Are we stigmatising Charlie Sheen?

Charlie Sheen's recent behaviour has led to media and medical speculation about his health

The recent behaviour of actor Charlie Sheen has led to some - including US TV doctor Dr Drew Pinsky and a number of bloggers - to suggest he has bipolar disorder.

In this week's Scrubbing Up column, mood disorders expert Dr Paul Keedwell suggests why many commentators tend to condemn or stigmatise celebrities who behave in this way.

Charlie Sheen has been flying the flag for the alpha male and the spirit of adventure with more than a little wit and bravura; something that has led to intense speculation about his mental health.

Whether or not Sheen does have a mental illness, the media coverage has told us important things about the way society sees mental health problems.

Articles on Sheen's behaviour have ranged from the judgmental - decrying his hedonistic lifestyle - to the celebratory - he has a right to behave like this and we should stop psychologising.

But there are also compassionate voices emerging: serious attempts to understand his behaviour.

Only a psychiatrist who fully assesses an individual face-to-face and takes a history from all possible sources is well placed to come up with a diagnosis and consider treatment options for mental illness.

Often more than one problem is identified, requiring a complex set of psychological, social and medical interventions.

However, many doctors in the media, and mental health discussion forums, have drawn parallels between Sheen's behaviour and the signs and symptoms of bipolar disorder.

These include increased rate of speech, speeding thoughts, increased sexual drive and reckless sexual behaviour, increased drug or alcohol misuse, profligate spending, irritability, thoughts of being especially powerful or gifted, thoughts rapidly jumping from one subject to another (known as "flight of ideas"), distractibility, paranoia, boundless energy and reduced need for sleep.

'A neat cause'

Discussions around the subject of bipolar disorder have generally been a good thing, highlighting the difficulties inherent in both diagnosing the disorder in the context of a hedonistic culture and drug misuse, and the difficulties in persuading the sufferer to accept treatment when they are feeling so elated and expansive.

However, it is worth considering the less charitable interpretations of Sheen's behaviour.

For example, we might take the line that he has brought his problems on himself by making a bad moral choice.

Drug use can certainly trigger and destabilise an underlying predisposition to mental illness.

However, even if mental illness runs in the family, predicting which of us will become ill is difficult.

To condemn someone with mental illness for using drugs is like condemning the smoker who has lung cancer.

Also, the more considered commentators realise that mental illness can lead to excessive drug misuse, as well as the other way round.

I believe that there are three basic motivations underlying such negative judgements.

Firstly, they provide us with what we think is a neat cause for his mental imbalance - a lifestyle so extreme that we can distance ourselves from it, satisfy ourselves that what he is experiencing would never happen to us.

Secondly, in judging him, we can all feel a bit better about our own transgressions. Finally, because we envy celebrity as much as we covet it, we have a morbid fascination with witnessing the downfall of those who we admired.

Another angle from commentators is that Sheen's behaviour is merely on a spectrum of normality and that he should be free to express himself.

The behaviour of someone with a mental health problem may be infectious and seductive: many of us are naturally attracted to someone who is happy, energetic, expansive and creative.

We can all 'win'

Superficially, behaviours expressed by individuals with a mental illness do not have a clear cut off from more common variation.

Bipolar disorder, for example, merges into cyclothymia - the moody personality.

This "bipolar spectrum" has expressed itself in our great poets, artists, scientists and novelists.

At the sharp end, though, there is a real risk of suicide (over 500 times the average population risk) or death through excessive risk taking, not to mention the long term social consequences of marriage break up, career meltdown or a prison sentence.

I once assessed a man in clinic who had rapidly descended from IT entrepreneur with a loving family to a divorced, unemployed ex-con living in a hostel in a deprived part of London, wondering how he could have been arrested two years earlier in a South London brothel, threatening a prostitute with a replica hand gun.

Mental illness is still treated differently to medical disease, even though at the extremes the disorder it is no less biological, and no more controllable through human will alone.

It can be remedied with a combination of medication, talking therapies and lifestyle changes.

We still cannot speak its name, in the same way as we could not talk about having cancer just a few decades ago.

Like cancer, mental illness is a common part of human life, especially as we get older, and it can affect us all, irrespective of lifestyle or background.

Also like cancer, much mental illness is most effectively treated in its early stages.

As the taboo of mental illness is broken down so people will present for help earlier, and society's burden of illness will come down: at this time we will all be finally "winning".