Fame Junkies: Dr Drew and Celebrity Rehab

Okay, I admit it. I’ve recently been tuning into Celebrity Rehab with Dr. Drew, on the not-so-venerable ABC2. It’s emotional car-crash television and I feel guilty watching it.

This low-rent reality TV program follows a group of the kind of people who qualify as celebrities these days – actors, porn stars, models, reality TV stars, rock stars, sports stars, and the parents of stars – as they attempt to recover from addictions to alcohol, drugs and prescription pills in a luxury treatment centre in Pasadena, California. Swollen lips, flouncy hair, floods of tears, tantrums and attitude problems abound. Perhaps the most poignant participant was Leif Garrett, a 1970s teen idol addicted to heroin and cocaine.

The group leader and treating doctor is celebrity medico Drew Pinsky, who was also executive producer on the first five seasons of the show. True to the fact that the budget of ABC2 matches its trashy values, the fourth season, which first aired in the US in late 2010, is currently screening in Melbourne.

When I started researching the show I discovered I was hopelessly out of date; Pinsky finally ended the series this year after six seasons. He'd grown tired of the storm of criticism he received from doctors, psychologists and addiction experts every time a former participant died. Those critics were quick to point the finger when Mindy McCready, a country singer who had appeared on the show’s third season in early 2010, shot herself in February 2013, just a month after her boyfriend’s suicide; she was the fifth former participant of the show to die. 

The experts who slammed Pinsky accused him of having an inherent conflict of interest: his need for the show to be entertaining versus his interest in his patients’ recovery. They claimed that his methods were dangerous and outdated, and went against treatment guidelines from the National Institute on Drug Abuse. Detoxing at the clinic was done quickly and painfully, a practice that was potentially deadly but conveniently dramatic; and contrary to Pinsky’s belief, 12-step programs and complete abstinence were not the only means of recovery, and not right for everyone.

They also criticised the fact that participants were paid to appear in the show – five hundred thousand dollars in some cases – because it amounted to luring addicts with the promise of money they could then splash on their addiction. This also goes against the whole concept of addiction recovery – the addict has to want to recover, and shouldn’t need a financial incentive to do so.

I’m in no position to make judgements about the causes of the deaths. The people concerned weren’t in Pinsky’s care at the time and in some cases it was years since he’d treated them, and addiction is a notoriously stubborn condition. But that’s not my main point here. My point is that the whole concept of filming a celebrity being treated for addiction is toxic.

Pinsky, by the way, is no Dr Phil - he is Assistant Clinical Professor of Psychiatry at Keck School of Medicine at the University of California.

Abusive therapy?

My issue with the show centres around narcissism. It’s the curse of our age, and the term narcissist is used as a term of derision, but narcissism is actually a crippling disorder. Many narcissists harbour deep childhood wounds from years of abuse. Pinsky himself has researched narcissism and fame, co-authoring a 2006 study that demonstrated that celebrities were significantly more narcissistic than the general population (which makes him doubly culpable for playing on his patients' incessant need for attention).

To be a celebrity these days almost automatically demands narcissism to begin with. To film these celebrity addicts is, I believe, a kind of abuse, because the presence of the camera actually encourages their narcissistic tendencies without dealing with those tendencies as part of the therapy.

A case in point is Janice Dickinson, who styles herself as the world’s first supermodel and these days makes her living as a talent agent, photographer and writer. With her face so plastered with filler she can barely move it, and beestung lips so thick she can hardly talk, this woman displays levels of anger and exhibitionism that suggest serious emotional damage. Dickinson has spoken out about the physical and emotional abuse she suffered at the hands of her father, and her decades-long drug habit. Given that she filed for bankruptcy earlier this year, it’s also likely she has a spending problem. 

In one scene she complains to Dr Pinsky that another patient has been playing up to the camera. She then stages a walk-out, declaring that she’s leaving the treatment centre. The camera keeps filming her and the question of whether she is acting or not suddenly becomes incredibly complicated. While she rants and packs, she accuses the camera of being intrusive. No doubt she too is playing up to it, and probably thinking about her own career, yet she also seems aware that the camera is actually part of the problem.

