A few years ago, the eminent professor of psychiatry, Dr Ronald Pies, wrote a commentary for Psychiatric Times titled, “Are We Misreading the Signs in Psychiatry?”1 In that article, Dr Pies discussed the need for the comprehensive evaluation of patients in order to arrive at the correct diagnosis. We want to take from his premise that this concept should be expanded to include that among patients presenting with substance abuse as a primary diagnosis, other co-existing Axis I diagnoses should be considered.
The recent passing of the famous British singer Amy Winehouse highlights once again the question: Is substance abuse a form of self-medication in some of the most well-known cases of public self-destruction? A People Magazine article2 reads:“Amy Winehouse Died from Alcohol Withdrawal, Says Family.” Several London newspapers previously speculated about a heroin overdose. Whatever the cause of death, the demise of Amy Winehouse again sparks the debate about public figures who die from “yet another addiction,” leaving open the possibility that other co-existing Axis I diagnoses are being ignored and untreated.
As psychiatrists, we are well aware of the co-morbidity of substance abuse with major mental illness. Long before Mickey Mantle declared that he always needed several shots of liquor to face the press (social anxiety?), we have been aware that Vincent Van Gogh, Charles Dickens, Lord Byron, Salvador Dali, Sylvia Plath, and many other famous artists have struggled with mental illness and co-existing substance abuse disorders.
We have also seen the other side of the coin, for example, when clear cut alcohol or opiate abusers present with racing thoughts and irritable mood upon interrupting the abuse of their substance of choice and a diagnosis of bipolar disorder is made, only to discover later that such presentation was part of the withdrawal syndrome.
We venture to speculate that we, as psychiatrists, are not the ones misreading the signs, but that it is the media who miss the signs and misinform the public. It is our responsibility as psychiatrists to educate the media and the public in general about the danger of oversimplification and of the possibility that behind egregious and self-destructive substance abuse, there is often a co-existing psychiatric diagnosis.
1. Pies R. Are we misreading the signs in psychiatry? Psychiatr Times. 2006;23(2):15-16.
2. Nudd T. Amy Winehouse died from alcohol withdrawal, says family. People Magazine. Available at: http://www.people.com/people/article/0,,20513558,00.html. Accessed August 15, 2011.