Noteworthy News Articles on Mental Health Topics, January 1-9, 2010



Men With a Message: Help Wanted
Alessandra Stanley, New York Times, 1/3/2010

The decade opened with an alpha male in a psychiatrist’s office and closed with an alpha male committing himself to a psychiatric institution. From “The Sopranos” to “House,” men marked the last 10 years of television less as hellions or healers than as analysands — fragile bullies who recognized they were damaged and sought help. The 21st century was ushered in by a He Decade: 10 years of men gazing at their navels.

Naturally, it’s the women’s fault. All those sitcoms and dramas of the ’80s and ’90s that reflected women’s liberation, self-actualization and consciousness raising paid off by wearing down the opposite sex; even made men buckled under the pressure. Accordingly, many of the most notable series of the last 10 years showcased men who examined their feelings or at least acknowledged their limitations.

Put it this way: “Sex and the City,” which began on HBO in 1998 and shut down in 2004, celebrated a certain kind of girl power of the ’90s. This decade is bowing out with “Men of a Certain Age,” a TNT drama about three male friends exploring their powerlessness at midlife.

Even reality television, perhaps the single most radical programming innovation of the last decade, reflects an altered male sensibility. Seemingly macho competitions like “Survivor,” a CBS show that began in 2000, are at heart jungle therapy. To the sound of Robert Bly tribal drums, contestants — male and female — are thrown into encounter groups and prodded to cooperate and clash, then taken aside to describe their fears and discontents in private sessions with the camera.

“The Office” on NBC and its many mockumentary successors are a comic inversion of the reality show stream-of-consciousness conceit. Self-deluded characters misinterpret their own behavior to an invisible filmmaker-therapist.

The first episode of “The Sopranos” actually began on HBO in 1999, but that’s a niggling caveat. It took a year or two for the series to catch on, and even the most distinctive eras sometimes spill over their calendar slots. (The Victorian age spilled into and beyond 1901.)

“The Sopranos” is a series that defined and helped determine the first decade of the 21st century, partly because it put a postmodern spin on the Cosa Nostra fable: the Mafia boss Tony Soprano was a suburban dad with a nagging wife and surly children who suffered acute spells of anxiety that drove him into therapy. The show was notable for its brutal violence and also for long, intense dream sequences that called out for Freudian interpretation.

“The Sopranos” paved the way for other dramas that burrowed into characters’ psyches, dreams and dysfunctions, most notably HBO’s “Six Feet Under,” about a family of undertakers who unravel after the death of the patriarch. The trend reached its apogee on HBO in 2008 with “In Treatment,” which takes place almost entirely in one-on-one psychotherapy sessions and which posits the therapist as a man as troubled and self-doubting as his patients. On television no pathology has been left unexplored: the hero of Showtime’s “Dexter” is a serial killer; its “Californication” is centered on a sex addict.

There are notable exceptions, of course, none better than “The Wire,” a Dickensian saga about crime and corruption in Baltimore that ran for five seasons on HBO. With multiple layers and scores of characters, the show required attentive viewing and to this day defies easy categorization. It was the best show of the decade if only because it was so different from any other.

So many dramas, good and bad, focused narrowly on the male mind. Every cop and fireman came with a set of complexes; witness “The Shield” and “Rescue Me” on FX. Fictional detectives have been eccentric and unorthodox since the days of Sherlock Holmes and Arsène Lupin, so it’s not unusual for television cops to be freakier than the robbers (and rapists).

But TV’s romance with the masculine psyche can be found even in the most prosaic network crime shows, including the evolution of “Law & Order” spinoffs. The original, which started on NBC in 1990, was conceived by its creator, Dick Wolf, as an antidote to crime shows like “NYPD Blue,” which fastened onto the psychic distress of antiheroes like Andy Sipowicz. For a while, at least, “Law & Order” kept crime and punishment in the foreground and gave viewers only sketchy details about the private lives of its detectives and prosecutors.

But even Mr. Wolf’s template gave in to the times. In 1999, on the cusp of a new century, came “Law & Order: SVU,” a procedural about sex crimes, but it soon turned out that some of the most lurid moments were found in the romantic and psychological entanglements of its central characters. By 2001 the lead detective on another spinoff, “Law & Order: Criminal Intent,” was a former altar boy burdened with a schizophrenic mother and a disturbing ability to bond with criminals and the criminally insane. In an episode titled “Untethered,” the detective (Vincent D’Onofrio) implodes and is suspended for psychiatric evaluation.

Female detectives are messed up as well, but in a welcome reversal of gender roles they are far more repressed about their feelings and failings. Nowadays they tend to follow the classic Raymond Chandler model, notably those played by Kyra Sedgwick, Holly Hunter and Mary McCormack on their shows on TNT. All three crime fighters are tough, dedicated loners who shirk help and hide their vulnerabilities under flip banter or bossiness. They are closer in spirit to Philip Marlowe than Miss Marple or Jessica Fletcher.

On the other hand, one of the most beloved private eyes of the decade was Tony Shalhoub in USA’s “Monk,” as a San Francisco detective with near crippling obsessive-compulsive disorder forced to leave the San Francisco Police Department. Private eyes have throughout history nursed their wounds with alcohol; the Chandleresque hero of “Bored to Death” on HBO smokes too much pot and has low self-esteem.

It may not be a coincidence that mental illness became a new frontier in television entertainment at the same time reality television took hold. But the trend reflects the popularization of serotonin and books like “Prozac Nation.” In 2005 NBC actually tried out a sitcom, “Committed,” a romantic comedy about an obsessive-compulsive math genius and his nutty girlfriend.

