Celebrity Rehab 3: Personal, ethical, professional boundaries may not be applicable

Posted on January 10, 2010 by Bose

I’ve been watching VH1′s Celebrity Rehab show optimistically, hoping that more structure was in place behind the scenes than was immediately evident to a bystander like me.

Supporting my optimism, in the season 3 premier, a patient asks Dr. Drew Pinsky for permission not to divulge a highly personal matter with cameras present.  Pinsky agrees, not to sending the cameras away, but to letting her write the secret on a piece of paper, not visible to cameras recording from a distance.  His voice-over explains that honoring the patient’s personal boundary was no problem (at the same time it reveals the salacious details, because the patient had done so previously to the media).

My optimistic assumption was that Dr. Pinsky was concerned about distinguishing between his roles as an executive producer of the show and physician to his fellow cast members.   In the context of his dual roles, it just made sense to me that he would put up some sort of firewall between himself and the production crew during the 21 days of filming, wearing the physician hat while treating his patients, and the producer hat while monitoring the editing process afterward.

An article in the NYTimes Magazine, alternately titled “Hitting Bottom” and “Is Dr. Drew Pinsky’s Show Therapy or Tabloid Voyeurism?” pokes holes in my optimism about the physician/producer boundaries:

  • Pinsky and Perez, the show’s supervising producer, are collaborating actively through the day.
  • Perez gets concerned about patients who are too sick to make good TV, and Pinsky intervenes in camera-friendly form.
  • Perez alerts the nearest camera person to be there.
  • Pinsky, Perez, and another producer (Irwin) confer “like three members of a rehab team.”
  • Pinsky reports on a patient’s progress and Perez responds approvingly.
  • Pinsky next reports on an unfilmed, one-on-one exchange with a patient.
  • In the group session that follows, Pinsky gently presses the patient to divulge, and Perez speaks into the camera person’s earpiece about when to zoom in.

The author of the article, Chris Norris, exposes all of the details above factually, judgment-free, and also exposes the empathetic/charismatic pull he feels:

Late one sunny afternoon, Pinsky picked me up in his black Lexus to drive to the “Larry King Live” studios in Hollywood.  [...]  He wore a navy blazer and silver tie that harmonized spectacularly with his hair.

[...]

As we drove, I was struck by Pinsky’s disarming conversation style, which involved frequent nods, appreciative laughs, affect mirroring and gentle knee pats — all of which had me sharing intimate details about my childhood before we reached the Hollywood border. Apparently, this comes with the territory…

To his credit, Norris is writing/reporting creatively for the NYT magazine, not reporting news for the NYTimes, and yet doing so with keen sensitivity about what is objective vs. subjective.

He gives us a picture of the conflagration between Dr. Pinsky and Executive Producer Pinsky on the set of Celebrity Rehab.  And, a sense of the professional Pinsky versus the personal magnetism of Pinsky who is available to ferry a magazine writer to his gig on Larry King and draw out the writer’s personal secrets along the way.

Is this a little convoluted?  A lot?

To be continued…

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Dr. Drew Fact Check: Addiction is the only disease…

Posted on January 9, 2010 by Bose

In one of the bonus clips related to the premier episode of Celebrity Rehab 3, Dr. Drew Pinsky says:

Addiction is the only disease that you have to convince patients that they have, and convince them to listen to what you want them to do as a doctor. It’s the most crazy-making conditions of all time.

Part of the disease is denial, so you expect people to be unwilling to accept the fact that they have an addiction. They get resistant to the idea that it’s a disease, and again, part of the disease is an unwillingness to participate in the treatment. It’s part of the disease.

In this case, even once you break through someone’s denial and they begin to look at and see that their thinking is distorted, their motivation is distorted, there’s something wrong with their brain function, then they usually jump to, “I see it, I can handle it, now I really don’t need your help at all.” And again, that’s how the disease works. It causes them to obfuscate, minimize, anything to get them out from under really having to do the work and stop using.

Coming from a guy who has studied and written about celebrity narcissism, this strikes me as unusually self-centered.  Pinsky’s chosen medical specialty stands alone in its complexity, if we believe him.

