Despite being very famous, Heath Ledger had somehow passed me by until a few weeks ago when I watched ‘Monster’s Ball’ and ‘Brokeback Mountain’ within a few weeks of each other.  It seems likely that his death was caused by an overdose of sleeping pills, either mistakenly or intentionally.  As a psychiatrist I was struck by something Ledger said in his last interview with Sarah Lyall, published in the Observer.

‘Last week, I probably slept an average of two hours a night,’ he said. ‘I couldn’t stop thinking. My body was exhausted and my mind was still going.’ One night, he took an Ambien sleeping pill, which didn’t work. He took a second one and fell into a stupor, only to wake up an hour later, his mind still racing

Obviously there’s not much to go on here, but I wonder if Ledger is suffering from hypomania, although I note that there is no mention of elevated mood in the article.  It is also worthy of note that Ledger had been flying between Manhattan and the UK, as he had been filming ‘The Imaginarium of Doctor Parnassus’ in London.  According to NICE guidelines, if a person has a predisposition towards bipolar disorder, relapses can be triggered by ‘night flying and flying across time zones, and routinely working excessively long hours, particularly for patients with a history of relapse related to poor sleep hygiene or irregular lifestyle’

There’s also been press speculation about Hedger’s history of drug use.  In 2006 he was the victim of a paparazzi sting operation during which time he was filmed admitting to smoking ‘five joints a day for twenty years’; in the background of the film were unidentified persons snorting what is presumably cocaine.  At the time the tape was not shown due to legal threats, but now Ledger is dead no such restriction aside, of course, from decency. 

Having sold 83 million records does not seem to be protective factor for Britney Spears’ mental health. In recent times she’s shaved her head, treated worldwide viewers to a peformance which was described as likely "go down in the history books as being one of the worst to grace the MTV Awards” and lost custody of her children. The celebrity site TMZ.com files many of her stories under ‘Train wrecks: Britney Spears’ and has described her behaviour as being ‘nothing less than a meltdown’ In the world of celebrity she is not alone her problems. On July 24 2007 actress Lindsay Lohan was arrested and charged with possession of cocaine and driving under the influence and driving with a suspended license. Her life relentlessly chronicled by tabloids and gossip magazines, it was well known that she had been going about her business the previous week wearing a device to monitor alcohol levels in her body.

How do rich, pampered, beautiful – and occasionally talented – people can end up in such difficulties? Here are just some of the ways in which celebrity lifestyles can destroy your personality:

Celebrities are a self selecting group

The tribulations and humiliations required to launch oneself as a celebrity may exclude many of the mentally stable.

Celebrities tend to be young

Spears is 25, Lohan is 21

Celebrities are often young, immature and impressionable

Exhaustion

Easy availability of drugs

Pressure to attend succession of parties and events

Itinerant lifestyle

Community and relationships

When entering the world of celebrity people swap their previously supportive community for one where one’s standing is based on the shifting sands of media profile and ‘bankability’.

Previously confiding relationships become strained and are often replaced with those that are superficial and sycophantic

Sycophantic friends will encourage narcissistic behaviour whereas constructive opposition from secure friendships and family leads to constant reevaluation and greater stability.

Constant media intrusion and intense scrutiny into private lives

 High media and public visibility brings with it relentless assaults on the ego.

 Celebrities careers very vulnerable to the evaluations of other people.

Simply being in the public eye gives them a public forum to act out attention-seeking behaviour when things aren’t going well, and this could exacerbate the other issues

In cases like Spears they have never known life out of the public eye. Media attention is closely aligned with their sense of self.

The conflict of personal and commercial career goals.

In his Kurt Cobain’s suicide note, he wrote that he was not being honest with his fans and feared that he had lost all authenticity

If you are interested there is a book published on the subject Illusions of Immortality: A Psychology of Fame and Celebrity by David Giles

Added 17 February 2008:

There’s an entertaining arcticle in the 17 February Observer Music Monthly about why rock stars ultimately disappoint us.  

‘Wankerdom of one sort or another is almost unavoidable, if you have that many people thinking you’re great’ nicely sums up the inevitable personality development.