It strikes me that the last thing these people need is to have a camera pointed at them. The lure and promises of the camera – an increase in fame, recognition, attention, love – would be a barrier against effective recovery. And surely the first thing a good doctor would do, for a celeb or would-be celeb deep in addiction, would be to turn the camera off; to hide her away from the world so that she has the chance to heal. These are people at rock bottom, at their most vulnerable. Privacy is the very least they deserve. Giving Dickinson a camera to parade in front of may have simply played on her vulnerabilities, and actually worsened them. Just because you exploit yourself doesn’t mean you’re not also being exploited by others.

But the show itself is the thin end of the wedge; the use of Dickinson to promote the show is far worse. In this video, probably promoting the show’s fifth season, Dr Pinsky and two others, who appear to be producers, start a line of questioning about the penis size of the many famous men Dickinson has bedded, and then prompt her to list these men (don’t watch it if you’re easily offended). She’s slurring just a tiny bit, which suggests that she may be on some kind of tranquilliser or antidepressant. This promo goes so far against the ethics of the patient–doctor relationship that it’s breathtaking. It also demonstrates that for Pinsky at least, the line between entertainment and therapy, between staged drama and reality, has not simply blurred but completely disappeared.

Dickinson has written about a hellish childhood in which she was beaten repeatedly by her father, a paedophile, for refusing sex with him. If we assume that her addiction is linked to that childhood abuse, it’s beyond the pale that a woman who has never been fathered is being encouraged by her male therapist to boast about her sexual conquests with men in graphic terms. It is likely that she would seek the love and approval from her therapist that she never got from her father, and would use her sexuality to try to obtain that love. If so, this would amount to a toxic relationship that involved simply re-enacting her incessant need for attention rather than actually examining it.

Dickinson, it must be said, credits the show with getting her sober. Good luck to her; perhaps in between all the exploitation by self and others, she somehow got what she needed. But to take the risk that a minority of patients, even a tiny minority, could be damaged or even killed by such a flawed treatment method seems negligent in the extreme. And it’s sad and disheartening to see these vulnerable people, sometimes with faces ravaged by abuse, parading in front of the camera.

Ethical TV therapy
The idea of filming people in therapy is not necessarily bad. I thought Pamela Stephenson’s ShrinkRap one of the best things on television, suggesting its potential as a medium for genuine inquiry and discovery. Sitting opposite each other in comfy chairs in a dimly lit room, Stephenson confronted a tortured celebrity or artist, and asked them therapeutic questions about their childhoods and the way their pasts affected their careers and personal lives. The show featured megastars like Robin Williams, Salman Rushdie and Joan Rivers (ironically, Stephenson like a few of her own guests, sports ironed hair and face).

There is a sense of dignity and choice. Stephenson manages to cover tabloid topics in a way that probes for the reasons behind public scandals and private torment. Questions mimick those of a therapy session but are cleverly geared to television, and the whole thing takes about fifty minutes, the time of an average therapy session. Stephenson's demeanour is respectful yet fairly detached, her approach finding a balance between letting her guest go off in their own direction, and bringing them back to difficult topics. Imagining yourself in that particular therapy chair is neither difficult nor unpleasant.

If you enjoyed this blog entry, you might also like The mysterious life of the psyche: on watching United States of Tara and A tale of two talk show hosts.

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Back from the Brink

For the last four months or so I’ve been going slowly downhill. Not surprisingly my blog has reflected a growing distance from self. Sometimes it is impossible to write about something when you are in the midst of it, because you actually lose sight of what is happening.

Insight is a strange beast. When it comes to my evaluation of my own illness compared with those of other sufferers, it seems everyone else is genuinely suffering but me. I’m not mentally ill at times like this, just a mass of self-loathing surrounding a collapsed ego. There is no me left to say ‘Don’t worry – you’re just having an attack of whatever it is’.

And when I emerge into the light, and find that self again, the eternal self that hid from me, I wish I could provide a magic thread from that knowledge to the collapsed me so that the collapsed me would always know that the real self would emerge sooner or later.

