‘This Is Us’ should be remembered for its nuanced portraits of mental health, dementia, and identity

Coming out as a queer teenager. Fostering a child to adopt. Grappling with transracial adoption. Examining how addiction and body image affect behavior. Coming to terms with dementia, depression, and anxiety. Taking stock of mental health across time.

“This Is Us” showed all of this and more during six outrageously successful seasons.

This NBC series explored the lives of three children — twins Kevin and Kate, whose parents adopted a third baby, Randall, whose father had abandoned him at a fire station. As avid fans, we debriefed weekly to discuss the twists, turns, and tears of the Pearson family saga, which wraps up on May 24. From our public health and ethnic studies perspectives, the series accomplished a rarity for a fictional TV show: It showed the ways the conditions in which people live, work, and play can influence their health.

The series’ subtle approach to sexual orientation and gender identity did its part to try to help normalize them in the real world. The show casually revealed that Randall’s long-lost birth father was bisexual when his lover showed up at a family gathering. And when a middle-school daughter came out as queer, it created only a relatively minor family drama.

The fact that neither storyline was a big deal is actually a big deal. The U.S. has come a long way as a society since Ellen DeGeneres came out as gay in 1997 on her ABC sitcom “Ellen.” Advertisers boycotted the show and the Rev. Jerry Falwell called her “Ellen Degenerate.” The final episodes of that season of “Ellen” were criticized for focusing too narrowly on gay issues, and the show was canceled the next year.

“This Is Us,” through its nuanced and sensitive approach to sexual orientation and gender identity, held a mirror up to the real world and tried to model an ideal — that many people are moving toward the idea that being openly LGBTQ is only one of the many characteristics that make up complex human beings.

Far more front and center in “This Is Us” is the thread of mental health, which plays out across many characters. The family matriarch is diagnosed with dementia, and as the show hops back and forth in time, viewers witness her decline even as they are reminded of what a vibrant young mother she was.

Across the seasons, the show highlighted post-traumatic stress disorder related to military service, first in Vietnam and then Afghanistan. Major characters struggled with depression, debilitating anxiety, addiction, disordered eating, and weight and body image. Each storyline explores the ways mental health affects day-to-day experience and how access to mental health care affects the quality of life.

Perhaps one of the best illustrations of this is how the series portrayed battles with substance addiction by the Black birth parents of Randall, compared to his white brother Kevin. Randall’s parents, William and Laurel, lose their child, their relationship, and years of their lives as they each attempt to get sober. But when Kevin — the rich celebrity with a family support system — grapples with addiction, it is invariably treated as an illness rather than a crime. His access to intensive rehabilitation, followed by a transitional stay at his mother’s, helps him secure his sobriety.

Though this story line may have been fictional, it shows how race and access to resources and support systems dramatically impact the outcomes of this disease for countless Americans today and specifically how addiction among the economically struggling Black parents leads to criminalization by the justice system.

One of the ways that structural factors concretely affect peoples’ lives plays out repeatedly through Randall’s storyline, from the events that lead to his adoption by white parents to the adoption years later of an adolescent named Deja by Randall and his wife Beth. Deja is shown to have a loving relationship with her birth mother Shauna, but it is not enough. Her lack of financial privilege and family support are shown, but “This Is Us” ultimately suggests that her risky decisions and personal irresponsibility cost her the loss of her housing and her child. In this case, the storyline missed the mark, minimizing the structural barriers Black mothers face and a foster care system that disproportionately removes Black children from their birth homes.

The show’s approach to these structural barriers was more nuanced as Randall worked through his trauma from transracial adoption. Viewers learned about his birth mother who, like so many Black mothers, was incarcerated instead of being treated for substance addiction, a pattern documented in real life by legal scholar Dorothy Roberts. Rather than judging his birth mother harshly — as he had initially judged Deja’s mom — Randall finally comes to terms with his birth mother’s inability to raise him.

Randall’s growing realization of the structural barriers that disadvantage marginalized groups is evident after he confronts a man who breaks into his home. When he realizes the intruder is desperate and ill, Randall — in his role as a city councilman — develops programs for people experiencing substance addiction. This shows a deepening realization that “crime” is often rooted in unmet needs that, rather than punishment, should be met with resources and support.

We will remember “This is Us” for showing us how people are the same in what affects our lives — love, family, grief, joy — without ignoring the factors that make our lives so different.

Sarah MacCarthy is the inaugural holder of the LGBTQ health studies endowed professorship at the University of Alabama, Birmingham. Jalondra A. Davis is a presidential postdoctoral fellow in the Department of Ethnic Studies at the University of California, San Diego.