Category Archives: Celebrities

What do you wish to understand further about Psychiatry in the Mainstream?

Here’s a poll : The top most voted choice will become the next topic of my blog. The options are:
 
1) What is Adult Attention Deficit Hyperactivity Disorder?
2) How does psychotherapy or “talk therapy” help people resolve their lifelong psychological issues?
3) How do psychotropic medications help people with mental health problems?
4) Why did Katy Perry marry a sex addict?
 
Please make your selection from the options above by leaving a comment. I look forward to your interest, particularly so that I could help improve the understanding of psychiatry per your curiosity. 
 
Best,
Dr. Psych Mainstream

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Bereavement, Grief, and Mourning

Steve Jobs 1955-2011

Steve Jobs, one of the most influential visionaries of our day, recently died. His untimely death not only left a void in Silicon Valley and an uncertainty in tomorrow’s society, but it also created an immense blanket of sadness over the world.

When someone leaves us in this world, sadness most often ensues. If not sadness or depression, death also triggers denial, anger, bargaining, or acceptance. What was your initial reaction when you found out Jobs died? What about your reaction now? Moreover, how did you react when you found out that a personal loved one was dying or suddenly passed away?

Bereavement and grief are terms used to describe aspects related to the matters of death. Bereavement refers to the state or the fact of the loss of someone to death. Grief, on the other hand, refers to the reactive process to the death which includes emotional, mental, and behavioral reactions.  A bereaved individual has experienced the death of someone, but will not necessarily be grieving, but a person in grief is inherently in bereavement. Grief also broadly describes the response to other types of loss, such as to the loss of youth, opportunities, and abilities. Think of Sharon Stone who now has to play second fiddle to a younger more beautiful actress or Peyton Manning who cannot quarterback this season due to injury (I wonder who’s grieving more – Manning or Colts fans?).

Mourning, another term associated with death, describes more specifically the behavioral manifestations of grief.  Mourning is a grieving process that is influenced by social and cultural rituals, including traditions like funerals, visitations, and other customary practices.

In psychiatry, treatment is not typically warranted unless grief becomes “complicated grief” or  the sadness worsens into a major depressive episode. Complicated grief, as opposed to normal uncomplicated grief, is prolonged and severe to the degree that causes significant impairment in work, health, and social functioning. Therapy and medications are standard treatments, with emphasis on coming to terms with the loss and working towards repairment.

Death is a natural part of life. As painful and unfair it feels to have lost a loved one, death and grief have their reason and purpose. If not, then it would certainly be difficult to comprehend why Jobs prematurely left us before we felt it was time.

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Bipolar Disorder

Britney Spears

Bipolar affective disorder (BAD) is a lifelong psychiatric illness characterized by severe and extreme mood instability. Also referred to as manic depression, people with bipolar fluctuate between periods of intense high and low moods like baseball fans following their beloved team deep into the October playoffs (Go GIANTS!!!). Many mainstream films have portrayed characters suffering from BAD – Mad Love, Bulworth, Running With Scissors, and King of California. Numerous famous folks have also been associated with the illness, including Beethoven, Edgar Allen Poe, Vincent van Gogh, and Britney Spears.

As its name suggests, people with bipolar vacillate between poles of euphoria, irritability, and depression, like a perpetually swinging pendulum. The mood episodes are sustained, autonomous, and occur independently of external circumstances and are not caused by substance use. For example, a person who flies high on cloud nine by winning the lottery, falls despondent after carelessly losing the winning ticket, and then becomes enraged when intoxicated at the bar is not bipolar. Moreover, people who experience severe mood instability that is triggered by interpersonal relationship difficulties are often misdiagnosed with BAD, but instead may suffer from borderline personality disorder (BPD).

The expansive or abnormally irritable moods are referred to as mania or hypomania, with the former being more intense and severe.  A manic episode lasts for at least one week and is accompanied with symptoms such as decreased need for sleep, grandiosity, hypertalkativeness, racing thoughts, increased goal-directed behavior, and impulsivity in pleasurable activities like spending money and sexual indiscretion. Psychosis may even ensue. Feeling energetically on top of the world, manics may generate many creative and innovative ideas. Our world would definitely not be as advanced and inspiring as it is today without the actors, entrepreneurs, mathematicians, musicians, and writers who lived with bipolar disorder.

Mania becomes concerning and problematic when people begin to lose their insight and judgment, making ill-advised decisions and engaging in destructive behavior – remember Britney Spears shaving her head completely bald and attacking an SUV with an umbrella? Social and occupational functioning may be profoundly impaired, necessitating involuntary inpatient hospitalization and mood-stabilizing medications.

