From the first days of reality TV—­narrative, character-driven storytelling that uses real people and real lives as its subject matter—the genre has left a trail of human wreckage. Its stars have been arrested for DUI, ­assault, drug possession, sex with ­minors and domestic violence. An MTV Road Rules alum and Challenge cast member who was arrested for public urination later smeared the walls of his jail cell with his own feces and then bragged about his misbehavior on ­Twitter. Survivor’s first winner is in prison—again—for tax evasion, the same charge a recent Big Brother winner eventually pled guilty to, in addition to possession with attempt to distribute oxycodone as part of a drug ring the government says he funded using his $500,000 prize from the CBS reality series.

Another Big Brother contestant morphed into a hard-core gay porn star, and he’s not alone. Familiar faces show up in adult films with surprising regularity. The first celebrity reality-TV show took cameras into the home of Ozzy and Sharon Osbourne for MTV’s The Osbournes. Two of their kids went to rehab for drug addiction, and Sharon went on to appear on other reality series, including VH1’s Rock of Love: Charm School, which ended with an out-of-court settlement following Sharon’s physical confrontation with a cast member, a woman who got her own series, which featured her dating millionaires and which was pulled off the air because one of them killed his wife and later committed suicide. His death was one in a series of suicides that received media attention in 2009 because the dead people had all once appeared on reality-TV shows.

These are just a few examples. Eleven years since reality programming came to prime-time network television in the United States, thousands of people have been featured on unscripted series across nearly every channel. Does reality TV attract or prey on people who are more likely to engage in horrific or illegal behavior? Does the experience send once-sane people down a path that ends in jail, where they proudly shit in their hands? Or does it attract media attention because these people are now familiar to us or worked on familiar shows, like the co-creator of Pimp My Ride and former ­Survivor producer who was arrested for murdering his wife in Mexico? What are the consequences of bonding with people we get to know on TV, of commercialized ­voyeurism?

While tens of thousands of people regularly apply for a chance at fame and new experiences, some who have appeared on television have publicly and privately complained of its impact. “I don’t think the cast or the producers knew what we were getting into that first season of The Real World,” executive producer and co-creator Jonathan Murray explains. Nineteen years after his MTV series debuted and defined reality television, it’s difficult to recall a time when real people’s lives were not prime-time entertainment. That first group of seven, he says, “had no way of knowing how exhausting it is to have a camera on you 24-7.”

And they certainly had no way of knowing what it would look like once they saw fragments of their lives in half-hour episodes.

The retracted red-and-white-striped awning on the former Woolworth’s in Wildwood, New Jersey is tattered, but inside everything is perfect—except no one can go inside.

Inside is Randyland. Randyland is a maze of fascinating things, including Fascination games, an early-1900s combination of Skee-Ball and bingo. And in between rows of old pinball machines are many more games, including boardwalk games, handcrafted and patented by Randy Senna, in which players shoot water at a urinal or toilet that has a mechanically flapping lid.

And there’s Randy. Not just the one Randy Senna but hundreds of Randy ­facsimiles: mannequins with blue eyes open with childlike wonder, plastic curls of brown hair and faces frozen in wide smiles. Some are just heads peering quietly out of ice cream ­cases or perched amid Enchanted Tiki Room memorabilia from Walt ­Disney World, where Senna once worked. Many of the Randyquins wear his old Disney costumes, their name tags still ­attached.

I’m inside only because a TV crew is here to film Senna (the human one) for the A&E reality-TV show ­Hoarders, which debuted on the cable network in 2009 to record ratings, probably because it featured a refrigerator full of gag-inducing liquefied rotten food that its owner wanted to keep because she thought it was fine. On a typical episode, two people whose hoards have created some kind of crisis, such as the threat of eviction, get help from an organizer and a team of workers who help clear the mess while a psychologist works with the hoarders to deal with the emotions that inevitably arise. It is obvious, as many of the Hoarders crew will say during my three days there, that hoarders’ brains work differently than ours. These ­reality-show cast members are mentally ill, and Hoarders illustrates that visually and viscerally. If someone says he loves cats but his cats are dead and petrified in the shape of the box they died in, something is very wrong.

