Source: Six Feet Under (HBO)

Source: Six Feet Under (HBO)

EPISODE 3 - Six Feet Under
Guest: Caroline Mazel-Carlton

Sandy chats with Hearing Voices movement activist, speaker, and rabbi-in-training Caroline Mazel-Carlton about death, spirituality, trauma, and healing on HBO’s dark comedy Six Feet Under. A transcript of the episode can be found below.


Caroline Mazel-Carlton (she/her/hers) has laid her head in a number of places, from Indiana jail cells to Texas psychiatric units, but now enjoys a freer existence as Director of Training for the Western Mass Recovery Learning Community.  She has been re-defining peer roles in diverse mental health settings and parts of the world for over a decade.  Her work with “Alternatives to Suicide” and the Hearing Voices Network has been featured in publications such as The New York Times, Foreign Policy and O Magazine.  She is passionate about re-claiming cultural and spiritual wisdom traditions for navigating extreme states and is studying to become a rabbi.



  • To learn more about Caroline’s story, here’s a great interview she did recently on Will Hall’s podcast, Madness Radio (a podcast with a big archive I recommend generally).

  • I encourage you to learn more about the Hearing Voices movement — especially if you think you might find participation in a group useful. Here’s the Hearing Voices-USA website where you can look up whether there’s already one in your area:

    And here’s the international Hearing Voices organization, called Intervoice:

  • The organization Caroline works for, called the Western Mass RLC, has a website with tons of great resources, including about the Alternatives to Suicide approach she mentioned briefly:

  • For more on the history of the Hearing Voices movement, check out Dr. Gail Hornstein’s Agnes’ Jacket. This is a book I often recommend to people who work in mental health and are just falling through the looking glass, so to speak. I’ve also got several other recommended books about HVN on my website:

  • A recommended book if you want to learn more about ECT/electroshock is Linda Andre’s Doctors of Deception

  • My tarot deck is The Wild Unknown:

  • To learn more about my journey learning about the Hearing Voices movement, read my book, A Kind of Mirrauclas Paradise: A True Story about Schizophrenia


CAROLINE MAZEL-CARLTON: In the history of psychiatry, too, like in the twentieth century, there was sort of this tension between is it — is it a biological brain disease, or is it all the mother’s fault? [Laughs]


CAROLINE: And, like, they — they were kind of —

SANDY: The two possibilities.

CAROLINE: Right. Those were the two camps.

SANDY: The only — that’s all I can think of.


SANDY ALLEN: This is Mad Chat, a podcast where we analyze and discuss what our pop culture is telling us about madness and mental health. I'm your host, Sandy Allen. I'm a writer and the author of A Kind of Mirraculas Paradise: A True Story About Schizophrenia. Today we are chatting about my favorite comedy show where somebody dies before each title sequence: Six Feet Under.


SANDY: Before we dive in, I wanted to say a quick note about spoilers. This is a spoilerific show. We’re gonna be analyzing a show that ran years ago, and we’re gonna be talking about all of it, including its plot. But we will be careful to not spoil, for example, the ending, which is famous. But I just wanted to say that this a show about analysis, not about plot summary. Today we’re talking about Six Feet Under, which aired on HBO from 2001-2005, and told the story of the Fisher family, who run a funeral home. Each episode, before the credits, viewers watch someone die. For that reason, the show was and is frequently credited by critics with transforming the American imagination around death. But the show also commented a lot on psychiatric treatments, on trauma, on madness, on altered states, on spirituality, on the relationships that people may continue to have with deceased loved ones. Today I’m talking about Six Feet Under with Caroline Mazel-Carlton. Caroline, I’m interested in having you on the show today because of your advocacy work. Do you mind starting off by telling listeners a little bit about who you are and what you do?

CAROLINE: Absolutely. So my official role is Director of Training of the Western Mass Recovery Learning Community. Our work involves creating a more just and healing world for people with those experiences. We have things like a peer respite, community centers; we’re the developers of Alternatives to Suicide groups; and we’re responsible for bringing the Hearing Voices Network to the United States and spreading a non-pathologizing approach to looking at non-consensus reality experiences — of which there are many in Six Feet Under — and looking more at the context and meaning of the experience versus just ignoring it, or trying to medicate it away.

SANDY: Right. And for a listener who’s maybe never heard of the Hearing Voices movement, could you just briefly, if you can, explain what that is?

CAROLINE: So the Hearing Voices movement began as a collaboration between a social psychiatrist and a woman who heard voices in the — the Netherlands, 30 years ago. And its approach where we — we talk about the voices that we hear, and rather than taking sort of an adversarial approach to these experiences, and trying to push them away, we seek to build stronger relationship with them. So looking at what they might mean — for a lot of us who have voices, they’re connected to past traumas or systems of oppression. Rather than the voices themselves being the problem, we look at them as messengers more about points of healing in our life.