Depressive episodes are more psychologically distressing to the individual than manic ones. Would you rather be anhedonic and socially withdrawn or elated and running around Nordstrom maxing out your credit cards?  Depression occurs 3 times as often than mania and raises the risk of suicide. Up to 50 percent of people with BAD attempt suicide, and 15 percent die from completing it.  Kurt Cobain, who was suspected of suffering from bipolar depression, sadly ended his life with a self-inflicted gunshot wound to the head.

BAD is a chronic illness which causes episodic and persistent functional debilitation. Psychiatric treatment is necessary to stabilize mood and maintain day-to-day functioning. Referred to as an illness that “benefits mankind at the expense of the individual,” I wonder if the aforementioned famous manic depressives were aware of their generosity in bestowing upon us The Fifth Symphony, The Tell-Tale Heart, and Starry Night, respectively. And I certainly cannot forget to include Oops!…I Did it Again.

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Codeine Syrup

Jamarcus Russell with the Oakland Raiders (2007-2010)

Jamarcus Russell, the former NFL quarterback and exorbitantly paid #1 overall draft pick in 2007, was arrested last week for unlawful possession of codeine syrup without a prescription during an undercover sting. He was suspected of illegally abusing the controlled prescription cough medication for recreational use as Purple Drank.

Purple Drank (aka Syrup, Sizzurp, Drank) is an increasingly popular party drink found in the South. It’s a liquid concoction typically consisting of codeine syrup, promethazine (antihistamine), clear soda, and Jolly Ranchers. It conjures up similarities to the super-sweet mystery “jungle juice” often found at college frat parties (which on the otherhand is legal unless underage drinking is involved).  The codeine-based mixture was born out of the underground rap scene in Houston in the 60’s.  It gained popularity in the early 90’s when hip hop music artist DJ Screw credited the drink as the source of his inspiration for creating the “chopped and screwed” remixing style. The music is characterized by the slowing down of the tempo of rap music, just as how codeine slows down brain activity. The drink’s popularity further spread from Texas to other parts of the South and later entered into the mainstream’s awareness when Three 6 Mafia released its hit single “Sippin’ On Some Syrup” in 2000. Now, Russell is almost rendering Purple Drank as much of a household term as The Office’s “That’s what she said!”

Codeine is an opioid, like morphine and heroin. The drug is abused for the euphoric high and rush that it gives people. Clinically, codeine is used as a painkiller, as in Tyelnol #3, and a cough suppressant, as opioids suppress the cough reflex. Although codeine is 1/10 as potent as morphine and way less toxic than heroin, it nevertheless carries all the potential negative effects of opioid misuse – intoxication with speech slurring and cognitive impairment, addiction, and death by coma and respiratory depression.  The effects of opioids are further intensified by alcohol, an often deadly combo of CNS depressants. You can probably guess what caused DJ Screw’s premature death.

Stopping or reducing heavy and prolonged opioid use will lead to withdrawals.  Although opioid withdrawal is rarely ever life-threatening, it causes very distressing symptoms like irritability and dysphoria, piloerection (fancy way of saying goosebumps), nausea, diarrhea, muscle cramps, aches, and flu-like symptoms.  It’s definitely not what you want to be going through on a first date. Interestingly, the common expressions used to describe the abrupt cessation of habitual behavior – go cold turkey and kick the habit – come from the opioid withdrawal symptoms of goosebumps (resembling a plucked turkey) and muscle spasms in the leg (causing kicking movements), respectively.

Prior to his recent legal troubles, Russell’s life on the field was no better. Two months earlier, the Raiders severed ties with him and released him to unrestricted free agency.  Currently, no NFL team would even consider touching him with a 10-foot pole. He’s arguably the biggest draft bust in NFL history. Notorious for his poor work ethic and bad decision making, he also had significant weight gain issues that seems to strengthen the case that he’s been sipping the syrup for some time (the sugar in soda and hard candy coupled with antihistamines will certainly make you a great candidate to compete on the Biggest Loser).  If codeine is truly behind his on-field failure, it would be wise for the once highly-touted natural athlete to seek professional help for his substance use. Maybe then, he could resurrect his career and possibly lead his team to winning a championship title (and then thank his psychiatrist on national TV as Ron Artest did).

If you’re interested in psych issues and sports, you should check out the Sports Psychiatrist, a dear friend and colleague of mine.

