In the many articles now current on the web discussing the Charlie Sheen media performances, there has been much speculation that what we've been seeing is evidence of bipolar disorder, or possibly effects of the prodigious drug and alcohol intake of which he has boasted.
Let's look seriously at these proposals.
There have been no reports of a depressive phase recently or in the past, which could help to add credibility to this diagnosis. His recent behaviour certainly does resemble that of someone in a severe and long-lasting manic phase.
Most of us are familiar with depression, at least in its mild forms. Mania (usually the milder Hypomania) is usually euphoric - you feel terrific, indeed far too terrific, have excessive energy, irritability, lack of sleep, delusions of grandeur (of being specially important and great) and/or of paranoia (conspiracy theories and excessive suspiciousness of others and their motives). It's not necessarily permanent euphoria, and may switch into a most unpleasant mood of dysphoria.
There is typically a loss of common sense and caution, a failure to test not so much the accuracy of your perception of reality, as a failure to check the realism and wisdom of bright ideas that occur to you.
When I worked in London, for instance, I treated a city trader who came to me soon after a manic phase had begun, and revealed that he had just cornered the entire world market in Pig Bristle (a variety of pig hair once used to make brushes, and no longer used). He had spent a fortune doing this, and was confident that the world, or at least its brush makers, would beat a path to his door begging to buy some. Needless to say, this never happened. But, as many formerly manic folks might say: it seemed like a great idea at the time.
Sheen has been heard making some ridiculously pretentious claims of being unique and enormously special in a superhuman way. These include claims of carrying tiger blood, and having "Adonis DNA" ! Good Grief, has he looked in the mirror lately?
These could indeed be "delusions of grandeur". They could also be cheesy attempts at humour from someone who may be skilled at delivering humour scripted by someone else, but who doesn't have good wit or humour, and is not able to notice how unfunny his remarks are to others. Someone so rich can easily be surrounded by Yes-men, and what one might call "He-He-men", who dutifully laugh at one's comments.
In an ordinary individual, we place importance on their capacity for "reality testing "- it is harder to assess in someone whose situation and surroundings limit their access to actual reality, and who may be assured by some they trust or believe that their warped views are valid or real.
Sheen in one TV interview on ABC, said: "You borrow my brain for five seconds and just be like, 'Dude, can't handle it! Unplug this bastard! It fires in a way that is perhaps not from this terrestrial realm." This sounds like a self-description of mania, or cocaine intoxication.
What me, bipolar?
When it's been suggested he could be bipolar, he's quoted as saying: "Wow! What does that mean? Wow. And then what? What's the cure? Medicine? Make me like them? Not gonna happen. I'm bi-winning. I win here, and I win there. Now what ? If I'm bipolar, aren't there moments where a guy, like, crashes, like, in the corner, like, 'Oh my God, it's all my mom's fault' ? Shut up. Shut up! Stop! Move forward."
The part of this that sounds most like someone with bipolar disorder is the rejection of medicine as "making me like them" - you may be having way too much fun to accept any idea of limiting the energy, and may be so entranced at your wonderfulness, that you reject anything that might make you like anyone else. And he might also be referring to a lack of a depressive phase.
Cocaine intoxication can mimic mania, but also has physical signs and symptoms, which one hopes someone would have checked here: changes in pulse rate and blood pressure, dilated pupils, weight loss, and others.
Especially if someone has any vulnerability to bipolar disorder, stimulant and cocaine intake could precipitate a mania. There can be a vicious cycle. People miserable with a mental disorder may self-medicate with alcohol, drugs or sex; and over-indulgence in substances can precipitate or worsen mental disorders. The problem with this diagnosis is that he is reported to have passed a least two blood tests performed by media groups, which makes current intoxication unlikely, though there can be lasting effects of major chronic drug abuse.
Actually, there are many possible explanations for the picture we have been seeing. Sheer lack of sleep in someone who has been indulging in stimulants and various over-activities could produce this sort of picture. So could mixtures of illicit drugs themselves, with or without prescription meds; or withdrawal from alcohol or drugs.
The Joaquin Phoenix Syndrome
We've recently seen another Hollywood actor, Joaquin Phoenix, simulate gross mental disorder for months, to make a film (I'm Still Here, directed by Casey Affleck) about people's reactions to him. Having seen Phoenix on Letterman, he was highly convincing. From his performances over his career, one doubts that this Sheen has the acting abilities to be simulating this credibly. But after Affleck, this will need to be added to the list of possible diagnoses.
Some pundits have timidly suggested he might have a Narcissistic Personality Disorder. Surely that's entirely convincing - but isn't that almost a requirement for a successful career in Hollywood?
A blogger (Spiked Online) makes the oddly inaccurate comments: "He’s my hero because he refuses to allow his behaviour to be psychologised. He refuses to genuflect before the Opralite altar of psychobabble and blame his antics on his “inner demons”. Instead he’s fighting like a terrier against experts’ attempts to brand him as “disordered” and in the process has made himself into a one-man army of resistance to the tyranny of therapy that has the twenty-first-century in its grip."
But of course no experts of any kind had any interest in branding him as showing any form of disorder, until his highly insistent and determinedly public displays led to others asking the experts how they might explain such self-damaging behaviour. And he has also denounced others for not trying to help him.
While avoiding the tiresome cliché of the Oprah fodder of celeb weeping and confessing to various disorders, he is enacting the alternate cliché of the hedonistic and hectically self-indulgent self-destructive star. And, typically, expecting, on no other grounds but wealth and stardom, exemption from the laws and rules that govern the rest of us who lack tiger blood. Either way, he's a terribly ineffective and inarticulate warrior against therapy, and massively boring, to boot.
Such attempts to depict hazardous self-neglect as heroic resistance, ignores the fact that most of these conditions, including untreated mania and severe cocaine intoxication, are dangerous and can lead to death. Hardly admirable, or deserving applause.
(Professor M.A. Simpson, aka CyberShrink, March 2011)
Copyright M. A. Simpson, 2011