Could Charlie Sheen Be Manic?

In an interview on NBC’s Today Show on Monday, February 28, Charlie Sheen commented on the brouhaha that has resulted in halting the production of his television show, Two and a Half Men, for the rest of the spring TV season. (CBS reports on the interview and shows a clip here.) Given Sheen’s recent history—the drugs, the prostitutes, his vague but apparently anti-Semitic comments about his producer, and his recent claims to have “tiger blood” and “Adonis DNA,” some people are asking: Is it possible that Sheen is actually manic, in a clinical sense? (This question has been addressed, for example, by a number of mental health experts in a news report on the HollywoodLife website, and in a post on Time magazine's website.)

The first possibility that comes to mind is that this is the result of the drugs that Mr. Sheen is alleged to have taken in many accounts in the news media (see below). Certainly Mr. Sheen's behavior is consistent with long-term, high-dose abuse of certain substances, such as cocaine.

However, just as a thought exercise, it is worth pointing out that substance abuse often "hides" mood disorders, especially in men. In particular, a 2006 study (Albanese et al.) found that, in a sample of 295 male patients admitted to a substance abuse program, 85 of them (about 29%) fit the criteria for bipolar disorder. Perhaps more interesting, and disturbing, are the facts about what happened when these 85 patients were assessed upon admission to their substance abuse program: 49% of them had never been previously diagnosed with bipolar disorder.

In plain language, if the 2006 study is typical of the general population, then it looks like (1) between a quarter and a third of substance abuse patients suffer from bipolar disorder, and (2) of those with bipolar disorder before admission to a treatment program, about half had not previously been diagnosed with the bipolar disorder.

So, it is at least plausible to wonder if someone with a widely alleged history of substance abuse suffers from bipolar disorder. The two disorders can co-occur. How plausible is that possibility with Charlie Sheen?

It would be unethical and illegal for me to render a diagnosis on someone I have not met with professionally. However, I have worked with several clients with bipolar disorder in my professional roles at institutions such as the Manhattan Psychiatric Center and Lutheran Medical Center, and I must say that there are elements of Mr. Sheen’s behavior that do raise questions in light of the technical criteria for a manic episode, as noted in the standard manual for psychiatric diagnosis, the Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition, Textual Revision (DSM-IV-TR). Consider the following:

• Many individuals with mania show “inflated self-esteem or grandiosity,” according to DSM-IV-TR. Given Sheen’s recent comments about having “tiger blood” and “Adonis DNA,” it would be easy to say in regard to this diagnostic criterion: Check!
• Many individuals with mania show “decreased need for sleep.” On the show Piers Morgan Tonight, Sheen recently stated that “I can function without sleep ... and handfuls of cheap trucker meth.” I would give this diagnostic criterion at least a qualified “check.”
• Many individuals experiencing a manic episode show pressured speech. Look at his recent interviews and see for yourself; they are not hard to find on YouTube. I would give this criterion a “definite maybe.”
• The DSM-IV-TR notes that many individuals with mania show “excessive involvement in pleasurable activities that have a high potential for painful consequences,” for example, “engaging in unrestrained buying sprees, [and] sexual indiscretions.” A news report in late January of this year stated that Sheen “spent more than $500,000 on escorts and drugs in the six months before he checked into rehab” recently. Check!

So, if Charlie Sheen is indeed manic, what would be the take-home message here? Some individuals with mania can be successful for many years—up until their disorder causes consequences that just cannot be ignored by their employers or family members.

If he is indeed manic, Sheen needs help: a strict course of anti-manic medication, accompanied by psychotherapy. The sad thing is, many individuals with mania do not really feel that they have a problem—in their manic episodes, they feel productive, creative, and powerful—and they do not consent to treatment until their families and/or employers make treatment a condition of continuing to occupy their roles in their families or jobs. Someone like Sheen has enough money that no one can really force that kind of choice on him.

My own sense of the situation is that this will not end well.

A tip of the hat to Kathleen Koltko-Rivera for bringing this topic to my attention.

(Readers are welcome to comment on this post, below. Readers are also invited to become “followers” of this blog, through the box in the upper-right-hand corner, to be notified of future posts.)

Copyright 2011 Mark E. Koltko-Rivera. All Rights Reserved.

[The image of Charlie Sheen was taken on March 11, 2009, by Ms. Angela George. It was obtained through Wikipedia, and appears here under the terms of the Creative Commons Attribution Sharealike agreement.]

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Boy Lacks a Cerebellum—But Doesn’t Need It!

Okay—this just seems impossible. However, this unusual news story illustrates something very important about the human brain (shown in the photo to the left).


A recent news story tells about a boy who rides a bicycle, runs about, and does other sorts of active things that a child of his age would do. This might not seem like much of a news story—until we realize that this boy was born without a part of his brain, specifically the cerebellum. To anyone who knows anything about brain anatomy, it might seem impossible for someone like this boy to have such a normal range of activity.

The cerebellum (highlighted in purple in the photo) is a part of the brain that seems to be involved in several functions, including emotional regulation and language. However, its best-understood function involves the fine tuning of large-scale body movements, including the keeping of balance, coordination, and timing. The cerebellum is involved in activities like walking, running, and, of course, riding a bike. Adults with damage to the cerebellum often show poorly coordinated movements, and do not walk smoothly. And yet the boy mentioned in the news story seems to have no problems with these kinds of activities—even though there is only fluid where the cerebellum should be. What gives?

The article speculates that the boy’s cerebellum was genetically defective, and its tissues were reabsorbed into the body while the boy was still in the womb. Further, the article speculates that the boy’s brain reorganized itself to distribute the processing of activities involving balance and coordination to other parts of his brain, while he was still developing prenatally.

