On Professional Ethics, the (Mis)Understanding of Mental Illness, and Charlie Sheen

Upfront Disclaimer: You will, perhaps, recall from the “Upfront Disclaimer” on the About the Site page (and from what is briefly touched upon in this post) that I’m not about to engage in discussions speculating on new diagnoses. By that, I’m not into pretending to diagnose people, I’m not into people being diagnosed by others who do not know them, and I’m really not into media speculation on someone’s mental health.

Fine. That being said, this Charlie Sheen crap* has stirred up some feelings that might be worth a discussion. [*Sidebar: I deleted one word after another before settling on “crap.” Other words and phrases under consideration: situation, fever, fervor, nonsense, frenzy, takeover, media coup, cult-creation, mutually beneficial media-based exploitation, mutually degrading media-based exploitation, glorification of a proven misogynist, possible transformation of a person in need of help into a dancing monkey, potential low point in our media culture, and full-blown and (in almost every literary sense) irony-steeped shitshow.]

On Bipolar/Biwinning Speculation: Not gonna lie. Watching the 20/20 interview reminded me of a past life. Reliving that time because of this recent reminder has been difficult, but that is not what this post is going to be about. I don’t know the guy and can’t tell you what’s going on. To say that he bears a behavioral resemblance to a manic bipolar person does not mean that he is bipolar. And the speculation as such is, in my H.O., damaging to the community of mentally ill people out there. IF he suffers no mental illness, then this speculation may have the same cultural effect as repeated colloquial use of the word “retarded.”

IF he does need psychological and/or psychiatric help, then who on this planet would say that this media shitshow is doing him any favors right now? If he is manic, then who would argue that the vocal reinforcement offered up by the Twitterverse is not wildly destructive? Further, here’s a thought exercise: regardless of your particular flavor of crazy (bipolar or anything else), recall the episode that led to your diagnosis. Now think about your treatment immediately following that episode, think about the months and years of working shit out. How would those months have been different if literally over a million people both watched and participated in your implosion? For those out there who do believe that Charlie Sheen needs help, it may not hurt to think for a moment about the ways in which either mockery or almost-demigod-level celebration impedes the whole help-getting process.

[For the record, I’d like to acknowledge that I am ranting. I do not mean to imply that any readers of this forum are mocking or speculating or being at all insensitive. It’s more of an open-letter kind of thing. If you know someone who should read this, please forward.]

Last note re the media’s public speculation on Mr. Sheen’s mental health: There is a difference between airing a psychological or psychiatric specialist’s explanation of a mental health disorder to clarify the public discussion regarding that disorder and airing some random doctor’s quasi-diagnosis determined from afar. I have seen and read too much of the latter lately. (Normally I would provide links here. There are too many. If you want references, google “Charlie Sheen Bipoar Diagnosis” or just about anything like that.) In the open-letter spirit, I’d like to propose that such behavior is not only unprofessional and inappropriate, but that it both contributes to the public misunderstanding of mental illness and is downright unethical. On this last point, I want to stress that I am serious.

[…and here comes the real ranting…]

Primum non nocere. (First, do no harm.) Nonmaleficence is one of but a handful of core ethical principles in medical practice. Making public, willy-nilly diagnostic statements without adequate basis for said statements is in direct violation of this principle. It is harmful (see above). And let’s think for a moment about the twisted mechanism of these professionals’ public fake diagnoses: If they were to have a substantial and meaningful working relationship with a patient, it would be unethical to disclose a diagnosis without the patient’s permission. It is precisely that they have no way to know what they’re talking about that allows them to talk about it. For this public, unethical, and absolutely irresponsible behavior, I honestly don’t think an investigation into the revocation of their licenses is out of order. That’s right. I said it.

  1. “possible transformation of a person in need of help into a dancing monkey”
    I just love that! Well, I think you’ve said it all. I am in agreement. Get those fuckers out of psychiatry. the media just chafes my ass. They can be useful as in telling us how insane our country is getting when people are screaming at military funerals because the dead person was gay. But they think they have free reign with celebs, as if they’re not people.

