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This article contains spoilers through all eight episodes of Russian Doll.

“No, no, no, no, no, we do not use that word in this house.”

So says Ruth, the no-nonsense parental guardian of Nadia, the ever-dying star of Netflix’s psychedelic triumph Russian Doll. Ruth, a therapist, actually says it twice—varying the number of nos each time—in separate “loops,” in separate episodes, when confronted with the forbidden word: crazy.

Ruth’s rule fits with changing mores, as health professionals have tried to retire the term crazy for being insulting to people with mental illness. But Ruth and Nadia share a particularly intimate understanding of the harm the word can do. With the same humanity and attention to detail that it vests in all its intricacies, Russian Doll unwinds how the incoherent, shame-laden cultural image of mental illness diverges from—and worsens—the real thing.

As she periodically expires and regenerates at her 36th birthday party, Nadia might be experiencing a drug trip, a video-game simulation, a spiritual trial, or a time-space glitch. Of all the possibilities, though, there’s one that frightens Nadia the most: What if it’s a psychotic break? When her friend Maxine calls her “crazy,” Nadia hisses back, “You know I hate it when people call me ‘crazy.’” When Maxine does it again, Nadia marches over to the uncooked chicken her friend has lovingly prepared and hurls it to the ground. That’s how much she doesn’t like the word.

The antipathy stems from childhood. Nadia’s mother, Lenora, feverishly obsessed over nonsensical quests: breaking the mirrors in her house, buying up all the watermelons from bodegas around town, attempting to acquire the Betty Boop trademark. She also swerved emotionally, lavishing love on her daughter but then showing frightening callousness toward her. “What was her diagnosis? What the fuck was wrong with her?” Nadia asks in the present, to which Ruth replies, “Do not confuse your mother with her damage.”

Lenora’s damage, though, clearly damaged Nadia, and in more than one way. Her mom’s episodes appear to have traumatized her, and Nadia refuses to talk about her memories until a mere glimpse of family photos she’s hidden under the bed unleashes a series of flashbacks. Her mother’s story also soaked Nadia with shame, because she believes her secret desire to live with Ruth rather than Lenora is what killed her mom. This guilt has almost literally short-circuited Nadia’s life, and restoring linear time requires her to finally confront it—and forgive herself—in a sit-down with Ruth.

But the guilt and trauma have also short-circuited Nadia’s life figuratively, causing her to close off from deep human connection. You see signs of a rut, of stuck-ness, in her reluctance to meet her ex’s young daughter, in Nadia’s stated misanthropy (“Other people are garbage”), and in what Ruth says during their climactic chat about Lenora’s death: “Sweetheart, where is that gorgeous piece of you pushing to be a part of this world?” At ComicsVerse, in one example of the insightful Russian Doll writing done by mental-health professionals, the therapist Tim Stevens explains:

Even if the effect of the trauma has not proven far-reaching enough to qualify [people who experienced trauma] for a post–Traumatic Stress Disorder diagnosis (PTSD)—or the more short-term Acute Stress Disorder—such people can tell you how much their life has been tossed into upheaval. Moreover, they can point to tricks or mechanisms they have developed to avoid retraumatization. In fact, for many, they are not just avoiding retraumatization but anything that’s four steps away from it. Live in that place long enough and the avoidance becomes rote.

Nadia might or might not have a diagnosable condition, but inherited trauma like hers is the sort of thing that psychology and psychiatry seeks to treat, as Russian Doll points out through the character of her parental guardian. Professionally, Ruth practices a form of therapy called eye movement desensitization and reprocessing (EMDR) that is meant to assist with difficult memories. Viewers see it in action during one short scene of Ruth with a male patient. A device flashes lights from side to side—that’s the “eye movement” component—as the man revisits what sounds like a frightening memory from his school years and then turns to the troubles in his marriage.

But Nadia doesn’t appear to be the therapy-going sort, which is one of the few things she has in common with Alan, the man who she discovers is stuck in the same time loop she is. Buttoned-up and routine-obsessed, he sometimes snaps into violent anger, and it’s eventually revealed that his loops began when he killed himself. Yet he repeatedly vows that he can handle his mental health without help. Like Nadia, he hates being called crazy. As someone obsessed with surface images—his physique, his tidy home—perhaps his aversion stems from fear of undoing the stolid image he wants to project.

Such aversion might, in turn, be tied to the stigmas bound up in the idea of crazy. The term sweeps together the extreme and the ordinary, the debilitating and the treatable. Its slur-like application in everyday speech renders behaviors as attributes, implying mental illness as necessarily dangerous, congenital, and weak. Seriously threatening conditions are made unduly comic, more commonplace ones are portrayed as bizarre, and in all cases seeking treatment becomes socially fraught.

This holds for many of crazy’s synonyms too. Throughout Nadia’s life, when she has acted with the outlandish mannerisms that make her so charming, one can assume that certain people have called her “whacko.” When she has tried dealing with her traumatic struggles, too, she’s likely been called “nuts” (look at how her ex, John, immediately writes her off when she confesses that she’s terrified and believes herself to be dead). But in Lenora, Nadia has seen a particularly distressing version of what those words can encompass, making it so that a mother cannot safely parent her child. Her great fear is that she shares that condition.

“Is there a history of mental illness in your family?” a drug-world doctor asks Nadia when she comes searching for explanations for her dying-and-reviving. She spits back, “That’s not it. No, no no, it’s not me. All right, understand, it cannot be me.” Yet within a few loops, she’s come to grapple with the suspicion that she’s indeed having a breakdown akin to what Lenora went through. She goes to see Ruth, who carefully asks Nadia to define the scope of what she’s experiencing. Nadia says their psychiatric safe word—“record player”—and has herself committed.

But in the ambulance ride with eerily familiar paramedics, she seems to realize that whatever her problems, this isn’t the treatment. The vehicle crashes, and she’s regenerated back in her friend’s apartment. “Nobody locks us up,” she says into the bathroom mirror.

What is the treatment? The drug-packing doctor, for what it’s worth, has some interesting ideas. Effusing about the ketamine in a joint Nadia smoked, he explains that the horse anesthetic and club drug might be a breakthrough medicine for depression sufferers. Fact-check: true, and an FDA panel just this month recommended a ketamine-laced nasal spray to go to market. At Vox, Alice Levitt described taking an intravenous infusion to treat her suicidal thoughts and ending up in a “K-hole”—an immersive psychedelic experience—that seemed to help her symptoms in the long term. “Users retreat into their minds and experience hallucinations, sometimes reporting religious experiences or even a feeling some compare to rebirth,” she wrote.

Levitt’s description is fascinating in the context of Russian Doll, and raises the possibility that Nadia’s adventure really is a ketamine vision involving a dream-Alan and a dream-Ruth. But the brilliance of the show lies partly in how it could be equally true that God put her through a series of loops, or a quantum bug did, or a computer did. In any scenario, the takeaway is the same. She had to get past the baggage around crazy so as to look in the mirror—an object Ruth likened to therapy—honestly. This took opening up to others, and it took dealing with her past. Having done so, she was then able to help someone else who, as everyone does, needed a mirror of his own.

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