Recent years have seen much research published that sheds light on the plasticity of the brain, that is, the brain’s capacity to reorganize itself and redistribute its functions as needed (for example, because of injury). Brain plasticity is most easily seen in the brains of very young people, and it appears to be the best explanation for what we see here with this young man.

Of course, this raises all sorts of questions. If a young person's brain shows a great deal of plasticity, why do not adult brains? Is there a way to encourage plasticity in adult brains? But if we do, what is the trade-off, the cost in other brain functions? For that matter, what is the trade-off in the brain function of the young man in the news story?

And, who will answer these questions? Brain researchers—perhaps even you.

(Readers are welcome to comment on this blog post, below. In addition, readers may wish to become "followers" of this blog, through the box in the upper-right-hand corner, to be notified of future posts.)
Copyright 2011 Mark E. Koltko-Rivera. All Rights Reserved.

[The image of the human brain (with the cerebellum colored in purple) was produced by the National Institutes of Health (NIH), an agency of the U.S. federal government, and so is in the public domain. It was obtained through Wikipedia.]

A Stroke or Seizure--On Live Television

We are surrounded by artifacts of both high culture and popular culture: literature, music, dance, art, drama, television shows, movies, and so forth—even advertisements. It is easy to think that these artistic productions come like lightning bolts of inspiration from some Mount Olympus of the Cool. However, every once in a while, we receive an abrupt reminder that all of this is the product of processes involving physical neurons and synapses in the brain, that three-pound mystery which governs our behavior.

One such reminder occurred a couple of nights ago at the Grammy Awards, when an on-site television reporter had what seems to have been a stroke or a seizure, right in the middle of her on-air report. The ABC TV report of this event, with footage of the reporter in the middle of her stroke or seizure episode, is available in video clips within this online article.


There are two basic kinds of stroke: those caused by an interruption of blood flow to a portion of the brain caused by some blockage of a blood vessel (ischemic stroke), and those caused by actual rupture of a blood vessel (hemorrhagic stroke). If I had to guess, I would say that the reporter in the clip suffered a transient ischemic attack (TIA), where blood flow to a portion of the brain was only temporarily interrupted. The photo above shows an image of a brain where a hemorrhagic stroke has occurred; the disturbance of the symmetry of the brain is obvious, and the larger “spaces” shown in one side of the brain show where brain tissue has been compressed or has died.

The reporter involved is lucky; if this was indeed a stroke or TIA, it appears to be very localized. She may recover completely, as I hope. Many stroke victims are not so fortunate; strokes can cause loss of any of many different kinds of psychological and physical functions, partial or full paralysis, or death. Even worse news: Strokes are remarkably common. In the Western world, strokes are the second-most common cause of death, ranking just after heart disease, and more prevalent than fatal cancers. This makes it important to understand symptoms of stroke, risk factors for stroke, and how to prevent stroke.

Stroke can occur at any age. (In fact, a report last week noted that there has been a sharp increase in strokes among children, adolescents, and young adults, in recent years.) Because it may occur in any portion of the brain, any sort of sudden change in abilities might indicate a stroke. The most common symptoms include sudden-onset weakness in the facial muscles, inability to control arm movements, and speech abnormalities. (We see the last of these, perhaps, in the news clip.) Think of the acronym FAST: Face, Arm, Speech, and Time (that is, sudden onset). People with symptoms like these should be seen immediately by medical professionals. Headache, otherwise unexplained vomiting, and loss of consciousness are also seen in some strokes.

Risk factors for stroke include smoking (active and passive), heavy alcohol consumption, illicit drug use (especially cocaine, amphetamines, and abuse of OTC cough and cold drugs), diabetes, high blood cholesterol, high blood pressure, an unhealthy diet, and obesity. Of course, some of these factors are interrelated; smoking is associated with high blood pressure, and an unhealthy diet is associated with high cholesterol, high blood pressure, diabetes, and obesity.

Research in prevention is in early stages. However, it seems wise to seek prevention of stroke by addressing risk factors. Do not smoke—anything—or be around people who smoke. Do not drink alcohol to excess. Do not use illicit drugs, or abuse OTC drugs. Lower your blood pressure to the normal range by (a) not smoking, (b) eating a healthy diet, and (c) exercise; these latter two will lower cholesterol, and improve obesity, diabetes, and diabetes risk, for many people.

While you're at it, cut out the energy drinks, too: a recent study (reported in a Los Angeles Times article) found that the extra but empty calories increase risk of diabetes; the drinks also seem to cause heart arrythmias in some adolescents, which can only increase the risk of a blood vessel rupture, and thus perhaps a hemorrhagic stroke.

I have worked with stroke patients as a therapist. To put it bluntly, the aftermath of stroke can be a living death in some cases. Stroke prevention is worth your best efforts. It can be done. You can do it.

UPDATE 2/17/2011

The Associated Press reported today that the reporter suffered a migraine, not a stroke. The report quotes a UCLA neurologist who treated the reporter as saying, "A migraine is not just a headache. It's a complicated brain event." No kidding.

(Readers of this blog are welcome to comment in the space below. Readers may also wish to become “followers” of this blog, above, to be informed of future posts.)

Copyright 2011 Mark E. Koltko-Rivera. All Rights Reserved.

[The image is of a CT scan of the brain of a person who experienced an intracerebral and intraventricular hemorrhagic stroke. The image was released into the public domain by its author, Glitzy queen00. It was obtained through Wikipedia.]