  2. Natalie said:

    Fucking sing it, sister! I have to admit I don’t get my Tweet on for this exact reason. First of all, every time I look at anything Twitter related, it makes me think the people who came up with it must have done so while psychotic (I actually know some of said people, and no, I’m not making fake public diagnoses here, I’m just saying it appears kind of whacked to me – that said, I’m not above using it to track Food Trucks). And secondly, it seems so full of masturbatory propaganda. Not just run-of-the-mill, but the extremely damaging, hurtful stuff of this Sheen shitshow.

    So I’ve not had much direct contact with said shitshow. But what I do know is shameful. And I don’t think it’s at all out of line to say these “doctors” should be investigated. When they make these public declarations, yes, they not only do an enormous disservice to someone who may be in dire need of help, they indeed also further mislead the public about the nature of mental illness. And increase the freak show stigma to boot. Beyond irresponsible practice of “medicine.”

    As someone who is still in the months following the episode that lead to my diagnosis (just coming up on a year this month!), oh my god, I cannot imagine having it happen in the public eye. It was painful enough knowing that people I cared about immensely had seen me behave so erratically and/or heard some of the shit I schemed up. If the world had been watching, and if I’d been made into a media monkey…I don’t know that I would have made it through.

    For the first time, I actually feel sorry for Charlie Sheen. I fucking hope someone cares about him enough to spirit him away somewhere and sort out what might actually be going on.

  3. said:

    Meredith & Natalie: I’m glad we’re in agreement. The thing that gets to me — in a non-mental health sort of way — is the lack of accountability out there. We’ve moved into an era when entertainment (its production and consumption) comes at the price of social responsibility. And in this kind of instance, the lack of responsibility could potentially hurt one person a lot AND an entire non-negligible portion of the world immensely. In so many ways, these mental health professionals are undoing the work of their profession in terms of how and what the general public understands of mental illness. Honestly, it’s gross.

    • Natalie said:

      It is gross. It speaks to the lowest common denominator of humanity. And they call us “ill.” I beg to differ!

  4. Woooo! you go, girl! Yes, who are the ill ones indeed?

  5. Jen said:

    I agree with the three of you on this topic. I was bored and tired and for whatever reason, looked at some of the Dateline episode tonight on Charlie. Some of it, because I couldn’t hack watching more than that. I am disturbed by the commentators and their celebrity-obssessed crap that makes no sense. On the one hand, they have him on their TV shows because he appears insane to them. On the other hand, they will make comments like, “While filming, Charlie seemed happy and healthy.” I wish the guy did seem happy and healthy, but if he did, he probably wouldn’t have been on TV 24/7 for this whole past week.

    I don’t do Twitter, so I can only guess the amount of crap on there about this. The intense media focus fails to include any adequate and educational information about mental illnesses such as Bipolar Disorder, which is the least you could hope for if they’re going to put on celebrity “doctors” telling us the guy is obviously manic. If he is manic, why the hell don’t they take this opportunity to talk about how hellish it is to experience mania and the following depression, how many people with mental illnesses die by suicide every year, how little federal or state or local funding there is for mental health treatment in these great United States, how little funding there is for research into mental illnesses and adequate treatments that don’t include severe obesity as a side effect that affects the majority of the people taking the drug so they get to experience Diabetes and heart disease in addition to mental illness???

    There is no discussion like this going on. Only a bunch of people watching a trainwreck and gawking at the bloody aftermath. I feel sorry for Charlie that nobody in his sad life seems to care enough about him to cut off this media tragedy and help him figure out what he needs to do to get his head back on straight, because if he is manic, he needs help, and if he is a drug addict he needs help. At the same time, I don’t like these so-called doctors diagnosing people based on their behaviors on TV.

