Mental Illness & Addictions Need Public Empathy; Not Public Enmity

The ongoing public infatuation with the emotional sagas of celebrities like Charlie Sheen raises an important issue about how we as a culture perceive and respond to the public self-destruction of others.

Whether we approach their conduct as “entertainment,” “bad behavior” or “mental illness” speaks volumes about us as a society. If we view public emotional breakdowns as entertainment, then what separates us from the gladiator-gawking Coliseum audiences of ancient Rome? Alternatively, judging such behavior as “bad” or “spoiled” leaves little room for empathy and healing. However, one designation—that of mental illness—opens the door for empathy, support, treatment, healing and hope.

Many in the media suggest that Charlie Sheen’s erratic behavior might stem from drug and alcohol abuse or withdrawal, bipolar disorder or even a negative response to prescription medication. Because I have not examined or interviewed Mr. Sheen, I am unable to diagnose him specifically. However, what I can comment on is that rather than ogling at celebrities suffering from behavioral problems, we need to instead try to understand what they are going through.

Such empathy is possible if we have a better understanding about mental illness and substance abuse overall.

What role does substance abuse play in mental illness? on psychoactive drugs such as amphetamines, cocaine and alcohol can trigger erratic and self-destructive behavior. These types of drugs activate the release of dopamine in the mesolimbic reward pathway of the brain, which is perceived as pleasurable to the individual, biochemically reinforcing the desire to use the drugs again.

Furthermore, some people are more genetically prone to addictions than others, making abstinence very difficult, yet possible, to achieve. Substance abusers need to consciously fight the pleasure-reward pathway in order to combat the temptation of another “high.” Such a fight is almost impossible without insight and guidance from mental health providers, support groups or rehabilitation centers.

While awareness is possible, many substance abusers do not become “conscious” of their difficulties until they lose what is most important to them and hit what we know as “rock bottom.” Others, with the help of friends and family, are able to achieve insight more quickly and benefit dramatically from ongoing treatment.

What is mania?

Manic episodes are periods of time characterized by agitated irritability or euphoria, inflated self-esteem, delusions of power and control, a decreased need for sleep, racing thoughts, scattered thinking, pressured speech and impulsive behavior. They are often associated with a mood disorder called bipolar disorder, from which approximately 1 to 3 percent of the population suffers.

Bipolar disorder, formerly known as manic-depressive disorder, is characterized by destructive fluctuations of mood ranging from deep depression to severe mania, and requires consistent psychiatric treatment encompassing both medication and psychotherapeutic treatment and monitoring to control its symptoms.

Manias can also be triggered or exacerbated by medical conditions such as seizures, elevated thyroid hormone levels (hyperthyroidism), certain vitamin deficiencies, various infections that affect the brain, strokes, brain cancers, brain trauma and even multiple sclerosis.

Medications, such as certain antidepressants and steroids, as well as alcohol and illicit drugs like cocaine and methamphetamines, can also trigger manic-like symptoms in people who do not have bipolar disorder, or worsen manias in those who do.

The most dangerous aspect of mania is its associated impulsivity. Often, manic individuals behave so erratically that they lose their jobs and estrange their families, get into legal trouble, participate in dangerous sexual behaviors, become bankrupt or commit suicide.

Sixty percent of people with bipolar disorder abuse, or are dependent on, drugs or alcohol, often in misguided attempts to self-medicate. The risks of self-destruction and suicide are heightened further in patients with bipolar disorder especially if they are not under the care of a psychiatrist and if they have a dwindling support network.

Because mania is caused by biochemical changes in the brain, sufferers are unable to simply elicit the use of willpower alone to control their symptoms. Asking someone with mania to control themselves would be like asking a person with Type I Diabetes to stop letting their pancreas experience dysfunction.

Fortunately, mania can often be treated with medications, psychotherapy and alcohol and drug abstinence. All too often, however, individuals with manic symptoms, particularly because of their grandiosity and difficulties thinking rationally, have poor insight into their condition and therefore resent, resist and abandon treatment of their mania and substance abuse.

In this way, mania often gets in the way of its own treatment, as the erratic mind is unable to realize it needs help. If a patient suffering from mania does not have an ongoing relationship with a trusted psychiatrist and psychologist who monitors them closely and can “catch” and treat a manic episode before it peaks, it becomes very difficult to control until the patient “bottoms out.”  If one does have ongoing access to mental healthcare, there is a much better chance that they can get the treatment they need to return to a fully functional and fulfilling life.

From empathy to healing

The self-destruction and lack of insight often seen in substance abusers and/or people with bipolar disorder need to be understood as symptoms of their conditions and as tragic complications, not as spoiled rampages or a lack of willpower. With this understanding, our culture must move its focus away from gawking and stigmatizing, and focus more on compassion, education and the treatment of people with mental illness.

If you know someone who displays or has displayed symptoms of mania or substance abuse, there is hope for them to, one day, return to a fully functional life of stability, especially if they gain access and accept mental health treatment.  If possible, reach out to them if you can, and recommend that they get psychiatric help.  If their condition is an emergency or if you have concerns that they are dangerous to you, others or themselves, then it is prudent to call their family or emergency medical services.

Offering assistance is not easy and may even put you in an adversarial position, at least until that person is able to self-reflect and develop more insight. While initially, individuals in the throws of mania or under the influence of drugs or alcohol are very likely to reject your offers to assist, such attempts are not in vain: The more “messages” they receive directing them to professional help, the more likely they will ultimately accept help before it is too late.

With regards to Mr. Sheen, it is my sincere hope that those in his life recognize his condition and make efforts to assist him in receiving medical help. Nonetheless, a proactive start lies with the public, to whom Mr. Sheen has turned to in recent weeks, to send out a consistent message of concern to him.

With appropriate diagnosis and treatment, there is hope for Mr. Sheen to live a more fulfilling and functional personal life, as well as regain a career that so many fans have enjoyed and appreciated.


Bipolar Disorder: A Guide For Patients & Families

The Harvard Bipolar Clinic

The Matrix Institute on Addictions

Alcoholics Anonymous

Clearview Treatment Program

Sierra Tucson Treatment Program

McLean Hospital Programs for Bipolar Disorder and Substance Abuse Treatment

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