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.]

{Technorati confirmation code: 6J8HBG8BD49D .)