    When the shooting in Arizona happened, everybody jumped on the “psychotic killer” bandwagon, failing to discuss what it actually is like to be psychotic and how rare it is to be both mentally ill and a killer, since most of us don’t spend our days hoarding away weapons and tracking people down to shoot them in the head. The opportunity for that incident to open a dialogue about the lack of mental health treatment that is affordable, adequate and available really passed without that discussion every happening anywhere except on some of our blogs. How freakin’ pathetic. The very people who wanted to scream about the shooter in Arizona being psychotic were the same people who didn’t care to discuss the fact that Arizona kicked half the people getting publicly funded mental health treatment right off the rosters last year due to massive budget cuts.

    In the U.S., I feel like we don’t look at the root causes of things often enough at all. It’s lame and this the reason we have so much of a fight advocating for people with mental illnesses, to just prove we are actually people in the first place and not subhuman psycho killers or celebrity freaks. When this will change, I do not know. I think it would take a massive outcry that hasn’t happened in my lifetime.

    • said:

      Jen: Thank you so much for adding the unforgivable negligence the American media really has shown by squandering the opportunity to educate. If irresponsible doctors are going to egregiously speculate out-loud and on-air about someone who may need mental health attention (but fail to act in providing help), then the very least (i.e. absolute bare minimum) those same media outlets should do is discuss both the illness and the very pragmatic difficulties involved in acquiring and living through treatment.

      Further — YES! yes yes yes — you are absolutely right to reference the sadness involved in everything surrounding the Arizona shooting. An unimaginably tragic event was only turned into something even more ugly (although I admit I thought that would be impossible) with the way psychosis was represented. Shortly after the shooting, I had this to say. The post is very brief, because I was too shocked about all things involved to really process it. I’ve had time to process now…and so much of the popular media’s speculation and representation of mental illness in that instance has now undeniably fueled my anger about the Sheen-omnimedia-extravaganza.

      Once again, all things considered: Tragic. Appalling. I am livid and sad.

    • Natalie said:

      Jen – Fucking sing it. I was so appalled by the media handling of the Arizona tragedy, that even though I researched like mad and tried like hell to write something that made sense, I was not able to do so. The whole thing just made me feel sickened with panic. I do still plan to write about one of my biggest problems with how the public debate unfolded, and how it always unfolds in such cases, and that was with the assumption that the shooter was in fact what would be defined as “mentally ill” and “psychotic.” When, in reality, without a length mental health evaluation, the only thing that could be assumed up front was that he was a psychopath…NOT a psychotic person. Two very different beasts. I found very little coverage to that effect, the best piece being this one:

      The reason this distinction is so crucial is precisely because those of us who do actually experience psychosis are, on the whole, anything BUT violent. While psychopaths are an entirely different story.

      Anyway, yes, the public teachable moments missed in that tragedy as well as the current Sheen situation are beyond shameful. The “mentally ill” are one of the last groups against whom wholesale discrimination is considered acceptable by the masses, and the media and these media-whore “doctors” are doing nothing to change that.

      (Sorry for the rant, I just finished reading this post about a campaign to stop the forced electroshock treatments of a Minnesota teacher, and I am so thoroughly saddened and disgusted: http://www.mindfreedom.org/shield/ellis/ee-4. Just one more example of why we need to advocate like hell for ourselves and each other.)

      • Tangent: I am still trying to figure out how I am reading Natalie’s post at 10:02 pm on Mar. 4 yet it says you posted at 12:24 am Mar 5 and I know where you live. Hmmmm temporal overload.

        • ok I get it. it’s all on NY time. thanks for not beating me over the head with a blunt object.

        • Natalie said:

          It was posted at 9:24 p.m. our time, 12:24 a.m. ∃’s time. :)

  6. Jess said:

    One interesting thing is that the mania might not be a sign of bipolar disorder, as you stated. My reasoning: drug use can contribute to a psychoitic episode, so the question is, what’s the primary concern? Is drug use causing mania (if indeed he has it) or is it BP? Again, differential diagnoses are important in the MI world to help identify correct diagnoses for various clients. That’s all I’ll say so I don’t rant and rave. :)

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