How a Show About a Cartoon Horse in Hollywood Gets Miscarriages Right

How a Show About a Cartoon Horse in Hollywood Gets Miscarriages Right
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In many ways, episode nine, “Ruthie,” of the fourth season of the Netflix series “Bojack Horseman” is typical: animal puns, jokes about sex, and diatribes against honeydew as a useless addition to a fruit bowl. But it also tackles a topic that goes uncovered in an irreverent comedy: the devastating loss of a pregnancy.

The series centers on an anthropomorphic horse in Hollywood, Bojack Horseman. The world, populated by animals and humans living side by side, presents fertile territory for satire of modern life. Targets include everything from Hollywood celebrities to modern marriage to Sartre. (“His philosophical arguments helped many tyrannical regimes justify overt cruelty,” says Bojack. “Also, the French smell and I hate them.”) The show is unabashedly goofy.

Bojack is an alcoholic, depressed former star of a 1990s family sitcom. Think Scott Baio or John Stamos with a heavy dose of self-loathing. He is combination hero and antihero, equal parts destructive to all those around him and sympathetic for his desire to be a better horse. The series has been moving, however, from his myopic but strangely lovable view since season two, now exploring the inner lives of those who surround him.

No episode has been as remarkable as “Ruthie,” where we enter the world of Princess Carolyn, a pink Persian cat who is Bojack’s former agent. Throughout the series, we’ve seen Princess Carolyn make difficult decisions between career advancement and personal relationships. She is tough and dedicated to her work and clients. Princess Carolyn is now in a happy relationship with Ralph (a mouse who runs a greeting card company) and pregnant.

We meet her waiting patiently in the office of her tone-deaf obstetrician (an albino rhino gyno). What happens next is a tragic, yet empathic depiction of a moment that occurs for 1 in 4 women:

Dr. Rhino: “I’m trying to think of the best way to put this…As Charles Lindbergh would say, sometimes you fly an airplane, sometimes you lose a baby. In this case you didn’t fly the airplane.”
Princess Carolyn: “Wait, what?”
Dr. Rhino: “Your pregnancy is no longer viable.”
Princess Carolyn: “Well…how do we make it viable again? How did this happen?”
Dr. Rhino: “Oh goodness, I don’t know! I wouldn’t beat yourself up; miscarriages happen for so many reasons. There’s nothing medically wrong with you. Maybe you just wanted the baby too much. Maybe you didn’t deserve it because you were unkind once. Maybe you ran afoul of a trickster God, who is now exacting revenge.”
Princess Carolyn: “Oof, this is a lot…”
Dr. Rhino: “Not for me. This is my job, so pretty regular day…Do you want Darlene up front to call someone to drive you home?”
Princess Carolyn: “No! I’m OK! I don’t need anyone.”

The bedside manner-lacking doctor is unfortunately far too common. As a medical student, I’ve often seen medical jargon replace plain English, particularly in times of loss. Here, Dr. Rhino refers to “viability,” but in the hospital I’ve heard obtuse medical terminology like “spontaneous abortion,” “no longer intact,” or “early fetal demise” to refer to a miscarriage. Such language creates unnecessary confusion and emotional detachment.

Additionally, Dr. Rhino displays the signs of burnout and desensitization that many physicians do after constant contact with death. This renders him less able to be an empathetic provider for Princess Carolyn on a “pretty regular day” for him. Only 45 percent of patients report adequate emotional support from doctors after a miscarriage.

The grief response, which often includes anger, despair, hopelessness, and exhaustion, is strongest within the four to six weeks of the miscarriage. Research shows that the trauma from a miscarriage is often underestimated, and can for last years.

Attachment theory is key: bonding to a developing fetus often happens from conception, during planning and confirmation of the pregnancy, and acceptance of the fetus as an individual. A hopeful pregnancy can lead to a state of yearning for that relationship that has been lost.

Princess Carolyn experiences this grief response with realism. She pushes away those closest to her, blames herself, and fantasizes about great-granddaughters. She finds it difficult to talk to her partner Ralph as nearly 40 percent of women do to their partners after a miscarriage. Instead, Princess Carolyn pushes him away, initially not telling him about her doctor’s visit, then later kicking him out of her apartment. It’s an informed portrayal of the real trauma many expectant mothers go through during a miscarriage, but this portrayal comes in a dark comedy about a talking cartoon horse.

Having open conversations with loved ones and doctors and depictions in the media about these profound yet common forms of loss is essential. The language to discuss such difficult issues will not come easily, as Princess Carolyn’s experience shows. Confronting and normalizing such losses as “Bojack Horseman” has done in “Ruthie” will help bring losses that are often layered with stigma and shame into the light, and deepen our empathy for those who are going through them.

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