Now that reality TV has been around long enough for the non-disclosure agreements to expire, NYT has done an article about how they get people to act whacked on TV: don't feed them, don't let them sleep, don't let them have any contact with the outside world (not even books or magazines), and give them an endless supply of alcohol.
I enjoy some reality TV, particularly Clean House and Ruby, and secondarily The Biggest Loser (but some series of that annoy me so much I find them unwatchable, and I fast forward through a lot). I will occasionally watch What Not to Wear, but it sort of pisses me off. It's a little tough to imagine any of these suffering from the alcohol problem, altho the sleeplessness does show up on Clean House. It is interesting to realize that I watch Reality TV -- but very little of the competitive stuff. Go figure.