I still don’t know if this latest outbreak is caused by OCD alone or from low-level OCD with, say, GAD and depression thrown in. But who cares? It’s my unique version of room 101 and my psyche cannot seem to let me off the hook.

Now that the antidepressants are kicking in, I look back and realise that I have been playing around with them almost from the very beginning. Still in thrall to the idea that they would harm both my short-term functioning and the long-term ability off my synapses to fire up. All I know now is that without drugs my brain is not a nice place to be any more. It’s a murky, guilt-wracked quagmire of morbid fears and misplaced connections. I wouldn’t wish my worst enemy to live there, let alone me.

With drugs, in contrast, my brain is like one of those characters in a 1950s Alfred Hitchcock movie - you know how in those movies everybody, even the extras, is so controlled as to seem to be obeying some invisible, internalised authority? Clip-clopping along in their hats and trench coats to whatever official or unofficial desk or meeting they're due at next. Even the crims - especially the crims - seem obsessively organised in Hitchcock movies.

I have a lot of vague hope right now – hope in my brain’s ability to renew itself, partly through chemical means but also through natural means – physical exercise, emotional support and perhaps some kind of mental exercise.

I picture a profound healing medium. It is an electric liquid, inkily reflective yet not wet – when you immerse yourself in it, it parts like a curtain. It is thick and dark but also ice-clear, not murky. A substance not of this earth but constituting it. A mysterious medium that renews and reawakens the essential self. Perhaps picturing this in my brain is helping me to move towards whatever healing the world might be able to bring.

If you enjoyed this blog entry, you might also like New and Improved Version? Or Slightly Nutty Does Drugs and Tiny Steps up the Mountain: Exposure and Social Phobia Recovery.

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Facing Machiavelli: Nicole Kidman’s Botox-Flavoured Success

I’m currently at the tail end of a mild obsession with Nicole Kidman. It started when I watched a DVD of The Hours and realised that there were moments in that film when she transcended Nicole Kidman-ness and became a serious actress.

And even times when it was possible to admit that not only did she successfully portray a fictional neurotic, English writing genius resembling Virginia Woolf but that it was fair to say she successfully portrayed Virginia Woolf herself, despite the double insult of her wildly unsuitable physical appearance and ridiculous fake nose.

If someone in the public sphere attracts your attention it may be because they portray a characteristic you've not developed fully. When it comes to Nicole Kidman, I have no trouble working out what it is – her untroubled, lighter-than-air Machiavellianism. This basic human trait (well, primate trait actually) is something I’ve always struggled with.

It also interests me because the sister just below me, I’ll call her Frances, has always had a very healthy Machiavellianism – perhaps even a bit too developed. And I hated her for it. I thought she was outrageous and I fought her bid for status and attention every step of the way. I have no doubt that my hostility, from the time she was only about two, strengthened that Machiavellianism, hardened it in her and made her see life as a fight to survive in the world.

I wonder whether my own Machiavellianism is somehow stuck at this early stage. Even now competition for me always has a pathological aspect. There is a bitchy, childish side to my dealings with the world that sees success as a zero sum game – I’m still working on the template of: if I win, Frances loses; if Frances wins, I lose. What about cooperation in an environment in which it’s safe to reveal you own skills? Other people seem to be able to do this effortlessly, yet it’s a mystery to me.

It’s not that I was devoid of Machiavellianism in the wider world; at school my social phobia meant that I was ultra-conscious of social hierarchy. I was just incapable of using this knowledge to advance my cause, my life, myself; indeed I used this knowledge against myself: I was low on the social hierarchy at school, therefore counted myself as lower in value. There is such a thing as good, healthy Machiavellianism. This is what I find so intriguing about Kidman: is her Machiavellianism pathological or not?

My sister actually looks a bit like Nicole Kidman. I watch Kidman in scenes with the great actors of ‘our day’ – Jude Law, Shirley MacLaine, Miranda Richardson – and wonder: how does she dare? (How come my sister is so different from me? How come she is, partly due to my early influence, Machiavellian to a fault?)