SANDY: I’m so excited that you chose Six Feet Under as the object of our discussion today. This was a show that I started watching in late high school, around the time when the series was ending. And at the time, it was, like, my favorite thing I had ever seen. And it had a huge effect, I think, on my — to that point, very undernourished sense of mortality.

CAROLINE: You know, my relationship with Six Feet Under is kind of interesting. So, I realized, as I began to rewatch it, that I had never finished the series when it first came out, you know, at the turn of the millennium. And I think one of the reasons why is a lot of it hit extremely [5:00] close to home, you know? One of the characters in the story — one of the main characters — shares a diagnosis with me, one that I had been given at around the time the show came out: bipolar with psychotic episodes. The character Billy and I share a diagnosis. And, you know, if you’ve seen the show, you know, Billy is — is — is a complicated portrayal.


NATE: So, uh —

BILLY: Who am I, and why am I in your girlfriend’s house, practically naked?

NATE: Yeah.

BILLY: [Chuckles softly] She’s my sister. [Slap.] She’s my mother. [Slap.] Sister. [Slap] My mother. [Laughs, then sighs] Sorry. Nobody’s ever laughed at that, I should know better.

CAROLINE: So for me, it was sort of hard to watch. I think he is one of the more difficult characters, and it was hard for me to not sort of see myself in him. Another experience that I’ve had that’s shared by a character on this show, um, is the experience of having a doctor write a book about me. [Laughs]

SANDY: Hmm. Fascinating. So that’s Brenda, Billy’s — Billy’s sister.

CAROLINE: Yeah. So in the case — the character in the show — the book is written about her because, you know, she has, you know, this high IQ. And there’s sort of this, you know, a lot of therapists and clinicians and psychiatrists kind of analyze her.


BRENDA: It is a fucking law of physics that the very act of observation changes that which is being observed. And now you’re gonna read that book and think that you know me. Well, you know what? You don’t.

CAROLINE: You know, the book that I’m in is not about high IQs. It’s about borderline personality disorder.

SANDY: To whatever degree you’re comfortable saying, do you mind giving listeners just a little sense of — of what had happened in your life, and — and — and what you were going through?

CAROLINE: Yeah. So I’m someone that was — was diagnosed as having a — a mental illness at a — at a fairly young age. I am someone that has experienced — I think, you know, at — at the end of the day, what Six Feet Under is really about, as a show, is, you know, all — all the exquisite flavors and dimensions of pain, and — and human suffering that — that there is.


CAROLINE: So, you know, I’m someone that has — had had a lot of pain in my life. And, you know, like one character in the show in particular, that got viewed through the lens of pathology. So I’m someone that spent a lot of time sort of on this kind of merry-go-round of, like, trying to figure out what — what’s — what’s the right diagnosis, and what’s the right medication. And none of it was really getting to the roots of my pain. And like a lot of folks that get caught up in systems, both the mental health system and the legal system, I got kind of stuck — was living at home, not successful in things like school or relationships, and, you know, have, you know, undergone periods of my life where I spent long stretches of time in psychiatric units.

SANDY: Right. And so, I — I do want to start with Billy. I think it’s great you mentioned him. I was really struck, rewatching the show — just some of the arguments that seemed to be being made by the show itself about Billy, his diagnosis, psychiatric treatments — including medication, also electroshock, or ECT. To your mind, what are — what are some of the ways in which the show’s portrayal of Billy is problematic and/or does a good — or I guess, to your sense, accurate — job of sort of talking about issues like psychiatric incarceration, for example, or psychiatric treatment.

CAROLINE: Yeah. Well, Billy is a really interesting character. And I think, you know, there are — there are certainly things that are problematic about the portrayal. I think for me what’s most interesting about Billy — he is the only main character that we don’t ever get to see his inner world.


CAROLINE: So we have this show where every other main character, we are experiencing with them their past traumas, their voices, you know, grappling with inner pain, experiences around homophobia, failure, abortion, loss. [10:00] It’s — it’s all in there. And it’s all portrayed in sort of this complexity. Like I said, I think this show is — it really is like a diamond. But I think Billy is the flaw in that diamond, because we are never given that window. And I think there’s something pretty interesting about that, because he is, for most of the series — until we’re introduced to George — he is the only character that’s truly, like, identified as “this is someone with a psychiatric illness.” And I think it’s problematic, but I think it’s also — it really opens up a discussion about how, as a culture, we treat people who receive psychiatric diagnoses in general.