Women are not spared the psychotherapy, of course (but they’ve been on the couch for a while). Most notably, Toni Collette plays a wife and mother with multiple personalities on “The United States of Tara” on Showtime. Nowadays the patient is likely male, and sometimes even a doctor, as in “House,” who last season checked himself into a mental hospital to grapple with his drug addiction and other demons.

In May, Fox tried to clone the success of “House” by adapting the trope to a psychiatrist, but “Mental” fell flat, perhaps because its hero was a little too well meaning and healthy for contemporary audiences.

Fox’s “24,” a cartoon thriller with complex special effects, also fell under the spell of the neurasthenic age. Unlike Bruce Willis in “Die Hard” or Steven Seagal in anything, Jack Bauer (Kiefer Sutherland) was an avenger with a delicate soul: no matter how hard he struggled to be a heartless, feel-no-pain alpha operative, Jack couldn’t suppress remorse and self-doubt. Terrorism’s toll on his mental health was almost as central to the series as the threats to national security.

Naturally, all this psychobabble met with resistance. Premium cable rebelled with period dramas that placed its characters in past eras untouched by Dr. Phil and the domestication of the American male. “Deadwood” on HBO was set in a lawless gold-rush town in the 1870s and offered viewers a primitive, brutal community with no room for angst or midlife crisis. “Mad Men” on AMC is set in the early 1960s, and its hero, Don Draper, shuns his past and refuses to deal with his inner demons; instead he sends his unfulfilled wife to a psychiatrist who reports back to Don about her progress.

There were other pockets of denial, notably the “CSI” procedurals on CBS that made a fetish of science and kept characters and their shadow selves in the background. The top CBS dramas provide a safe haven from all these masculine effusions of feeling and self-scrutiny: the characters on “NCIS” and the spinoff “NCIS: Los Angeles” stay light no matter how dark the crimes; almost all the heroes have murky, traumatic tragedy in their past and choose not to dwell on it. It could be that the pendulum on television is already swinging the other way; 2010 could be the beginning of the end of the years of living introspectively.

Three mounted widescreens were broken into a dozen digital monitors, each showing a face from television past: Dennis Rodman, Heidi Fleiss, Mackenzie Phillips, Tom Sizemore and other less-celebrated substance abusers filled surveillance shots from around the building, the composite grid of video screens suggesting “Hollywood Squares” as directed by David Cronenberg. In one square, Sizemore, an actor known for playing hardboiled military men in such movies as “Black Hawk Down” and “Saving Private Ryan,” lay half conscious in his bed, detoxing from heroin, crystal meth, benzodiazepines and marijuana. He’d been in that state for two days, said Mark Perez, the show’s supervising producer, which didn’t seem to augur for great TV. But moments later, when I checked back in with Sizemore, the entire screen had lighted up: Dr. Drew Pinsky had entered the frame.

Dr. Drew edged up to the pajama-clad Sizemore, bent over his bed to draw some blood and then left — only to appear the next screen over. Robocams and roving camera operators tracked the show’s star from room to room, as he ministered to nine fallen souls. Perez alerted a cameraman of Pinsky’s approach — “Mustang, coming to you, in three, two . . . one . . . ” — as he passed across another screen, then another, to enter through the door right beside me.

“What’s happening?” Pinsky said, greeting me with a sly half-smile, looking and talking just like TV’s Dr. Drew. He carried a clipboard and wore a tie, a cobalt dress shirt and pleated gray trousers, his gym-buff torso suggesting a medical-board-certified Clark Kent. Unlike the hospital scrubs Dr. Mehmet Oz wore to Oprah’s soundstage, the stethoscope around Pinsky’s neck was not a prop; it had just been used to check Tom Sizemore’s lung capacity. Pinsky’s close-cropped silver hair and crow’s feet lent him a gravitas that befitted his 20-plus years’ experience treating addiction, while his tanned skin and stylish rectangular glasses attested to his camera readiness: Dr. Drew, face of addiction medicine, surgeon general of youth culture and now — either through unsurpassed gamesmanship or cultural harmonic convergence — something even greater. Perhaps even, as the media scholar Mark Andrejevic would have it, “TV giving itself a moral center.”

With a glance to the screens, the moral center turned to confer with Perez and John Irwin, one of the show’s executive producers. “Did you see that?” Pinsky asked Irwin. “Sizemore? He’s sick.” As they moved on to other patients, Pinsky, Irwin and Perez conferred, like three members of a rehab team. “How was Kari Ann?” asked Irwin, referring to the meth-addicted former Miss United States Teen Kari Ann Peniche. “Kari Ann was good,” Pinsky said. “I did Dennis — he committed to not drinking, but he’s ambivalent about 12 Step.” “That’s good,” Perez said. “That’s a start.”

Pinsky then reported on his unfilmed, one-on-one session with Lisa D’Amato, an “America’s Next Top Model” contestant and alcoholic, who had relayed a harrowing memory that he planned to bring up in a group therapy session. Not a half-hour later, as Perez and I watched on three screens covering the therapy room, Pinsky prompted D’Amato to share this story with six patients, two camera operators and, potentially, 1.2 million viewers.

“I don’t want to cry again,” D’Amato protested. “Just tell them the story,” Pinsky gently urged. Then, as Perez gave directions from the control room, D’Amato puffed out a deep breath and began. “Um . . . I went on a European trip?” she said and then stopped, eyes pooling. Pinsky watched patiently, a clipboard on his lap. As D’Amato began to haltingly recount her traumatic memory, Perez positioned his crew to zero in.

