Sensationalism at its Best: Psychological Disorders and the Media

The season premiere of Hoarders airs tonight at 9 PM Eastern, 8 PM Central time.

Since the show began, it has elicited a lot of discussion among professionals and the public about whether it’s true-to-life, and whether it is helpful or harmful to the individuals featured on the show. To address this issue, I’ve invited Dr. Marla Deibler back as my guest blogger to share her views as a mental health professional who specializes in the treatment of anxiety, OCD, compulsive hoarding, and trichotillomania.

Television has been flooded in recent years with “reality” shows about psychological disorders. From anxiety and obsessive-compulsive disorder, to trichotillomania and compulsive hoarding, documentary-style programs have attempted to capture the experiences of these individuals for public display. Public reaction seems to be generally positive, as evidenced by the continued growth of this television genre; however, there is also a consistent undertone of questioning whether there is an exploitive nature of such programming. Is it helpful to the public, or, is it simply voyeuristic, like a train wreck we cannot help but watch?

The Undisputed Advantages

There are a few clear societal benefits to this new genre of programming. First and foremost, they do raise awareness. They inform the public of problems of which they may never have heard or understood. For example, there will be at least a couple of people reading this who saw the word ‘trichotillomania’ above and recognized it as being a disorder in which individuals pull out their hair because they saw a person who had it on TV. Awareness is something for which we, as a profession, strive, as it helps to educate the public, provide access to treatment, provide impetus for research funding and development of community resources, etc. Furthermore, as public awareness grows, public acceptance grows, and any shame or embarrassment associated with the disorder decreases. Awareness is good.

On another note, not only do the individuals featured on these shows receive the televised intervention, but they are frequently provided with follow-up services free-of-charge, such as six months of paid psychotherapy or professional organizing. So, although the shows are frequently filmed in a whirlwind period of time, there is often continuity of services to assist the participant. This is good.

Disadvantage in Potential Inaccuracies

Advantages being said, intervention shown on television can be unintentionally distorted or misleading. Remember, this is television; good TV needs to hold the attention of its audience and audiences like TV that evokes emotion. Therapists do not make these shows, the film industry does. They have different goals and very different timeframes.

For those readers who have never been engaged in quality psychotherapy, know that many of the shows seen on TV that are promoted as being therapeutic in nature do not depict therapy as we truly conduct it. For example, on hoarding television shows, a therapist goes into the home with an organizer over the course of a few days to help sort through the clutter and clean up the home. In reality, yes, we do home visits, but the goals are quite different. In treatment, we focus on helping the individual to learn more about their attachment to items and their erroneous beliefs, develop cognitive flexibility, problem-solving skills, decision-making skills, and coping skills, and learn how to let go. True therapy is a process that takes time and does not easily lend itself to being accurately summarized in a 60-minute show.

Keep in mind that these ‘shoots’ are edited for television. The editor’s challenge is to keep the program moving, while holding interest, and telling a provocative story. For example, the therapist may have felt he or she had some great breakthroughs with a participant during a shoot, but these moments wind up on ‘the cutting room floor’ in exchange for provocative interpersonal conflict between family members. Unfortunately, the end result can minimize the role of psychotherapy (because it frankly does not make for good TV), emphasizes the drastic change from start to finish, and can set up unrealistic and misleading expectations for individuals who are seeking treatment and have seen these shows. I frequently find myself at the outset of treatment for these disorders, educating the new patient and dispelling any misconceptions or anxieties regarding treatment borne out of the individual’s assumptions based on what he or she has seen on TV. For example, in treating OCD, panic disorder, or phobias, I frequently find myself explaining to patients that exposures are done in a gradual, structured, hierarchical manner, and that the extremely anxiety-provoking exposure they saw on TV must have been toward the end of treatment, after smaller exposures that worked up to it.

Disorders depicted do not often occur without a lot of other history to consider and process or co-occurring psychopathology that also needs to be treated. In the interest of ‘story’ simplification and time restrictions for TV shows, these important aspects of case conceptualization and treatment can be left out; thus, the problem is oversimplified.

It is important to remember that although the producers frequently have the best of intentions in providing the public with accurate information, the information is only as good as its sources. Some shows are better than others in terms of accuracy. For example, I have seen two shows that have stated that trichotillomania is a type of OCD (It is not) and one that focused on mood instability, anger, aggression, and noncompliance with treatment, in a man with trichotillomania, when although he did have trichotillomania, these characteristics were features of a poorly managed co-occurring bipolar disorder.

Misleading depictions are also borne out of the tendency for these programs to choose to show extreme cases. Although these cases may be very interesting to the viewer, they may also serve to lead some to believe that less significant problems are not significant (and, perhaps fail to seek treatment). For example, hoarding shows have shown dead animals, infestations, rotting food, toxic mold, feces, and other extreme examples of problems in the home. Although cases such as these do exist, these squalid conditions are seen less often than what may simply be described as extreme clutter.

Television is not Reality

This is television. It is not ‘reality.’ Let’s face it, day-to-day reality is not interesting enough to be compelling TV programming. People would not watch if it were not made to be consistently interesting, thought provoking, or emotionally evocative. For this reason, there will be some who read this blog post and think, “Well, I love these shows because I have finally begun to understand why my mother had such a problem with clutter.” They feel understood or they can relate to the struggle depicted. Others may find the situations interesting or thought provoking, while others still, may find these shows exploitive. As a specialist in the treatment of these disorders, I see concern amongst my colleagues that the media has a tendency to sensationalize these problems, while also presenting them as being more simplistic to treat than they truly are. I believe this true. However, there is a tremendous advantage to the attention brought to these disorders; they encourage public discussion of the problems and may motivate individuals to seek professional help. And, in the end, the potential to improve quality of lives is good.

For more information, contact Marla W. Deibler, PsyD:
email:mail@thecenterforemotionalhealth.com
phone: (856) 220-9672
fax: (856) 673-0630
Her office is located at:
385 North King’s Highway
Cherry Hill, NJ 08034