The Housemaid: When the Only Collateral Is the Husband

Bias in psychiatry is not limited to diagnoses; it also shapes whose stories feel believable. In The Housemaid, this is evident in the dynamic between Nina, her psychiatrist Dr. Hewitt, and Nina’s husband, Andrew.

Dr. Hewitt is a female psychiatrist, an important detail because it reminds us that bias is not confined to gender or intent. Bias often operates through social scripts. Andrew is outwardly composed, wealthy, articulate, and conventionally attractive. He presents as the archetype of the concerned, reliable spouse. Nina, by contrast, is first encountered by clinicians and law enforcement in a highly compromised and chaotic moment, one that immediately frames her as unstable and dangerous.

Psychiatry, like the rest of medicine, is not immune to the halo effect. The assumption that someone who appears successful, calm, and socially credible is unlikely to be dangerous is a bias we rarely name, yet one that quietly influences clinical judgment. When this assumption is paired with a patient first seen under emergency conditions, the imbalance can quickly harden into narrative certainty.

Complicating matters further, Andrew is the one who initiates the wellness check that leads to police involvement. When officers arrive, they encounter Nina attempting to remove her child from a bathtub. Interpreted through Andrew’s account, this moment is framed as an attempted drowning. At face value, the sequence appears straightforward: a concerned husband calls for help, authorities intervene, and a psychiatric crisis is identified.

And yet this framing itself deserves scrutiny.

If Andrew were the source of harm, why would he be the one to call for a wellness check? The question is tempting, but it rests on the assumption that abusive dynamics and help-seeking behaviors are mutually exclusive. In reality, initiating contact with authorities can function as a means of narrative control, preemptive credibility building, or containment, particularly when one party is already positioned as unstable.

There is also a broader systems-level concern, raised not as an accusation but as ethical awareness, that social power, professional proximity, or institutional familiarity can subtly shape clinical decisions. Any direct influence on psychiatric care would be unethical and illegal. However, recognizing how power and bias shape credibility, even in the absence of misconduct, helps explain why premature certainty, rather than careful assessment over time, became the clinical response.

In this context, particularly in the absence of independent collateral, psychiatry would rely heavily on direct clinical assessment alongside parallel safety planning. This would include careful evaluation of Nina’s emotional expression and responsiveness, thought process, and behavior over time, as well as close attention to whether her narrative remains largely consistent across interviews. It would also involve thoughtful consideration of her own reported history, recognizing both its limitations and its necessity when no other sources are available. Her report of possible drugging would warrant medical evaluation, including laboratory studies, a urine drug screen, and, when indicated, more comprehensive toxicology testing to assess for substance-induced states or altered consciousness. Diagnostic formulation in this context would necessarily remain provisional and grounded in observation rather than assumption. Given the potential risks involved, clinicians would also be expected to involve social work or case management to assess safety, coordinate follow-up, and support discharge planning. If Nina expressed fear for her child’s safety, consultation with child protective services would be appropriate, not as a determination of wrongdoing, but as a protective measure. These steps reflect how psychiatry manages uncertainty: by expanding assessment, engaging systems of support, and prioritizing safety rather than prematurely narrowing the explanation.

Psychiatry is often forced to act under uncertainty. But uncertainty should prompt broader safety evaluation, not narrower interpretation. When a patient’s account cannot be fully explained by an identifiable psychiatric syndrome, and when there is reasonable concern for harm, the clinician’s obligation is not to decide who is telling the truth, but to ensure that concern is assessed through appropriate medical, social, and legal channels.

The Housemaid illustrates how easily psychiatry can mistake narrative coherence for truth, and how bias, even when subtle and unintended, can become clinically consequential.