There was no fugue state. I remember everything.—Walter White, Season 2, Episode 3: “Bit by a Dead Bee”
It’s not all cold-hearted chemistry and explosive physics at work in Breaking Bad. The reason that viewers get so invested with Walter White and his slow descent into villainy has much more to do with character interactions than chemical reactions. Walt’s increasingly violent and selfish choices come with unavoidable blowback that affects not only Walt himself but also the people around him, friends and enemies alike. Sometimes these effects manifest physically, as is often the case for antagonists who cross Walt’s path and are permanently put to rest, but those who survive his villainy are left with their own invisible scars from emotional trauma.
There’s a psychological tension that runs throughout the entire series, and it’s portrayed in different ways. Sometimes, as in his infamous fugue state, Walt uses his odd and questionable behavior as a means to an end in order to bail him out of trouble or provide an alibi for his criminal misdeeds. And other times, innocent bystanders are caught in the crossfire, often with devastating psychological effects. Breaking Bad’s most extreme example of the far-reaching consequences of PTSD (post-traumatic stress disorder) claimed the lives of 167 people, thanks to a domino effect that began with indecision on the part of Walter White, which led to the death of Jane Margolis (the tattoo artist who was Jesse’s landlady and girlfriend), and ultimately ended with her father Donald Margolis, a depressed and distracted air traffic controller, making a costly mistake.
While we never spend any screen time with these 167 victims, we do spend a lot of time with two central characters who both suffer, directly and indirectly, at the hands of Walt. Hank’s multiple panic attacks and Jesse’s struggle with PTSD throughout the series are two additional ways the show brings attention to psychological trauma. Now let’s explore these phenomena further.
While the psychological trauma that Jesse experiences is very real—more on that in a bit—Walt’s own brush with a psychiatric disorder was 100 percent fabricated. In Season 2, Episode 3: “Bit by a Dead Bee,” Walt needs a realistic excuse to explain his absence, having spent days in the desert under Tuco Salamanca’s control, enough time out of contact to cause his family to put up “Missing” posters. Short of claiming he was kidnapped, got lost, or was moonlighting as a meth-making drug-dealer, Walt’s next best option is to walk completely naked through a supermarket until the authorities pick him up and reunite him with his family at the local hospital. His ruse works just long enough to throw any suspicion out the window since his family’s just happy to have him back, safe and sound. But do fugue states like the one Walt made up really occur?
Perhaps not surprisingly, they do! In what’s known as a dissociative fugue, a type of amnesia, people lose some or all of their personal memories, usually caused by trauma or stress. These events can last from a few hours, to months, to possibly decades, and people suffering through it may travel far from home, assume a new identity, and even start a new life unawares.1 Things get a little complicated when medical professionals attempt to separate a legitimate dissociative fugue, for which there is no direct physical or medical cause, from someone who’s “faking it” in order to escape a frustrating marriage, dodge accountability, or avoid military combat, for example, but there are definitely ways to sort this out.
However, the uncertainties of the fugue state actually play right into Walt’s hands. Dr. Soper and Dr. Delcavoli—Walt’s attending doctor and oncologist, respectively—look into any potential side effects from his cancer medication or interactions between them, but find nothing to explain his behavior, so they refer him to psychiatrist, Dr. Chavez. Walt confesses to making up the fugue state, under doctor/patient confidentiality of course, as an excuse to simply get away from his family obligations for a few days. Clever guy, that Walt, and a great actor, too. He stops short of confessing his real crimes but manages to concoct a story that gives him a clean bill of health and covers his very suspicious behavior ... for a time. It’s a good one-use plot device in the Breaking Bad narrative, but fugue states get much more complicated in the real world.