SANDY: And, uh, through the course of the show, there’s a big plotline, which is Brenda, Billy’s very close sister, basically deciding, against her own intuition and instinct — but I would guess experience, you know, sort of given what’s implied about her life — that she has to ultimately decide to have Billy committed. And the show also very early on has Nate, who comes out in front as being very opposed to Billy and calling him a psycho and basically implying Billy needs to be locked away right away.


NATE: Billy is severely fucked up, Bren. I don’t like being stalked by a psycho.

BRENDA: Billy’s not psychotic. He has a disease. He’s fine when he takes his meds.

NATE: Yeah? Well when the fuck is that? Look, has he ever done anything weird?

BRENDA: [Scoffing] Uh, yeah, he’s bipolar. His whole life has been weird.

SANDY: Why does the show’s bigotry against Billy, matter? Or why is it so telling that of course he is the character whose internal experience we have the least sense of? Or even just like, on a very plot level, you know, we don’t follow him to the psychiatric hospital. We don’t — we don’t experience whatever he experiences in treatment.

CAROLINE: Yeah. I think Billy also — you know, he is one of the characters that — there are other characters where we see the impact of ECT and pharmaceuticals, like Vanessa and George, where that’s a lot more of an accurate portrayal. In the case of Billy, though, you know, there are scenes it’s like — it’s very much: Is Billy medicated or not medicated?

SANDY: Right. And do you want to pause and just explain a little bit, like, why is that an annoying, I guess, stereotype that we have in so much of our pop culture? Basically like: Is this person on his meds? Oh, he’s not on his meds. Now something really bad is gonna happen. Like, why is that a pernicious kind of — I guess meme, almost, that — that we return to again and again?

CAROLINE: Yeah. I think the first — I mean the first piece of it is that it’s not exactly how human distress or medications work. Like, most people — myself included — our distress has a context. You know, there’s actually a funny scene with George in the show where George has a breakdown and at the mental hospital they say “Oh, George’s breakdown is being caused by stress. That’s why he’s experiencing, like, paranoia and fear and — and voices. It’s being caused by stress.” But the solution that they offer is ECT.

SANDY: Right.

CAROLINE: So it’s like —

SANDY: Electroshock.

CAROLINE: Yeah. So instead of ok, this is being caused by stress or past trauma — and so the solution would be to reduce stress or address past trauma — instead they’re like, the solution is to shock his brain.

SANDY: Right.

CAROLINE: Sometimes ECT is framed as being, you know, much more humane these days. There’s some great — I think they have some great lobbyists. But I think it is important to talk about, for many of us, the effects of memory loss can be much more than short-term memories, but entire chunks of life. And there is always a chance when damaging parts of the brain when going into a seizure — which is what ECT is, it’s electroconvulsive, that convulsive piece refers to a seizure — that there are parts that we might never get back. And a lot of folks that have ECT, you know, it’s much more than a headache afterwards. It can be kind of, like, a whole week of not really being able to function. So for me, it’s always important to just mention, like, how these effects can actually play out in people’s lives and offer that there are other alternatives out there, such as neurofeedback, which is something that I use now [15:00], that does not involve damaging brain tissue. You know, there’s not a chemical substrate out there that a person can take that’s gonna provide them suddenly more insight and clarity. It would be great if there were drugs that worked that way. But trust me, I’ve been prescribed everything, and spent a lot of time on — on units with people that, you know, have — have taken — taken it all. There are things that drugs can do. They can help you sleep, they can make you feel detached from a situation. But in the case of Billy, like, you know there are scenes where, oh, he’s taken his meds, and all of sudden he has all this deeper understanding, and that’s just not really how drugs work.

SANDY: Right. There’s some false assumptions about what these drugs are and can do that’s underlying the way that Billy’s plot line is, oh, Billy is dangerous and unmedicated. And I — I think we should also probably just discuss the dangerous part, which I think is also one of those I think really powerful myths that’s in so much of our pop culture, which is, like, psychiatric patients are dangerous — murderous, even — right? Like that’s a plot point that’s unfolded over the course of the first season, is Brenda kind of via Nate learning more about her own brother’s history when he was a — a younger — a younger man, in terms of him, you know, putting people in danger and her sort of realizing his — his dangerousness. And that ends up becoming the reason that I guess we as the viewer are supposed to kind of, like, agree with her that it’s important for her to come around to Nate’s side and commit Billy after all.

