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Neurology a Little Too Up Close and Personal — Why ‘Black Box’ Is Must-Not-See TV

Avitzur, Orly, MD, FAAN

doi: 10.1097/01.NT.0000449808.98134.a1
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Dr. Orly Avitzur reviews a new ABC series that features a beautiful, brilliant neurologist who happens to be bipolar.

It's been eight years since prime time featured a medical drama focused on a neurology team, so when I heard ABC was about to release “Black Box,” a show touted to highlight enigmatic neurological cases that expose the ultimate mystery of the brain, I was eager to check it out. Clearly, it's time for the nation to recognize the value of a neurologist, and what better vehicle than an American television series!

The premiere, which appeared on April 24, stars Kelly Reilly as Dr. Catherine Black, a world-famous neurologist, who is both genius and gorgeous, and who was recently named by Newsweek “one of the 100 most prominent people in medicine.” The promos promise “medical stories that are moving, bizarre, and a visual feast in a brand new, cutting edge ABC drama series.” There is no shortage of hype, but I think one plug is undeniably true: The brain is the source of everything.

Dr. Black is the director of the Neuroscience Research and Treatment Center in New York City, a position which has earned her the nickname “The Marco Polo of the Brain.” Her institution, easily recognizable as the less-than-fictitious Columbia University Medical Center, where a television crew was spotted filming last December, is dubbed “The Cube.” (This is no relation to the 1997 horror film of the same name, depicting seven complete strangers involuntarily placed in an endless Kafkaesque maze containing deadly traps.)

Inside The Cube's hollowed halls — yes, I mean hollowed, as in vacuous and devoid of substance — this neurologist draws patients from all over the world, brilliantly solving cases no one else can touch.

Alas, there is one hook: Dr. Black is bipolar and likes going off her meds, allowing the writers to showcase the doctor during her sex-crazed, self-destructive manic breaks, chock-full of pressured speech, delusions of grandeur, disordered thinking, and vivid hallucinations. “A freaking rocket ride,” Dr. Black confesses to her unquestionably medically necessary psychiatrist (played by Vanessa Redgrave), adding, “If you want to know the truth, I've never had a better time.”

After seeing her first on-screen patient, an 18-year-old physics major who develops a sudden compulsion to draw, Dr. Black needs initial convincing by the parents that he is not schizophrenic, the conclusion arrived at by the emergency department. Her mentor also leans towards the diagnosis, but when she describes an absence seizure — she may have said absent, but I am giving her the benefit of the doubt — that she herself, witnessed, he responds, “You surpassed your teacher long ago, do what you think is best,” so Dr. Black orders a full lab work-up, and both CT and MRI scans.

Although the patient spirals out of control, Dr. Black quickly gains his trust, by exposing her forearm, replete with evidence of her own manic hypergraphia. Later, when a guitar-playing tech announces she has bad news — the patient has a brain tumor — Dr. Black cries out victoriously, “Ye-es!”

Perhaps it's no surprise that Dr. Black's social life is a mess. She seems to have a great boyfriend who wants to marry her, until she finally confesses her condition. “I have a history of noncompliance,” she admits, “…because it's an incredible high. When I'm ramping up, I do my best work, life is beautiful, I feel like I could conquer the world, and sometimes, [drum roll, please]…I do very bad things.”

This opens the plotline to a flashback with Dr. Black as a pregnant teen, begging her then-boyfriend, “This is your baby, too, Johnny, don't leeeeave me.” Sadly, by the end of episode one, her initially rational partner, professes that he liked her most recent bout of mania for the great sex that accompanied it, closing the door for any hope Dr. Black will stay on her lithium, but allowing hunky David Ajala to keep his TV role secure as Will, the enabler.

Like the CBS series, “3 lbs,” starring Indira Varma as a confident, reassuring neurologist, who had dispassionate Stanley Tucci for her neurosurgical sidekick, this show also has a detached neurosurgeon in a lead role — Dr. Ian Bickman, played by the dashing Ditch Davey. [”3 lbs” lasted three shows before it was cancelled in November of 2006.] Arriving on scene as “the new can opener” nicknamed “BIG-man” for unambiguous reasons, this chief of neurosurgery, is more cartoon caricature than human being. Depicted as a modafinil-popping sexual predator, introduced after a marathon super-cool-never-performed-before operation, when Dr. Black presents her temporo-limbic tumor patient, the ensuing confrontation is a stereotype on steroids. After a mere glance at the films, Dr. Bickman says, “It's surgically inoperable, but I could introduce LID, no radiation, no skull flap.” And when Dr. Black expresses some doubt, he responds, “I got incredible stats; if I say no problem, no problem.”

I showed this clip to my own neurosurgical colleague and neither of us could make out the reference — he suggested LIFT? LIP? — a neologism clearly referring to a cutting-edge interventional technique found only in the imagination of script writers. About one thing we did agree, neither of our fictional counterparts were remotely realistic or flattering to our respective professions. (I spared him a subsequent episode in which it was disclosed that a huge percentage of neurosurgeons are functional psychopaths and during which Dr. Bickman breaks scrub to push the chief of obstetrics out of the OR, leaving the neurosurgeon to perform an emergency C-section.)

“You always get so worked up in defense of your patients, I mean it's cute, but take my advice and detach, emotions get in the way of everything,” warns Dr. Bickman before he leaves, foreshadowing their first sexual encounter in a medication closet.

If you've heard enough, I understand, but I still had two DVDs to view and the first episode was not yet over. Wincing through another 90 minutes of soap opera plot lines punctuated by melodramatic music, sensational overacting, and cliché dialogue (in which Dr. Black uses a repulsive little-girl voice to comfort her patients), I sat through a case about a lady with Lewy body dementia who hallucinates dwarfs, a woman with Capgras delusion as well a history of LBD — lesbian bed death, according to the show's writers who have a predilection for both urban myths as well as medical eponyms — a homeless shelter volunteer with hemi-neglect due to parietal tuberculoma, for which the brainy Drs. Black-Bickman duo try to perform a lumbar puncture just before she herniates.

These were followed by a makeup artist with cerebral achromatopsia — pronounced cerebral pharmatopia by Dr. Black, who, as it's clear by now, flies, along with the rest of the cast, sans medical consultants — a condition cured by a synesthesia machine reverse-engineered at The Cube to translate color into sound. Finally, there is an opera singer with live ammo lodged in her brain, for which the building was evacuated and power shut off, forcing Dr. Bickman to extract the explosive in the dark, guided only by Dr. Black's knowledge of neuroanatomy and a recent review of the CT scan. (At the end of that scene I thought my own head would explode if I had to watch even one minute more of episode 7.)

In a rant-message left on her psychiatrist's answering machine after giving a speech at the Neurological Institute of America, a familiar-sounding organization, Dr. Black boasts, “Every man in the room wanted to sleep with me and every woman wanted to be me.” While I would like a huge office with foosball, an embarrassment of flat-screen TVs imaging 3-D models of the brain, and cool sci-fi technology, to be Catherine Black? Uh, not so much.

Dr. Avitzur, an associate editor of Neurology Today and chair of the AAN Medical Economics and Management Committee, is a neurologist in private practice in Tarrytown, NY, who holds academic appointments at Yale University School of Medicine and New York Medical College.

© 2014 American Academy of Neurology