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Wonderland's Distorted Vision

Mark Dombeck, Ph.D.

Like many diligent USA mental health professionals, I tuned into ABC Television the other night to watch the premier of "Wonderland", a new nighttime drama set in a psychiatric emergency ward in New York City. This show had managed to offend many mental health advocates even before it had premiered because of the sensationalized ways in which it depicts persons suffering from mental illness. Just how bad could this show be? I wanted to know. One viewing has made it pretty clear, at least to me, that "Wonderland" presents a fairly distorted vision of what psychiatric institutions and mental illnesses are like.

"Wonderland" is set in a fictional New York city psychiatric hospital called Rivervue. It concerns the operation of one ward within that hospital, having to do with forensic emergency triage. For you uninitiated out there, triage refers to a place where assessments can be made regarding what is wrong with people and how to treat them. The word forensic refers to legal, criminal or justice system related stuff. So, basically "Wonderland" is set in an emergency room similar in function to the one on the TV show "ER" , only "Wonderland" is a Psychiatric ER dealing with mental illness only. The unit is further specialized it would seem, in that it deals exclusively (?) with mentally ill persons who are accused of committing crimes.

The "Wonderland" unit is staffed by a bunch of doctors (probably psychiatrists, but this is not made clear), residents, nurses, etc. just like a real psych unit. The doctors we are introduced to are frazzled and have lots of life crises to deal with. We are quickly introduced to a group of disturbed patients who are being treated in various group therapies. Some of these individuals are quite agitated, while others just rock back and forth. Aside from excessive portrayal of agitation on the part of the producers this is not an untypical scene for an inpatient hospital.

The action for the first episode revolves around a major story and two minor stories. The major story has to do with a fellow who is brought into Rivervue after shooting several police officers and civilians in Times Square. He is brought on to the unit where he is assessed. He remains quite agitated through this assessment process. At one point he is able to grab a big needle and stab a pregnant doctor in the belly, harming her fetus. The story continues, showing the pregnant doctor and her husband (also a doctor on the unit) learning that the fetus has sustained an uncertain amount of damage. The two decide they want to have the baby anyway. It comes out that the pregnant doctor had seen the shooter patient several weeks before and had turned him away at that time. We see her (the pregnant doctor) feeling very guilt-ridden at her lack of ability to have stopped this man before he caused all this chaos. The two minor stories lack in detail. The first minor story has to do with the chief doctor on the unit having to go to court for a custody hearing to see if he can retain guardianship of his two young boys. The other minor story has to do with a banker who has attempted suicide after his wife has left him for another man, and who doesn t want to talk about it. In the course of his interview with a doctor, we see his self-inflicted wound from his suicide attempt.

While I didn't see much in "Wonderland" that couldn't happen in real life, I saw a whole lot that was highly stretched, distorted and otherwise isolated from proper context until what was presented was a caricature of the real thing. And given the stigma that is already attached to mental health issues, this level of caricature and distortion is just not good, will only make the problem worse.

Mental Health is already associated with inaccurate stereotypes such as the violent crazy murderous lunatic stereotype featured in the first episode (most people with serious mental illnesses who do not behave in these ways). To the extent that "Wonderland" presents this stereotype as a daily part of the reality of mental health, the stereotype is made stronger and we all lose something. Persons who see the show will be less likely to want to seek appropriate treatment. Persons in need of help will feel more shame and will be less likely to want to seek help. And persons who could help mentally ill persons remain integrated in society will be less likely to do so as well, out of fear.

The larger points of distortion and inaccuracy featured in the show are worth some discussion. I've provided a short list just below:

The Extreme Violence Featured in "Wonderland" is Unrealistic

Sure, mentally ill persons kill people. But so do so-called sane persons. In fact (although I don t have my stats handy to document my claim), proportionally more violent crimes are probably perpetrated by sane persons than by mentally ill persons. Even in a psychiatric inpatient setting, the vast majority of patients are not dangerous (except perhaps to themselves in some cases).

"Wonderland's" Forensic Emergency Room Setting is Not Typical

Sure, places serving the function of "Wonderland's" Rivervue hospital do exist. But they are hardly typical of the vast bulk of mental health institutional settings. Most mental health problems are dealt with on an outpatient basis. More serious problems are dealt with in inpatient hospitals. Even amongst the inpatient hospitals, only some units are locked down. Inpatient hospitals do not look like prisons ("Wonderland" s Rivervue Hospital does look like a prison complete with metal bars and gates). Most mentally ill patients are not a danger to themselves or to others. Most mental illness is not as severe as is depicted on "Wonderland". By featuring the most extreme and agitated examples of mental illness, and not even mentioning the vast bulk of less extreme settings, "Wonderland" exaggerates the true nature of mental health treatment.