Unlike other spaces that have been featured on the show, Randyland has no dead animals and no animal or human feces. There is just Senna and, behind a never-opened door, his parents, who have declined to be included in the five-day production. Upstairs, above the museum-like presentation of Randyland, is storage—the hoard of antique games, piles of stained napkins, Priority Mail boxes, batteries, scattered quarters, buckets of tokens and box after box of VHS tapes. There are also slices of birthday cake, still under the plastic dome that protected the full cake in the grocery store, and a collection of ­Senna’s own hair, saved from haircuts past.

Like so many people featured on this show, Senna does not think he is a hoarder.

The possibility of a horrific outcome haunts reality TV. The first person voted off ­Expedition Robinson, the Swedish series that gave Survivor its format, threw himself in front of a train before the show ever aired because he worried about public humiliation. When producer Mark Burnett brought the format to the U.S. in 2000, his team turned to a psychologist, Gene Ondrusek, to help prevent a similar outcome. “We will put people through some potentially demeaning, degrading, stressful, humiliating experiences,” Ondrusek says producers told him. “They wished to not have someone who was psychologically vulnerable or fragile be damaged by that process.”

After signing a contract and consenting in writing to every possible outcome, including disease and death, potential contestants on many shows are now subject to medical exams, psychological testing and background checks. That is “so it’s clear they’re going to be able to handle the situation,” says Bravo executive vice president Andy Cohen.

The industry’s pursuit of compelling characters and stories has led some shows to cast people who may not be able to handle it, such as those who are in the middle of once-private crises. Alan Keck, a psychologist who practices in the Orlando area, says, “The harm for a lot of folks in that kind of position is that they’re already psychologically vulnerable.” Still, like the B-list celebrities who get paid and receive free treatment (never mind the attention they crave) on VH1’s Celebrity Rehab With Dr. Drew, people willingly sign up. “There are some addicts who are pretty narcissistic and who love that kind of attention,” Keck says. “That doesn’t mean it’s necessarily good for them.” They will be affected to varying degrees. “To somebody with a good, strong ego it may not be a big deal. But most of these people don’t have good, strong egos. They’re already suffering. And this is just one more addition to that.”

On one episode of Hoarders the young son of a hoarder broke down and cried when he realized the show’s crew was leaving. ­Reality-show producer Chris Cowan says cast members can experience “a form of postpartum depression” when the show ends, because the attention evaporates and they are faced with watching the show and dealing with the fallout.

“I went through a lot, man,” Ben Wade tells me. “I really feel like they damaged me, and if I weren’t a Christian, I’d be screwed, man.”

Wade is a delusional liar. At least, that was the consensus when he first appeared on Survivor in 2009. I’ve been covering reality TV for 12 years and publicly called him “impossibly arrogant” and a “liarface idiot douche,” and those were some of the nicer things people wrote about him. We first met in Brazil before the 39-day production of Survivor’s 18th season began, when I was on location to interview contestants and observe the first episode. He went by the nickname Coach, compared himself to Jesus and told his college soccer team that he was being tested for brain cancer. After my interview was published, someone posted on a fan message board, “Ben needs to go DIAF”—that’s “die in a fire.” He soon became the most infamous reality-TV show contestant in the country, thanks to his over-the-top personality and the nonstop attention editors gave him. He called himself the Dragon Slayer and claimed to hold the world record for the longest solo kayak ocean expedition, a claim the editor of Canoe & Kayak ­Magazine disputed. He told fantastic stories, including one about his escape after being kidnapped and tortured by Pygmies while kayaking on the Amazon. He was ridiculed, on the show and off.

