How Charlie Sheen's meltdown could affect patient care

Recent news and interviews on the trials and travails of Charlie Sheen have garnered countless print media stories, network TV specials and hours of fodder for bloggers and talk radio hosts alike.

But as the media feed a seemingly insatiable appetite for the antics of the beleaguered 45-year-old actor, physicians working in mental health and addiction treatment look on with a concerned eye.

Hollywood has a long history of sad, yet often colorful transgressions, including those of Howard Hughes, Michael Jackson, Mel Gibson and Lindsay Lohan, that have grabbed headlines for weeks on end. Those working every day with individuals struggling with addiction or mental illness question how the world's voyeurism of the troubled rich and famous affects their patients living outside the spotlight.

Physicians have a range of views on the subject. Some see little impact, while others say news of celebrity meltdowns can be devastating for patients and their families.

"When you see someone falling apart before your eyes, there is a realization that this happens to even the rich and famous," said Philip R. Muskin, MD, a professor of clinical psychiatry at Columbia University Medical Center in New York City.

Such reports can be tremendously harmful to patients and doctors working to overcome the stigma of addiction, said Petros Levounis, MD, director of the Addiction Institute of New York and chief of addiction psychiatry at St. Luke's-Roosevelt Hospital in New York City.

"Instead of most people getting the message that addiction is an illness like other medical illnesses that has a diagnosis and a treatment, they see that this is something to make fun of -- more like a social ailment rather than a medical illness," he said.

The way the media portray such stories is a major part of the problem, Dr. Levounis said. When a celebrity has a stroke or a traumatic injury, the media often turn to physicians to help the public better understand what the star is experiencing.

But specialists are rarely consulted when a celebrity grapples with substance abuse or other addictions, he said. Instead, stories highlight the scandalous or ridiculous.

"It reinforces the stigma of addiction, and I think [people needing treatment] feel even more isolated and somehow hopeless," Dr. Levounis said. "Rather than a message of hope, it is a message of despair."

People often compare themselves to troubled celebrities, and in that sense news reports can help bring attention to an illness, said Melvin McInnis, MD, a psychiatry professor at the University of Michigan Health System.

"It very often spurs people to make sure that their illness is taken care of, or that this doesn't happen to their family member," he said.

At the same time, people undergoing a manic phase of bipolar disorder, for example, have a diluted capacity to acknowledge they have a problem. Often that requires a loved one stepping in to push them toward help, Dr. McInnis said. "It's the family members who contact us on a regular basis when we get these kind of things," he said.

Fuel for denial

Dr. Muskin said news of celebrity misbehavior such as Sheen's don't cause a noticeable uptick in people seeking mental health treatment, largely because most people have a hard time relating to them. If anything, they see celebrities making excuses for their bad behavior, and that encourages people to make excuses for themselves.

"Celebrities get away with stuff that none of us could ever get away with," said Dr. Muskin, chief of service in consultation-liaison psychiatry at Columbia and New York-Presbyterian Hospital. "I think the way it's portrayed allows people to use it more for denial rather than moving forward."

Occasionally, news reports of out-of-control celebrities spur an increase in interest and admissions as more people seek treatment, said Robert R. Johnson, DO, medical director of Sierra Tucson, an addiction and mental health treatment center in Tucson, Ariz.

But celebrities who have gone public about their treatment have the most positive impact encouraging others to seek help. Some examples are Betty Ford's battle with alcoholism and drug dependency and Patty Duke's honesty about her bipolar disorder, he said.

"When people in the public eye own [up to] their struggles with depression, mood cycling or substance abuse, it has led to both heightened awareness and a greater openness for treatment within the general public," Dr. Johnson said.

"I am thrilled when celebrities decide to enter treatment. They often have both an amazing gift and an amazing life story, which effective treatment will enable them to utilize in the service of their own and others' recovery."