But, does that thought stand up to simple scrutiny?

  • Mental illness.  Do people living with depression, or a bipolar disorder, or schizophrenia, need to be convinced of their diagnosis?  Does it take a lot of time for them to accept the fact that they have been diagnosed?  Is that part of the disease?  Are they unwilling to participate in the treatment?  Once they accept the diagnosis, is it obfuscation or minimization to ask about, or insist on, receiving evidence-based treatment?
  • Diabetes.  Denial of the diagnosis, or its severity, is non-existent?
  • Obesity.
  • High blood pressure.
  • Anorexia.

With each of these, it’s an entirely normal, human thing to question diagnosis.  Being open about initial resistance to the necessity of treatment is preferable to hiding it.

Resistance and deep questions often recur over the course of chronic diseases.  Uncomfortable side effects of drug therapies emerge.  People with high blood pressure and limited health care often believe that buying other necessities instead of their meds will work well enough because they feel fine.

Addiction is the only disease you have to convince patients that they have?  False.

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Dr. Drew: Heidi Fleiss / Tom Sizemore Matchmaker

Posted on January 9, 2010 by Bose

Early in the first episode of Celebrity Rehab on VH1, Dr. Drew Pinsky’s voice-over intro includes:

An interesting aspect of this year’s treatment group is Tom Sizemore and Heidi Fleiss. They have a very tumultuous history together, and yet they’ve consented to come to the same treatment program at the same time. They’ve been clear that it’s not going to derail either of their treatments, and they can stay focused on their sobriety.

Later in the show, Fleiss mentions that she left the relationship with Sizemore severely battered.  He was later convicted of assault and battery against her and served time.

The Sizemore mention ends up being a tease — the previews hint that he will show up soon.

So, is it all good?  Fleiss and Sizemore are both reasonable, functional, grown-ups, setting their own boundaries?  Let’s look at what else Dr. Pinsky has to say about the typical condition of patients arriving for treatment:

It’s the end of day one, and many of the patients are starting to do very serious detox. This is just the beginning of a very long journey for them. [at the close of the episode]

Many of the patients go on a major binge just prior to checking in, meaning, most of them arrive high and distracted.  My staff and I need to be prepared for anything.  [from the bonus video clips]

Part of the disease is denial [...] even once you break through someone’s denial and they begin to look at and see that their thinking is distorted, their motivation is distorted, there’s something wrong with their brain function, then they usually jump to, “I see it, I can handle it, now I really don’t need your help at all.”  And again, that’s how the disease works.  It causes them to obfuscate, minimize, anything to get them out from under really having to do the work and stop using.  [from the bonus video clips]

Listening to the good doctor, isn’t there reasonable doubt that Fleiss and Sizemore are in good places to set appropriate boundaries for themselves?  Two people with a long history of violence, coming into the same space, likely on the tail end of a binge, with distorted thinking and motivation, as well as impaired brain function?

I’m the layperson on the outside here, getting by on tiny threads and shadows of the fuller truths which lie behind the TV curtain.  It strikes me as reasonable and rational for laypeople to ask questions of the experts, like:

  • Where’s the evidence? What are the conditions under which exes with a “very tumultuous history” have had good treatment outcomes together?
  • What are the standards of care?  What is being taught in medical schools by board certified addiction medicine specialists?
  • Do clinicians in addiction treatment facilities take responsibility for creating a healthy treatment environment?  Would it be typical to consider whether having previously-volatile exes might affect other clients negatively?
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Dr. Drew: Where's the evidence?

Posted on January 9, 2010 by Bose

Dr. Drew Pinsky has just kicked off the third season of Celebrity Rehab on VH1.  Seven celebs with rich histories of drug and alcohol use were followed on their arrival, intake, and first group meeting of their 21-day stay.  Two more are mentioned as cast members, apparently to arrive after everybody else.

I’ve got a fetish for watching reality TV like this; I’ve seen a most of the first two seasons as well as all of the companion show, Celebrity Sex Rehab.

