More and more characters, including Mickey, are taking the black pill in American Horror Story season 10, though episode 4 explains why he originally refused them. The black pills in Red Tide are a mysterious drug used to give talented individuals immediate and intense inspiration, with a side effect that includes a thirst for blood. When someone untalented takes the pill, they have a horrible reaction in which they lose their hair, cognitive abilities, can only focus on quenching their thirst for blood and turn into the terrifying Pale People.
Harry Gardner, a screenwriter, moves to Provincetown for the winter with his young violinist daughter and pregnant wife to cure his writer’s block. Harry meets some of American Horror Story season 10’s other talented residents who happen to be accomplished playwrights and authors. They introduce him to The Chemist’s black pills, which instantly cure his writer’s block, though causes him to effectively turn into a vampire. While many of the AHS characters have now taken the pill, several others like TB Karen and, at first, Mickey were hesitant to try them.
American Horror Story episode 4 is a flashback to The Chemist moving to town and introducing the pill to the residents. She first meets Mickey (Macaulay Culkin), explaining the exact science of how they work and eventually offering him one, though he declines. Instead, Mickey becomes a middle-man for the black pill market, being the one to introduce them to Belle Noir and one of the more notable Pale People in town. The Chemist is disappointed when Mickey says no, but it seems it’s because he isn’t confident enough in his talent as a screenwriter yet. He tells her that he thinks he’s pretty good, but he’s never shown his work to anyone, likely because he fears someone will trash it. As the saying goes, “ignorance is bliss,” so Mickey at first chooses to believe in himself over having his dreams possibly crushed by the pills not working.
While Mickey was still not taking the pills himself, he essentially became a talent agent, bringing Red Tide's The Chemist people he thought the black pills would work on. This leads to Mickey bringing Belle to The Chemist, where he explains to her the pill is “not for me.” He says they only work on people like Belle, “artists,” which is Mickey’s way of doubting himself, believing he’s not an innately talented writer like her. Mickey’s first recruit was a man who sang at The Muse who had a really nice voice, though he ended up becoming one of the Pale People for whom the pill didn’t work. Since Mickey genuinely thought the man was a great singer, it seems seeing him turn into a Pale Person was another reason for his hesitation; just because someone is good doesn’t necessarily mean they’re talented or creative.
Although Karen initially advised Mickey to not take American Horror Story's black pills after knowing how they change users, he eventually gives in to his desires and takes one in episode 2. After 5 years of seeing Belle and other residents take it and have their wildest dreams come true with unparalleled success, Mickey decides he would rather take it with the possibility of turning into a Pale Person than to keep living as a struggling drug addict and sex worker. Karen warned him not to, fearing him possibly turning into a bloodsucker, but Mickey is finally ready to see what happens if they work. Thankfully for Mickey, the black pills worked for him and his talents as a screenwriter were enhanced. While he works with Ursula to get his screenplays turned into TV shows, he is set to become one of American Horror Story’s next successful vampiric artists.