Dear BRAVO TV,
I have been a regular viewer of your series of shows entitled “The Real Housewives of [Insert City Here because, truthfully, I watch them all]” since it first aired in 2006 featuring Orange County. As a student of psychology, I love watching the housewives – seeing how other people engage in various interactions and decision-making and trying to understand how poor communication can spiral into unrelenting drama. I devour each episode! More recently, though, I have been disgusted by your destructive and wrongful portrayal of mental health on the show. One event, in particular, has struck me; allow me to paint a picture (or if you’d prefer, watch the clip here).
The Real Housewives of Beverly Hills: Season 8, Episode 13. Lisa Rinna, a prominent model, actress, and socialite, has proven to be outspoken, nosy, and full of “rage and regret,” as she will be described throughout the season. Newcomer Dorit Kemsley and her husband PK have had numerous issues with Rinna’s gossiping and, following a tumultuous girls trip, Dorit complains to her husband that Lisa “is one person one day and another person in another moment” and her husband quickly replies “there’s a term for that, it’s called ‘schizophrenic’… I think she’s dangerous.” This is not only said once but is also referenced back numerous times on the show, as well as during the reunion. What’s more, during the reunion episode, which could serve as an optimal time for host Andy Cohen to provide some psychoeducation, nothing regarding stigma nor the inaccuracy of the claims is stated.
This description of schizophrenia is not only a gross over-exaggeration, it is also blatantly wrong, and the viewers (or many of them) do not know it. So, I was compelled to write this letter, albeit delayed, for two reasons: (1) to shed light on the disorder of schizophrenia and (2) to implore Bravo TV to use its status as a national network to eliminate stigma and promote understanding of mental health issues instead.
I would like to first take a moment to clear up this grave distortion and misunderstanding of schizophrenia. Schizophrenia is a thought disorder named in 1908 by Eugene Bleuler [1], though the symptoms had been identified in earlier accounts — including by Emil Kraepelin, who called the disorder “dementia praecox” or a premature dementia [2]. Schizophrenia is estimated to afflict 1% of the population and costs the US upwards of $100 billion annually in direct care and loss of revenue [3]. The term ‘schizophrenia’ comes from the phrases ‘schizein’ and ‘phrene,’ meaning split mind. This literal translation is likely where the misinterpretation of schizophrenia as a disorder of multiple personalities (formally termed Dissociative Identity Disorder) or rapidly changing moods emerges. Instead, this split mind can be understood as fragmented thinking, resulting in loose associations — finding meaning or coherence in things that are unrelated.
Loose associations can underlie what has traditionally been conceptualized as negative and positive symptom phenomenology of the disorder. Negative symptoms are phenomena that are missing or lacking, and include: poverty of speech, flat affect (an absence of the natural ebbs and flows of our tone during conversation), an inability to think abstractly, tangentiality (or an inability to maintain a logical flow of thoughts), lack of motivation and/or pleasure, and catatonic movement including rigidity and/or odd posturing. Positive symptoms are things that are present above what is usually expected, primarily delusions and hallucinations. Delusions are strong beliefs that are unlikely or untrue and are maintained despite evidence to the contrary. An extreme example may be the thought that one’s heart has been permanently removed by aliens. Hallucinations are the perception of sensation when no present external stimuli exist, such as hearing voices, seeing figures, or feeling insects crawling on your skin.
As you can imagine, many of these experiences can be highly distressing to the person experiencing them and they can also make everyday life challenging. In fact, many individuals with schizophrenia also experience cognitive deficits – things like learning, memory, executive functioning, and abstract thinking – as well as social deficits. These additional challenges can make it difficult to maintain a job, social or romantic partners, or perform daily tasks. It should be noted, though, that this is not always the case and some individuals are quite well adjusted.
The bottom line is this: the disorder being described on BRAVO TV is, in fact, not called schizophrenia. Moreover, to do so is stigmatizing. I have 3 major issues with this. First, the Kemsleys were misdiagnosing someone, creating the perception that mental health diagnoses can be easily observed, understood, and attributed to others by any layperson. This is incorrect, as extensive clinical training underlies the formal diagnoses made by medical or psychological professionals. Second, they were using a diagnosis as a label. Someone is not schizophrenic, someone has schizophrenia. Seeing a person as a cluster of symptoms rather than an individual can cause self-stigmatization and prejudice. Third, the label they were creating was negative – representative of problematic behavior and negative perceptions. This, in my opinion, is completely unacceptable. Unfortunately, stigma is highly prevalent and, even more unfortunately, contributes to people not seeking or accepting the treatment that they need, increasing discrimination and prejudice, and/or perpetuating misinformation [4].
In sum, as a network with a high impact, I would expect that BRAVO TV devote some time, during a reunion show perhaps, to educating the public and its cast on mental health and stigmatization. The network could make amends by instead cultivating understanding and sensitivity to such issues in their wide viewership.
Disclaimer: For the sake of this format, the complexities and nuances of this disorder, and psychoses more broadly, have been greatly simplified. In addition to extensive phenomenological research, schizophrenia has also been studied at a range of other levels, including behavioral, genetic, endocrine and biochemical, and neural. For more information, please visit the National Institute of Mental Health website.
Update: This problem of layman diagnoses conferred by fellow cast members has continued in the Real Housewives franchise spanning diagnoses of alcoholism (alcohol use disorder), depression, etc. As cast member Shannon Beador has addressed in this current season of the Real Housewives of Orange County (Season 13), it is “unethical” to make diagnoses without proper assessment and credentials. I would argue that this extends outside of BRAVO TV; such claims are damaging. They model this behavior to watchers and substantiate misinformation, fuel stigmatization of mental health issues, and undermine clinical science. Again, I call to BRAVO TV to address these problems.
Edited by Lana Ruck and Riddhi Sood
[1] Bleuler, E. (1908). Die Prognose der Dementia praecox (Schizophrenie-Gruppe). Allg Z f Psychiat Psychisch-Gerichitliche Medizin, 65, 436-464.
[2] Kraepelin, E. (1971). Dementia praecox and paraphrenia. Krieger Publishing Company.
[3] Chong HY, Teoh SL, Wu DB, Kotirum S, Chiou CF, Chaiyakunapruk N. Global economic burden of schizophrenia: a systematic review. Neuropsychiatr Dis Treat. 2016;12:357-373.
[4] Corrigan, P. (2004). How stigma interferes with mental health care. American psychologist, 59(7), 614.