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Obsessive Compulsive Disorder

The OCD Project (2010)

Summer television has arrived and with it comes the barrage of new and returning unscripted reality programs. 57 and 65, respectively, to be precise. One can probably identify numerous implicit psych issues embedded in some of the reality shows, and likely more so in their cast members.  I don’t watch Jersey Shore, Bridezillas, or Toddlers and Tiaras, but I’m sure that the DSM-IV applies to some individuals on those shows as much as an instruction manual titled “How to Clean Up an Oil Spill” to BP.

Obsessive Compulsive Disorder (OCD) is the focus of the new voyeuristic reality series The OCD Project.  It airs on VH1 and follows a group of six strangers diagnosed with quite severe OCD, who are forced to live together under one roof to receive intensive exposure therapy treatment.  It’s Intervention meets Fear Factor.  Dr. David Tolin, a PhD clinical psychologist who specializes in anxiety disorders, plays the host and head therapist on the show.

OCD is an anxiety disorder characterized by intrusive thoughts and repetitive behaviors. Obsessions are persistent anxiety-provoking thoughts that invade one’s conscious awareness; they are distressingly difficult to ignore like seeing a pregnant woman drinking a 40 and smoking a pack of Marlboros. Obsessions commonly have a fearful theme that either neglecting to do something or making a mistake will lead to some sort of catastrophe.  For example, “If  I don’t check if the front door is locked 6 times before I leave the house, then I’ll get into a car accident today.” Other types of obsessions may center on a fear of contamination, a need for exactness or symmetry, irrational saving and hoarding, or unpleasant aggressive impulses and sexual imagery.

Compulsions are repetitive behaviors performed intentionally to neutralize or alleviate the anxiety resulting from the obsessions. These rituals may range from subtle mental acts like counting or repeating numbers to more obvious physical acts like excessive hand-washing, checking, or rearranging objects. Compulsive behaviors consume time and interfere with routine activities, often to the point of severe functional debilitation. Imagine if the Iron Chef had OCD relating to a fear of contamination and had to wash his hands every time he felt germs defiled them. What type of cuisine, if any, would be prepared then?

Interestingly, many famous and successful celebrities live with OCD. Billy Bob Thorton reportedly obsesses about repetition, Cameron Diaz doorknobs, Howie Mandel germs, and David Beckham symmetry and evenness. In his role as Howard Hughes (who also suffered from OCD) in The Aviator, Leonardo DiCaprio channeled his childhood obsessions with sidewalks to devotedly play the part more effectively.

Reality shows can be repulsively annoying or entertaining and amusing to watch. The OCD Project is definitely more of the latter. It raises awareness of OCD to the mainstream and helps destigmatize mental illnesses, of which I’m definitely a proponent. Nevertheless, I can’t help but feel that it does so at the expense of exploiting and tormenting its cast members in its attempt to cure them of their disorders. Although the VH1 network executives are probably concerned primarily about the show’s numbers and lucrativeness, I hope that patient care is the foremost interest for Dr. Tolin.

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Ambien

Hamlet by William Shakespeare

“To sleep, perchance to dream…,” Hamlet wondered  in his famous To Be or Not to Be soliloquy.

If he lived in modern times, Hamlet would probably pop an ambien and call it a night if he desired to sleep. This popular sleeping aid is gaining quite a bit of attention in the mainstream celebrity world- it’s use amongst celebs is almost as ubiquitous as their active Twitter accounts.

Jay-Z along with Alicia Keys raps about it in Empire State of Mind in reference to partying in NYC- “the city never sleeps, better slip you an ambien”; John Mayer tweets about his personal use and sings about it in Heartbreak Warfare; Jimmy Fallon jokes about it on his late-night talk show; and Tiger Woods probably takes it on nights before playing in the majors. Why not? He takes it for crazy ambien sex with one of his many former mistresses. You probably remember that infamous night he crashed his SUV which led to the unraveling of his secret lifestyle- yep, he was driving under the influence of ambien.

Ambien is a sedative or hypnotic prescription medication that knocks you out like a left hook from Manny Pacquiao.  It was first approved by the FDA in 1992 for the short-term treatment of insomnia. But it didn’t gain widespread use until the generics (zolpidem) came out in 2007. Although not approved for treatment of chronic insomnia, it is not uncommon for doctors to prescribe it for long-term use.