Day and night on reality-TV shows, cast members are pushed physically and mentally. Often sleep-deprived, they’re cut off from friends, family and the outside world, then asked to do things they wouldn’t do in real life. Survivor, with its $1 million prize, is a simple game complicated by starvation and exposure to the elements, and the experience is brutally real, with the exception of inconsequential cheats: During challenges, helicopter shots are of stand-ins, for example. In Brazil, Wade’s weight dropped from 205 pounds to 149 pounds as he participated in challenges that tested physical strength and mental acuity, all while competing to outlast fellow competitors in votes that took place every three days. He also had to answer producers’ interview questions. “When you’re out there, audience members are the producers, and you want to please them,” he says. But pleasing them turned him into a joke.

During his second season, filmed just a few months after his first season aired, Wade broke down. “I was like, ‘Fuck you, man. You know what I did in Brazil. You know I was honorable. I didn’t do anything wrong. I didn’t hurt anybody. Fuck you for making an ass out of me. I’m out of here.’ ” The threat to quit, he says, wasn’t serious.

Later, Wade will tell me, “I had a good coaching career, and for that to be pissed away like that *[snaps fingers] because they wanted their ratings to be good was not fair.” He was fired from his coaching job at Southwest Baptist University for essentially disappearing for six weeks to be on the show, which he said was because producers threatened to sue him, invoking the contract’s $5 million penalty, if he revealed where he was really going. When prospective *Survivor cast members sign the 32-page contract and nine-page rule book, initialing each page, they agree to be inflicted with “severe mental stress,” allow the network to register websites using their name, “not defame, disparage or cast in an unfavorable light” CBS or Mark Burnett Productions and never write a book about their experiences. They also agree to the fact that the television program may reveal things “of a personal, private, intimate, surprising, defamatory, disparaging, embarrassing or unfavorable nature that may be factual and/or fictional” and that may expose them to “public ridicule, humiliation or condemnation.”

It is a fairly typical contract. “Few contestants read their contracts or have a lawyer read it,” Marc Marcuse says. “You’re going to be on fucking TV. It could say, ‘Give me your firstborn child,’ and they’d sign it. They want fame.” Marcuse would know: After appearing on NBC’s Average Joe he started working as a booking agent for reality-TV stars. Is it possible to make an informed decision about the consequences of page after page of legalese—especially if you’re in a crisis or mentally ill? “No, which is why I handed my contract to a lawyer, and my lawyer said, ‘I would never sign this contract,’ ” Marcuse says. “And I did anyway.”

At first Randy Senna rejected Hoarders because he didn’t like the contract Seattle-based Screaming Flea Productions wanted him to sign. His countercontract detailed the “moving services” that would be performed and asked, among other things, for the production company to essentially agree to its own terms and allow its crew to be filmed. Producers did not agree, and the episode was called off.

But Matt Paxton persuaded him to do it anyway.

Paxton is 35; he looks older on TV but younger in person. He sometimes swears, mentions the importance of his religious faith but doesn’t get specific, rejects friendships with people who don’t support gay marriage and lives in Virginia. In his 20s Paxton went from working as a Federal Reserve analyst to getting beaten up by a bookie after becoming addicted to gambling. In 2008 he was ready to close his business, Clutter Cleaner, which emptied out foreclosed houses and, occasionally, the homes of hoarders, because he could no longer afford rent and his wife was pregnant. Paxton had to beg Verizon not to cut off his cell phone service. The producers of Hoarders were looking for messy houses to clean and were referred to ­Paxton. A week later he was on location, being filmed cleaning a house in Alabama. The show had found one of its go-to stars. His lack of a filter and his humor make him the person most willing to call the show’s hoarders on their shit. Now, because he is on television, he can pay his rent but cannot go to the grocery store during the middle of the day. And recently a stranger rang his doorbell to see if he was there, terrifying his wife.

About six weeks before filming, ­Paxton visited Senna, spending a 10-hour day touring the space and talking to him over lunch. Senna was ambivalent. He and Paxton talked four or five times a day for several weeks. Paxton persuaded him to say yes, to let people into his maze of artifacts, all of which mean something to Senna. It wasn’t an easy decision. Senna likes control, but being on Hoarders means giving that up.

