Celebrity Triggers Tumult Over Psychiatric Care: Did the News Media Make Things Worse?

Psychiatric Times

September 2005

Vol. XXII

Issue 10

Take years of research, clinical observations, technological advancements and scientific discovery, and then subject them to derision and skepticism during a celebrity rant that's part of a promotional tour for an upcoming movie, and suddenly it's a media event. Sounds odd, but it describes what happened after Tom Cruise decided to take on psychiatry while hawking his new movie, War of the Worlds, and the news media decided to turn the story into the latest shouting match for talking heads. While the episode aired some important issues about mental health care's benefits and limitations, it also confirmed that stigma is alive and well.

In a way, the prime-time conflict epitomized the marketplace of ideas that a democracy with a First Amendment should generate. Hollywood beauty Brooke Shields has a baby, suffers postpartum depression, seeks treatment (including taking a selective serotonin reuptake inhibitor) and ultimately transforms into the loving mother she's always imagined. She also becomes an author, whose sentimental memoir Down Came the Rain (Hyperion) described her experience.

Then, Hollywood heartthrob Tom Cruise, a long-time Scientologist who--true to his religious principles--abhors psychiatry, takes to the TV airwaves to pout over psychiatric treatment, insisting that it should be criminalized and that Shields endangered her health and undermined her acting career by seeking treatment following the birth of her child. "She doesn't know what these drugs are and for her to promote it is irresponsible," he told Access Hollywood.

If the dispute had stayed grist for the entertainment gossip mill, the uproar likely would have faded as quickly as yesterday's blockbuster. But when the mainstream news media stepped into the fray, the controversy escalated beyond a mere actors' tiff. Ultimately, even the venerable New York Times chimed in, publishing an editorial by Shields in which she defended herself against Cruise's onslaught.

During an interview on NBC's Today Show on June 24, Cruise laid into interviewer Matt Lauer, accusing him of not understanding psychiatry or its history. Seemingly cowed, Lauer ultimately yielded. "It's very impressive to listen to you," Lauer complimented Cruise, "because clearly you've done the homework and you know the subject."

Whether actors, particularly those with a religious agenda, can authoritatively comment on a field as broad as psychiatry and mental health is an important question, particularly when--in Cruise's case--it triggered appearances on prime-time television of "experts" who contended that vitamins and exercise are a better option than psychiatric care.

"If you sort of force things into this medium of 'we need two talking heads and they have to disagree with each other,' you can be mistaken, even if you're a fairly knowledgeable viewer, [into] thinking there's a good number of doctors and psychiatrists who think one thing and a good number who think the other thing," Ivan Oransky, M.D., deputy editor of The Scientist and a board member of the Association of Health Care Journalists, told Psychiatric Times. "In fact, what this case demonstrates is that the format does not reflect current thinking at all. And it tends to highlight people who are a bit out of the mainstream."

In an effort to achieve balanced reporting, journalists will often treat medical reporting like political reporting, where the sides are clearly demarcated, Oransky said. "Medical reporting needs to be based, obviously, on solid critical thinking and great reporting. You will see the fringes of science and medicine because, for whatever reason, journalists are not able to distinguish between an either mainstream or prevailing opinion and not."

That may account for appearances by Julian Whitaker, M.D., a California physician trained in orthopedics, who promotes and markets a regimen of diet, exercise and nutrients for a variety of serious health issues. Whitaker acknowledges on his Web site that he's a practitioner of "alternative medicine," who's taken "the road less traveled." On both CNN and Fox News prime-time evening programs, Whitaker, representing the Scientology-sponsored Citizen's Commission on Human Rights, denied that mental illness had any basis other than the whim of psychiatrists.

"I didn't realize until just a couple years ago that all psychiatrist diagnoses are clusters of human behaviors that are voted on and then classified as a disease," Whitaker told CNN's Anderson Cooper. Later, on Fox News' O'Reilly Factor, Whitaker praised Cruise for raising issues regarding "what I consider to be psychiatric abuse of children of a nonscientific, pseudo-science standing." Whitaker went on to say, "Well, if you look at psychiatry, it's not science. It's not even a pseudoscience. Most people don't know, and I only found this out a few years ago, that, in order to be labeled with a psychiatric diagnosis, [psychiatrists] vote on a cluster of human behaviors, and then label that as a disease."

Those kinds of statements surprised Carol T. Fletcher, assistant professor at Hofstra University's department of journalism, media studies and public relations, and a 20-year veteran health and science reporter. "I was expecting there to be very little information, but what I wasn't expecting is that there would be so much wrong information," she told PT. "I guess what is disappointing to me is that the interviewers don't seem to push points so that people can just pontificate and say ridiculous things and no one challenges them."