Pinsky brings full body of experience with addiction care.  As his bio at the VH1 site mentions, he’s a physician, board certified in addiction medicine, and an Assistant Clinical Professor of Psychiatry at USC.

Watching him stand up as an addictions guru who also wants to shed light on the issue in pop culture venues, I’ve listened for him to frame his work in the context of evidence.  The wait has borne no fruit yet — if he has spoken of evidence, it’s been a brief mention, and I’ve missed it.

What’s the big deal about evidence?  Let’s check in with the NAATP — the National Association of Addiction Treatment Providers — and it’s mission statement:  (emphasis added)

The mission of the National Association of Addiction Treatment Providers (NAATP) is to promote, assist and enhance the delivery of ethical, effective, research-based treatment for alcoholism and other drug addictions. NAATP will seek to accomplish this mission by; (1) providing its members and the public with accurate, responsible information and other resources related to the treatment of these diseases; (2) advocating for increased access to and availability of quality treatment for those who suffer from alcoholism and other drug addictions; and (3) working in partnership with other organizations and individuals that share NAATP’s mission and goals.

NAATP’s beliefs include:

Addiction treatment providers, as with other providers of health care, must be accountable for the services they provide. Therefore, NAATP and its members will engage in outcome and cost effectiveness studies, and subscribe to high ethical standards so as to be accountable for the financial resources invested in addiction treatment.

Surely, the growing awareness of evidence-based treatment is no surprise to Assistant Clinical Professor Pinsky, right?

So, why not talk about it?  When we get a doctor’s care for diabetes or cancer, we expect to learn:

  • how our disease has traditionally been understood and treated
  • latest research-supported treatments
  • ambiguities and areas in which the evidence isn’t yet perfectly clear

I heard Pinsky acknowledge more recent developments in addiction care only once.  In one of the bonus clips posted to the show’s site, while speaking with Mackenzie Phillips, he mentions that the prescription drug Chantix has proven effective for smokers who wish to quit.

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Addiction Treatment Pop Culture: Why it matters

Posted on January 8, 2010 by Bose

I’m going to track and write about some of the pop culture surrounding addiction treatment.

At first, it might sound silly to study reality TV and the like.  It’s reality TV!  It’s only as real as life can be while being swarmed by camera and sound crews, after agreeing to be followed into the bathroom and through every difficult moment.

I have questions, though.  Like:

  • Do participants in reality TV sign away their rights to treatment in which their needs come first?  Or, do reality TV physicians add an asterisk to their oath to do no harm, “unless it’s minor harm, and makes for good TV.”
  • Do the producers of reality TV have an obligation to provide relevant context?  For example, the conditions under which participants are offered treatment, the costs, and/or the payments?  Or, the evidence which supports their treatment approach?
  • Do the folks watching reality TV which follows the delivery of health care services have a right to information about the availability or cost of similar services?

My concern is that reality TV producers (including the on-camera professionals) have a veneer of wanting to inform their audiences, giving them essential data and insight into how help with addiction might benefit them, without a substantive commitment underneath.

It makes sense, in my mind, to ask questions about these kinds of things.

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Aerosmith's Steven Tyler: Not a 12-step guy?

Posted on December 27, 2009 by Bose

People Magazine reports he’s back in treatment.

“With the help of my family and team of medical professionals, I am taking responsibility for the management of my pain and am eager to be back on the stage and in the recording studio with my bandmates Joe Perry, Joey Kramer, Tom Hamilton and Brad Whitford,” Tyler says in a statement released to PEOPLE.

While it’s impossible to be certain, note the big picture:

  • Tyler’s experience with treatment goes back 20+ years, so the language of addiction and treatment is not new.
  • He’s “taking responsibility,” not hitting bottom or expressing powerlessness.
  • Pain management is a priority, without demonizing prescription drugs or ruling future pharmacotherapy in or out.
  • Care is being sought from a “team of medical professionals,” suggesting that evidence-based care is expected.

That’s not to say that some 12-step-based principles may not be meaningful or helpful to him.  But, he speaks as if the language of self-empowerment and self-reliance embedded in Smart Recovery might be more comfortable.

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