“Rehab was supposed to be a fresh start” was doomed to fail.

What is Rehabilitation Psychology?

Rehabilitation psychology is a specialty area of psychology aimed at maximizing the independence, functional status, health, and social participation of individuals with disabilities and chronic health conditions (Cox et al., 2010). There is an element of rehabilitation in the fields of clinical and counseling psychology, as they involve the recuperation of individuals dealing with mental disorders and their reintegration into society. In this blog, the case of rehabilitation from substance use/abuse disorders will be analyzed; more specifically, the rehabilitation shown in Bojack Horseman, an adult comedy-drama TV series.

A Brief about Bojack

The protagonist of the show, Bojack Horseman, is a deeply troubled individual. His traumatic childhood leads to unhealthy coping mechanisms, the most prominent one being Alcohol Use Disorder (AUD). Throughout the six series, we see the very realistic character of Bojack Horseman grapple with the gordian knots of life, and attempt to cut them, before eventually falling back on old harmful patterns. 

In the first episode of the final season—titled “A horse walks into a rehab”—Bojack is taken to a Rehabilitation Centre in Malibu by his close friend Diane. This is also where the infamous dialogue “Rehab was supposed to be a fresh start,” comes from. This blog aims to analyze his experience in the center and compare it to real life alcohol rehabilitation.

Alcohol Rehabilitation

Alcohol Rehabilitation can be primarily broken down in three steps: detoxification, rehabilitation, and maintainance (Galbicsek, 2014). When an individual with any kind of substance use disorder first reaches out for professional help, the initial concern is to slowly wean them off the substance; this is detoxification, a process where the toxin is allowed to escape the body. 

However, this can cause withdrawal, and make the individual prone to relapse. Symptoms of Alcohol withdrawal include mild to moderate tremors, irritability, anxiety, or agitation. The symptoms can also manifest severely as delirium tremens, hallucinations, and seizures (Saitz, 1998). Therefore, detoxification is mostly done in in-patient facilities where the environmental triggers can be controlled, and the patient can be monitored and escorted gently into sobriety. In the show, this process is done successfully for Bojack Horseman. However, we can see it fails in some cases, as patients like Jameson—a minor character in the show—struggle with withdrawal and find ways to use the substance again. 

Next comes rehabilitation, which also includes counseling, and other therapy. We see Bojack attend group therapy with other patients, have one-to-one sessions with Doctor Champ, engage in mindfulness activities, etc. Although attempts were made from both sides, Doctor Champ fails to tap into Bojack’s true emotions and intentions, or his past experiences or history. In several instances in the episode, we see Bojack deflecting from important parts of his trauma by making jokes. We can also see how he never truly connects with any of the group therapy or activities, as he eventually points out that all the patients are lying, and many of them have managed to sneak alcohol in the facility. Therefore, we might be able to conclude that Bojack overcame his addiction due to his own will-power, and not necessarily through the counseling and therapy he went through.

And lastly, there's maintenance. The show completely missed the representation of this factor. We never see Bojack attending any follow-up sessions or visiting a professional again. His will-power keeps him afloat for a while, but he eventually drowns back into his addiction—both literally and metaphorically. The recovery rates of alcoholism are modest; less than half relapse after 1 year of sobriety, and only around 15% relapse after 5 years (Galbicsek, 2014). However, we see Bojack fall back onto unhealthy patterns as a result of unresolved trauma and the guilt of his own mistakes.

Successes and Short-comings 

Alcoholism is a highly stigmatized issue in modern society. In my opinion, Bojack Horseman wonderfully describes the struggles and the context behind what leads to substance use disorders. It does not romanticize or undermine the severity of the illness, but rather aims to show its true nature, including the parts where the individual may fail to recover. However, the treatment lacked in many ways. There was a deprivation of appropriate psycho-education, a majority of Bojack's issues remained unresolved and unaddressed, there was no maintenance or suggestions of support groups such as Alcoholics Anonymous (AA). 

