ABC’s new drama "Wonderland" has created quite a buzz among psychiatrists and mental health advocates. The first television series set in a psychiatric emergency room of a busy inner-city hospital has been panned as sensational and stigmatizing by some and hailed as realistic by others.

The most vocal critic has been the National Alliance on Mental Illness (NAMI), which joined 14 mental health groups last month in calling for disclaimers and warnings to be issued before each show.

"The show stigmatizes the mentally ill by portraying them as killers, freaks, and crazies. But of far greater concern are the themes of violence, suicide, and lack of hope, which may discourage people from seeking or continuing needed treatment," according to a NAMI press release.

Other members of the coalition are the Mental Health America, American Psychological Association, and Association of Community Psychiatrists.

APA has not joined the coalition but sent a letter to ABC this month. "We said we would like to use the controversy surrounding the show to discuss the depiction of psychiatric issues on television with television-industry representatives. We also stated that it was reasonable to warn viewers about potential violence and to run suicide hotline numbers during the second program, as NAMI had requested," said John Blamphin, director of APA’s Division of Public Affairs. In the first episode, which aired March 30, a man with schizophrenia opens fires on people in Times Square and is ordered by a judge to be put on medication. Doctors tend to a suicidal man who gashed both his arms and to a psychotic boy who bit off his mother’s finger. In the second episode, which aired April 6, the man with schizophrenia commits suicide after he begins to improve on the medication. He realizes that he shot and killed several people when he was psychotic and is filled with remorse.

NAMI Executive Director Laurie Flynn called on ABC and "Wonderland" producer Peter Berg to eliminate or edit the suicide scene and to warn people that the show is not representative of mental illness and that people with mental illness are no more violent than the general population, according to her March 27 letter to the network.

Donna Norris, M.D., immediate past speaker of the APA Assembly, said in an interview, " ‘Wonderland’ does a disservice to the public by showing patients committing violence or suicide to tantalize viewers without offering messages of hope. It doesn’t benefit anyone to encourage stigma. I am concerned that the average viewer will come away thinking the show is representative of psychiatric practice and be discouraged from seeking treatment. The psychiatrists portrayed on ‘Wonderland’ appear disorganized and insensitive to the patient’s need for confidentiality and privacy.

"I hope there will be an opportunity as the series develops to demonstrate the caring aspects of psychiatry and expose the inequality of mental health care available for people with psychiatric illnesses—particularly children and the constraints their psychiatrists face trying to provide needed services."

Producer Berg doesn’t plan to make any changes to the series, according to an April 4 Washington Post article. "My intent was to explore the complicated and difficult issues surrounding mental illness and the dilemmas faced by patients, their families, and the people who treat them in a realistic and sensitive manner that will stimulate public discussion."

Berg attempted to model the series on the psychiatric wards at Bellevue Hospital in New York City.

"He spent six months here last year and became fascinated with the emergency room and prison ward and chose to focus a lot of his attention there," said Robert Berger, M.D., director of Bellevue’s forensic psychiatric unit.

Berger and A. Sasha Barday, M.D., former deputy director of the forensic psychiatric unit at Bellevue, told Psychiatric News they were consultants for the series, which included discussing story ideas and reviewing manuscripts.

"The series was never intended to represent all aspects of psychiatric practice but rather to offer viewers a glimpse of forensic practice at Bellevue," said Barday. "Many patients are brought to Bellevue from prison or the police and are in a state of acute psychotic decompensation."

Berger said, "In my 23 years here, I have seen it all—a doctor has been stabbed with a pen 27 times in the face, and I have had my face, tie, and clothes cut with glass by a patient."

He agreed that the pilot episode was "over the top" visually in a few scenes but added that it was a condensed version of what possibly could happen over several years of professional practice.

"What viewers see in 45 minutes on ‘Wonderland’ is no different from seeing chests cracked open and hearts massaged every five minutes on ‘ER,’ " said Berger.

The psychiatric consultants said some of the scenes were not based on fact or their advice but on Berg’s and the screenwriter’s imagination.

For example, Berger said he was surprised to learn about the suicide scene in the April 6 episode. "I told the screenwriter that a suicide has never occurred in Bellevue’s 70-year history. I also mentioned that the suicide reflected badly on the course of treatment and that in real life it would not happen that way."

He added that future episodes would show life-affirming moments with patients asking for or accepting their need for help.

Barday commented that regardless of whether people like the show, it has provided a forum to increase public awareness about mental illness and psychiatry.

Sally Satel, M.D., a psychiatrist in Washington, D.C., shared that opinion in a letter published in the April 3 New York Times. "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."

She continued, "Although most people with mental illness do not pose a threat to others, this is not true of the types of severely ill patients that cycle in and out of psychiatric hospitals like the one in the show."

Although the antistigma campaign has legitimate concerns, "those running it should realize that realistic portrayals of the mentally ill might be the best way to drive home the point that the severely mentally ill need far more care than they are currently receiving," she wrote.