CAROLINE: Totally. And yeah, there — there is very little evidence — like time and then time again studies show us that folks with psychiatric diagnoses are not more dangerous than the general population, and are more likely to be victims of violence. So for me, in looking at Billy, like, and what the story of Billy is really about — honestly, I mean, we know Billy does do some violent things in the show. But when I see the character Billy, I think it really is more about someone who is possessive of women than someone who is struggling with, you know, what Billy I think — this is — I think this is a hard word sometimes for people to hear, but this idea of — of toxic masculinity. And, you know, I — I’m married to a man, I do not have problems with — with masculinity. But there are certain forms of it where, you know, a right — a right to women’s bodies or times, and if that’s denied, you know, we become violent or possessive. That’s really what I see in the character of Billy. And in our culture, at large, there is a tendency that, when this comes through — and it’s coming through a white man — that it gets portrayed as a mental illness. So we see this time and time again, you know, with instances of violence in our culture, where maybe if it’s a person of color it’s like, “Oh, that person is a terrorist or a thug.” But if it’s a white male people say, “Oh, we need more mental health treatment. That is what would’ve prevented this.” And so in some ways Six Feet Under, I think, captures a narrative that really is in — in our culture, to pathologize within an individual something that’s really more of a social problem. But there’s this really great scene, this scene that I — that I wept. Billy is truly trying to get to the root of his struggle, which is beyond just being medicated versus unmedicated. He — he actually — he invites Claire over to take photos of him, a photo of his — his scar for where he — he cut his tattoo off his body. And he says to Claire:


BILLY: I need to see what I’ve done. [Two shutter clicks.] Need somebody else to see me. Somebody who isn’t Brenda.

CAROLINE: And what I really saw in that moment is someone who is realizing the need for accountability, and amends, and repair, and acknowledging that he needs to see [20:00] — he needs Claire to help him see his impact. You know, he needs to be in relationship with someone and hear how he has impacted her in order to move forward and sort of heal his life. And it’s this really, I think, important moment, and what’s sad about it, though, is it is this powerful moment of him reaching out for accountability and relationship, and during that time, he cries. And it’s — and it’s a different kind of crying. It’s not a crying where he cries because someone won’t have sex with him. He’s crying because he wants to be different, and he wants change, and he needs help to make that happen. And Claire just walks out — like, she’s not comfortable with his tears for whatever reason. I mean, when we’re talking about how masculinity’s treated in our culture, we have a huge problem with embracing, you know, men’s tears. And so it’s portrayed in the show. And for me, this scene, you know, it — I think it’s really sort of redeeming of the character of Billy, and it shows, you know, that he does deep down know what he needs to shift things, but he’s just not getting it, even — even when he’s asking for it. And there’s something so — so painful and sad about that.

SANDY: Yeah. You’ve mentioned another of the characters who has a psychiatric history in the show, and that is Ruth’s eventual new husband, George Sibley.


SANDY: I think it’s interesting to think through the contrast in how much access we are given to George’s backstory, for example, and sort of the origins of his trauma in terms of this relationship that he has with his mother, who is in — in this very haunting sequence, we are watching a young — young George Sibley watch his mother die of what looks like suicide. I was wondering, why do you think it is that the — the show is so much more permissive in sort of thinking through the root of George’s problems, but it doesn’t really give us any access to Billy beyond sort of, like, a vague allusion to Billy being upset at psychiatrists for making Brenda the center of this book, Charlotte Light and Dark. But we don’t — we don’t have, like — we don’t have flashbacks to Billy’s childhood. We’re not — we’re not following him through a journey in — in — in his early life at all. He’s not even mentioned, really, in terms of this whole thing that we have with Brenda. It — it’s sort of like the two backstories of these two characters sort of felt like they were written in different rooms, and like no one told each other, like, what they were gonna be. But I’m curious to ask you a little bit about George, and about electroshock, or ECT, and — and what the show seems to be telling us about ECT versus what is actually true about ECT.

CAROLINE: Right. Yeah. I wondered the same thing, really, while watching the show. And I guess all I can — you know, I can only just hazard to guess what was on people’s minds is George comes into the show much later, so maybe there was some learning, maybe they had some conversations about portrayals. I — I’m not sure. But I think, you know, the show does do an excellent job with George of actually showing, like, how these extreme states come about. Because, you know, I’ve certainly had times in my life where I was like hearing voices that people were trying to kill me, and where I barricaded myself into my room. I’ve — I’ve talked to many folks that have had these experiences, like the ones that George has, and the — the show explores. And yes, I have never met someone for whom they hadn’t gotten the message at one point in their lives that the world is a very scary place, and they had to find a way to, like, make control and make sense of things that are so terrible.

SANDY: What’s frustrating about George is that in that episode, we have this sense that this is what’s triggering him. It’s the anniversary of this really gruesome death. And yet in the show, we don’t — no one learns about that, as far as we can tell. He’s not saying: “Oh, here’s my story.” And — and as you’ve alluded to, he’s just given an electrical solution to this problem.