“Um . . . my mom was upset with me,” D’Amato said, “I was pushing her buttons and she was pushing mine.” Perez called out to Sarah, a camera operator, to move in. D’Amato’s voice became tiny, then started trembling and, as she finished her brief tale of a life-scarring confrontation, she broke into sobs. A screen held a close-up of her doe-eyed, tear-streaked face. “Thank you so much, Sarah,” Perez said in a reverent sotto voce. “Thank you.” Minutes later, Pinsky popped in the control room. “Nice job there, Doc,” Perez said. “That all right?” Pinsky said, turning bright-eyed to Perez. “You like that group? Interesting, right?”

Dr. Drew is a TV doctor seemingly engineered for this moment. Unlike talk-show therapists whose go-to prescription is “get real,” he commands an unusual blend of medical credentials and pop-culture savvy — he is fluent in textese, neuroscience, nitrous hits and psychodynamics, which he combines with a cool, eloquent charisma honed over 25 years in the media. In 1983, when Pinsky was a student at the University of Southern California medical school, KROQ radio introduced “Loveline,” a new late-night call-in segment that was just catching on with listeners, who tuned in to the program’s D.J.’s as they fielded requests for sex and relationship advice. Pinsky hadn’t been following “Loveline,” but a friend at KROQ approached him and asked him to appear in a new segment being developed called “Ask a Surgeon.” Though not yet licensed to practice medicine, Pinsky — who by day was watching the AIDS epidemic unfold at his hospital and who believed that the reigning sex expert, Dr. Ruth, with her focus on ridding Americans of their repressions, was at odds with the younger, quite-unrepressed generation — eventually, though somewhat reluctantly, agreed.

He soon became a regular on and then a host of “Loveline,” which went national in 1995. In 1996, with the comic Adam Carolla installed as barstool wiseguy to Pinsky’s expert, the show moved to MTV, marking the small-screen debut of Dr. Drew: a young crush-worthy doctor in a tie but no jacket, with an easygoing, nonjudgmental manner. The show added celebrities and a homey, denlike set, but the main attraction remained Pinsky, who, even as he shared a sofa with gangsta rappers and teen-flick hotties, gave calm, informed answers to questions about anal sex or Nyquil abuse that were, in their very earnestness, sensational.

In a sense, Pinsky has played some version of this high-profile mensch his whole life. At Pasadena’s Polytechnic High School, he was a top student and captain of the football team, and played Tevye in “Fiddler on the Roof.” He went on to Amherst College and then returned to Los Angeles to attend medical school. After months of balancing med school with his radio-show job, he began a residency in internal medicine at Huntington Memorial Hospital, while moonlighting at Aurora Las Encinas Hospital in Pasadena, where he provided basic medical care to psychiatric patients, many of whom were also addicts. It was there that Pinsky had a burning-bush moment: he was struck by the disease’s narrative arc.

“I watched these people — these young people — go from dying to better than they ever knew they could be,” he said. “And I was like, ‘Whoa.’ In medicine you go from dying to chronically ill. You don’t go from dying to better than you ever knew you could be. That just doesn’t happen.”

Over the next several years, Pinsky was certified in addiction medicine, an emerging specialty; underwent additional training in related fields; and became the medical director of Las Encinas’s addiction program. “For me, addiction exposes all of the brain mechanism under the influence of a profoundly distorted primary motivation,” Pinsky said. “It’s such a window into how we function as human beings. And the patient doesn’t know that’s happening! Doesn’t believe that’s happening! That’s the fascinating part.”

Pinsky maintained the media presence he had established, hosting “Loveline” five nights a week on KROQ, doing health shows for MTV and other networks and serving as an expert commentator on news programs. He tiptoed into reality TV just as it began to take off, working as a “health and human relations expert” for the 2000 U.S. debut of “Big Brother.”

Then, in the middle of the last decade, the metastasizing of gossip sites, tabloid shows, reality TV and celebrity overdoses put addiction, Pinsky’s longtime specialty, at the center of the culture. Alarmed by the tabloids’ portrayal of addiction as yet another indulgence of the rich and famous, he decided to stage a media intervention on this latest misunderstood health crisis. Working with independent producers, he approached VH1 with a proposal for a subversively authentic reality show, in which such common action-inducing tricks as sleep deprivation and free shots of liquor would be unnecessary. Instead, it would follow actual substance-abusing celebrities (as defined by cable) through an actual detox in actual rehab. “It all stemmed from Drew,” says Jeff Olde, VH1’s executive vice president of original programming and production.

Using the decade’s most derided TV genre to combat its most high-profile illness required a mix of showbiz savvy and bona fide credentials few but its host could provide. “Dr. Drew is one of a relatively small number of psychiatric professionals who is both credible and 100 percent TV-friendly,” says Michael Hirschorn, the former head of original programming at VH1 who gave the green light to “Rehab” in 2007 (and for whom I worked at Spin in the late ’90s). “And he was willing to take all of the risks on himself, to say, ‘I’m gonna guarantee that this will be a legitimate and nonexploitative process.’ ”

In 2008, “Celebrity Rehab” made its debut, with a cast of derailed actors, porn stars, pro wrestlers and reality-TV veterans. It was an immediate hit, prompting two more seasons and the spinoffs “Sober House” and “Sex Rehab With Dr. Drew.” The show didn’t shy away from the tropes of train-wreck TV — the sobbing and fighting, the seizures and vomiting — but it still staked a claim to therapeutic value. While Pinsky’s methods were mainstream, his gentle confrontations with addicts in denial often provided the cat-and-mouse tension of a “Law and Order” cross-examination. In an inspired cultural mash-up, “Celebrity Rehab With Dr. Drew” aligned reality TV’s need for conflict and meltdowns with recovery’s need for honesty, humility and group support. And it pre-empted charges of intrusive voyeurism by appropriating the dictum “You’re as sick as your secrets.” With reality gimmicks like emo-rock cues, dramatic cutaways and chronologically remixed story lines, the show created dependable redemption arcs for its characters that helped distract the audience from the fact that the biggest celebrity on “Celebrity Rehab” was Dr. Drew.

