Prime-Time Psychosis

The New York Times, April 3, 2000

By Sally Satel

Sally L. Satel, a psychiatrist, is the author of the forthcoming “PC M.D.: How Political Correctness Is Corrupting Medicine.

Television is finally portraying mental illness realistically, and the mental health establishment isn’t very happy about it.

Before Thursday’s premiere of “Wonderland,” a prime-time drama on ABC set in a psychiatric hospital, the newly formed Mental Health Coalition Against Stigma in Hollywood urged the White House to use its influence against “stigmatization of mental illness” in the movies and TV. The National Mental Health Association warned that the show “plays to people’s worst fears about the mentally ill.” The National Alliance for the Mentally Ill says it makes patients look like “killers, crazies and freaks.”

But a show like “Wonderland,” with enormous potential to educate audiences about tragic clinical realities, could be one of the best things to happen to the severely mentally ill.

Most of “Wonderland” takes place in the bustling emergency room of an inner-city hospital. In the first episode, we see a schizophrenic man who opened fire in downtown Manhattan. Doctors tend to a suicidal man who gashed both his arms and to a psychotic son who bit off his mother’s finger.

Alarmed by this portrayal of violence, Michael Faenza, president of the the National Mental Health Association, urged ABC to run a disclaimer saying that most mentally ill people pose no threat to others.

This is true of people with psychiatric illness in general, but not of the types of severely ill patients that cycle in and out of psychiatric hospitals like the one on the show.

Numerous studies confirm that people with unmedicated psychotic illnesses are three to six times more likely than the general population to be convicted of violent crime.

However, being honest about the potential for violence throws a wrench into the anti-stigma campaigns that are the main focus of the advocacy groups. These groups often cite a 1998 MacArthur Foundation study that found comparable rates of violence in a sample of psychiatric patients and in the general population. But the actual study was subtle. It ended up excluding the sorts of classic psychotic patients most prone to violence. Many of the patients it studied were already in treatment. Researchers agree that psychotic people undergoing treatment are indeed no more aggressive than anyone else, but these are not the people that “Wonderland” is portraying.

The anti-stigma campaigns stem from legitimate concerns. These groups worry that if people are afraid of the mentally ill, they won’t support treatment and other services and won’t let housing for the mentally ill into their neighborhoods. But those running this campaign should realize that realistic media portrayals of the mentally ill might be the best way to educate. What better way to drive home the point that the severely mentally ill need far more care than they are currently receiving? In fact, some medical schools reportedly will use the first eight episodes of the show to help teach students about severe mental illness, like schizophrenia and bipolar illness.

Instead of reflexively boycotting depictions of mental illness, those who care about the fate of the mentally ill should welcome “Wonderland.”