Saturday, August 16, 2014

Footnotes About Commenting On Mental Health Tragedies In the News

Recent events have led me to think about the issue of commenting about tragedies that affect celebrities and their families.  American culture and even the law suggests that anyone who leads a public life should expect public commentary even during a time when it would be considered poor form if applied to anyone else.   It is an interesting twist for people who are protectors of confidentiality their entire careers and who know some of the real reasons why that is important.  One of the most critical is the issue of self aggrandizement as in "I am a special person because I have access to information that nobody else has access to."  Introspection and self analysis are generally useful tools to examine this aspect of personal information and whether or not it can be handled neutrally.  As an added corollary whether that information comes from a celebrity can create an additional burden on the person who has received it.  Can the information be handled neutrally when the source is a celebrity who has millions of fans?  A few observations about the recent events:

1.  The event is a projective test - there are clearly individuals and groups who have specific points or observations that they would like to make about the person or event.  Those points may have very little to do with the reality of that person's life and more to do with the agenda of the observers.  In the worse case scenario there may be public remarks that are controversial or in some cases very negative about the person or the event they were involved in.  Nobody ever seems to bring up the obvious conflict of interest issues when these remarks are made, not the least of which is selling more media stories.

2.  In the case of a loss there is public but appropriate grieving.  Reminiscences about shared common events and critical events in the persons public life are good examples.  In this case, a psychiatrist generally has no more to offer specifically about that person than anyone else.  In the event that the psychiatrist was actually treating that person, ethical guidelines prohibit any disclosure about that treatment even after death.  That should include the identification of a person as a patient.

3.  Stereotyping can occur and I am thinking of the general sequence of events that "this person belonged to this subgroup and what happened to him/her happens to a lot of people in this particular subgroup."  Things are rarely that simple.

4.  Medical professionals are no different from anyone else and may make remarks that have more to do with their own interests than the deceased or the aggrieved family.  In some cases the medical professionals are paid to give their opinion in the media either as a regular commentator or as an interviewed guest.  I have heard some argue that their credentials allow them to make special interpretations of events to the public, but I have never really seen that play out.

5.  Commenting on these tragedies does very little to change the inertia in the system.  The problems with the care for addictions and mental illnesses are well documented on this blog.  The main problem is that our federal and state governments are oriented more toward enriching health care companies rather than providing practical and affordable health care insurance to the average person.  They do this by a number of state sanctioned rationing schemes and that rationing falls heaviest on the care for mental illnesses and addictions.  It is one thing to lament the tragedy of another fallen star, but the commentary is never followed up with any action to prevent further tragedies.

6.  A condensed life is one worth living.  A lot of media have canned obituaries that people have been working on for some time.  In the event of an untimely death, it seems that there is a lot of cutting and pasting going on.  It gives the appearance of a detailed analysis of the person's life.  The appearance of thoughtfulness.  People rarely think about why editors include some paragraphs rather than others.  The press generally gets far too much credit for objectivity and there is not enough focus on the ever present conflict of interest.  Articles are written after all to generate advertising dollars and in today's world that means clicks.  Controversy generates clicks and detailed objective analysis does not.

If it was up to me (and it clearly is not) - the whole process of the way celebrity tragedies are covered and reported would be revisited.  There is no evidence that I am aware of that the wisdom of professionals or public health officials regarding mental illness or addiction treatment is conveyed any better in this context than others.  The more specific problems of drug addiction and suicide are after all tough problems that generally do not respond well to basic education.  Attaching celebrity to those problems does nothing to heighten awareness or advance the public health message.  These tragedies are also common.  It is difficult to find a family that has not been personally impacted by similar events affecting the people that they personally know.  I take a very negative view of trying to "analyze" a persons problems based on media reports and other sketchy information and yet it is common to see experts in the media drawing all sorts of conclusions.  What I have personally found useful in the grieving process is a review of the person's positive accomplishments.  It is amazing what an "average" person can accomplish over the course of their lifetime.  Celebrity in all likelihood extends and intensifies that list.  It is also a prerequisite that people who actually know the person - that is people who have been in real relationships with that person - compile the list.

With that approach experts are left with offering their condolences to the survivors - like everybody else.

George Dawson, MD, DFAPA


  1. It is interesting to me now important Robin Williams's suicide is to my patients. A lot of grief out there so we talk about it. I am terribly sad too as I am when anyone is so depressed and hopeless they die. Thanks for the article.