Pinsky soon became the national face of addiction medicine, acquiring a mystique distinct from any other celebrity physician’s. To the general public, “he’s sort of the god of 12 Step,” says Duncan Roy, the 49-year-old British writer-director and patient on the new “Sex Rehab With Dr. Drew.” Roy’s wit and maturity made him an unusual patient for a Dr. Drew show, and he would later write an article questioning Pinsky’s expertise with sex addiction. But shortly after “Sex Rehab” was shown, Roy joined Pinsky on a TV news program and found himself humbled by the doctor’s mastery. “Sitting next to him,” Roy says, he saw that “he has an enormous power. I mean, I’m used to being interviewed but — God.”

Capitalizing on what many saw as his genius for explaining America’s psyche to itself, Pinsky began to focus on what he considered a bigger opponent, the disease that lay beneath them all: a toxic new form of narcissism, stoked by the media. In his latest book, “The Mirror Effect: How Celebrity Narcissism Is Seducing America,” he diagnoses today’s obsession with fame as a potential public health issue. The book incorporates a 2006 study conducted by Pinsky and his co-author, S. Mark Young, in which they subjected 200 celebrities to a standard psychological test, the Narcissism Personality Inventory, and found that celebrities were 17 percent more narcissistic than the average person, reality-TV stars being worst of all. Narcissistic celebrities aren’t exactly news, but this newer variety, according to Pinsky, is. It has been bred for years by casting directors screening for what are known as “Cluster B” personalities, those prone to histrionics, aggression, hypersexuality, drug abuse — and auditioning for reality-TV shows. This emerging strain of supernarcissism, Pinsky says, turns especially virulent in the world of social media, where young people, who are chasing an increasingly accessible kind of fame, begin to mirror the increasingly pathological behavior of their idols. According to Pinsky, our fascination with these newer narcissistic role models may seem a mere guilty pleasure, but, he argues, it is a reflection of the deep, primal chord they strike within us, the desire to emulate and then destroy our icons. It’s a kind of envious compulsion that tabloids have fed for decades and that new media now intensify with fast, cheap dopamine-blasting hits at the click of a remote.

This, says Pinsky, is the real sickness, the American addiction. So just as the intrepid epidemiologist flies to ebola-infested Yambuku, Pinsky has come to meet the monster where it lives. At least that’s the pitch. “Sometimes I think the patient I’m treating is the culture,” he told me. But the addiction model of celebrity comes with its own baggage, especially in a patient population prone to the subtle thought distortions of a brain under the influence. If, as Pinsky and Young write in “The Mirror Effect,” “nothing demonstrates a celebrity’s basic drive for attention more powerfully than a willingness to check one’s dignity at the door, week after week, in front of millions of viewers,” such a perspective casts a strange light on a program that gives these same people high doses of their drug of choice, week after week, in front of millions of viewers. Addicts are known for the prodigious logic they supply for patently irrational behavior; if the sickness of the culture is contagious, Pinsky, too, is at risk, and his mode of clinical outreach is potentially exploitation in denial.

On the eighth day of “Celebrity Rehab” treatment, the new cast met with alumni from previous seasons, among them Rodney King, star of what might be coldly described as the most momentous reality-TV clip in history. Seeing King chatting with celebs of utterly featherweight significance prompted me to put a few commonly asked questions to Pinsky. Doesn’t luring cast members with promises of money and exposure cast doubt on their commitment to sobriety? And doesn’t broadcasting amid other hormone-and-booze-soaked reality shows undermine the show’s supposedly dead-serious message? Pinsky had ready replies to both.

“My whole thing is bait and switch,” Pinsky said. “Whatever motivates them to come in, that’s fine. Then we can get them involved with the process.” As for the context in which this proc­ess is made available, this, too, is merely a come-on. “The people that need what we have are watching VH1,” Pinsky said. “Not the people watching educational TV, the NPR crowd. You gotta give ’em what they want so you can give ’em what they need.”

But is Jeff Conaway — the prescription-drug-addicted, alcoholic ex-sitcom-and-sci-fi star who screamed abuse from his wheelchair through much of Season 1 — really what today’s at-risk youth need? Perhaps, Pinsky said, citing the number of patients who arrive at his Las Encinas treatment program and say they came after seeing “Celebrity Rehab.” And, he pointed out, nearly all former cast members credit “Rehab” with helping them. Many physicians who treat addiction salute its efforts, and a large number of recovering addicts praise its portrayal of addiction as a disease.

None of this counts as statistically significant data, of course. In fact, many take issue with Pinsky’s methods. Jeffrey Foote, a clinical psychologist who specializes in the treatment of substance abuse, points out that “the velvet-glove confrontational stuff Pinsky does is what works for TV, but it’s not what works for patients.” In fact, the Web site for Foote’s Center for Motivation and Change Web site uses a clip from “Celebrity Rehab” to demonstrate poor techniques. “The dramatic confrontations seen on the show are actually more likely to drive less-severe substance abusers, who are by far the majority, away from seeking treatment.” And whether or not the show helps motivate addicted viewers, critics claim that the on-camera treatment of patients is fundamentally compromised. “I think that if you waterboarded [Pinsky], he’d maintain that he’s really helping people,” says Dr. John J. Mariani, director of the Substance Treatment and Research Service at Columbia University. “The problem here is that Dr. Drew benefits from their participation, which must have some powerful effects on his way of relating to them. He also has a vested interest in the outcome of their treatment being interesting to viewers, which is also not in their best interest. Treatment with conflicts of interest isn’t treatment.”

