What Physicians Can Learn From 'Painkiller' (2023)


The series explores the origins of the first opioid crisis in the United States.

Victor Moussa AdobeStock

Victor Moussa AdobeStock

The recent Netflix TV series Painkiller (2023) depicts the first opioid crisis in the United States. The plot merges an article by Patrick Keefe—“The Family That Built an Empire of Pain”—and a book by Barry Meier—Pain Killer: An Empire of Deceit and the Origin of America’s Opioid Epidemic.

The series explores the dynamics originating the first opioid epidemic in the 1990s and holds the Sackler family, owners of Purdue Pharma, responsible for it while denouncing the deceitful marketing strategies they used to sell the addictive drug oxycontin.

The story is told in a mixed resemblance to Hollywood’s academy winner The Big Short (2015) and Scorsese’s mafia films. Most of the characters are fictional and contrast with real testimonies of victims from the epidemic at the beginning of each episode. The result nonetheless seems a little in-cohesive.

Throughout the series, we can see how 1 family is destroyed after the father is prescribed oxycontin following a back surgery intertwined with the story of Richard Sackler and the steps he took to build his “empire of deceit.” The series does a good job of making the viewer frustrated at seeing how a group of psychopathic businessmen become filthy rich by causing major damage in society.

Furthermore, it destroys the idea of human integrity: Everyone has a price, and everyone is corruptible by money. The spectator is left in an existential crisis, only to be rescued by the protagonist, Edie Flowers—a lawyer whose family was affected by the crack epidemic and brings the case against Purdue Pharma.

Painkiller has a villain, Richard Sackler, and a heroine, Edie Flowers. Richard is the son of Raymond Sackler and nephew of Arthur and Mortimer Sackler, the patriarchs who bought Purdue Pharma, starting the Sackler dynasty. Arthur Sackler is inaccurately portrayed as a frivolous psychiatrist who practiced lobotomy before coming up with the idea of marketing thorazine. After dying of a heart attack, his nephew took over the company; however, his hostile ghost will appear to Richard Sackler throughout the series to remind him of the legacy of the family.

Richard seems to have an unresolved Oedipus complex when dealing with the introjection of his uncle and his family’s legacy as a bad object and an inferiority complex.

Psychiatrically, that relates to his narcissism, his obsession with greed and power, and his lack of remorse for the impact and consequences of his practices, deeming him incapacitated to feel empathy for anyone. However, the repression is not always effective and the neurosis here is manifested in the spirit of his uncle, who torments him reminding him of his failure to keep the family legacy.

In contrast, Edie Flowers is a victim of the prior crack epidemic. As a result of it, her mother died, and her brother went to jail. Edie and her brother became estranged. She blamed him for selling crack to her mom. Now, as an adult and as a lawyer, she will have an opportunity to redeem and heal with an act of altruism. By bringing a case against the Sackler family, she can restore justice and undo the guilt of not having saved her family.

The TV series is effective at expanding solidarity for the victims of the first opioid epidemic and the subsequent epidemics. However, it is told in a sensationalized manner, leaving the viewer with the biased idea that 1 individual could be responsible for the whole current opioid problem in North America. As we know, in the real world, the factors related to the current opioid crisis in society are much more complex and the individuals are neither all good nor all bad.

However, as physicians, we can learn a few lessons from Painkiller. Marketing aims to sell, and often at the cost of offering biased science, advice, and practice. It is our responsibility to read and critique what we are taught and what we read, to stay humble, and to constantly search truth.

At an individual level, we must evaluate and foresee the impact that prescription patterns of opioids, benzodiazepines, stimulants, and antipsychotics will have on our patients and our society in both the short and the long term. As clinicians, we are an important and essential element in the chain, and thus we are responsible.

Dr Espí Forcén is founder of The Journal of Humanistic Psychiatry. For more information, see Dr Espi Forcen’s book, Monsters, Demons and Psychopaths: Psychiatry and Horror Film. Podcast: El Último Humanista: https://elultimohumanista.libsyn.com

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