This article is a “reboot”—the newsletter was born out of the work Carlene MacMillan, M.D.1, and I did on Clubhouse back in the day. This was a good article then, and it seems relevant again now, so I’m relaunching to the world. She is busy doing super corporate important things at her company and at AACAP, CTMSS, and APA so she has less time for this newsletter foolishness. That having been said, she wrote a mean article then, and might again. Who knows! If I get enough subscribers, I can peer pressure her. What follows, with a personal post script, is her original article:
In addition to raising concerns about how to help vulnerable individuals under conservatorships, the #FreeBritney movement also pulls back the curtain on how we hold celebrities to impossible ideals and how hard it can be for them to lead happy lives despite seemingly limitless fame and fortune. This past week the world watched as American Gymnast Simone Biles withdrew from the team competition at the Olympics citing overwhelming mental health concerns she refers to as her inner demons. She has been managing intense pressure to continue to be “the best gymnast the world has ever seen,” which the media reminds us at every turn. It is hard for any of us to imagine the level of scrutiny and admiration that individuals like Simone and Britney face. In our most recent Clubhouse show we were joined by several mental health and medical professionals to the stars as well as a former MTV VJ to think critically about this toxic celebrity culture that places one’s inner demons on very public display.
Regardless of how closely one follows celebrity news, if we take a look at celebrities whose lives have been cut short due to some combination of drugs, alcohol, suicide or other emotional tragedy, chances are you have been moved by at least one of them. Here is just a sampling: Marilyn Monroe, Judy Garland, Amy Winehouse, Anthony Bourdain, Kate Spade, Kurt Cobain, Chris Cornell, Whitney Houston, Robin Williams, Prince, Avicii, Alexander McQueen, Chris Farley, Janis Joplin, River Phoenix, Princess Diana, Jim Morrison, Philip Seymour Hoffman, Heath Ledger, Corey Monteith, John Belushi, Karen Carpenter, Jimi Hendrix, Elliott Smith, Chester Bennington and DMX. Had they been able to get the support they needed, imagine what else they could have done in the world. In 1994 Kurt Cobain quoted Neil Young in his suicide note “It’s better to burn out than to fade away.” As a psychiatrist who works with individuals struggling with similar demons, I disagree and I think we can do better by our idols.
The Hell of Hyperagency
Dr.Paul Hokemeyer, a psychotherapist who specializes in working with celebrities and is the author of Fragile Power: Why Having Everything is Never Enough, does too. He notes that when it comes to mental health care, the best help is not always the most expensive. It is help by people that understand the cultural context someone is living in and can work with the specific challenges faced by the individual that are a result of their environment. For celebrities there are three common cultural elements at play that can make for a pretty miserable, lonely existence despite having 30 million Instagram followers:
Isolation
Suspiciousness of others
Hyperagency
Hyperagency in particular plays itself out when celebrities access healthcare and mental services. Much of the work we do as psychiatrists involves holding limits, being consistent and recommending specific treatment plans. For someone of modest means who is using their health insurance, given the massive shortage of mental health professionals in the United States, if someone disagrees with their psychiatrist, they are more likely to try and work through the disagreement to come to a collaborative decision than fire the psychiatrist and go elsewhere. For a celebrity with hyperagency, however, they can fire a psychiatrist when they are not getting the prescription they want. Sometimes that prescription is for a controlled substance like Klonopin that can be dangerous and lead to death in overdose. John Samuels, the founder of Better Health Advisors, notes that this can lead to poor treatment plans for so-called VIPs and medical errors that can sometimes be fatal. For example, Michael Jackson was being prescribed a powerful medication for sleep that is rarely if ever used in that manner in a regular outpatient setting and it led to his death.
Now of course, in the case of Britney Spears, perhaps one of the reasons there is such a public outcry is her lack of agency due to her conservatorship. It is so counter to how we think of celebrities operating that it sticks out. However, the person in her life that does have hyper agency is her father and conservator, Jamie Spears. He has been widely accused of getting rid of anyone in Britney’s circle who opposes his point of view, resulting in the nightmare we have today and a petition by her new attorney to remove him as a conservator. Should she no longer have a conservator in the future, it is important to note that it won’t be smooth sailing for a celebrity in her position. Unfortunately, many of the same pressures that have haunted celebrities throughout history are not going anywhere.
The Company We Keep
Quddus, an MTV VJ on Total Request Live from 2001 to 2006, held a very privileged vantage point into how celebrities coped with the pressures of becoming household fames overnight. He emphasized that the quality of the community around them was the biggest difference in how celebrities like Britney Spears and Justin Timberlake carried themselves with grace or with infamy. Justin Timberlake, in particular, always seemed to surround himself with solid folks who helped him stay grounded, whereas many other celebrities had entourages of people with less than healthy motivations.
Regarding misaligned incentives that motivate celebrities to behave in ways counter to their mental health, reality TV, like The Real Housewives franchise on Bravo. Reality shows walk a fine line between wanting their stars to act in erratic and outrageous ways but not so erratic and outrageous that they die. They seem to select people with personality disorders like Narcissistic and Borderline Personality Disorder because, let’s face it, well-adjusted, mature individuals make for bad TV. We were joined by one of the leaders of Club Bravo on Clubhouse, Jim Nickerson, who shared the number one piece of advice for the Real Housewives that is given but consistently ignored “Do not believe what people say on social media that hate you and do not believe what people say on social media that love you.” There is tremendous pressure to be at your worst or edit it to appear that way. This is why it is so important to have a close circle of supporters who accept someone for all their complexities, not just the ones that make for good TV.
Man’s Search for Meaning
Given the intense pressures of being constantly in the spotlight, it could be tempting to think the only solution is to withdraw from it altogether and go off the Hollywood grid. While this can be the right choice for some people, it is not the only path to being mentally well as a famous person. Humans thrive when they can make meaning of their lives and authentically connect to others. Celebrities are no different. Quddus brought up George Clooney as an example who uses his platform and privilege to raise awareness of causes that matter. There are also more and more examples of celebrities like Naomi Osaka or Simon Biles being open about their mental health demons and garnering massive support.
Perhaps this is why social audio platforms like Clubhouse appeal to celebrities to connect with their fans authentically. Signing autographs in the mall or performing to thousands of screaming fans is one thing. Still, quite another to participate in spontaneous conversations in Clubhouse rooms with people who may not even know they are speaking to a celebrity. For example, we did a show with singer-songwriter Jewel on Mindfulness earlier this year, and we had some individuals come to the stage who simply were drawn to the topic of Mindfulness and didn’t know who Jewel was. That makes for a very different type of interaction that feels less hollow than garnering thousands of likes and random comments on an Instagram post carefully curated by your social media manager.
Maybe, just maybe, when Britney Spears gains full freedom to appear wherever and however she wants, she can hit the hallways of Clubhouse for the types of connected conversations that keep so many of us on their day after day. In the meantime, let’s all remember that every time we put celebrities on a pedestal only to later knock them down for being mere mortals like us, that speaks volumes about our insecurities and worst tendencies. Let’s save the pedestals for statues.
Post Script: Carlene ended up appearing on Morning Joe on this topic!
And honestly, the striking thing—to me—just looking at that now, again, is “Carlene makes good points,” but also: metabolic syndrome is an illness. Out of solidarity, she supported me in my recovery from obesity and type II diabetes by changing our lives and diets and working with an obesity medicine doctor. This is her with our daughter our front of Barbie!
With our rockstar daughter Quinn.
Thanks for reading.
yes, she is my wife.