Pinsky admits that using media to treat media addiction can seem fundamentally contradictory — a way of baiting fame addicts with more fame. “That’s the Achilles’ heel of this thing,” he said. “Gratifying an addict’s sense of specialness.” But he stands by his mission. “The problem with my peers is they don’t understand television,” he said. “You have to work within the confines of what executives will allow you to put on TV. Otherwise, we’ve not done anything, we’ve not really struggled to change the culture at all.”

Late one sunny afternoon, Pinsky picked me up in his black Lexus to drive to the “Larry King Live” studios in Hollywood. He had been booked to advance his theories on what led to the hospitalization of the British singing star Susan Boyle, to limn the psychological fissures in the marriage of Jon and Kate and to answer the question: “Reality Television Out of Control?” He wore a navy blazer and silver tie that harmonized spectacularly with his hair.

Right after I climbed in, he showed me a text message he’d just received: “One year clean and sober June 10th. Thank you so much.” “Nikki McKibbin,” he explained. “From Season 2. She was a difficult drug-addict-alcoholic and had never contemplated getting better. This was her only addiction treatment, I think.” A few minutes later his cellphone rang. “Tom Sizemore,” he said, with a glance at caller ID. He spoke for a minute, hung up and chuckled. “O.K., here’s how addicts work,” he said. “That was Seth Binzer,” from the show’s first and second seasons, “calling on Tom Sizemore’s phone to get directions to a therapist’s office. I love addicts.”

Pinsky traces that love to what lay beneath the surface of his otherwise happy childhood in Pasadena. His mother, a retired actress and singer, suffered a near fatal miscarriage and was taken from home in an ambulance when Pinsky was 1. This event, Pinsky writes in his memoir, “Cracked,” triggered a lifelong anxiety he tried to manage with certain compulsions. “I rescue people,” he writes. “I have to make sure no one else gets carted away.”

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. “We affect each other,” Pinsky said of his relationship with addicts. “You’re telling people, I’m here with you, having your feelings, sharing them, understanding them, appreciating them.” As Pinsky described it, his function is fairly modest, a mere facilitation of basic human contact. “I’m Buberesque in my thinking,” he said. (The philosopher Martin Buber saw the path to divinity through human contact.) “Before there is a self there is an Other,” he said, negotiating a tight turn. “In human development. Period.”

Pinsky, who in addition to his media work maintains a private practice, teaches psychiatry at the Keck School of Medicine at U.S.C. and directs the chemical-dependency services department at Las Encinas, said he lives a quiet life. Long ago, he had what he describes as “very limited” experience with the substances that his patients use. Though he does drink, moderately, his only real vices are compulsive exercise — running daily one month, lifting weights the next — and the workaholism he attributes to the angst stemming from his childhood. His main passions, aside from his work, are his wife, Susan, and their 17-year-old triplets, Douglas, Jordan and Paulina. He doesn’t count fame as even a secondary motivation. “Now I just want to see my kids do well and hang out with them and I want to make a difference,” he said.

While this suburban idyll certainly suits his public image, others insist there is indeed a celebrity Dr. Drew. “He goes to parties, he does the whole kind of L.A. thing,” says Duncan Roy, the British director from “Sex Rehab.” “He doesn’t just go back to his surgery and pore over medical journals. I mean, he’s a celebrity doctor.”

Whether this role rewards or induces grandiosity, Pinsky does show certain signs of it. Roy recalls his surprise in an unbroadcast moment from “Sex Rehab” when he complimented Pinsky on some work. “He very quickly said, ‘You shouldn’t treat me as a God,’ ” Roy says, bursting into laughter. “I said, ‘I’m not!’ He immediately went to that place where any kind of compliment confirmed his omnipotence. He’s a good guy, a sweet guy, but he’s a TV guy. In some way, I think he wrote the book on narcissism to understand his own.”

In “The Mirror Effect,” Pinsky admits that he scored a high 16 on the Narcissism Personality Inventory and shares several traits with the “closet narcissist,” who may seem unassuming but manifests narcissistic traits like overattentiveness and exceeding vulnerability. And Pinsky certainly seems self-effacing to those who know him. “For a long time at the radio station, if an assistant came into the booth and asked him to go get coffee, he’d do it,” Adam Carolla says. “Seriously. I had to remind him they’re supposed to do that for him.” He can also be extraordinarily solicitous. If half the people who claim to stay in contact with Pinsky do so, he must be on the phone every minute. The comedian Andy Dick, who arrived on “Sober House” solely to get treatment from Pinsky, has since made him his primary-care physician. “It’s almost like getting on the phone and calling God,” Dick told me. “We’re in contact constantly. A while ago, I was up at 3 a.m., having a panic attack, and I called three people — Drew, my lawyer and someone else. Drew’s the one who called me back and helped me, right then. I hear people say he’s like a media whore or he’s only in it for the attention, but I have to say, he really is just this unbelievably caring guy. He really is. He’s almost too caring.”

Not long ago, on his Twitter page, alongside tweeny text-shorthand interjections like LMAO and IMHO, Pinsky quoted a line from Goethe: “Deeply earnest and thoughtful people stand on shaky footing with the public,” to which he added, “Fascinating and sad but found this to be true.” He posted it during a tumultuous recent period. On Oct. 27, Pinsky’s father died suddenly of a brain bleed. Days later, at his sons’ high-school football game, one of their friends and teammates collapsed on the sidelines. “I ran over there and found him not breathing, eyes open, fixed and disconjugate,” Pinsky said. He resuscitated the boy and kept him alive until the paramedics arrived. “He survived, thank God,” Pinsky told me two weeks later. “And I just heard today he had his first solid meal.” News items hailing the celebrity doctor’s dramatic rescue ran with little comment from Dr. Drew.