Not a specific disorder itself, a dissociative fugue is considered to be under the dissociative amnesia disorder in the Diagnostic and Statistical Manual of Mental Disorders, or DSM-5. As hazy as the cause of real-world fugue states are, there are numerous documented accounts of them taking place: There’s the 2006 case of a fifty-seven-year-old lawyer, husband, and father of two who left his Westchester County, New York garage one day and was found six months later in a Chicago homeless shelter living under a new name with no recollection of his former life; a combination of his experience as a Vietnam War veteran and narrowly avoiding the 9/11 attacks likely triggered a return of painful memories that caused his condition. In his book “The Medical Detectives, Volume II,” Berton Roueché tells of a man who, in the mid-twentieth century, found himself in a New York hotel, unable to remember his name, after failing to show up at his father-in-law’s store in Boston. Those details came back to him suddenly and all at once after many failed attempts to jog his memory.2 Even mystery and thriller author Agatha Christie supposedly experienced a fugue state, having disappeared from her home in the winter of 1926 following the death of her mother and learning of her husband’s ongoing affair. In fact, she had checked herself into a health spa under a different name (one she cheekily borrowed, in part, from her husband’s mistress) and concocted a whole other story for why she was there, further muddying the waters regarding the cause of her disappearance.3
Symptoms of a dissociative fugue event include sudden travel away from home and habitual places without any ability to recall one’s past, identity confusion, and either partial or complete assumption of a new identity.4 Causes of a dissociative fugue tend to be severe stress or an emotionally traumatic event, something so painful or disturbing that the mind opts to file that information away in a hidden folder somewhere, taking related memories along with it. That’s an important distinction from other types of memory loss since a fugue state’s forgotten information can be recovered. Doctors will usually be able to distinguish between a legitimate fugue and an illegitimate one through neuropsychological tests, since fakers tend to overdramatize and exaggerate their symptoms, and they often have more practical reasons for faking memory loss that better explain their behavior. (Let’s just say it’s a good thing Walter White inherited some of Bryan Cranston’s acting skills.)
But much like Walt wasn’t off the hook because he claimed to be fine after his fugue episode, real-world dissociative fugue events should result in a doctor’s evaluation. Even when examining patients experiencing memory loss that seems to have no obvious physical cause, the first step is to look for a neurological cause, such as stroke, viral encephalitis, epilepsy, or head injury. Also, the loss of generic knowledge and memory points to a psychogenic or psychological origin instead of a physical cause. A functional MRI (magnetic resonance imaging) or PET (positron emission tomography) scan may also reveal underlying brain damage as a potential cause.5
The really difficult part of the fugue state isn’t necessarily the fugue itself; the person may exhibit no symptoms beyond mild confusion. However, once the memories return and the realization sets in that not only were they in a fugue state but also they must now face the original cause of their stress, a patient can experience depression, grief, aggressive impulses, and even suicidal tendencies. Treatment for these feelings includes psychotherapy, hypnosis, and interviews facilitated with the use of drugs, like an intravenous sedative. This approach is more in line with helping the patient figure out how to respond better to the situations and emotions that trigger these events, and thus hopefully preventing more in the future. However, said treatments are less successful with recovering memories from the fugue period itself.
So Walt’s relatively easy-breezy “recovery” period after his fugue state may have tipped off his medical professionals—and Skyler and Walt Jr., if we’re being honest—that everything was not on the up and up. However, with panic attacks and PTSD, Breaking Bad wasn’t faking it.
Arguably, two of the most physically and psychologically damaged characters on Breaking Bad, as a direct result of Walt’s actions, are Hank Schrader and Jesse Pinkman. Sure, numerous innocent victims and criminals alike have paid the ultimate price for crossing Heisenberg’s path, and Walt’s fictional family will likely carry the emotional trauma with them well after the scripts have ended, but Hank and Jesse bear the brunt of both physical and psychological violence throughout the series.
Hank, introduced as a macho, boisterous DEA agent as a foil for the mild-mannered Walter White, quickly rises through the ranks of law enforcement. From busting low-level meth-heads early on, to his assignment to the Tri-State Border Interdiction Task Force (before getting suspended temporarily), to his appointment as ASAC (Assistant Special Agent in Charge), to the point that he ultimately resumes his one-man mission to find Heisenberg, the career pressure on Hank rises exponentially as the seasons wear on. He also survives a shootout with Tuco Salamanca; a deadly explosion in Juárez, Mexico; another shootout with the Salamanca cousins; and the stunning realization that his brother-in-law is a meth kingpin. That’s a lot to ask of anyone.
When picking bar fights, brewing beer, and studying minerals don’t offer enough of a pressure release, Hank’s inner anxiety manifests in debilitating panic attacks. Gilligan even references Hank’s brushes with PTSD—specifically the panic attack in the elevator in Season 2, Episode 5: “Breakage”—as laying the groundwork for his car crash following his realization that Walt is in fact Heisenberg.6
Jesse, meanwhile, was perfectly content as the low-level meth-maker “Cap’n Cook” before Walt brought a world of hurt to his door. Over the seasons, Jesse has had to dispose of multiple bodies (including one kid ...); has witnessed first-hand the deaths of friends, loved ones, and enemies alike, and is guilty of taking lives himself; and has been beaten within an inch of his life by both drug dealers and law enforcement; not to mention his history dabbling in illicit drug use. All of these factors lead straight to PTSD. This trend continues throughout the rest of the series, even complicating the DEA’s attempts to get Jesse to turn on Walt. (Jesse gets spooked in Season 5, Episode 12: “Rabid Dog,” as a result of his PTSD when trying to lure Walt into a confession.) Show writer George Mastras believes that Jesse is clearly suffering from PTSD and said as much in the Breaking Bad Insider Podcast episode for Season 4, Episode 2: “Thirty-Eight Snub.”7
Hank and Jesse have lived through some traumatic events, so to not have those events affect them in some profound ways would be a disservice to the show’s basis in reality. Hank’s panic attacks—sudden onsets of anxiety and fear that manifest physically through shaking, sweating, shortness of breath, and heart palpitations—are completely understandable considering the things he’s seen and dealt with; Jesse’s disturbing thoughts and visions, mental stress, and ratcheted-up fight-or-flight response are on par with people suffering from post-traumatic stress disorder following a particularly troubling experience. (Hopefully Jesse gets the help he needs wherever he ends up, but unfortunately Hank’s beyond such therapy.)