When I started researching this topic, what I discovered surprised me. Machiavellianism is almost always portrayed as a negative thing, a pathology. Wikipedia reports that it’s now lumped in with narcissism and psychopathy as part of a Dark Triad, with researchers claiming that there is significant overlap between these traits; some psychologists believe it to be a subclinical version of psychopathy. Yet interestingly it's never been included in the Diagnostic and Statistical Manual of Mental Disorders. Does this suggest some ambivalence about it on the the part of researchers?

This illustrates what bugs me about the way psychiatrists look at personality. With a focus on pathology, they don't seem interested in character for its own sake. Yes, they talk about 'subclinical' and bicker over what that means. But surely a characteristic such as Machiavellianism is fine within a constellation and only a problem when it gets out of hand? And perhaps insufficient amounts of it could also be a clinical problem? A lack of Machiavellianism – taking everything at face value – could be the very definition of unworldliness. Perhaps mental health researchers need to start concentrating on the factors enabling societies to grow balanced human beings with the right proportion of each characteristic.

Defining Machiavellianism

But what is Machiavellianism anyway? Wikipedia defines it as 'a duplicitous interpersonal style associated with cynical beliefs and pragmatic morality'. I’ve always had a more benign view, assuming it was simply the human desire to advance your chosen interests, combined with the social skills needed to assess the environment you’re in and to use it to advance those interests. That usually means being part of a group, and using the group to get ahead. Even at a non-pathological level, Machiavellian motives have the potential be in conflict with the interests of the larger group.

That all sounds calculating and negative, makes Machiavellianism seem an unpleasant fact of life; perhaps it also demonstrates the gap between the way the world operates and the way we would like it to. Many workplaces are seething hotbeds of the overambitious; the more unequal society gets and the more tears in the welfare net, the rifer Machiavellianism will probably become.

But Machiavellianism is clearly necessary for the complex social groups primates form, and the advances we have made as humans. And we label people who don’t have this ability as having Aspergers, and all too often we let them know in no uncertain terms that they don’t belong.

Machiavellianism is not the same as personal ambition. Someone could have a great deal of ambition, a great desire for success, and be hopeless at using social groups and people to advance those ambitions, or just be average at it.

But nor is it necessarily always about self-interest. If it involves a knowledge of how power works, much depends on what you do with that knowledge, and whose interests you try to advance in using it. Bob Brown, former much-revered leader of the Australian Greens, was and is Machiavellian down to his last pore, but not in a venal way. He wasn’t interested in accumulating money or power. Instead, he cleverly used the structures of power – parliament in this case – to advance the interests of a larger group: his fellow Australians and indeed all the future citizens of planet Earth. Not only that, but he tried to use his position not to consolidate his own power, but to share power around more freely – to make Australia more democratic. So simply a knowledge of how groups work and using that knowledge to advance your cause doesn’t make Machiavellianism pathological.

Perhaps we have to distinguish between the Machiavellianism of a Bob Brown and that of the average, self-interested person who wants their share of power and wealth – let’s call this self-interested Machiavellianism. Even here, it isn’t easily divisible from a healthy interest in one's own welfare and that of one's family. At what stage does Machiavellianism, whether self-interested or not, descend into evil rubbing of palms together and a sinister cackle? At what stage does the calculating type become the stereotypical villain? 

Perhaps this depends on what exactly you’re willing to do with your knowledge of power structures to advance your cause. Are you willing to manipulate others? Pit people against each other? Sabotage their careers? Lie about them? This is clearly Machiavellian behaviour at the unhealthy level, regardless of whether your motives are selfish or selfless. Perhaps a healthy institution is one in which an individual's ability to succeed depends on their ambition, hard work and talent more than it does on their degree of Machiavellianism, whether healthy or unhealthy.

Bob Brown’s version means that his own personal ambitions are not easily separable from those of the larger human group; he positions himself and his struggle as part of the struggle of humanity for a better world. But self-interested Machiavellianism, however seemingly benign and non-pathological, always has the potential to be in conflict with the needs of the larger group.