Pinsky isn’t always so reticent. In just the past year, he has speculated freely in public (almost all of these statements are available on RadarOnline) about possible signs of mental illness in Joaquin Phoenix’s “Letterman” appearance, diagnosed borderline personality disorder in the Octomom (without ever examining her), warned the president about the risks of disappointing the public, pronounced Michael Jackson’s personal physician negligent, expressed concern about Miley Cyrus’s lack of a normal developmental process during her adolescence and weighed in on Brad Pitt’s marijuana use and Michael Phelps’s bong scandal. His comments about Tom Cruise’s belief in Scientology and Lindsay Lohan’s drug abuse prompted Cruise’s lawyer to compare him to Goebbels and Lohan (to whom “Rehab” producers reportedly offered six figures if she would join their cast) to Tweet: “I thought REAL doctors talked to patients in offices behind closed doors.” It’s a sentiment echoed by some members in Pinsky’s field.

“I don’t mind the criticism, especially from my peers,” Pinsky said. “But really my book is about the emotion envy, and I’m telling you a lot of what you’re talking about is envy. I was never motivated to do these appearances by fame, but to explain the medical facts behind stories so distorted by media ignorance. When a 22-year-old rock star is hospitalized for exhaustion, I’m sorry, somebody needs to go: ‘Um, excuse me, 22-year-olds run around football fields in 120-degree heat, they don’t get exhaustion. It’s something else.’ ”

By being unafraid to call attention to the medical facts and to do so often — on news slots, cable shows, Web sites and radio slots — Pinsky has tapped into a very powerful mode of branding. “He does seem like the designated adult, the voice of reason,” says Anna McCarthy, an associate professor of cinema studies at New York University’s Tisch School of the Arts, who has written about reality TV. “But he relies upon others to emphasize these qualities. Part of his exemplary appearance is a product of context. He needs the crazy people around him in order to appear so sane.”

On my last day< in rehab, I sat in the control room amid cables and empty coffee cups, watching simultaneous vignettes unfold on different screens. Just as the doctrine of recovery says that there’s no such thing as a former addict, shows like “Celebrity Rehab” prove there is no such thing as a former celebrity. Whether or not they ever achieve sobriety, the people in that video grid will in some way remain in it forever. Dr. Drew won’t bring them any closer to escape.

On three screens, group therapy was beginning with a new member, Tom Sizemore. Wearing a Lonsdale warm-up jacket, his short hair matted, his eyelids swollen, he rested his head on one fist. He was looking at his ex-girlfriend Heidi Fleiss — whose accusations of harassment and abuse resulted in his conviction on a domestic-violence charge — with an expression that was either fond, bemused or resigned.

On another screen, Pinsky sat in a cornflower blue shirt with a navy-patterned tie, his sleeves rolled up. Earlier he told me that his patients always have a history of trauma. “It’s essential to face this trauma, to feel it, grieve it and let it go, and move on,” he said. After checking in about his mood, Pinsky tried to begin this process with Sizemore. “Tom, do you want to share?” “My name’s Tom, I’m an addict,” he said.

One of the cast’s sickest addicts and its most accomplished actor, Sizemore was the last to join the show’s cast. In the context of Hollywood, his greatest tragedy wasn’t his ravaged health, his homelessness or his life-threatening addiction, but his fall from an Olympus populated by Pacino, DeNiro, Spielberg and Scorsese to this beige-carpeted, cable-only Hades. He was, in a sense, the show’s quintessential subject and — whether for TV, treatment or some unstable mixture of both — Dr. Drew began leading him to the work of disclosure. “Do you want to share your life experiences?” Pinsky asked. “Not today,” Sizemore said.

“May I just say that Tom’s experience, Tom’s childhood experience?” Pinsky told the group. “Common to many experiences here. He actually told a story once that stayed with me.” Pinsky looked at Sizemore with obvious sympathy, then tried to prompt him. “You know?” he said. “About the crib?” As Pinsky tried to draw him out, Sizemore looked back at Dr. Drew with a soft, tired smile. Finally he said, “Not on TV.”

Painful digestive problems can trigger problem behavior in children with autism and should be treated medically, according to the panel's report published in the January issue of Pediatrics and released Monday.

''There are a lot of barriers to medical care to children with autism,'' said the report's lead author, Dr. Timothy Buie of Harvard Medical School. ''They can be destructive and unruly in the office, or they can't sit still. The nature of their condition often prevents them from getting standard medical care.''

Some pediatricians' offices ''can't handle those kids,'' Buie said, especially if children are in pain or discomfort because of bloating or stomach cramps. Pain can set off problem behavior, further complicating diagnosis, especially if the child has trouble communicating -- as is the case for children with autism.

Autism is a spectrum of disorders affecting a person's ability to communicate and interact with others. Children with autism may make poor eye contact or exhibit repetitive movements such as rocking or hand-flapping. About 1 in 110 U.S. children have autism, according to a recent government estimate.

More than 25 experts met in Boston in 2008 to write the consensus report after reviewing medical research. The Autism Society and other autism groups funded the effort, but gave no input. The report refutes the controversial idea that there's a digestive problem specific to autism called ''leaky gut'' or ''autistic enterocolitis.'' The hypothesis was first floated in 1998 in a now-discredited study by British physician Dr. Andrew Wakefield. His paper tied a particular type of autism and bowel disease to the measles vaccine.