CAROLINE: And it’s — it’s so common that that’s [25:00] how things look in — in the day-to-day. You know, we show up at psych hospitals and it’s, you know — we’re having a really hard time, and there’s just not that attention paid to, like, is this the anniversary of something? You know, what has happened in your life before? What do we need to address and talk through? But yeah, very frequently, you know, people will turn to these really extreme measures — like ECT — and the show really, I think, minimizes — in terms of how it portrays the ECT, they do share a little bit about, like, yeah, you might get a headache, or have some short-term memory loss.

SANDY: Right. There’s a scene where — where Billy and George are kind of sittin’ outside together —

CAROLINE: Oh, I love that scene.

SANDY: — and they kind of just talk for a second about ECT.


GEORGE: I go in. They put me on a bed. They give me some oxygen. They say, “You’re gonna feel a little prick in your hand.” That always makes me laugh. And then the next thing I know, I wake up with the worst headache I’ve ever had in my life.

SANDY: It’s like the only scene where we have multiple people with diagnoses talking to each other.

CAROLINE: That scene is so powerful for me because yes, it is our one moment — in all of Six Feet Under — of peer support.


SANDY: Hey, let me save you a Google. Caroline just said the phrase “peer support,” and I wanna make sure that listeners understand what that is. Peer support is a term that you’ll hear really frequently in alternative and radical mental health circles. It refers to the practice of people who have certain experiences or diagnoses offering one another support, like it sounds, as in a Hearing Voices Network meeting. And in that circle, folks are asked to set aside, you know, psychiatry words, and they’re asked to set aside judgements, and they’re more asked to bring their own experiences and to offer one another support, especially when it comes to what can be the very real challenge of living with voices.


CAROLINE: And it is so profound, the scene where they’re sitting on the porch there and they’re talking about the impacts on their body, of all these treatments, and being in the system. And Billy says to George:


BILLY: Yeah. It’s hard to get your shit together when they’re watching all the time.

GEORGE: [Chuckles] Yeah, it is.

CAROLINE: It’s hard to get your shit together, you know, to paraphrase, when people are constantly seeing you through this lens of pathology. And George turns to Billy and says:


GEORGE: But when no one’s watching, then where are you? Where the fuck are you then?

CAROLINE: And that is when they sing an amazing — they break into, like, this amazing Johnny Cash song —


BILLY AND GEORGE: (singing) Me and little brother, would you join right in there / Singin’ seems to help the troubled soul

CAROLINE: — and like, sort of lift their voices together. And for me it’s like, you know, this moment that feels so familiar to me from, you know, all the times that, like, I’d be in hospital, but we would have these moments, like when we weren’t supposed to be in treatment groups, or therapy, where we just be sitting together like smoking cigarettes and having a conversation, and how those were some of the most healing moments. So yeah, Six Feet Under — I’m glad, you know, that it has at least that five minutes [SANDY laughs] that it gives us to show, kind of, the power of peer support, because mostly it is — it is a show about, you know, these very clinical methods and world views.

SANDY: I’m — I wanna shift a little bit to talking about kind of one of the other — the big manifestations of interior life that is very interesting in this show, and that is the prevalence of ghosts. So Richard Jenkins portrays the Fisher family patriarch, Nathaniel, and except for a few minutes during the pilot episode, he is dead through the course of the series. But his family nonetheless have conversations with him all the time, and in various kinds, particularly his son Nate who’s sort of on this, like, journey to better understand his father. And elsewhere in the series we have characters having conversations, for example, with bodies on the table downstairs that are awaiting their funeral. And so I guess I was curious to ask you a bit, first of all, about this phenomenon of hearing a voice of an ancestor, or a relative, or a loved one who’s deceased. I’ve interviewed people before who hear voices who’ve had recently deceased loved ones who talked to them. I assume this is something you’ve encountered [30:00] quite a bit, right?

CAROLINE: Absolutely. It is probably the most common voice-hearing experience that people have is someone who has — has passed on. Though it’s also really common to hear the voice of a — someone you were in relationship with, but maybe not have them in your life anymore, but still very much have them in — in your awareness, in your consciousness. So yeah, the — the show’s portrayal of that is — is really excellent, and incredibly common experience.

SANDY: And I guess one of the things that’s just noteworthy is that the show doesn’t highlight these interactions as hallucinations or delusions or sort of judge the characters, if that makes sense, for the fact of having a conversation, for example, with a dead client throughout the course of the episode. It — it sort of does this without explaining it, which strikes me as, like, quite impressive, I guess, that they manage to do this without sort of making it something cheap or — or a joke, or making it root for these characters to then be viewed pathologically.

CAROLINE: Yeah. The show doesn’t pass judgement, and it’s just really incredible, I think, how accurately it portrays kind of the diversity and themes of some of the experiences, not only in how they occur, but when they occur. So, you know, it — just looking at the example of David.