Another ethical issue that Bojack himself pointed out in the show, was the incredibly expensive cost of the treatment—$100,000 for a six-week package. Surprisingly, this cost is actually less than what the prices are in Malibu in real life, as they can range from $38,000 to $80,000 per month (Mueller, 2020).  In India, the prices may range from ₹1500 to ₹2,00,000  (Rathod, 2021). Although ₹1500 sounds like a very minimal amount, this cost might still be too expensive for India’s economically weaker populations, who might actually be more prone to substance use disorders. Besides, the cheaper costs might also come with sub-par facilities and treatment, which further makes effective rehabilitation difficult.

Conclusion 

Alcoholism, and any other Substance Use Disorder is a complex problem to solve. It requires utmost care and holistic treatment of the patients, during the active detoxification and counseling, and also after the patient has left the facility. Individuals suffering from such disorders need support and motivation, rather than scorn or judgment. Bojack Horseman displays the struggles of a patient brilliantly, however, the treatment shown falls short in many aspects. Let us try to change the tide in the coming years, by building empathy and understanding of the problem, asking for help ourselves, and supporting others who may need it; try to spread awareness whenever we can. If you, or someone you know suffers from addiction, please call this National Toll Free drug de-addiction helpline Number: 1800-11-0031.

About the Author

Zeba Chogle, Head, PsyCreative Column

Psychology committee, JDSOLA, NMIMS.

Zeba is an 18 year old student of Applied Psychology in NMIMS, Vile Parle. Her favorite word is "buoyancy". To her, it means the ability to stay afloat even when all odds are against you, it means to maintain balance with grace and determination, it means to have an undeniable, stupid kind of faith that you'll never sink. She tries to follow these principles in everyday life. Although extremely creative and imaginative, she tries to master the ability to remain rational and practical in situations that require so. In art and writing, she has found solace and comfort. In academia, she finds resolve and hope. She imagines herself perched upon a tightrope, and aims to make it all the way through one day.

References 

Aron, E., Bob-Waksberg, R. (Writers), & Hollingsworth, M. (Director). (2016, July 22). A horse walks into a rehab (Season 6, Episode 1) [TV series episode]. In R. Bob-Waksberg, N. Bright, S. A. Cohen, B. Fetter, J. Wiseman, W. Arnett, A. Paul, & A. Weil (Executive Producers), BoJack Horseman. Tornante Television; Boxer vs. Raptor; ShadowMachine.

Bob-Waksberg, R., Tafel, A. (Writers), & Hollingsworth, M. (Director). (2016, July 22). The View from Halfway Down (Season 6, Episode 15) [TV series episode]. In R. Bob-Waksberg, N. Bright, S. A. Cohen, B. Fetter, J. Wiseman, W. Arnett, A. Paul, & A. Weil (Executive Producers), BoJack Horseman. Tornante Television; Boxer vs. Raptor; ShadowMachine.

Cox, D. R., Hess, D. W., Hibbard, M. R., Layman, D. E., & Stewart, R. K. (2010). Specialty practice in rehabilitation psychology. Professional Psychology: Research and Practice, 41(1), 82–88. https://doi.org/10.1037/a0016411

Galbicsek, C. (2014). Treating Alcoholism - Alcohol Rehab Guide. Alcohol Rehab Guide. https://www.alcoholrehabguide.org/treatment/

Mueller, O. (2020, January 16). What Does It Cost to Go to Rehab in Malibu (And Why Do So Many People Pay)? Recovery.com; Recovery.com. https://recovery.com/resources/what-does-it-cost-to-go-to-rehab-in-malibu-and-why-do-so-many-people-pay/

‌Rathod, R. (2021, April 20). How much does rehab cost? [Review of How much does rehab cost?]. Rehabs.in. https://rehabs.in/news/how-much-does-rehab-cost/

‌Saitz, R. (1998). Introduction to Alcohol Withdrawal. Alcohol Health and Research World, 22(1), 5–12. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6761824/