Keeping Up With the Ketamine: Psychiatric Diagnoses and Treatment on Reality TV

Almost 40% of American adults report watching some form of reality television regularly.¹ What constitutes reality television can vary widely; These shows may have competitive and noncompetitive formats in a wide range of subjects such as cooking, romance, and performance. Despite the multifaceted formats and contents, many shows prominently feature psychiatric diagnoses and treatment. Many reality TV stars disclose their psychiatric conditions and even assert that their peers have psychiatric diagnoses—accurate or not. Some reality TV even explicitly airs “therapy sessions” meant to portray real psychotherapy, to varying degrees of accuracy. But reality TV’s portrayals can lead to misunderstandings, and multiple reality TV stars have later died by suicide.

This article will update the psychiatrist about reality TV, its portrayals of mental health and mental health treatment, as well as its potential to propagate misinformation about psychiatry, and will then describe important points for discussion with patients.

Mental Health in Reality TV vs Scripted TV

Irving Schneider aptly described it: “If psychiatry had not existed, the movies would have had to invent it.”² Schneider described characteristics of psychiatrists in film and TV. In recent scripted TV, 4 archetypes of psychiatrists are portrayed: Dr Dippy, Dr Wonderful, Dr Evil, and Dr Detached.³ Dr Wonderful is an effective, well-intentioned psychiatrist. Dr Dippy is an odd, incompetent psychiatrist without basic common sense, such as Dr Tobias Funke in Arrested Development. Dr Reston of Seinfeld is an example of the Dr Evil archetype, a malevolent psychiatrist who manipulates his patients for his own personal gain. The final archetype, Dr Detached, lacks any meaningful emotions towards his patients, adopting a cold and unemphatic attitude towards patients. Dr Beverly Hofstadter of The Big Bang Theory exemplifies Dr Detached, for example via her cold analysis of her own son. Of course, concerns of stigma and misconceptions about mental health and psychiatry already exist in the real world, and these are perpetuated by Hollywood portrayals of psychiatrists and psychiatry.^3-6 Portrayals of mental illness and of mental health professionals in reality TV have one foot in the fictional psychiatry world, and one foot in the real world.

Early reality TV, such as competition-based shows, included mental health primarily backstage; for example, there were consultant psychologists for Survivor, and an internal and addiction medicine physician on Big Brother.^7,8 Some of the background involvement included screening contestants. M. Gene Ondrusek, PhD, a psychologist consultant for Survivor, described assessing for medical and mental health disorders, as well as interpersonal interaction patterns and behavioral responses.⁸ By the mid-2000s, therapy appeared often as a plot device, such as in Breaking Bonaduce where couples therapy was a device to point out cheating and flaws.⁹These presented real risks of negative impressions of both mental health disorders and therapy.

More recent reality TV models a more documentary-like style, following the daily lives of reality TV stars—including into their therapy sessions. In contrast to the background mental health involvement of early reality TV, these series allow the audience to “join” treatment sessions, breaking the fourth wall (the theoretical space that separates performer from audience). For example, in The Real Housewives of New York and Bethenny Ever After, viewers witness therapy sessions between Bethenny Frankel and Xavier Amador, PhD, addressing issues of friendship, divorce, career, and childhood trauma.¹⁰ Couples therapy in Bling Empire allowed for exploration of family trauma and abandonment issues.¹¹ Documentary-style reality shows are perhaps more likely to delve into personal details, as this is the focus of the show, rather than a competition show where the main focus is on the contest at hand, although of course contestants’ mental health may play an important role in their competitive performances.

Psychiatric Illness on Reality TV

Some reality TV shows explicitly feature psychiatric illness or mental health treatment, such as Couples Therapy, Hoarders, Intervention, My Strange Addiction, LA Shrinks, and SuperNanny. Mental health professionals are on the scene, such as David Tolin, PhD, on Hoarders.

Many reality stars self-disclose either their own diagnoses or the diagnoses of family and friends. The Table provides some examples of diagnoses self-disclosed by reality TV stars. At this point, it is prudent to discuss the Goldwater Rule—the ethical prohibition of psychiatrists from diagnosing individuals they have not personally examined.¹²In this article, we do not opine on any specific star’s diagnoses—self-disclosed or suspected. However, reality TV stars often offer their own thoughts about psychiatric diagnoses. Regardless of their accuracy or inaccuracy, these diagnoses are discussed in this arena and the implications of these discussions on TV warrant consideration by the psychiatric field.

Speculation about psychiatric diagnoses of others often serves as discussion fodder on reality TV. For example, season 6 of the Real Housewives of Beverly Hills prominently featured the storyline exploring whether or not one of the housewives had a diagnosis of Munchausen syndrome. Vanderpump Rules star Tom Sandoval took a “narcissism test” while on an episode of the Everybody Loves Tom podcast to refute claims that he had narcissistic personality disorder. Cast member Stassi Schroeder administered a “sociopath test” to Jax Taylor while recording an episode of her podcast, which was shown to viewers in season 5.