The Lack of Restraints and Safety Procedures is Unrealistic

A key element of the drama in the first "Wonderland" episode is an agitated patient s ability to stab a pregnant doctor in the belly. While I suppose this type of event could happen, the possibility that it would happen is almost zero in an actual institution. Psychiatric hospitals anticipate the possibility of chaos and take steps to make sure it is minimized. No sharp objects would have been near an agitated person. An agitated person (especially one who had just murdered several people) would have been restrained in some form for his own safety and the safety of others. Of course, most viewers of "Wonderland" will not understand that what they see on the show is not how things would actually occur. Rather they will probably conclude that violent attacks occur inside of psychiatric institutions with great frequency. Such an outright misrepresentation creates panic and fear in an unnecessary way.

The Whole Guilty Doctor Scene is Unrealistic

Anyone viewing the "Wonderland" scene where the pregnant doctor speaks on how she might have prevented the shooter from killing people in Times Square would get the impression that she actually could have helped him if only she had been in a better mood. This is an outright distortion. In my experience, I have never seen a physician make an error of this type. Almost without fail, physicians and clinicians are aware of dangers and desire to treat when it is appropriate. It is usually the lack of insurance coverage, or denial of need by insurance carriers that motivates a lack of treatment (e.g., the doctor may wish to treat, but the insurance carrier declines to pay for unnecessary care , leaving the doctor responsible for the outcome but not able to get the needed care paid for). It is not a good scene. (why don't you dramatize this fact of clinical life "Wonderland"? - this would make more sense). Even if a patient was deemed dangerous or in need of care, it is against the law to hold a patient against his or her will for more than several days (even when they have recently been suicidal or homicidal!) and it is against the law to force a patient who doesn't want treatment to accept it (with rare exceptions). The guilt situation would just never happen as depicted.

Showing the Suicide Wound Was in Very Bad Taste

Finally, I have to comment on the producer's decision to include a scene where a suicidal banker patient has his wrists unbandanged, and we see the results of his previous suicide attempt - a stitched line on his wrist where he cut himself. It is sheer sensationalism and bad taste to show this grisly scene. Does television really have to teach us how to harm ourselves in order to get ratings?

My fear is that any random person watching "Wonderland" won't have the experience working in a psychiatric hospital or receiving care for a mental health problem to know that what they are seeing is distorted and unrepresentative. A random person is likely to think that the vision of mental illness presented by "Wonderland" is more or less accurate. It is exactly in helping the audience to form a mistaken and exaggerated understanding of what mental illness is like, that "Wonderland" does its worse disservice to the population at large.

I guess I can't complain too much. At least "Wonderland" may put mental health on the map a little better. In America these days, attention is attention. It doesn't seem to matter if it is negative or positive attention. Maybe as a reaction to the show (and other recent events such as the surgeon general's report), public policy makers will take mental health issues more seriously.

Of course, the final judgment as to whether "Wonderland" will survive, will be its ability to generate an audience and sell advertisements (and not on whether it will help or hurt people). Based on this financial criteria, it is not at all certain that the show will survive in its present form.

I'll be the first to say that I know nothing about how the TV industry works. However, I find it a shame that the first prime time show about mental illness needed to be done in this overblown way. Ultimately people tune into shows like "Wonderland" because they want to care about and connect with the characters portrayed on the screen. Yes, cliff hangers and excitement are necessary components of this drama, but I don't believe that excitements are the primary reason for tuning in. Life is dramatic all by itself, and stories of healing and the hard work of finding your way in the world (which is what mentally ill persons, just like anyone else, have to do to get by) can be quite moving all by themselves enough to find an audience. Rather than choosing to focus on the most extreme forms of mental illness and the most extreme criminal actions perpetrated by mentally ill persons, how much more wonderful could "Wonderland" be if it chooses to focus on the quieter but just as dramatic stories of recovery and hope that mental health clinicians see every day. We may never know.

Mark Dombeck, Ph.D.
Director,

Dombeck, M.J. (Apr 2000). "Wonderland's" Distorted Vision [Online]. .