To find out just how close to reality the psychiatric issues portrayed in Breaking Bad really were, our discussion will have to get a little more advanced.
“Panic attack” is the colloquial term that has gained acceptance in recent years, but there’s also the related “anxiety attack.” Ricks Warren, PhD, a clinical associate professor of psychiatry at the University of Michigan at the time he spoke with the university’s health blog reporter Kevin Joy about panic and anxiety attacks,8 remarked that the attacks have “very different emotional conditions.”
Anxiety can be understood as excessive worrying over impending events (death or illness), minor events (appointments), or general uncertainty. Normally a chronic condition, symptoms of anxiety include “fatigue, hyper-vigilance, restlessness, and irritability.” It’s what people experience while worrying about an event in the future and its potentially bad outcome; as such, anxiety attacks tend to come on gradually. Neurologically, these attacks are associated with the brain’s prefrontal cortex, which handles planning and anticipation.
Panic attacks, meanwhile, are short, intense bursts of fear from a sense of immediate danger; the fight-or-flight alarm response is at work here. These symptoms, which can resemble a heart attack, include increased heart rate, chest pains, and shortness of breath, and typically last no longer than thirty minutes, though they can occur without reason. The body’s autonomic nervous system (which includes bodily functions that are not consciously controlled, such as breathing, heartbeat, and digestion) and amygdala (an area of the brain involved in emotions, survival instincts, fear, and memory) are active here since their roles are to detect threats and respond to them accordingly.
People can experience both panic attacks and anxiety attacks simultaneously. Imagine walking down a dark alley (or don’t, especially if you’re already experiencing anxiety from reading this section); anticipating possible danger could lead to an anxiety attack. Now, God forbid, should something dark and dangerous actually confront you in that alley, a panic attack would be perfectly understandable. There’s actually an effect dubbed “anticipatory anxiety,” which accounts for people worrying about a future panic attack, resulting in a positive feedback cycle. People who suffer multiple panic attacks, as in chronic cases of anxiety disorders, may even begin avoiding the places where these attacks have occurred in order to minimize their anxiety and decrease the risk of future incidents.9
Throughout Breaking Bad, Hank never seems to show symptoms of having an anxiety disorder, but anxiety itself is often anonymous; most people won’t even be able to spot when someone else is anxious. It’s a normal, adaptive, and temporary aspect of our everyday lives and in no way a measure of “toughness.”10 According to the Anxiety and Depression Association of America, about six million American adults experience panic disorder annually, with women being twice as likely as men to do so.11 The good news is that there’s no need to suffer in silence or be embarrassed by it; the disorder is very responsive to treatment through counseling or even medication.
Hank’s very specific panic attacks occur when his comfortable routine and worldview are shaken, if not shattered. His unexpected run-in with Tuco Salamanca, the subject of the DEA’s manhunt at the time, ends with the drug dealer’s death at Hank’s hands, a feat that gets him appointed to an elite task force. In a typical drama, this would be the law enforcement tough guy’s dream scenario: Kill the bad guy and reap the rewards. In Breaking Bad, however, the real-world implications of taking a man’s life in self-defense and the rushed promotion that puts extra pressure on Hank’s shoulders is too much for him to adjust to in a healthy way. Then, when Hank, who’s barely keeping it together at this point, enters into the confined space of the elevator, his fight-or-flight response goes into overdrive; he can neither flee from the tiny metal box, nor can he fight an enemy that’s already been dispatched or has yet to manifest.
