State-Sponsored Psychosis: What Peaky Blinders and This Is Going to Hurt Say About the UK’s Past and Future

In the 1930s, Britain was the site of a troubling spread of fascism. Fascist rallies across the country centered vehement racism and anti-semitism, usually featuring—and encouraging—violence against those who opposed the brutish faction. While the defeat of fascist nations by the Allies in the Second World War didn’t eradicate Britain’s tolerance of racist and anti-semitic views, it did prompt progress of a different kind: a comprehensive, national health service.

The landslide Labour victory in 1945 was on a platform of post-war reconstruction. But after a couple decades of growth for the National Health Service, increasing anxieties about how much was being spent on the service paved the way for Thatcher, whose rejection of every principle that birthed the NHS resulted in its restructuring in line with the Conservative goal of privatization. When Labour returned to power in 1997, despite campaigning for a mass reversal of Thatcherist policies, their neoliberal ideology added more strain on a service that desperately needed a socialist treatment.

All of this highly abridged prologue can be gleaned from any introduction to British 20th-century political movements. But two British TV series airing in the U.S. this June give a perspective you won’t find in Wikipedia entries, showing the irrevocable psychological effect repressive political movements have on those caught in systems they can’t alter or improve alone.

The protagonists of gangster series Peaky Blinders (Netflix) and medical dramedy This Is Going to Hurt (AMC+) both suffer from trauma. Tommy Shelby (Cillian Murphy), the leader of the eponymous Birmingham crime syndicate, carried home with him the trenches of the First World War, and suffers from hallucinations, paranoia, and seizures despite (or because of) self-medicating with opium. In the final season, he’s sober, and must now reckon with his legacy as he attempts to sabotage Britain’s growing fascist movement from within—for none other than Winston Churchill.

This Is Going to Hurt’s Adam (Ben Whishaw), by contrast, is a doctor working on the Obstetrics and Gynecology ward of a NHS hospital in the tail end of Labour leader Tony Blair’s term in office, meaning the hospital is under ridiculous pressure to perform without necessary funding and staffing. Adam’s frequent blacking out in his car plus his never-ending shifts means he bows to his consultant’s advice to send a non-urgent patient home, thus failing to diagnose a serious condition. After the traumatic birth of her severely premature newborn, he’s rewarded with all the trappings of PTSD.

Both Tommy and Adam’s psychosis come from their treatment by an unfeeling state, but where Adam’s results from a medical altruism are mangled by the machinations of capitalism, Tommy has none of Adam’s noble cause. After experiencing being a commodity for the empire, he re-enters society eager to take advantage of it, to further his family’s position in direct opposition to legal and moral order. But ethics have never been black and white when the British state is involved, and he soon finds himself aligned with military and political powers on undisclosed missions, which has a deadening effect on his livelihood. In the final season, after a devastating diagnosis that partly explains his physiological afflictions, we see Tommy, like an automaton, mutely and methodically typing up minutes of a meeting with fascists, dedicating himself to one final job before he allows himself the indignity of prioritizing his well-being.

Just as Tommy’s cruel and confrontational personality conceals a wounded interior, Adam’s biting, abrasive sarcasm deflects from any admittance of weakness. He too recognizes the degradation of his mental state as dangerous, but a culture of overworking and derision in the hospital makes it impossible to secure help. Because the pressure on NHS staff is so monumental, Adam and his colleagues must toughen up and risk becoming numb to the emotional toll of their labour. Structural mistreatment then becomes cultural; ideas of being able to cope with unreasonable demands speaks to a strength or weakness of character, being able to detach oneself from enormous human pain is seen as necessary to put up with the job. If not, they’re seen as less competent and efficient, only worsening the well-being and performance of staff.

What really cements Adam and Tommy’s psychological unwinding as institutional are the ways they’re responded to by the powers they serve. When complaints about Adam’s work performance develop into a tribunal, he is instructed by his consultant to lie about the instruction he gave that led to the misdiagnosis. Later, after a doctor who could corroborate the truth dies, he is encouraged to pass the blame down to the dead colleague. Such commands are dealt out so plainly it only makes their staggering amorality more devastating. Institutions rely on the fact that it’s simpler—and therefore more believable—that faults lie on individuals rather than complex pressures manufactured by the system.

Even when Adam is told the complaint is not really about him, rather the hospital, the patient fails to understand that in an environment where blame is always diverted to broken individuals, no institution will ever be punished; it’s people taking flak for structural problems all the way down. You can pretend that the problem is bad apples, punish them, and immediately expose the next burnt-out medic to the same conditions that led to the mistake. It’s easy to blame a rot on the person it shows up on, rather than the conditions that cause it.

In the case of Tommy, such isolation is welcome. The Shelby family have a rigid policy of individualism; as a group of travelers and laborers in a city the government is not interested in developing, the only road to prosperity is one they pave themselves. But such an ideology has a flip side; Tommy is the first one to be abandoned by his co-conspirators and commonwealth, as there is rarely reason for those with more power to protect him. At his weakest, Tommy would rather remove himself from his circle to avoid being seen as vulnerable, something that’s ultimately exploited by the powers who want him out the way. As someone always looking for weaknesses to squeeze in others, Tommy sees his psychosis as something needed to be protected from view.

Such alienation results in a strange self-delusion; you start to believe you’re the one really in control. Deep in the churning wheels of history, Tommy survives by convincing himself he has the power to undermine fascism in Britain, despite the dramatic irony that, as a fictional character surrounded by historical ones, he is the least likely to affect the political movements of the 20th century. After standing for parliament over the prior two seasons, Tommy has grafted closer to the systems of conventional “clean” power, and repeatedly tells people in the final season that he’s capable of causing real change from the inside, insisting his existence is worthwhile. Even when his wayward brother Arthur flirts with aligning with the fascist cause, he doesn’t comprehend how the movement’s appeal stretches far beyond his own subversive capabilities. He’s become lost in a sweeping system, his function exclusively defined by others, convincing himself he’s in control. It’s something Adam, as a doctor whose well-being is disregarded despite his medical skills are desperately required, is familiar with.

How do you fight becoming institutionalized? Neither show gives a conclusive answer; what makes their comparison resonant is that, despite their obvious differences, each shows the thorny catharsis of breaking away from a punishing system, even though clean-cut justice isn’t an option. Peaky Blinders and This Is Going to Hurt speak to a human sickness—not the tuberculoma Tommy suffers or the conditions Adam treats, but one where Britain as a state contributes to worsening the lives of its populace. The setting of both shows in the past is meaningful; not only are we aware of how much worse fascism and austerity will get in the immediate future of the narratives, we know how tight a grip they currently hold in Britain today. As long as such a grip continues, it’s impossible to see how the British state is upholding its duty of care.

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