Psychiatric Treatment on Reality TV

Reality TV could help destigmatize mental health issues, rather than blame or mock. Millions of viewers seeing reality stars in therapy can help plant a seed. But, solving complex mental health issues in time for a commercial break can set up false expectations in viewers too.

When interviewed, reality stars have reported the potential for decreased stigma from portrayals of therapy. Jamie Otis (Married at First Sight) said,“10, 20 years ago, therapy had such a stigma to it. That means you’re flawed. Now, people are able to come out a bit more and share their stories.”⁹ Similarly, Lindsay Hubbard (Summer House) said “my TV show is helping normalize therapy.”⁹

Therapists also report the positives of portraying therapy on reality TV. Therapist Kerrie Mohr (Summer House) shared: “Being open and honest about their struggles, and really relying on a therapist to work through those things…. See that they’re not alone with what it is that they’re dealing with.”⁹ Elizabeth Winkler, therapist on Vanderpump Rules, explained: “the gift of being able to witness [therapy] on television is that it gives you permission to maybe try it yourself.”¹¹ Esther Boykin, therapist on Real Housewives of Potomac, similarly explained, “People who are watching these shows who can relate to the storylines, who relate to having difficulties as an adult, having difficulties with their mother, or who have struggles with their husband or have trouble conceiving—understand that watching people has value, it helps people to feel less alone.”⁹

Cameras are in the therapy room in various reality TV shows.¹⁴ Cameras most certainly change what is said, and the course of therapy. As well, directors choose specific clips for various reasons.

Therapy is not the only form of mental health treatment portrayed on reality TV. Many reality TV stars have discussed their use of psychiatric medications, such as antidepressants. In 2023, The Real Housewives of Miami showed one of Adriana de Moura’s ketamine treatment sessions, where she on camera reported conversing with her deceased father and brother.¹⁵

The dark side is whether these short clips of sessions are really therapeutic for the patient, or whether they are creating conflict and scene. Privacy and confidentiality become lost when therapy is entertainment. The Unscripted Cast Advocacy Network Foundation has raised concerns about harm done to cast members and the need for guidelines, as well as enforcing privacy of evaluations and protecting emotionally distressed cast members.¹³

Suicide and Reality TV

As of 2020, at least 28 reality TV stars have died from suicide.¹⁶ Reality TV stars certainly put forth many psychiatric diagnoses or conditions—whether accurate or inaccurate diagnoses. Taking part in reality TV shows may be stressful for myriad reasons, including opening up even the most intimate, private moments to public scrutiny and possibly public bullying. Multiple stars of the romantic-competition based show Love Island UK have died by suicide, including a former host and 2 contestants,¹⁷ prompting the British Parliament to evaluate potential ethical concerns about the treatment of reality television stars.¹⁸ Concerns noted included whether the shows had a duty to the participants, such as an obligation to provide psychological support and to avoid excessively psychologically taxing situations. Love Island USA, as of 2025, has a mental health support team that includes 2 on-call psychologists and requires that contestants receive psychological assessments prior to beginning the show.¹⁹

How to Have Conversations With Patients

As with all forms of entertainment and artistic media, there are opportunities to foster meaningful conversation and address bias, but also possibilities to reinforce stigma. In reality TV more specifically, the viewer sees “real people” in their everyday lives, including discussing and addressing their mental health. Inquiry about patients’ media consumption and content themes can lead to fruitful dialogue. More specifically, asking about how the media portrays mental illness and its treatment can result in open discussions about the patient’s own perceptions about their illness and treatment, their responses to treatment, and sociocultural understandings of psychiatry and mental health care.

Television media and the reality TV genre has led to real-life portrayals of mental health treatment, including that therapy is longitudinal. A representative from the American Foundation for Suicide Prevention said this about reality TV: “They show what [therapy] looks like and that it’s not a quick fix; that therapy is generally a positive experience.”⁹ However, discussions with patients can focus on the intent behind reality TV, namely entertainment, including the crafting of a storyline based on a cast member’s life experience, in a short scene or series of scenes. This focus will necessarily simplify the scope of a person’s engagement with mental health treatment, and may result in assumptions about mental health providers, treatment modalities, and treatment outcomes. We recommend providers explore these dualities (unmasking or normalization of mental health treatment vs simplification of the process to fit into episodes or storylines) with their patients in order to develop therapeutic rapport and understanding but also importantly to realign their patients’ experiences with treatment goals and realistic long-term outcomes.

Discussions with patients can include that while identification of mental health diagnoses for reality TV stars may foster discussion and exploration in audience members, descriptions of diagnoses may be lacking in detail, misidentified, or overly simplified. Additionally, reality stars may pursue in-vogue or expensive treatments that have limited evidence to support their use or may have previously pursued gold standard treatment with partial response before. These representations in reality TV may create a sense, whether true or false, of increased legitimacy or necessity of treatment, in comparison with fictional portrayals.