Things don’t get any easier for Hank. In Season 2, Episode 7: “Negro y Azul,” he finds himself a fish out of water in the El Paso office where no one appreciates his brand of humor and he literally doesn’t speak the language of his cohorts. A minor panic attack here actually saves Hank’s life since it takes him out of the deadly range of an improvised explosive hidden away within the severed head of an informant attached to a living tortoise. Hank’s mental resolve takes some time to recover after this traumatic event and that of the shoot-out against the Salamanca cousins that almost claimed his life in Season 3, Episode 7: “One Minute.” It’s a testament to his commitment to his job that he soldiers on. The next major panic attack occurs in the Season 5 midseason finale, “Gliding Over All,” when Hank fully realizes that Walter White, his mild-mannered brother-in-law, is actually Heisenberg. This “sky is falling” realization causes Hank to careen off the road while driving, owing to the overwhelming surplus of poorly managed psychological stress.
It’s interesting to note that, when faced with actual danger, Hank is cool and calculating. It’s only after surviving that danger that Hank’s anxiety and panic kicks in. Dean Norris’s performances throughout the show bring the very real symptoms of anxiety and panic attacks to life—rapid heartbeat, sharp chest pains, lightheadedness, difficulty breathing, difficulty focusing, trembling, sweating, and more—in terrifying fashion. His performance opposite Cranston also brings a whole new level to Walter White’s intimidating line, “If you don’t know who I am, then maybe your best course ... would be to tread lightly.”
It’s that simmering danger that Walt brings to Breaking Bad from the very beginning, and it’s his partner Jesse Pinkman who often finds himself paying the price. Jesse’s slow-developing PTSD builds on a series of increasingly traumatic events over time. He’s able to rationalize some of these experiences, regarding them as nudges toward straightening his life out, but the first such event that pushes him over the edge has to be the death of Jane Margolis in Season 2, Episode 12: “Phoenix.”
The resulting guilt trip sends Jesse into and out of rehabilitation facilities and on drug-fueled, downward spirals. The show’s writers doubled down on that guilt by having Jesse kill Gale Boetticher in the Season 3 finale, “Full Measure,” resulting in Jesse’s attempts to escape those feelings by hosting endless, drug-fueled raves and house parties.
Unable to escape from Walt’s machinations, Jesse becomes increasingly distrustful of his partner and more and more paranoid (rightfully so) by the day. His mental state also comes into question when he’s found absent-mindedly tossing money out of his car into an Albuquerque neighborhood in Season 5, Episode 9: “Blood Money.” After five seasons of witnessing Jesse’s psychological decay from his proximity to death and violence, it’s hard not to get emotional at the overall final shot of Jesse, laughing and crying exuberantly, once he is finally free.
It’s no stretch to claim that Jesse suffers from PTSD. This mental disorder develops following exposure to traumatic events that range from threats to a person’s life, to car crashes, near-death experiences, sexual assault, and the complicated arena of warfare. A host of disturbing thoughts, feelings, and dreams that are related to the event stem from it, along with mental and physical distress that can be triggered by related cues. Attempts to avoid these cues through changes in behavior and the way the person thinks and feels, and an uptick in the fight-or-flight response soon follow. That last one should sound familiar from our discussion of panic and anxiety attacks, which makes sense considering that PTSD can cause such attacks to occur. A difference here, however, is the longevity of such symptoms; PTSD effects can last for more than a month following the original event while similar effects occurring for less than a month could be diagnosed as acute stress disorder.
Officially recognized by the American Psychiatric Association in the third edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-III) in 1980, the term PTSD replaced the World Wars-era references to “shell shock” and “combat neurosis” following the Vietnam War. It was classified as an anxiety disorder in DSM-IV and reclassified again in the current DSM-V as a trauma and stressor-related disorder.
Following a physical examination and a psychological evaluation, a doctor may diagnose PTSD if the patient directly experienced the traumatic event or saw it occurring to others, or both, is repeatedly exposed to traumatic events’ graphic details, and if symptoms last for more than a month, impair a patient’s ability to function in society, and affect relationships in a negative way.12 I’m no doctor, but it sounds like Jesse Pinkman’s experiences fit that diagnosis.
Part of the long-term struggle with the disorder is an increased risk of self-harm and even suicide. Luckily, counseling and medication are available to help people suffering from PTSD. Psychotherapy, or “talk” therapy, can help improve symptoms by teaching the skills needed to address thoughts of self-harm and suicide in the first place and cope with them should they arise, encouraging a more positive outlook in general, and treating other issues such as depression, anxiety, and drug abuse. Patients can seek out one-on-one therapy, group therapy, or both. Different types of psychotherapy also exist, including:13
Additionally, medication is available for patients suffering from PTSD:
The main understanding to take away here is that anxiety disorders and PTSD are very real problems in our society but are common enough that there are many options for treatment for anyone suffering from them. I like to think that Jesse, having escaped the deadly world of illegal meth making once and for all, went on to seek out the help he so desperately needed and is now making a living as a happy, healthy, wood-working artisan in Alaska.