Botox and self-interest

This leads me back to Nicole Kidman. She is obviously ambitious – nothing wrong with that. She has worked very hard and taken carefully calculated steps to build her career. She has done so to the extent that if you think of her mainly as mediocre, as I do (not in lighter roles – she is perfect for light comedy), her success has prevented much better actresses from playing the fascinating gamut of characters she has portrayed. Who knows what Hilary Swank, Chloe Sevigny, Tilda Swinton or even Cate Blanchett might have done with some of her juicier roles?

This is not something peculiar to her of course. Gwyneth Paltrow did the same thing for many years. Remember her in Sylvia?

Despite her very public breakup with Tom Cruise, Kidman has always struck me as someone who, when compared with a lot of other celebrities of similar prominence, had a high degree of psychological health. Her father is a psychologist, her mother a teacher; the family are close, and Kidman talks about her parents and sister with great warmth. She has never appeared to have a serious drug problem, made inappropriate remarks, or fallen into the traps of celebrity, except in one area – her use of Botox and other ‘fillers’.

And this is part of the question that exercises me – given her apparent psychological health, why has Kidman been willing to distort her face to the extent that she is now the butt of unpleasant YouTube videos? Her balanced personality sits at odds with this extreme.

My answer: Kidman's obsession with Botox isn't the result of some deep-seated childhood emotional deprivation. She's simply Machiavellian enough to know that in a toxic industry that rewards youth and cookie-cutter Barbie Doll beauty, her career will benefit from the regular application of Clostridiuim botulinum. And this canniness has paid off: at 44, she landed the role of Grace Kelly in the forthcoming film Grace of Monaco, directed by Olivier Dahan, a role every female actress in Hollywood was surely drooling over.

I say this not to denigrate her but to acknowledge that Machiavellianism is the ability to judge the particular environment in which one finds oneself and to work out how to succeed within it. That Kidman has judged her level of Botoxification necessary demonstrates that her healthy Machiavellianism is at the upper end of the scale; but also perhaps that the environment she is working in is toxic for women.

Now, bear with, as Miranda would say; this is where things get interesting. As I’ve said earlier, self-interested Machiavellianism is usually in tension with the broader interests of the group. While our toxic societies tend to reward unhealthy Machiavellianism, in our public discussions we applaud those who put the interests of the group ahead of their individual advancement. Not everyone has to make this choice of course, but sometimes a clear choice has to be made. And Kidman, while seeking her own career advancement, is a tiny bit responsible, along with the other legions of the facially adjusted, for making it difficult for women as a whole, and female actresses in particular, to succeed without taking a syringe to their faces.

So, while her Machiavellianism is not pathological in itself, the decisions she has made to appease it are the result of her immersion in a toxic environment. If we still insist on seeing Kidman as part of a community, part of a society, she has failed us. Not only by making an ironed face the norm, but by providing a poor example to the millions of young women who consume Hollywood gossip. Stars are role models, whether they choose to be or not; Kidman has put her career above this consideration.

This is not to say she makes decisions any different from a number of stars. Kate Moss posed topless in a blonde wig for the December 2012 issue of Vanity Fair, in photos accompanying a long  article exploring her career longevity; now that we're saturated in porn culture, it's simply what you do to stay ahead if you're a supermodel. In 1994, Kylie Minogue went raunchy in the video clip for her single 'Confide in me', and stripped naked for the follow-up single, 'Put yourself in my place' (below, looking uncannily Kidmanesque). Unfortunate choices, but plenty of men would have done the same if facing the same constraints; women are no more Machiavellian than men, we just make choices within more difficult circumstances.

Yet these are choices, albeit made in misogynist environments. I don't want to give the impression that you need to do bizarre and antisocial things to succeed in life. Some people are strong and talented enough to carve out their own niches simply by being very, very good at what they do. Australian comedian Magda Szubanski has had a self-admitted weight problem since the year dot, yet through sheer talent, and probably a healthy dose of Machiavellianism in other areas of her life, this aspect is part of the charm she brings to her most memorable characters.

So why was Kidman so damn good in parts of The Hours, I hear you ask? Ha! That's another story and another blog entry.

And, no, my sister Frances doesn’t use Botox – as far as I know.

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