Ben Wade’s anger toward Survivor appears and fades like the snow tumbling through the well-spaced evergreens that line the drive to the small church where he preaches. Anger has become recognition, resignation or both. “I’m not upset about it at all. In fact, I’m really glad they did it—it was just really hard to live with,” he says.

“My friends were doubting me. They were like, ‘Maybe he hasn’t done anything. Maybe he can’t play the trumpet like he says he can. Maybe he is a fucking liar that sat on a beach and pretended like he kayaked the Amazon but didn’t.’ ”

“That’s the power of editing,” I say. Editors have the challenging task of turning hours of boring film into compelling entertainment by assembling footage. And by selecting what to include and then juxtaposing those images, they have a lot of power. On the show, the sequence in which Wade tells the story of being kidnapped and tortured before escaping from indigenous people was edited for time (of course), drama (music enhanced his story) and humiliation (his tribe mates were shown looking bored and, in private interviews filmed later but spliced in, doubting his story). As pressure to produce attention- and ratings-grabbing series increases, producers and editors have privately complained to me that networks sometimes demand more, leading some editors to construct sentences from ­fragments—essentially allowing a show to write its own script and cast members to complain later of misrepresentation (information that fans salivate over because it adds an extra dimension to the reality they’ve come to know).

Still, producers have only so much footage to work with, and Marcuse tells me, “I’ve known well over 1,000 reality people over the course of the years I’ve been doing this, and I represent more than 400. I can count on one hand the people for whom it was the editing. Is it the editing, or is it really that they’re not self-aware?”

Maybe both. “I did it to myself too,” Wade says. “I was so psyched to go into the game that I put on this whole facade, like I am the man, I am the coach. And that is a part of my personality I have to fight.”

Producer Cowan says he tells cast members that “cameras and shows are kindest to those who are just letting themselves be themselves. If you try to control the impression of your personality or who you are, what your image is, in the end you’re going to be unhappy. Because the camera doesn’t get to see all the nuances in your head. It sees only your actions.”

Wade never locks the door to his house, which, like his personality, is an eclectic, complicated mix. Fragments of Survivor are everywhere: on the bar, shot glasses from his two seasons; cast photos; a newspaper article about a charity event appearance, framed and leaning against the wall of the guest bedroom I stayed in. (Yes, I called him a “liarface idiot douche” in public and yes, he still invited me to be his houseguest.) An alcove off the dining room overlooks ­Susanville, California, where the high desert and mountains meet, and in front of the windows, on a table, sit a flatscreen, a computer keyboard and a musical keyboard. It’s here that Wade composes, sometimes not moving for 12 hours, not even to take a bathroom break. He rents out his basement to four soccer players, who interact with him as though he were their older brother, borrowing his clothes and jokingly calling him an asshole.

Everyone in town who knows Wade seems to adore him, from his friends to the little kids who seek his autograph (he signs “Dragon Slayer”) to the senior citizens who call him “maestro” in the lobby of the church where the pews are filled with hundreds of residents to hear a Susanville Symphony Society concert. There, a back room is packed with people and sound. More than 50 musicians—some ­teenagers, others professionals from Reno; some paid, others volunteers—fall quiet to listen to Wade, their conductor, who, in 2003, two years after coming to Susanville and transforming the women’s soccer program at the community college into a success, merged local quintets and became the group’s reluctant, and eventually professionally trained, conductor and composer.

Sometime after Survivor, while he was wading in the shallow pool of postfame fame-seeking that so many attention-drenched reality-TV show cast members dive into—he was offered his own dating series similar to The Bachelor—Wade moved back to Susanville so he wouldn’t become a “whoremonger.” Wade later says, “I’m not fuckin’ faking everybody. I must really care. I’m not narcissistic. I could fool a couple of people, but I’m certainly not going to fool an entire town.” For all the hell television put him through by exploiting his personality, his frustration is nearly always followed by appreciation: for the opportunities it opened up, for the experiences and for the personal growth. “Without question, the producers take advantage of you. It’s what you sign up for,” he says. “You’ve got to flip the coin and say, ‘Thank you, guys, for doing this, for honoring me with your edit, because you made me into an iconic figure for that season.’ I guess you gotta take the good with the bad.”

