Conflict Of Interest, Primitive Defenses, And Celebrity Death

I don't think there is any good way to say it.  Minnesota's greatest celebrity died recently.  I am not going to use his name or picture on this blog.  It seems fairly obvious that he would not want that.  There was the expected and understandable outpouring of emotion from his tens of millions of fans.  And then he became a projective test for anyone who wanted to sell their idea or opinion or get exposure in the press.  Some of those ideas and exposures included:

1.  The opioid epidemic - he is another statistic.
2.  Opioids are bad drugs and they can kill you.
3.  We could have saved him if he went into treatment.
4.  We could have saved him with Suboxone.
5.  Public scorns buprenorphine (Suboxone) - a medication that could have saved him.
6.  We could have saved him with a treatment intervention.
7.  His problem wasn't addiction at all it was chronic pain.
8.  We could have saved him by treating his chronic pain.
9.  The doctors prescribing these medications need to be disciplined.
10.  The people designated to save him - should have saved him.
11.  His death was "pathetic".
12.  That publicity rights legislation that exceeds copyright protection is necessary for the heirs.

None of these ideas are my ideas and I am sure that by the time you read it - this list is incomplete and outdated.  This is what I have heard or read about his death since it happened.  Some of the dynamics are familiar to me.  The gossip columnists and sites trying to show that they have special contacts and insight and therefore may be more important than other gossip sites.  The insiders proclaiming special knowledge that only a person very close to the celebrity could have.  The very human tendency for some to celebrate the death of those with special talents and capabilities that none of the rest of us have.  Death seems like the ultimate revenge of the mediocre and personality disordered - the final verification that a high flying person dies just like the rest of us.  The entire debacle reminds of a sentence I read somewhere (the reference eludes me): "Only a primitive man celebrates the death of his enemy."  How primitive would the man need to be in order to feel elevated by the death of a superstar?  I realize that these more drastic formulations may be rare.  What fuels all of the controversy?  Some may say morbid curiosity.  They are compelled to look at adverse outcomes whether it is a car wreck on the side of the road or a celebrity death under various circumstances.  It still comes around to what one of my psychoanalytic supervisors described as the most primitive underlying and unspoken thought: "Better him than me!"  The first time an analyst told me that I was somewhat taken aback and then over time I noticed that he was right.  I expected to hear this kind of attitude from non-professionals but not from physicians.  It turned out that I could hear that attitude from a broad spectrum of people.

My biases tend to be at the other end of the spectrum.  I see special capabilities as a celebration of what human beings can do.  Whether that is in athletics, entertainment, art, or my co-workers doing the job in a way that nobody else can do it.  Individual talent and unique capabilities are there to be celebrated and not envied.  I discussed this in an earlier post where the concept is that even people who aren't soccer fans can appreciate the greatness of Pele and just by watching him realize that we are all lifted up by that performance.  Envy seems like a marker that we should all use to determine our own sense of self and our own boundaries.    

In today's conflict-of-interest morality analysis anyone wanting to capitalize on the reputation of the celebrity to sell their wares escapes criticism.  The people involved will say that this is the price of celebrity and if you did not want everything that went along with celebrity you should have avoided it.  You are protesting too loudly when your privacy is invaded in real life or after you die.  There is another argument that the fans are entitled to this information.  To me that would depend on who is dispensing it and what was their reason.  There are numerous analyses of this problem from the perspective of defense mechanisms and the study of life satisfaction based on the level of those defenses.  Defense mechanisms may be interesting to psychiatrists and other mental health professionals but I don't think that they have to be brought out for this discussion.  At some point in life everyone needs to take a close look at how they interpret both misfortunes and good fortunes of others.  What does it really mean to them?  What does it indicate about their philosophy of life?  What does it mean about their life satisfaction?  When you do that - I think that most reasonable people stop for accidents because they are there to help.  They are not spectators.  Human consciousness has the unique property of allowing us to imagine good and bad things happening to us without having to see the real thing happening to somebody else.

I hope that at some point the culture can move past the all too predictable sequence of self aggrandizement and the obvious conflict-of-interest that occurs when a celebrity dies.  Human life and human achievement is worth celebrating and just like a single person can make us all better or at least feel better - it doesn't take much to bring us back down.  In order to break out of these predictable patterns, it takes a conscious awareness of better ways to be or exist in life and that includes examining and rejecting reasons for continuing the old patterns.

I will personally remember his shining star and some of the accolades from the top performers in his field.  He was truly one of a kind and his art was uplifting to me.  


George Dawson, MD, DFAPA

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