The new report says the existence of autistic enterocolitis ''has not been established.'' Buie said researchers and doctors have avoided digestive issues in autism because of their connection with Wakefield's disputed research, which set off a backlash against vaccines that continues to this day.

The new report calls for more rigorous research into the prevalence of digestive problems and whether special diets might help some children. For now, the report states, available information doesn't support special diets for autism.

Diets have been promoted by actress Jenny McCarthy, whose best-seller ''Louder Than Words'' detailed her search for treatments for her autistic son.

Nearly 1 in 5 of children with autism are on a special diet, according to a project that tracks what treatments parents are trying. Most of them were on diets that eliminate gluten, found in many grains, or casein, a protein in milk, or both, according to the Interactive Autism Network at the Kennedy Krieger Institute in Baltimore, Md.

The new report advises doctors to watch for nutritional deficiencies in patients with autism. It recommends a nutritionist get involved if a patient is on a special diet or only eats certain foods.

The report drew praise from Rebecca Estepp of Poway, Calif., who believes a special diet is helping her autistic son. She said the paper gives pediatricians credible recommendations they've needed. ''I'm filled with hope after reading this report,'' said Estepp of the support group Talk About Curing Autism. ''I wish this report would have come out 10 years ago when my son was diagnosed.''

Lee Grossman, president of the Autism Society, a funder, said many doctors have written off autistic children's digestive problems as untreatable. ''I think we still have a lot to learn about the gut and how it contributes to behavioral symptoms,'' Grossman said. ''We have a lot to learn about how to treat this.''

Buie said his clinic has various techniques for treating children with problem behavior. They schedule early morning appointments so children aren't delayed in the waiting room or blow bubbles during a blood draw as a distraction. As a last resort, they use anesthesia. ''If a child is going to be asleep because of a dental evaluation or an MRI study, we will do our endoscopy, our blood work, spinal tap, haircuts or teeth cleaning at the same time,'' Buie said. ''Our nurses do beautiful haircuts.''

Although she said it was her first time smoking meth, Ms. Fu, 41, was promptly sent to one of China’s compulsory drug rehabilitation centers. The minimum stay is two years, and life is an unremitting gantlet of physical abuse and forced labor without any drug treatment, according to former inmates and substance abuse professionals. “It was a hell I’m still trying to recover from,” she said.

According to the United Nations, as many as a half million Chinese citizens are held at these centers at any given time. Detentions are meted out by the police without trials, judges or appeals. Created in 2008 as part of a reform effort to grapple with the country’s growing narcotics problem, the centers, lawyers and drug experts say, have become de facto penal colonies where inmates are sent to factories and farms, fed substandard food and denied basic medical care.

“They call them detoxification centers, but everyone knows that detox takes a few days, not two years,” said Joseph Amon, an epidemiologist with Human Rights Watch in New York. “The basic concept is inhumane and flawed.”

On Thursday, Human Rights Watch issued a report on the drug rehabilitation system that replaced the Communist Party’s previous approach of sending addicts to labor camps, where they would toil alongside thieves, prostitutes and political dissidents. The report, titled “Where Darkness Knows No Limits,” calls on the government to immediately shut down the detention centers.

Under the Anti-Drug Law of 2008, drug offenders were to be sent to professionally staffed detox facilities and then released to community-based rehabilitation centers for up to four years of therapeutic follow-up.

But substance abuse experts say the legislation, part of a stated “people centered” approach to dealing with addiction, has simply given the old system a new name. What is worse, they say, is that it expands the six-month compulsory detentions of old into two-year periods that the authorities can extend by five years. The “community-based rehabilitation” centers, treatment experts add, have yet to be established.

Wang Xiaoguang, the vice director of Daytop, an American-affiliated drug-treatment residence in Yunnan Province, said the government detox centers were little more than business ventures run by the police. Detainees, he said, spend their days working at chicken farms or shoe factories that have contracts with the local police; drug treatment, counseling and vocational training are almost nonexistent. “I don’t think this is the ideal situation for people trying to recover from addiction,” Mr. Wang said in a phone interview.

In its report, Human Rights Watch, which largely focused on Yunnan, says the abuses at some of the province’s 114 detention centers are even more troubling. Those with serious illnesses, including tuberculosis and AIDS, are often denied medical treatment. Many inmates reported beatings, some of them fatal.

Han Wei, 38, a recovering heroin addict who was released from a Beijing detention center in October, said the guards would use electric prods on the recalcitrant. “At least they’d give us helmets so we wouldn’t injure our heads during convulsions,” he said. Meals consisted of steamed buns and, occasionally, cabbage-based swill. Showers were allowed once a month. And the remedy for heroin withdrawal symptoms was a pail of cold water in the face. “They didn’t give me a single pill or a bit of counseling,” Mr. Han said. Despite the deprivations, Mr. Han, a former nightclub owner, said his two-year sentence achieved the desired goal: it persuaded him to kick a habit he began in 1998. “I’m never going back,” he said.

Zhang Wenjun, who runs Guiding Star, an organization that helps recovering addicts, said such determination was most often fleeting. At least 98 percent of those who leave the drug detention system relapse within a few years, he said.

Mr. Zhang knows something about falling off the wagon. His own addiction to heroin has landed him in detox centers and labor camps six times since the mid-1990s. “What the government doesn’t realize is that this is a disease that needs to be treated, not punished,” said Mr. Zhang, 42, a tattooed man who speaks in a growl.

In some ways, he said, the stigma of addiction is as crippling as the lure of the next fix. Those arrested for drug offenses are branded addicts on their national identification cards, which makes applying for jobs and welfare benefits acts of futility. And because the local police are automatically notified when former offenders check into hotels, traveling often involves impromptu urine tests and the possibility of humiliation in front of colleagues. “In China, to be a drug addict is to be an enemy of the government,” Mr. Zhang said.