Common side-effects of ambien are drowsiness, impaired motor function, and a drugged feeling.  But more interestingly, side-effects may also include hallucinations, amnesia, euphoria, increased appetite and libido, and extroversion in social settings. And these effects may perhaps be the reason behind  the trend in ambien misuse for recreational purposes.  There are also many documented reports of ambien-related bizarre behavior, ie.  people cleaning out their fridge from sleep-eating politicians involuntarily joining the DUI club from sleep-driving, and wives engaging in unusual sexual behavior of which they have no recollection.

Before the days, or nights, of ambien, the common sleeping pills were the benzos (xanax, valium, ativan) and the barbiturates. These medications are far more dangerous than ambien. They are addictive and lethal in overdoses.  Guess which prescription meds were found in Marilyn Monroe, Jimi Hendrix, and Heath Ledger when they prematurely died?

Ambien is potentially lethal in an overdose since it’s a sedative, especially if combined with alcohol. The cause of death is cessation of breathing. Fortunately, there aren’t too many documented cases, if any,  of death primarily by ambien overdose. In my own clinical experience, I haven’t seen any yet.

Hamlet was contemplating suicide in his soliloquy- “for in that sleep of death what dreams may come.”  If he were to take a large dose of ambien, he would be at some risk of a fatal overdose. But he’s more likely to hallucinate and engage in an ongoing conversation with the skull until he falls soundly asleep, and not remember a thing the following morning.

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Borderline Personality

Ryder and Jolie in Girl Interrupted (1999)

Hollywood is rich in mainstream movies with characters with Borderline Personality Disorder (BPD)- Winona Ryder in Girl Interrupted, Penelope Cruz in Vicky Cristina Barcelona, and Uma Thurman in My Super Ex-Girlfriend to name a few.  Even celebrities themselves have been associated with the disorder- Angelina Jolie, Megan Fox, Lyndsey Lohan, Amy Winehouse, and Christina Ricci to name several. I wouldn’t be surprised if the list of celebrity borderlines ran longer than that of their fictional counterparts.

So what is Borderline Personality Disorder?

Borderline originally earned its name in psychiatry from being thought to be on the “border” between psychosis and neurosis. In lay terms- almost but not entirely crazy (now refer to the aforementioned celebs to see if you get an aha reaction). The disorder is characterized by pervasive instability in mood, self-image, behavior, and interpersonal relationships. This typically means people suffering from BPD have chronic feelings of emptiness and low self-esteem, suicidal thoughts and gestures (cutting), anger issues, and even bisexual tendencies. Marsha Linehan, an expert on BPD, describes borderlines as “the psychological equivalent of third-degree-burn patients. They simply have, so to speak, no emotional skin. Even the slightest touch or movement can create immense suffering.”

Relationships tend to be very intense and unstable. I don’t watch much reality TV, but I’d bet network executives cast borderlines primarily to inject drama into their shows to boost ratings. Borderlines are capable of switching from deep affection and adoration to hostile rage and contempt quicker than you can say Britney Spears.  Breakups are especially difficult. Due to fear of abandonment, borderlines may threaten to hurt themselves if their partner wants to move on or date others.

The cause of BPD is unknown, but almost certainly there is a history of childhood trauma. This includes parental abandonment and neglect, poor communication and disruption in the family, and physical and sexual abuse. Clinically, BPD is often misdiagnosed as Bipolar Affective Disorder (BAD) because of the overlap in mood instability symptoms. The main difference is that borderline symptoms are triggered by interpersonal difficulties while bipolar symptoms are autonomous and independent of relationship stressors. Medications are far less effective for treatment of BPD than BAD.

The treatment of choice for BPD is Dialectical Behavioral Therapy (DBT). It’s a form of talk therapy that helps borderlines learn to manage intense emotions to minimize self-destructive, maladaptive behaviors and thus function better in relationships. The goal is to promote acceptance, yet encourage change, which is inherently contradictory and confusing.

For simplicity’s sake, let me use Bruce Banner and his emotional self-destructive alter ego, the Hulk, as a case in point to illustrate the theory behind DBT. In order for Bruce to have a functional relationship with any woman, he cannot transform into the Hulk. But the Hulk is an inseparable part of Bruce, which he can never truly get rid of.  Similarly, borderlines can never get rid of their childhood trauma. DBT will help Bruce learn to accept that he is the Hulk, while concurrently teaching him to harness his emotions so he will not become the Hulk.

BPD can be quite a severe and debilitating disorder. Relationships are particularly intense and unstable. In the entertainment world where steady relationships are already few and far between, an aging celebrity borderline probably stands a better chance of sustaining a career without needing cosmetic touch-up surgery than maintaining a lasting marriage.

Good luck Brangelina.

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