Fletcher not only cited Lauer's and other reporters failures to challenge erroneous information, but also pointed to claims by Sanjay Gupta, M.D., a neurosurgeon and senior medical correspondent for the health and medical unit at CNN, who attempted to controvert Whitaker's statements by showing brain images and saying that they revealed depression or attention-deficit/hyperactivity disorder. Fletcher said, "When a doctor throws scans up and says, 'See we can tell a depressed brain from a regular brain,' oh really, I've never heard of someone being scanned to see if they're depressed or not. Where are they doing that? No one pushes it further."

Although Lauer, through a representative, declined an interview request, Gupta defended his on-air segment to PT, saying that he was attempting to counter the claims that there was no science or objective evidence behind mental illness, and he was not implying that brain imaging was a readily available treatment or diagnostic tool. "What was being called into question was that there is no objective criteria at all by which any of these illnesses can be measured or diagnosed and therefore it must be a sort of pseudoscience," Gupta said. "In no way did I assert this is a widely available thing or that anybody could get this now."

The problem for Fletcher, however, is that news media have stopped making the effort to inform the public, substituting instead what she refers to as "pro/con" approach. Particularly when it comes to broadcast media, people don't tune in for information, she said, they tune in to watch people fight and to "get mad."

"Why was this such a big story? That's what interests me in a way," Fletcher said. "It plugged into things people wanted to get mad about. Interviewers are geared toward playing to that emotion in the audience. Commentators know that's what people want to hear. [Television] is giving the audience, in a way, what it wants, and what it wants is not necessarily information."

The harm in all of this, according to Fletcher, is that the stigma attached to mental illness is perpetuated, not only because it is not explained properly but also because the "experts" asked to interpret are often less authoritative, something usually not found when physical illnesses are the subject of news reports. "When media talk about mental health, any point of view is a legitimate point of view," she said. "They don't feel that way when they talk about oncology or heart disease."

Not everyone is ready to condemn the media over their handling of the Cruise/Shields dustup, particularly not Steven S. Sharfstein, M.D., American Psychiatric Association president, and president and CEO of Sheppard Pratt Health System in Baltimore. Invited to appear on NBC's Today Show three days after Cruise, he had the chance to tell the audience that Cruise's statements about psychiatry were "irresponsible."

"It was an opportunity for psychiatry to get the message out about psychiatric treatments, about the fact that mental illnesses are real and there is real suffering, that treatment works, that psychiatrists are physicians, and that what we do is based on science," Sharfstein told PT. "In that sense, Mr. Cruise provided a service."

But Sharfstein downplayed the circus atmosphere that sometimes surrounds news media coverage, accepting that it often requires head-on debates and promotes those whom he views as fringe elements. Sharfstein said that Scientology continues to recruit celebrity messengers, and whether in the news media or in legislative hearings, psychiatry has held its own by countering what he considers the more specious claims with science and evidence of treatment efficacy.

True to form, however, Sharfstein did not get center stage on the Today Show without having to confront an antagonist. Joseph Glenmullen, M.D., a psychiatrist at Harvard University Health Services and the author of two books, Prozac Backlash: Overcoming the Dangers of Prozac, Zoloft, Paxil, and Other Antidepressants With Safe, Effective Alternatives (Simon & Schuster) and The Antidepressant Solution: The Only Step-by-Step Guide to Safely Overcoming Antidepressant Withdrawal, Dependence, and "Addiction" (Free Press), defended Cruise to an extent, telling PT that some of his comments rang true, at least in a technical sense.

No one ever had a problem with celebrities who endorsed psychiatric care, Glenmullen said. Endorsements from Mike Wallace, Patty Duke and Dick Cavett, to name a few, never resulted in anyone challenging their claims, despite the potentially dangerous side effects caused by psychiatric drugs during treatment and after individuals attempt to stop their use. "It just happens that people can make outrageous claims endorsing the drugs and virtually no one questions it," Glenmullen told PT, "but it's the tenor of our times that the minute anyone raises doubts about the drugs, all of these objections get raised."

Although Glenmullen uses psychiatric medications in his practice, he has urged physicians to prescribe conservatively and to warn patients about the potential withdrawal side effects in advance. Those opinions have often put him at odds with drug manufacturers and the psychiatric mainstream. While disagreeing with Cruise's anti-psychiatry stance, Glenmullen said that he's correct in challenging the extent of data supporting claims of chemical imbalances and the rate of overprescription of drugs. By doing so, "some fundamental issues got coverage," Glenmullen said.

Most likely this will not be the last time mental illness and the quality of psychiatric care ends up in the crosshairs of news media coverage. For both the medical profession and the media, the challenge remains to better inform the public about the benefits and limits of treatment. As one observer close to the debate wryly noted, "To change the way the public thinks about something either takes a million dollars or a stack of bodies."