The pattern of comorbidity between mental health issues and substance abuse has recently manifested itself in a startling new demographic: fictional characters of TV series. Mr. Robot (USA Network), the third season of which is now streamable online, centers on a complicated anti-hero replete with inner turmoil, whose primary coping mechanisms are hacking, denial and drugs.
Nothing is ever really spelled out regarding the protagonist’s mental state. It is up to you as the viewer to play therapist and identify Elliot’s particular mental health struggles. Warning: spoilers below! Warning #2: don’t try this on your friends!
Set in contemporary times (but with a beautiful 80’s-inspired soundtrack), Mr. Robot takes brooding, hoodie-wearing Elliot as its unlikely protagonist. Like many of today’s heroes, Elliot is a bit of an anti-hero: he has a strong moral code at his core with a loose, morally flexible approach to supporting his ideals. He will hack anyone without hesitation, including neighbors, coworkers and romantic interests- even his therapist; but will alert the police when he discovers foul play in others (such as a man’s involvement in running a child pornography website). While it is not clear if Elliot even likes people, he cannot stand to see regular people being abused by the rich and powerful. So, he takes to his keyboard. His moral flexibility is widened even further by an alter ego that lives through Elliot and seems to have an agenda its own.
Dissociative Identity Disorder
Following in the footsteps of its conceptual parent film Fight Club (1999), Mr. Robot’s principal character has a very literally divided sense of self: sometimes he is shy, eye-contact avoiding Elliot Alderson and sometimes he is a straight-shooting, rough-talking version of his father, who is bent on taking down modern society. In clinical psychology, this is known as Dissociative Identity Disorder (DID), an almost made-for-TV condition characterized by two distinct personality states . While its pathology and even existence are disputed, it is believed to be the result of trauma, possibly in childhood, which leads to the forming of dissociative states as a coping mechanism . According to the Merck Manual, “about 90% of people with this disorder had been severely abused (physically, sexually, or emotionally) or neglected when they were children” .
A recent neurophysiological study attempted induction of another personality state in individuals with DID and in healthy controls using a memory script. They measured regional cerebral blood flow (rCBF – via PET), autonomic signals and subjective report. The authors found that high fantasy prone healthy controls who “played along” with the induction had smilar rCBF patterns to those of people with DID during induction of the alter ego. They also found different patterns of neuro-physiological activation when the alter ego was induced by a traumatic or non-traumatic memory script . Whatever the cause, the behavior of acting out two distinct personalities is clearly present in patients with DID, to a degree that far extends beyond the normal switching of different personality types in everyday life.
Does Elliot have DID? His symptoms seem to match up. While Elliot’s manifestation of the disorder would still be considered dramatized for the screen, it is clear the writers have done their research beyond Tyler Durden’s symptoms in Fight Club: Elliot has a traumatic memory of being pushed out of a window by his father as a young child (the details of which come under dispute), shortly before his father died of cancer. The events of the show suggest that the violent incident and the early death of his father, perhaps combined with Elliot’s tendency for social anxiety, created the conditions consistent with the trauma-induced or socio-cognitive theory for the development of DID.
Autism and Social Anxiety
Elliot may very well be on the Autism spectrum. He has trouble with eye contact, does not feel the need to follow social conventions (“I’m okay with it being awkward between us” he tells a coworker point blank (Season 1, Episode 1), does not like to be touched and is prone to extreme concentration on certain tasks . However, if Elliot is autistic, he is very high-functioning and does not have the characteristic deficit in Theory of Mind (the ability to understand that other people have different perspectives) . He frequently imagines the perspectives of others to engage in what engineers sometimes refer to as “social engineering,” the ability to “hack” information out of other people via conversation or in-person deception.
Elliot may also have Social Anxiety Disorder, which is often comorbid with ASD and almost everything else . Social anxiety disorder is characterized by fear of or in social situations to a degree that impairs one’s functioning in life . In classic hacker fashion, he wears unassuming clothing, shuns social interaction and muses to the viewer in brooding voiceover about how he does not like talking to people.
Is there evidence of anxiety, though? Or is it just a preference? Though Elliot has social interactions outside of the social engineering variety, they are few. In Season 1 he attends a dinner party with his boss and a few coworkers, for appearances in a phase where he is trying to “live a normal life.” In one scene in season 3, he walks into a corporate meeting in order to avoid detection by security and improvises a story until the officers outside walk away – this is something that someone with social anxiety might have great difficulty with.
Finally we come to depression. Is Elliot depressed? He spends a lot of time alone in his room with the lights low (inactivity and low mood). He seems numb to joys in life (anhedonia). He has trouble sleeping. And he is sad, primarily as a result of his loneliness. As far as we can tell, these symptoms are persistent. These are characteristic of depression .
It’s opiates to the rescue. “What do normal people do when they get this sad? I do morphine,” Elliot tells us in Season 3 (Episode 8). In season 1 he had convinced himself that he could use morphine without becoming an addict, yet slipped off the wagon anyway, forcing himself into a classic drug withdrawal montage à la Trainspotting (1996) or Requiem for a Dream (2000).
A recent review found that patients with chronic pain who were also depressed were slightly more likely to abuse their opioid prescriptions than non-depressed people . This may suggest that depression increases the odds of opiate dependence; however, there is also some evidence that the careful application of morphine could actually help with depression . A paper in 1985 by psychiatrist Edward Khantzian brought the “Self-Medication” hypothesis of drug addiction into the mainstream, positing the now cliché idea that addiction develops because a person finds that drugs temporarily (but only temporarily) ease psychological pain .
Elliot is a hacker, after all, with a strict moral code; so for him, sitting at home alone could be considered a normal, even “healthy” activity. The DSM definition of depression requires disruption to your life, an inability to do the things you normally do. This raises a larger question, which might be out of the scope of this article: should Elliot be considered to have a mood disorder (on top of other comorbidities) simply because he spends most of his time brooding?
And if so, should Batman?
Mr. Robot is available for streaming on Amazon Prime (amazon.de).
 American Psychiatric Association, Diagnostic and Statistical Manual of Mental Disorders (5th ed.), 2013
 Hart, Carolyn, J Child Psychol Psychiatry, 2013
 Simone Reinders AAT et al., PLOS ONE, 2012
 Babiak, P, Neumann, CS & Hare, RD, Behav Sci Law, 2010
 Baron-Cohen, S., Leslie, A. and Frith, U., Cognition, 1985
 Lynard, R.B. J Clin Psychiatry, 2001
 Sullivan, M., Clin J Pain, 2018
 Khantzian, E. J., Am J Psychiatry, 1985
Originally published in Charité Neurscience Newsletter, September 2018, Vol. 11, Issue 3