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Psychologists Should Not Diagnose Celebrities

Why clinical evaluation cannot be skipped, even for celebrities.

Scandals involving celebrities such as Justin Bieber can spark public desire to not only condemn but also understand the behavior of public figures. Bieber's recent arrest for DUI has been the target both of public outrage and speculation as to the psychological causes of his behavior.

Psychologists and other mental health professionals are in a unique position to inform this discussion. Trained to diagnose, understand and treat mental health conditions, we have the potential to perform a valuable service of diagnosing and explaining perceived dysfunctional behavior of celebrities to the public. Yet diagnosing celebrities we have not met runs the risk of undermining the perceived integrity of our field, damaging the celebrity assessed, and jeopardizing our role in society.

There is no precedent in the mental health field for diagnosing an individual without receiving direct information from that individual. Standard practice involves using a range of sources of information, but almost always involves direct information from the patient, preferably in the form of clinical interview. Making a reliable and valid diagnosis (e.g., mood disorder, addiction) is difficult enough with the full range of assessment tools available, but doing so without any contact with a person is extremely difficult and risks misinterpretation of the facts of a case. Even more problematic is attempting to explain celebrity behavior with hypothesized unconscious psychological mechanisms, as evidenced in the recent media coverage of Anthony Weiner and Alex Rodriguez; both accused on deficiencies of the "ego" and "self." These constructs are theorized to be entirely or partially non-conscious, and thus cannot be definitively proven or falsified. Further, they are assessed through self-report or projective testing. The combination of presenting a potentially unreliable and invalid diagnosis with an explanation that by definition can't be proven or adequately assessed opens our field up to questions regarding the integrity of our diagnostic process, a foundation of our profession.

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Further, speculative assessments run the risk of damaging not only the targeted celebrity, but also those who struggle with similar issues. Receiving a mental health diagnosis can be stigmatizing even in the context of a private, controlled clinical setting. Yet being diagnosed publicly by a mental health professional runs the risk of a stigmatizing experience. In this case, it is arguable that a biased observer (i.e., mental health professional with limited knowledge of a celebrity) is able to enact discriminatory behavior (i.e., publicly criticizing celebrity) with the risk of negative effects for the celebrity. This also potentially damages others who privately struggle with similar issues who may fear similar treatment if exposed. As one of the core missions of our profession is to help de-stigmatize mental illness and dysfunctional behavior diagnosing celebrities may undermine this goal.

Finally, the combination of an unreliable diagnosis and criticism of celebrities runs the risk of damaging the crucial role psychologists and other mental health professionals play in society. In theory, our job is to provide a safe, confidential space for people to treat their most difficult issues. Two of the most important aspects of this process is trust that psychologists will accurately evaluate and will not unfairly judge our patients. Public celebrity diagnoses thus hurts the field's mission of providing a "safe place" for people to work out their issues and undermine our societal value.

It is unlikely that the goal of any mental health professional in presenting celebrity diagnosis is to harm the profession or others. There are specific guidelines that we can set to help in avoiding this trap:

1) Do not talk directly about the diagnosis or psychological processes of anyone. We are bound by confidentiality not to discuss people we have assessed, and bound by our ethics to not discuss people we have not assessed. 

2) Focus on educating the public on the diagnosis and possible causes and treatments of disorders without linking them to a specific person.

3) Finally, model how we want the public to treat individuals with mental health issues by speaking out when lay persons or journalists use psychological terms frivolously and inaccurately.

Treating celebrities with the same courtesy and respect as we would provide our patients allows us to set an example of how to understand and treat people with mental health and behavioral issues and further the goals of our profession.  

Michael Friedman, Ph.D. is a clinical psychologist specializing in how social relationships influence mental and physical health.
    
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