kim obliges, and prescribes her lover/patient a lethally high dose of morphine, even though she's a psychiatrist, not a general practitioner or oncologist, and said prescription would raise the suspicions of anyone paying attention.

After Thomas dies, his son Sam Grey begins to tailspin, partially out of understandable grief, and partially because he believes his father was having an affair. After his father's funeral, Sam seeks out Dr. Kim for support. While seeing Sam as a psychiatric patient is inadvisable, due to her former treatment of (and affair with!) his father, Sam comes to Dr. Kim in somewhat of an emergency state, and she subsequently provides crisis triaging, and offers to refer him to another clinician who could adequately and ethically provide him services. Sadly, this is one of the last times we see Dr. Kim interact with Sam in a way that clearly upholds ethical standards.

Sam develops a bit of a crush on Dr. Kim (which, for the record, is on him, not her), and calls her at work and at home quite frequently. (How did he get her home number, again?) Initially, Dr. Kim does not respond. Sam then drops out of college, drinks too much when celebrating said drop out, gets in a car accident, and calls Dr. Kim again for help. Dr. Kim picks him up from the hospital, expresses concern while remaining professional, and drops him off at home. Unfortunately, he leaves his wallet in her car, and when she swings by his apartment (formerly his father and Dr. Kim's lovenest) to drop the wallet off in his mailbox, she runs into him. Sam insists she come in and stay for dinner, and non-consensually kisses her as she attempts to leave. Sam's obsessive crushing behavior continues to escalate, including showing up uninvited at Dr. Kim's office, stalking her outside of her home, scheduling an appointment with her partner in order to have a reason to show up at her work (after being asked not to return), and, oh yeah--breaking into her office in order to leave a photo he took of her. Cause that's romantic.
 

Sam invading Dr. Kim's personal space in episode 4

The majority of the onus here is on Sam--societally, he possesses more power and privilege as a man and as a white person, and he abuses that power and privilege through his unrequited romantic and sexual pursuit of Dr. Kim. Additionally, while it's understandable that Dr. Kim is grieving both the loss of a patient and someone she loved, and is therefore not thinking as clearly as possible, she also continues to involve herself with Sam and the Grey family in a way that is inadvisable and unprofessional. This does not, however, excuse Sam's stalking and boundary-crossing, nor does it place responsibility for them on Dr. Kim. Rather, as a separate issue, integral to the provision of mental health services are the definition and upholding of clear boundaries. Dr. Kim, perhaps due to grief and guilt, seems to understandably struggle to clearly define her new role and boundaries with the Grey family, while Sam Grey frequently violates the boundaries that Dr. Kim does set. Which creates a really problematic situation.

Meanwhile, an insurance investigator, Detective Anthony Newsome (played by Gary Dourdan) begins to ask questions about Thomas Grey's mental health and the nature of his treatment with Dr. Kim. Though not unethical, Dr. Kim's initial reactivity at Detective Newsome's inquiries is surprising, as nearly all mental health professionals learn quite early in their training that clients' records are considered legal documents, and can be subpoenaed. Moreover, as Detective Newsome did not have a subpoena when he initially interviewed Dr. Kim, she did not have to disclose anything to him about Thomas Grey, or any of her patients, for that matter. Because she did, she violated the American Psychiatric Association's Principles of Medical Ethics and breaks Thomas's confidentiality in the scene below.

Detective Newsome and Dr. Kim at Kim's office.

Sadly, we see Dr. Kim break confidentiality again and again--ranging from discussing various details of Thomas Grey's case (post-mortem) while out with friends, as well as with Detective Newsome in a public hardware store, to chatting with and seeking consultation on specific patient matters in her office, with the door open, as well as in her practice's (open) waiting room, where anyone could have walked in and overheard mid-conversation. Confidentiality is taken VERY seriously in the provision of mental health services...aaaaand, it seems like Dr. Kim and Dr. Pollack missed the memo on that one.

