You would not think a pop culture diva like Britney Spears would fit into the usual fare on discussion at the annual winter conference of the American Psychoanalytic Association.
But last week, on the sidelines of the gathering of hundreds of analysts from around the country, the topic did arise — specifically the armchair diagnoses of the troubled starlet's mental health that have popped up in celebrity magazines and tabloids everywhere.
Under such headlines as "Britney's Mental Illness" and "Bipolar Britney?," articles have quoted psychiatrists or psychologists who have never met Spears, saying she exhibits "classic" signs of one disorder or another.
"I've been very upset about this," says Mark Smaller, a psychoanalyst from Chicago who attended last week's meetings at Manhattan's Waldorf-Astoria Hotel. "This idea of making a diagnosis of someone they've never met is completely inappropriate, and it gives mental health professionals a bad name."
Not to mention that it is medically wrong. Smaller says that to make any real diagnosis it can take several thorough consultations with a patient at the very least. "Trying to make such a diagnosis based purely on someone's behavior" — and worse, their behavior as portrayed selectively by the media — "is scientifically impossible," says Smaller, who is also director of the Neuropsychoanalysis Foundation.
Speculation could harm Spears
But even more, say Smaller and other therapists, it could actually harm Spears by preventing her from getting the real help she needs. And on a broader scale, such therapy-by-media could discourage other troubled people from seeking care as well.
"It's not right to this one person," says Dr. Gail Saltz, a New York psychoanalyst and psychiatrist. "But on a grander scheme, it also makes people afraid. They're afraid their confidence might be broken. Or they're afraid they'll become labeled. And labels are very frightening to people."
It is hardly a cause for wonder how coverage of Spears has reached the point of quibbling over which mental illness might afflict her. Each development in the Spears story, including Wednesday's sudden departure from court before a custody hearing, has upped the scandal quotient. From her "mommy foibles," which now seem positively quaint, to her head-shaving incident to her attacking a car with an umbrella to her painful custody dispute, her story gets so much more dire with each passing month that you wonder what could possibly be next.
But the moment that set headline writers into overdrive came on Jan. 3, when police were called to Spears' home after she refused to turn over her two boys to a representative for ex-husband Kevin Federline, locking herself in a room with one boy. Police, who said she was intoxicated, had to restrain her; paramedics were called and she was whisked away to a hospital, paparazzi in pursuit.
That is when TV talk show host "Dr. Phil" McGraw paid a visit, then made public statements later that she was in dire need of medical and psychological help. Relatives said he had crossed the line in talking about her publicly, and he later said he regretted making the statements.
But numerous other psychiatrists and mental health professionals have been quoted as well, speculating on what might afflict Spears. And that, says People magazine's deputy managing editor, Peter Castro, was a necessary element of the story.
"What people need to realize is that we had sources very close to Britney — more than one — telling us that they believed she did indeed suffer from mental illness, and some even used the term bipolar disorder," says Castro. "So it was only responsible on our part to ask a specialist in this kind of behavior. You had a woman here who was hospitalized. This is the first time we were hearing that hey, all this nutty behavior may really have something to do with mental illness, maybe bipolar disorder."
The National Institute of Mental Health defines bipolar disorder (also known as manic-depressive illness) as a brain disorder that causes unusual shifts in a person's mood, energy and ability to function. About 5.7 million American adults or about 2.6 percent of the population age 18 and older are said to have the disorder. It is often treated with medications known as mood stabilizers.
Saltz, who comments regularly in the media, says she is frequently been asked to comment on Spears. It is one thing, she notes, to discuss what concerns a doctor might have when a young woman has two toddlers, is going through a divorce and is suspected of substance abuse. It is another thing, she says, to speculate she has something specific like bipolar disorder.
'Brains don't have a check box'
After all, Saltz says, a diagnosis of bipolar disorder is a very complicated one — one that takes knowledge and context, a lot of questions and a lot of patient history.
"It's not like a blood test," she says. "Brains don't have a check box."
Others point out that it is exceedingly hard to diagnose any mental illness, let alone bipolar disorder, when substance abuse plays a possible role. "How do you know what's going on?" asks Dr. Susan Jaffe, a psychiatrist and analyst in New York. "It confounds the diagnosis because you don't have a clean slate."
Jaffe says another contributing factor has to be considered: the strain of the constant media coverage itself. "What's all this media stress doing to her?" she asks.
All the speculation over Spears' mental health strikes Jaffe, for one, as unseemly, and for a reason entirely unrelated to the medical issues.
"Everyone's standing around and watching her fall apart, and that's just very sad," says Jaffe. "This is someone's life."