On a Saturday in late March, the bad is about to start for Randy Senna. Day laborers Paxton hired are moving pinball machines from the storage space above Randyland to a truck, ready to be transported to a new location. Almost every episode of ­Hoarders includes a psychologist who helps the hoarder process the emotions that arise from the crew’s work, and therapist Suzanne ­Chabaud has noticed boxes of videocassettes.

“If you outlive the point at which your things will become valuable, what happens?” she asks Senna in her light New Orleans drawl, her head tilted back to look up at him through her glasses. “You’re gone, and the VHS will still be thrown into the trash.”

As Pat Barnes, the episode’s producer, looks at a handheld monitor that allows her to instantly switch between the two camera shots, Senna says, “The legend of Randy will continue forever, and those who will have the treasures of the Randy archives will thank their lucky stars that I saved all these treasures.” The workers move Senna’s original baby carriage, along with old Pepsi cups, fading and cracked and still in plastic bags.

There are many types of reality shows, from competitions to fly-on-the-wall documentary series, but they all share DNA from MTV’s The Real World. Followed by an entourage of camera operators, sound engineers and producers, cast members are placed in atypical, high-stress ­environments—whether a house or a beach on which they play a game for $1 million—and asked constantly to explain and justify their behavior in on-camera interviews. Some shows are carefully orchestrated, with producers setting up artificial situations and then filming what happens, but the very best ones, such as Discovery’s Deadliest Catch or Animal Planet’s Whale Wars, merely observe real life.

Hoarders is somewhere in between, because the intervention wouldn’t have happened without the show. Cameras aren’t always on, and producers let the therapist and organizer do their work. Barnes frequently checks in with Paxton about what he plans to do next. Sometimes filming interrupts work, for a pull-aside conversation with ­Paxton, Chabaud or Senna, or for a scene like the one now being filmed, in which they talk to Senna about his hoarding. In the same cheery tone, Senna repeats the themes of his collection’s contribution to humanity.

“You’re using objects. Other people might use words,” Chabaud says.

Reality-television producers and the networks that air their shows are conscious of their impact because the well-being of their cast members is, at the very least, good business. “Broadcast networks are incredibly conscious of weighing the risks,” producer Cowan tells me, describing “significant risk-management protocols,” including having mental health professionals on location. Cowan has produced shows such as Joe Millionaire and, most recently, Fox’s Mobbed—shows that involve some kind of deception, and from the moment a format is conceived, he says, “you deal with the potential consequences of whether or not you’re going to be injurious to somebody or exploit someone for the sake of entertainment. It’s a fine line.” It’s also flexible. Cowan says, “The cable world is more cavalier in what it’ll do and the chances it’ll take.”

Bravo created a new subgenre of reality TV when it debuted Project Runway in 2004. “We try to protect them and us every way we can before they wind up going on camera,” Andy Cohen, the cable network’s executive vice president, tells me. “Overwhelmingly, in the many, many seasons [of competitive reality shows that feature creative professionals], our success rate is very high when it comes to ensuring that we cast people who are able to handle the process.” He adds, “It is grueling; we all agree with that. It’s in our interest to showcase these people, because we’re invested in their success.”

The Real World creator Jonathan ­Murray says cast members are savvier now and “know what they’re getting themselves into,” though producers remind them that they have to “be prepared that anything in their life could end up on the show. We developed this application that was 28 pages long, which asked every intimate detail, and we said, ‘If you’re uncomfortable talking about any of this, you probably shouldn’t do this show.’ ” Murray adds, “You don’t know what’s going to happen.” Over the course of his show’s 25 seasons, real life has happened, from pregnancy to death.