In addition to confidentiality breaches, Mistresses' Dr. Kim commits other serious ethical violations, including falsification and improper destruction of client records. Dr. Kim's former patient, Thomas Grey, shared with his wife, Elizabeth Grey, that Dr. Kim wrote him a prescription for morphine in order to facilitate his suicide when the cancer-related suffering and pain became too much.  Early in the series, specifics are unclear on whether Thomas administered the morphine to himself, or if his wife assisted in its administration; however, in any scenario, Thomas, Elizabeth, and Dr. Kim are all somehow implicated in Thomas's death. When the insurance investigators begin to suspect that Thomas's death may not have been due to natural causes, Elizabeth entreats Dr. Kim to "protect" them both, and either edit her existing progress notes for Thomas or fabricate new notes indicating that he experienced acute suicidality in the last months of his life. She even provides Dr. Kim with a specific date and event on which to base these claims.

We later see Dr. Kim delete a file on her work computer entitled "T. Grey," shred the morphine prescription she wrote for Thomas, fabricate notes for Thomas's file based upon Elizabeth's report and request, and break confidentiality yet again, by visiting the Grey home and sharing her concerns about Sam's mental health after he no-showed for his appointment with her partner. All of which were REALLY bad ideas in and of themselves--

--and even worse when we learn that Elizabeth knew about the affair, and out of hurt and spite, intentionally provided Dr. Kim with incorrect dates and events, in order to make her record falsification even more damning. Elizabeth then files a wrongful death suit against Dr. Kim, and claims that Dr. Kim administered the fatal dose of morphine. Dr. Kim has no legal counsel, as her friend Savi's firm is already representing Elizabeth Grey. After stopping by Dr. Kim's office uninvited yet again (boundary violation #1), Sam learns that Dr. Kim has not yet secured legal counsel, and sends Attorney Natalie Wade to represent her (boundary violation #2). He then invites himself over Dr. Kim's home (boundary violation #3), and is waiting in her driveway for her when she returns home to see how things went with Attorney Wade.

Sadly, this escalates to Sam and Dr. Kim sleeping together, which, while not blatantly unethical based upon the letter of the Principles of Medical Ethics, is at the very least, unprofessional and a splendidly bad idea. Because you know what's worse than sleeping with your client? Sleeping with your client's child, after you've already had an affair with your client! Oh, Dr. Kim. :/ (Additionally, this particular Dr. Kim/Sam interaction promotes unhelpful messages that support rape cultural beliefs, and will be discussed further in the next post). Dr. Kim is then coached by Attorney Wade to plead the 5th amendment--a lot--in reference to the wrongful death suit, and when all else fails, lie--encouraging Dr. Kim to obtain not one, but 2 false alibis for the night of Thomas Grey's death. 

Somewhat surprisingly, Dr. Kim decides to tell the truth about her prescription of morphine to and affair with Thomas at a deposition meeting--much to the horror of her business partner, Dr. Pollack, who is learning this information for the first time, and to her attorney, who is sure they will now lose the case. However, the judge overseeing the case dismisses it, describing the presented evidence as circumstantial, at best.

Attorney Wade, Sam Grey, and Dr. Kim in the courtroom following dismissal of the case.

Dr. Kim's partner, Dr. Pollack, is not as elated by the case dismissal, and discloses to Dr. Kim that he reported her to the state board, and that since he can't trust her anymore, their business partnership is over. We then see Dr. Kim interviewed by a representative of the California State Licensure Board, neither admitting nor denying her affair with a patient, and subsequently, having her license suspended for 6 months.

So how does Dr. Kim measure up vis à vis On the TV Couch's ratings? See below. And please--please oh please--before season 2, could someone enroll Dr. Kim in an ethics class? Or even just introduce her to her profession's ethics code. E.g., "Dr. Kim, meet the American Psychiatric Association's Principles of Medical Ethics. Principles of Medical Ethics, meet Dr. Kim."

Mistresses Mental Health Professional Scorecard

Social Settings: 

    4/episode = A+

Positive Contributions of Professional Expertise: 

    1.5/episode = C

Ethics: 

    13 ethical acts, 22 unethical acts = 13/35 = 37% = F

Total Score:  C-