Guest Post Contributed by: David M. Reuss, M.D., Psychiatrist
The suicide a young person under any circumstances represents that worst and most tragic outcome of any type of intervention, therapy or rehabilitation (other than when the outcome involves violence towards others). There are so many problems with the current mental health system that it is often easy point fingers in many directions where there are contributory causes to a disaster. However, we are often totally bewildered when a young, otherwise healthy, “rich and famous” celebrity – who can afford the best and most comprehensive treatment available – takes their own life.
Not every suicide is even “theoretically” preventable. There are some persons who suffer from such severe mental illness in the psychotic realm (e.g., paranoid schizophrenia, intractable bipolar disorder) that other than very long-term treatment in a 24/7 contained and controlled (hospital) environment is the only way to eliminate risk. Yet way too often, we are learning of suicides by persons who have been through “rehab” and, as far as we know, were not psychotic and by all logic, had a “treatable” disorder/addiction.
Of course, every case is different and every person is unique; the reasons for any particular tragic act may include issues far out of the public’s awareness. Yet the pattern is striking and far to frequent not to look for common factors.
Talented individuals with media exposure, including professional and college athletes as well as actors, singers, and others in the entertainment industry, are, by virtue of their environment and circumstances, at increased risk for exercising poor judgment – which all too often leads to dysfunctional, self-destructive, and even dangerous behaviors. While celebrity status obviously carries with it may benefits unavailable to the “common” person, there are also related risks – especially for those very talented (or very “lucky”) persons who begin to exhibit exceptional abilities (or who are “discovered”) at a relatively early age. Being in the “spotlight” and being seen as “special”, even in what seems to be a very positive manner, can interfere with optimal personal character development as a mature individual, leaving a person financially wealthy and/or famous beyond all expectations but at the same time, emotionally immature, anxious, insecure and unstable.
Talented and successful individuals are often seen as “different” and treated “preferentially” in both positive and negative ways, often since a young age. However, one result of being “protected” is never learning to take responsibility or to be accountable 1) until it is too late, 2) without confidence in one’s ability to cope with true life challenges outside of “the field of play” and/or 3) without an inner sense of overwhelming failure and guilt.
Thus, the types of “rehab” which only address an “addiction” and at most give lip-service to character development will frequently have some positive short term effects but, without attention to the deeper characterological issues (i.e., emotional immaturity), leave a person particularly vulnerable to severe depression and impulsivity when (often inevitably) a relapse occurs. On an emotional basis, the person is ill-equipped to cope with their “failure” and at the same time, when there are mind-altering drugs involved, the effects of those agents exponentially amplify the risk of a person acting impulsively and the results of those actions being extremely dangerous or fatal.
The emotional immaturity that is often unwittingly fostered in persons who are accustomed to being seen a “celebrities” – perhaps since as early as high school or even before that – involves issues such as:
-An inability to truly differentiation between personal identity and public persona
-Feeling so “special” that there is an impaired perception of how to relate to others:
-Within personal/intimate relationships
-With family
-With personal friends
-With peers
-Integrating competition and camaraderie
-With promoters, investors, agents, administrators, etc.
-With the media
-With fans and/or the general public
-With those who seek to become an “entourage”
Optimal and comprehensive treatment for these individuals of course should include “rehabilitation” for any true addiction to drugs or alcohol, but also must include:
-Exploration and attention to an individual’s sense of self, personal identity and self-esteem
-Exploration and attention to interpersonal relationships in all areas of life, personal and professional
-Detailed consideration of the nature and impact of any physical/medical issues present as well as general health and conditioning status
-When necessary and appropriate, addressing issues related to use of prescribed medications or non-substance abuse types of addiction or compulsive behaviors:
-Differentiating between benign recreational uses of legal substances vs. substance-related problems.
-Recognition that once an addiction is present, “benign recreational” use is impossible.
-Understanding the risks and benefits of use of medicinal psychoactive agents – analgesics, “pain management”, anti-depressants, anti-anxiety medications, etc.
-Use and abuse of performance and physique enhancing substances, including anabolic steroids, peptides, nootropics, elective surgery, etc.
-Recognition of any addiction as a multi-faceted disorder requiring a comprehensive approach involving the integration of medical, psychological, physical and spiritual perspectives.
Sadly, as in many areas of endeavor, “Good money drives out bad.” People with these problems generally – or in the case of celebrities, almost universally, are narcissistically vulnerable or are significantly narcissistic. That is, they have a distorted and exaggerated sense of self that on one side, is glamorous, rather grandiose, entitled, surrounded by “worshippers” and “living above the fray” but on the other side of the mirror is the individual is often secretly insecure, needy, and unable to form a truly mutually mature intimate relationship. This leads to a growing dependence upon the “false self” and constant external reinforcement (by fans, the media, promoters, agents, hangers-on – who are not infrequently dysfunctional or jealous family members) to maintain the illusion of “specialness” and in fact “omnipotence” – with the consequence of that illusion shattering being total devastation of the sense of self and hope for the future.
In fact, part of the draw of substance abuse itself is looking to find a state of mind where one’s self and one’s comfort are the all-important “center of the universe.”
True treatment involves carefully and therapeutically confronting and exploring those issues and NOT reinforcing or playing into them. Particularly when the person does not have the ability or insight to be able to acknowledge that those tendencies are problems, it is the responsibility of the therapist to be constantly vigilant not to overtly or covertly reinforce a destructive sense of entitlement and “specialness” or to personally take advantage of the person – obviously a difficult task when working with the “rich and famous” whose every move is constantly followed by the media – and via current social media, broadcast world-wide within minutes.
There will always be more practitioners intentionally or unintentionally taking advantage of these people by manipulating their narcissism than there will be practitioners who refuse to be co-dependent. Practitioners themselves (individual therapists, owners of clinics, etc.) often overtly or covert seek to share the limelight and the benefits of celebrity – which is even more enticing when offered great sums of money to play a co-dependent role and help to only superficially address an “addiction” while and actually serving to help “cover up” the true pathology. For obvious reasons, the rich and famous will gravitate to the charlatans who reinforce their pathology and help them to “cover up” rather than insist that they go through the difficult process of true therapy – and being willing to be therapeutically confronted in all necessary areas of their increasingly dysfunctional lifestyle.
There are many good practitioners and success stories. We hear of the celebrities who dramatically and tragically fail – those who succeed, become wise and mature enough to respect their own privacy and keep their issues out of the public’s eye as much as possible, perhaps until much later stages of recovery when they have the stability to be able to use their journey through recovery to inform and help others. There are also tragedies that occur despite the best intentions and optimal interventions provided by all involved.
However, the “entertainment-medical-rehabilitation complex” is imperfect and at times cynically or intentionally corrupt – way too frequently, with horrendous results.
Dr. Reiss is currently working in private practice in San Diego, CA, and New York City. He is a former Interim Medical Director, at Providence Behavioral Health Hospital, Holyoke, MA.