SANDY: And David is the middle Fisher child and the one who at the start of the series goes to church with Mom every Sunday and is closeted, still, as a gay man.

CAROLINE: Exactly. David is someone that has a lot of non-consensus reality experiences.

SANDY: Right.

CAROLINE: Yes, they’re people that he has embalmed, like Paco, who was a gang member, and then another murdered teen — a teen that’s murdered because he’s gay, that shows —

SANDY: Yeah, there’s a hate crime victim.

CAROLINE: Exactly. So the way that those — ‘cause I — I totally, like, I know many people whose voices shift when — when they have come out, either as like gay or trans, in — in positive ways, or who, like, systems of oppression, like homophobia, have impacted the voices that they hear. So it’s really powerful the way the show portrays that in David. And it’s really true to life, too, because after the hate crime, you know, the voices are pretty nasty, saying, like, all these slurs —


VOICE: No matter how nice you fix me up, I’m still going to hell. You know it. ‘Cause you’re going there, too.

CAROLINE: But there’s this powerful scene where David stands up at church and he’s reading a psalm about not living in shame.


DAVID: I’ve been ashamed my entire life. I grew up thinking I was unworthy in the eyes of God instead of trusting God. How am I supposed to spread God’s love throughout the love when I deny it to myself? [Single person clapping, turns gradually into thunderous applause]

CAROLINE: You know, he’s a spiritual guy, and he’s talking, you know, in front of his spiritual community about how being out and open and loving who he is as a gay man is — is an expression of his faith and God. And he’s embraced by his community. And we immediately see, the show does a great job of showing how when David does that, in the consensus reality, it changes the way this voice speaks to him in the non-consensus reality. And so in, you know — in my own experience with voices and supporting others, you know, often times when we can stand up for ourselves or be embraced by our community, it’s that that shifts the content of voices much more than just trying to, like, numb the voices with drugs. And the show just does an incredible job with that throughout.

SANDY: Yeah, and we can — as a — as the audience, if we are someone, for example, who’s never thought about voice-hearing, perhaps, before listening to this conversation, Six Feet Under was this incredible vehicle in a sense to sort of normalize this experience. Even viewers who maybe didn’t really read it as that at the time.

CAROLINE: There’s [35:00] so many great scenes that, you know, as someone who has voices, like, you know, when he’ll be down in like the embalming room and someone will walk in and be like, “Who are you talking to?”, that moment where someone, like, kind of breaks in on your conversation that feel, like, so very true to life. But yeah, I love — I love the way that the show portrays sort of the complexity of the experiences, and how they’re intimately connected with our external realities. Because another common thing that happens is, you know, after like a birth or a death in our life, we may revisit some of those old voices that challenged us in the past when there was a big shift in our life. I know for me sometimes I’ve thought, “Oh my god, I thought I resolved this thing.” But, you know, there’s always, you know — there can be a return and a new lesson to learn. So we see that in David, too, when after there’s a significant death — I won’t say who it is — but he has, you know, a return of some of his challenging voices from a past trauma.

SANDY: What you’re talking about, Caroline, made me just want to mention this, because I think there’s something so crucial in, you know, the work you do, and something that I think is — is highlighted in so many ways in this show. And it’s kind of a basic — very basic observation, but in so many cases we would do so much better to locate quote mental illness in systems, in communities, in, you know, oppressive systems particularly, rather than attempt to pinpoint these problems as if they are pathologies within individuals. So, for example, the relationship between homophobia and what we witness David going through, both privately and publicly. And we see sort of the doubleness that he has to occupy as someone who’s closeted, and even after he comes out, you know, it’s not like his own internal homophobia just switches off because he started, you know, bringing his boyfriend around. I’m curious to hear you talk about, I guess, the shift from thinking about a conversation about mental health strictly as one that belongs in sort of the language of medicine or science and kind of elevating it more into a discourse of civil rights.

CAROLINE: Yeah. I — I think it’s a great topic, and, you know, what we see play out in this show is sort of the tension — we have — so in the history of psychiatry, too, like in the twentieth century, there was sort of this tension between is it — is it a biological brain disease, or is it all the mother’s fault? [Laughs]

SANDY: Right.

CAROLINE: And, like, they — they were kind of —

SANDY: The two possibilities.

CAROLINE: Those were the two camps.

SANDY: The only — that’s all I can think of.

CAROLINE: Yeah. So there’s a great scene where Ruth, you know, of course we’ve talked a lot about how, you know, Billy is — is pathologized. There’s a point where he jokes about how this is the Chenoweth family, everything has to be analyzed, diagnosed, and turned into evidence of pathology. And then there’s other scene, you know, with Claire and Ruth — her mother — where Ruth says to Claire:


RUTH: Claire, are you depressed?