Regardless of the direction of the dialogue, it is important for the real-world psychiatrist to maintain a neutral, curious approach to a patient’s engagement with and perception of media depictions of mental illness and treatment, including reality TV. Additionally, psychiatrists may benefit from familiarizing themselves with different popular reality TV shows, particularly those with portrayals of mental health, to further discussions with their own patients regarding impressions of their own mental health treatment and developing realistic treatment goals together.

Dr Hatters Friedman is the Phillip J. Resnick Professor of Forensic Psychiatry; professor of psychiatry, reproductive biology, and pediatrics; and adjunct professor of law at Case Western Reserve University in Cleveland, Ohio. She served as editor of the Group for the Advancement of Psychiatry volume Family Murder: Pathologies of Love and Hate, which won the Manfred S. Guttmacher Award. Dr Ross is a forensic and reproductive psychiatrist at Trinity Health Michigan and an adjunct clinical assistant professor in the Department of Psychiatry at the University of Michigan. Dr Kruse is a forensic child and adolescent psychiatrist, and a clinical assistant professor in the Department of Psychiatry at the University of Michigan.

References

1. Patel R. Reality Tv viewership statistics. Gitnux. Updated January 26, 2026. Accessed February 3, 2026. https://gitnux.org/reality-tv-viewership-statistics/

2. Schneider I. Introduction. In: Gabbard GO, Gabbard K. Psychiatry and the Cinema. American Psychiatric Press, Inc; 1999.

3. Ross NE, Jain A, Hall RC, Friedman SH. Psychiatrist archetypes in comedic television. Acad Psychiatry. 2023;47(5):556-560.

4. Friedman SH. Hollywood and psychiatrists: from Professor Plum to Dr. Melfi. MedPage Today. January 24, 2024. Accessed February 3, 2026. https://www.medpagetoday.com/popmedicine/popmedicine/108408

5. Friedman SH, Forcen FE, Shand JP. Horror films and psychiatry. Australas Psychiatry. 2014;22(5):447-449.

6. Friedman SH, Cerny CA, Soliman S, West SG. Reel forensic experts: forensic psychiatrists as portrayed on screen. J Am Acad Psychiatry Law. 2011;39(3):412-417.

7. Melman L. Getting to know physician and Hollywood radio-tv personality Drew Pinsky. Jerusalem Post. September 28, 2025. Accessed February 3, 2026. https://www.jpost.com/diaspora/article-868550

8. Ondrusek G. Survivor psychologist.CBS News. January 31, 2002. Accessed February 3, 2026. https://www.cbsnews.com/news/survivor-psychologist/

9. Burton S, Holmes L. Reality TV has been quietly normalizing therapy. Huffington Post. September 11, 2019. Accessed February 3, 2026. https://www.huffpost.com/entry/reality-tv-normalizing-therapy_l_5d77d4e5e4b075210233f4f9

10. Ries Wexler J. Are the therapy sessions on reality TV shows even remotely legit? Self. April 7, 2024. Accessed February 3, 2026. https://www.self.com/story/reality-tv-therapists

11. Nath I. The power (and risks) of therapy on reality TV. Refinery 29. April 14, 2023. Accessed February 3, 2026. https://www.refinery29.com/en-us/2023/04/11355793/therapists-on-reality-tv-shows-ethics

12. Blotcky AD, Pies RW, Moffic S. The Goldwater Rule is fine, if refined. Here’s how to do it. Psychiatric Times. 2022;39(1).

13. Unscripted Cast Advocacy Network Foundation. Accessed February 3, 2026. https://theucanfoundation.org/ 

14. Prinzivalli L. How real is reality TV therapy? Atlantic. September 20, 2016. Accessed February 3, 2026. https://www.theatlantic.com/health/archive/2016/09/reality-tv-therapy/500801/

15. Moylan B. The Real Housewives of Miami recap: specialist K. Vulture. November 29, 2023. Accessed February 3, 2026. https://www.vulture.com/article/the-real-housewives-of-miami-recap-season-6-episode-5.html

16. Longman M. When reality TV contestants die, who should we blame? Refinery 29. July 27, 2020. Accessed February 3, 2026. https://www.refinery29.com/en-us/2020/07/9826219/reality-tv-contestants-suicide-mental-health-problem

17. Peele A. How Love Island became a TV reality of sex, fame, and sometimes tragedy. Vanity Fair. June 2, 2022. Accessed February 3, 2026. https://www.vanityfair.com/style/2022/06/how-love-island-became-a-tv-reality-of-sex-fame-and-sometimes-tragedy

18. Committee announces inquiry into reality TV. UK Parliament. May 15, 2019. Accessed February 3, 2026. https://committees.parliament.uk/committee/378/digital-culture-media-and-sport-committee/news/103566/reality-tv-inquiry-launch-17-19/

19. Noble A. Can I pull you for a chat? A look into Love Island USA's mental health team. Vogue. July 12, 2025. Accessed February 3, 2026. https://www.vogue.com/article/love-island-usa-psychologist