Paxton actually cares about Senna. That’s despite the conflict brewing this morning in the empty space Senna has rented for an antiques arcade, where Paxton discovers a massive 30-foot, two-piece boardwalk horse-racing game in which players roll balls up ramps and into red, blue and yellow holes to make their plastic horses run, trot or walk to a stuffed animal or other prize. All 10 of Paxton’s day laborers, using dollies, are barely able to roll the 10,000-pound top half. It’s impossible to see how either of the two 30-foot pieces will make the S-turn and go down two short sets of stairs. Paxton says, “I started to get really mad at him. And then my labor guys said, ‘That guy’s crazy!’ I said, ‘Don’t call Randy crazy! That guy’s my man.’ I started sticking up for him.”

I ask if he thinks Senna is mentally ill. “Yes, Randy has a disease. Absolutely. He does not have the same brain as you and I,” Paxton says. “I think he was just weird and made fun of and never had a chance to make friends from a very early age.”

A full-fledged fight between friends develops when Paxton discovers Senna moved half the game by himself while the crew was at lunch. Senna leans on its end as the two men get more and more agitated. “You did not show me this or that monstrosity,” Paxton says, cameras hovering a few feet away.

“I described it all in the e-mails back and forth,” Senna insists. “But the bottom line is you didn’t hire professional people who are movers.”

The argument builds in intensity as it circles the same issues for more than 25 minutes. “I feel hurt and betrayed,” Senna says, choking up. He insists he did tell ­Paxton and thinks he’s being set up because five days of production have resulted in only a portion of his hoard being moved, and now Senna’s going to be humiliated on TV and have little work done.

Paxton is so pissed he yells at Chabaud when Barnes indicates the therapist should join in the conversation. “I want you to wait a second,” Paxton barks. “I need to talk. Both of you need to not talk. Randy, look at me. Please do not condescend to me.” ­Chabaud shuffles away. “You and I have made a commitment to each other, as friends, to finish this job. I will stay no matter what, except if you talk down to me,” Paxton says.

Senna knows this fight is the obvious climax of the episode: “This part of the show will ruin the show.”

Paxton disagrees. “People need to see that friends are able to argue and move forward,” he says.

Little of the fight will make it on the air, particularly Senna’s claims about his deal with producers, which Paxton attributes to Senna wanting to feel in control, common among hoarders. But it may actually have been therapeutic. Earlier Chabaud told me, “There are some situations where the person is so impervious to any kind of intervention that the camera actually serves as a tool to get them to come out because they may be really angry.” A lot of work forHoarders, here and on other shoots, takes place off camera or never airs, including conversations among therapists, hoarders and their family members. As a result, Chabaud says, “I have never left a show without feeling there was some healing.”

Paxton echoes this. “I would not be doing this if we were not helping. If we didn’t offer that aftercare, this would absolutely be cruel, because then you’re not giving them the chance to get better.” Besides paying for the cleanup to alleviate whatever crisis exists and, if necessary, making emergency repairs, producers offer therapy and continued work with an organizer. The money can’t be used for anything else, though sometimes it pays for family members to get counseling. A dedicated staff member now coordinates aftercare, researching therapists and following up with the hoarder a few days after the cameras leave. The goal is to have therapy start immediately because, as series producer George Butts says, “it can be traumatic for them when the shows air.” He adds, “Unfortunately, we can’t force them to take mental health therapy.”

He estimates that fewer than half actually do.

Senna expects to be among the majority of hoarders who reject aftercare. “I don’t believe in any way, shape or form I need therapy. There’s nothing wrong with me,” he says, his jacket flecked with sawdust from his lunchtime work yesterday, his black, graying hair unraveling from its wavy curls.

“I’m strong enough to deal with the emotional stress because, again, I knew this was going to happen when I went into it,” he says. He has, from the very beginning, expected the worst. “They blew that all out of proportion in order to create conflict,” he says. “I felt very betrayed, very hurt. I felt they were my friends, and they came in and literally put me in a corner, and I didn’t think that was fair.”

Senna takes a breath as his eyes dampen and his mouth quivers. “I’m more surprised that they sold me out, because I thought I had won them over. I’m not mentally ill, but I’m sure that will appear at the front of the show, that hoarding is a mental disorder. So they’re going to label me from the beginning.”