CAROLINE: And Claire kinda is just like, “[Scoffs] whatever.” And the mom says:


RUTH: Whatever you’re going through, I hope you don’t blame me. [Door slams]

SANDY: Oh my god. Such classic Ruth.

CAROLINE: Yeah, it’s like the most — it’s classic — it’s the honest parental moment. So, you know, through a lot of the twentieth century it was that: Do we blame the mother or do we blame the biology? And now, you know, I — what I — what I see more of is this movement is gaining steam where we are looking at the broader social implications, in — in who struggles, and how we define that struggle.

SANDY: Let’s talk about spirituality. On the show, especially via Nate, we have — he’s not a church-attending Christian like his brother, and he seems to sort of be on this, like, personal, spiritual journey throughout the show. And you are — if you don’t mind me saying this — beginning your journey to becoming a spiritual leader, as it were — a rabbi.


SANDY: And I’m curious, how does that decision that you’ve made kind of come from your peer work? And what role does, or should, the spiritual play in a quote on quote mental healthcare system?

CAROLINE: Absolutely. So [40:00] for myself, and for a lot of people I meet, like, the things that cause us to end up in the mental health system have to do with crises of meaning: looking for purpose, looking for identity, looking for a spiritual community, or just community in general, looking for tools to deal with our distress. And, you know, the mental health system can do certain things well. It can provide you with an identity, usually in the form of a diagnosis, and it’s really good at providing you with medications. But when it comes to questions of purpose, meaning, identities of strength, tools to deal with distress beyond medication, there can be less of that. And what I’ve found in my own life, my own process of healing, is that spirituality, you know, at it’s best, can provide a lot of those things. It can provide, you know, meaning, identity. So yeah, you know, one of the things that helped me kind of move out of the system, move out of the group home, was — was claiming — reclaiming my Jewish identity. You know, I skated roller derby, my roller derby name was Mazel Tov Cocktail, and like finding the sort of strength — there’s a lot of Nate’s journey I think that is really powerful. I love — I love the portrayal of the — that the show does of many different ways. Because when people die, you know, when we’re dealing with grief and loss, this is a time where, you know, a lot of us do turn to culture and faith and spirituality. And so the show does an amazing job of demonstrating many different cultures, how they engage with death. And you can see Nate’s sort of fascination with that. And he has a close relationship, for a time, with a rabbi. And what’s interesting is when we come close to death, I think that is a time when — when we’re spiritually seeking. And for a lot of folks, you know, that I meet, myself included, times of deep despair, we’re also coming close to death, because we’re considering ending our own life. And I’ve really found, in a lot of ways, the medical model of mental illness to be an insufficient lens to look at human life and pain. And, you know, I think there’s some much broader lenses available to us in — in spiritual frameworks.

SANDY: Yeah. And part of what’s fun, when you mention the different communities that we get to watch mourn on this show, is it’s not just various religious faiths or ethnic groups or national backgrounds. It’s like porn stars, it’s like bikers, you know? One of the things that rewatching it I was thinking about was actually something that the last time I saw you was in The Hague in the Netherlands at the World Congress for Voice-Hearers. And you gave an excellent keynote address at the Voice-Hearing World Congress, the tenth annual meeting of voice-hearers. And one of the things that you touched on during that talk, and that I heard, you know, alluded to in various ways through that conference and — and other times that I’ve spent time, you know, around the voice-hearing movement, is talking about the full range of human emotion, and the right to experience the full range of human emotion. That when we are thinking about, oh, what would full civil rights and equality look like for voice-hearers or people who see visions or hold, you know, what are thought to be unusual or extreme beliefs? Well, what would it — what would it be like if we could actually all just experience whatever we experience and feel whatever we feel? And I think like Six Feet Under is this interesting celebration, in a way, of a really big range of human emotion, perhaps much bigger than I had ever seen on television before and maybe since. So I guess I was curious to hear you talk a little bit about that idea of — of the right to — to feel.

CAROLINE: Yeah. One of the big shifts that I think is gonna be necessary to make — and I’m worried we’re getting farther from this with like social media, I think people are becoming more isolated and their lives are becoming more curated — is to allow for that human right for the full expression of emotions, and to feel like I’m allowed to be sad, I’m allowed to be angry, and that I can [45:00] still be fully embraced by my community. And I think a show like Six Feet Under can do a great service to us by portraying, like, all these different flavors and dimensions of pain and allowing us to really see ourselves, because I think it is in all of us, but, you know, sometimes if I don’t see something represented, I might not have any language for it. So one of the things that’s benefitted me from being a part of the hearing voices movement is hearing people talk about the content of their voices, the emotions their voices heard. And when people were having those open discussions, it allowed me to do it because I wasn’t quite given the language. In the medical model it’s like, you know, they’re auditory hallucinations, and you’re not supposed to really explore what they mean. So having shows, having role models that show us how to, you know, open that dialogue, I think is gonna be really healing.


