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Mark Goulston, M.D.

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Under the Sheen: What Makes Charlie Run, Crash and Burn...Again

Posted: 02/01/11 09:59 AM ET

"Keep this in mind, Mark, regardless of how erratic, irrational, self-defeating and self-destructive a person's behavior, somewhere in their mixed-up mind, it is in the service of self-preservation."

I'll never forget those words to me from a very wise supervisor and mentor during my psychiatric training.

So when I see, hear and read about Charlie Sheen falling apart yet again, I think of the above and also of the many Charlie Sheen-like individuals I have seen over the past 30 years.

My seeking to understand such people is still a work in a progress and I hope that never ends.

What I currently understand when people self-destruct repeatedly "in the service of self-preservation," is that there are often one or more of three forces present that drive them to their outwardly crazy behavior.

The first is the fear of being controlled. That is often about their experience of feeling and being used by others, which can feel invasive and assaultive to their core.

Years ago I made house calls to a famous musical composer as he was dying, who was as well know for his drug use, run-ins with the law and making the people around him nuts, as he was for his music.

I asked him what that was all about during one of my house calls shortly before he died. He told me, "I have been fortunate that I have been successful with my music for over 30 years and I wasn't foolish enough to throw away such a gift. However, whenever I was doing well, many people -- not the least of all was my pushy stage mom -- would tap me on the shoulder, smile and essentially say, 'That's my good little boy' and then I would often see them taking credit for it. It made me want to vomit, but as I said, it didn't make me throw away my talent. When I did my drug use and had my run-ins with the law, nobody wanted to take credit for that, so those were things that I absolutely knew belonged to only me. Everybody needs something that belongs just to them."

The second force is the fear of depression. Sometimes that is due to having had previous undiagnosed manic or hypomanic (hyper, energetic, but not psychotic) episodes and then suddenly crashing off them and sometimes going into a full-blown depressive episode. Novelist William Styron called it, "despair beyond despair," in his book, "Darkness Visible: A Memoir of Madness," about his own struggle with depression. It has been said that a number of people thought to be bipolar such as Ernest Hemingway or Sylvia Plath, committed suicide after they had come off a manic high, started to plummet towards depression and despair, and killed themselves while they still had the energy to do so and before they became so depressed that they couldn't move.

In the people I have seen that Charlie Sheen reminds me of, their crazy behavior was not suicidal (although occasionally they would slip into suicidal ideation -- maybe that was the case with Owen Wilson), but really was the often used phrase, "a cry for help."

The third force is the fear of mania. A number of the people I have seen over the years have felt and believed that no matter how successful they became, they were doomed to fail. Sometimes it was because they felt that they were a fraud in terms of how truly talented they were. In other cases it was because they felt they were undeserving, because down deep they often confessed to me that no matter how generous the world thought them to be, in truth, they didn't care about anyone but themselves and were filled with jealousy and envy and therefore not a worthy person who deserved to succeed.

So instead of getting too successful and feeling they would inevitably fail and fall, they did self-destructive things to make the fall less. In an odd way, it was their way of exercising some control over how far they would fall.

Fortunately, in many of the cases of fear of depression and fear of mania, medication can be helpful and even life saving. And of course, 12 Step Programs have an even better track record in the case of alcohol and substance abuse. However, in cases where both of those are insufficient, often the missing element is the deeply felt, selfless (but firm) loving and deep empathic understanding from another person that the troubled person truly trusts, admires, respects and believes. I don't know the details, but something such as that may be the case with Robert Downey, Jr. where his wife, Susan, has all the right stuff to have helped him out of his difficulties and to whom he has given much credit.

One of the most dramatic examples of self-destruction in the service of self-preservation was a patient of mine who seemed to have suicide on her mind on a daily basis. Since that thinking never left her, hospitalization (which had failed to change her thinking) didn't seem to be an effective option and there was no way to talk her out of it.

One day her suicidal thinking was getting to me more than usual and I asked her about it. She replied, "Oh I never tell anyone else about it, because it would really spook them (which was what it was doing to me on that day), but I gotta tell you. If I didn't have my suicidality (i.e. a way out if it really got bad), I would have killed myself a long time ago."

 
 
 

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