Senna is hopeful, though. “Maybe the producers will look at themselves and say, ‘Well, gee, maybe sometimes we’re doing more harm than we think.’ ” He brings up aftercare. “They know they’re causing emotional stress in these people’s lives. You’ve left these people in a clean house but in an emotionally empty spot.”

Senna, as Paxton constantly points out on camera and off, is most likely smarter than the rest of us, even rewiring the lift gate on the faulty truck Paxton rented. So why would Senna agree to this? Why expose himself to the world, to the pain, when he could have just hired professional movers himself? “Nobody in their right mind should sign that contract,” Senna says. “Nobody. And I am smart enough to know I shouldn’t have signed it, but.…”

“But you did,” I say.

While we talk upstairs, the production team gathers around a glass-covered game that holds boxes of bobbleheads. Team members are concerned about Senna and the public’s eventual perception of him—a remarkable conversation for a reality-TV crew to have. They ask, “How can we present Randy in a positive light today?” Chabaud tells me this outside Randyland’s front doors, where she’s wrapped in a full-length black coat and smoking a cigarette.

I ask about Senna’s concerns about how he’ll be portrayed. “That’s a responsibility he has to take: that he applied for a show that portrays mental illnesses,” she says. “Even if there’s a personal price they have to pay for seeing themselves on TV, they have to realize they’re doing something for the good, and I try to instill that before I leave.” Hoarders has brought the disease of hoarding to the attention of hoarders, family members and even mental-health professionals and has intervened in about 80 hoarders’ lives.

But can kids who appear on camera, victims of their parents’ illness, take that same responsibility? “I’m not trying to justify everything, but if I sense there’s something about that child that may cause them problems after the show, I work with them and give them some tools before I leave,” Chabaud says. “And I really think they have more tools after I leave than before I came. Many of them were teased anyway, but they didn’t have the tools to deal with it.”

As for the boy who cried when the crew left, he was filmed for a follow-up episode. Chabaud says, “After kids saw the show they teased him about sleeping in his mom’s bed. I said, ‘Well, how do you deal with that?’ He said, ‘I need to tell people out there that when you’re raised in a home that’s hoarded, sometimes you have to do things that are not normal, and kids need to know it’s not their fault.’ And that was—wow! That was so powerful. I almost cried. It’s not their fault.”

Upstairs, as our conversation ends, Senna pulls folded pieces of paper from his pocket and has me read aloud passages from an e-mail message that proves he was right and Paxton was wrong, which Paxton later readily admits. All that pushing, challenging, yelling—unnecessary but genuine. Minutes after I leave, Paxton smashes his hand in the freight elevator doors and goes to the hospital. In his absence Senna is forced to lead Paxton’s crew, and together they move the rest of the game down the stairs. Cameras roll, and soon editors will compress five days of footage into an episode that will be watched, discussed and judged by millions.

Forty years ago the Loud family let cameras into their lives for An American Family on PBS, showing us the possibilities and perils of turning life into entertainment. Despite the constructed nature of this kind of television, the entire production is usually invisible, which is both necessary for compelling TV and part of the overwhelming lack of transparency. Cast members on some shows have been told to restrict their comments during interviews to what has aired, even if that doesn’t reflect their reality. On CBS’sBig Brother, raw footage of an interview with a contestant leaked onto YouTube and showed a producer flirting heavily with a cast member, readying her for his questions; her answers would later be spliced into footage from events the contestant was discussing.

That’s why the media and critics often reduce the final product to oversimplified terms: Fake. Manipulated. But reality is messier. For a long time Ben Wade talked about how he created a character on ­Survivor so the person on TV wasn’t fully him. It wasn’t. It couldn’t possibly be. Watch YouTube to see how excruciatingly boring people are without editors. Entertainment takes skill, like that of the crew who will introduce Senna to the world.

“For people like myself and Dr. Chabaud, we really care. We’re here to help,” Paxton says. “A&E’s just there to make a TV show; it doesn’t really care either way what happens. Obviously it wants the person to get help, but its ultimate goal is to just film what happens. That’s a scary thing when you combine mental illness with entertainment.”