CASH: Daddy sang bass (Mama sang tenor) / Me and little brother would join right in there / Singin' seems to help a troubled soul / One of these days and it won't be long / I'll rejoin them in a song / I'm gonna join the family circle at the throne

SANDY: We have a last segment on Mad Chat that is called What’s Helping Today? And we’ll just each share one thing — it can be anything — what’s helping you today? Do you want to go first?

CAROLINE: I don’t know. I think it’s really exciting to be kind of just having this conversation right now about art, essentially. You know, as someone who, you know, I — I wasn’t successful academically in life, there were a lot of conversations that I wasn’t privy to, you know. A lot of times when I was on the psych unit it’s like you’re supposed to talk about yourself and focus on your treatment. For me, I think it’s really — there’s something powerfully healing to be invited into this discussion about, you know, portrayals of emotion and loss. So yeah, I would say connecting with you. And gosh, I just love to be able to talk about death, too. That really works for me, since it’s gonna happen to all of us. You know, that’s working for me right now, to really just connect around some of these taboo topics that I was left out of in the past.

SANDY: Right, yeah. Talking about death is — is — it can be so powerful.

CAROLINE: Absolutely.

SANDY: And I think for me what’s helping today — I want to shout out tarot cards.


SANDY: I — I have — I have over the last year or couple of years gotten into reading tarot cards for others and myself. And I was reading cards earlier I think ‘cause I was anxious or nervous, you know, around recording. And it was — it was one of those things where I was — I was doing it and it always ends up yielding something, you know, when I look at the cards or I sit with them and I sort of think about the stories and I think about what the symbols are — are causing me to reflect on in my own life. And I’m someone with no religious or spiritual upbringing of any kind. Like, I came from a family that didn’t even explain what atheism was, and celebrated Christmas in like a capitalism fashion, but like, no Jesus. And so I’ve always struggled to, I think, give myself permission to even try something as light as tarot cards. But it has been a really wonderful kind of grounding mechanism, in a way, to — to just allow myself to maybe get out of my own head or my own kind of settled meanings for a moment. So —

CAROLINE: I love tarot cards.

SANDY: I’m glad to hear it. We should read tarot sometime.

CAROLINE: Yeah. Do you want to share, like — did you pull a particular card today?

SANDY: In the first — I — I did like a three card draw — so sort of like past, you know, present, and the future, or like, you know, set up, action, result. And so in that first one, I had hermit.

CAROLINE: Oh, wow.

SANDY: You know, which — which I — I kind of, I think, is accurate. This is an idea for a podcast I’ve carried around by myself for a couple of years and, you know, have been very, very slowly — the image on my hermit card is a turtle with his head pulled all the way — I feel like I’ve very slowly poked my head out. And the middle card is that — the — the disks, like it’s like the prosperity one, and it’s sort of a branch in my set.

CAROLINE: Oh, yeah.

SANDY: And that felt really cool ‘cause hopefully it means someone’s about to hand us a lot of money to do this podcast.

CAROLINE: Yeah! That’s a good card.

SANDY: And then the final one is a card that was about — it’s like a [50:00] single match that’s sort of lit, and all the other wands are kind of around it. And I think it was a card about, you know, kind of standing up for — for what you know is right or sort of forging a way. And that really speaks, I think, to the fact that on this show, I want to change up the metaphors, you know? I want to — I want to switch up the language, I want to bring people like you to this conversation, because it’s really important, I think, that especially people who’ve never really thought a lick about mental health become aware of the work that you and your peers are doing world-wide to completely change what we think about when we think about mental health, and how to help, you know, one another. How to make sure we don’t end up in these really bad places, or how to find our way back if we do.

CAROLINE: That sounds like an awesome reading. I’m excited for the spark, the fire that this is gonna start.

SANDY: [Laughs] I’m gonna read some credits.

CAROLINE: Big Wand Energy.

SANDY: Big Wand Energy.


SANDY: Mad Chat is produced by Lee Mengistu. Theme music by Lee Mengistu and Ruthie Williams. Our Social Media and Community Manager is Annie Mok. Logo and other design work by Chris Ritter. Thanks today to New England Public Radio. Engineering assistance from my unpaid intern, Rob Dubbin. Episode transcriptions by Alex Cornacchia; find those transcripts at our website: If you want to continue the chat online, follow @madchatshow on Twitter, Instagram, or Facebook. I’m Sandy Allen. This is Mad Chat. Thanks for listening. Talk to you again in three weeks.