Still, he and other drug treatment workers are quick to acknowledge the progress that China has made in recent years. There are now eight methadone clinics in Beijing, serving 2,000 people, and more than 1,000 needle-exchange programs have opened across the country since 2004.

Yu Jingtao, whose organization, Beijing Harm Reduction Group, distributes 30,000 clean needles a month, said the government was slowly moving toward the drug treatment model common in much of the developed world. “We’re just caught in a transition period,” said Mr. Yu, himself a recovering addict. “Transition periods are never very pretty.”

Finally, after several false starts, a long period of quitting with a relapse, and a new baby daughter, Ms. Guess quit again. She has not smoked for two years. “I’m so relieved,” Ms. Guess said. “It’s so great to be free and not be controlled by cigarettes anymore.”

Another thing Ms. Guess was relieved about: Her insurance paid for most of her quit-smoking aids. “It can really add up,” she said. “Fourteen patches used to cost as much as $40.”

Indeed, experts say, sometimes the costs associated with smoking cessation can provide their own psychological barrier to quitting.

There are 45 million adult smokers in the United States, but even more — 47 million — former smokers, according to Cheryl Healton, chief executive of the American Legacy Foundation, an antismoking, nonprofit group financed by tobacco litigation settlement money.

Studies indicate that at any one time at least one-third of smokers want to quit, especially around this time of year, when New Year’s resolutions are still fresh.

And yet, it takes most smokers eight to 11 tries to quit for good, Ms. Healton says. Paying for treatments that may not work or aren’t right for you in the first place only adds to the frustration. “It’s a form of denial, but often smokers will balk at the upfront cost of quitting and say ‘forget it,’ ” Ms. Healton said.

So this column is meant to help you, or a smoker close to you, sort through the options for quitting. And look at it this way: No matter what you spend, it will probably never add up to more than the cost of continuing to smoke.

“If you’re paying about 10 bucks a day for a pack of cigarettes in New York City, that adds up to about $6,000 over two years,” said Thomas Glynn, director of cancer science and trends at the American Cancer Society. “You could check yourself into the in-patient program at Mayo Clinic for that.”

And that doesn’t begin to count the extra health care costs of smoking.

WHAT’S RIGHT FOR YOU? If you are intent on giving up smoking, evidence suggests that a combination of mood-altering drugs, nicotine replacement therapy and counseling can be three times as effective as simply trying to go cold turkey.

But there is an overwhelming range of no-smoking products and treatments, so it’s important to figure out what might work best for each individual. To learn more about your options, call your state’s toll-free telephone quit line. (To find the number in your state, log onto the North American Quitline Consortium map at www.naquitline.net.)

In most states a counselor will ask you a series of questions, like “How much do you smoke?” and “What are your five favorite cigarettes of the day?” The aim is to help determine what type of smoker you are and what regimen will best help you quit.

You’ll learn, for instance, about the various nicotine replacement products, which experts say are crucial to successful smoking-cessation efforts.

Nicotine patches, gums and lozenges are all available over the counter. Nicotine nasal sprays and inhalers, both of which deliver nicotine to your system faster than the other methods, are available by prescription only. But at a cost of about $400 a month, inhalers are considerably more expensive than other nicotine replacement products.

Nicotine patches work best for someone looking for convenience — you put them on once a day.

Nicotine gum, lozenges, sprays and inhalers work better for smokers who want to control when they get that “hit” of nicotine — after dinner, for instance, or during a coffee break. Sometimes, heavy smokers with serious cravings will need to supplement the patch with gum or a lozenge during particularly tough moments.

The counselor will also talk to you about prescription medicines. Several antidepressants are now commonly prescribed “off label” to smokers to help them deal with the irritability and anxiety that nicotine withdrawal can cause. Chantix, a newer drug that reduces nicotine cravings and which Ms. Guess used successfully, is also available by prescription.

CHECK WITH YOUR DOCTOR Once you get guidance from a smoking-cessation counselor, you’ll need to check with your doctor for more advice on what type of stop-smoking method will work best with your general health. Some of the prescription drugs, for instance, may not be right for you if you have health problems.

And the Food and Drug Administration last year warned that patients taking Chantix or Zyban, a smoking-cessation form of the antidepressant Wellbutrin, should be watched for signs of potential mental problems. But the agency said those concerns should not stop people from trying the drugs.

Mr. Glynn says it’s a matter of proceeding with caution, “The percentage of patients who experience extreme symptoms is minuscule,” he said. “Still, patients taking these drugs must be carefully monitored.”

Even the nicotine replacement therapies have side effects that you should discuss with your doctor.

BEWARE THE UNPROVEN “Everyone knows someone who went to the hypnotist or the acupuncturist and never smoked again,” Mr. Glynn said. And for those people, for whatever reason, it really did work, he added.

But there is little hard clinical data to suggest that either acupuncture or hypnosis is an effective way to help quit smoking, he said. And they are costly; single sessions can cost $100 or more.

Electronic cigarettes, which dispense nicotine and mimic the act of smoking, are not approved by the F.D.A. Worse, some have been found to emit harmful toxins. Mr. Glynn advises staying away from these gizmos.

Also watch out for expensive smoking-cessation programs that administer drugs or make promises that are too good to be true. “Often, these are fly-by-night operators,” Mr. Glynn said.

With any tobacco-cessation program, always ask for details about success rates. For instance, is a person considered a success if they have quit smoking by the end of the program? Six months afterward? A year? For more details on smoking-cessation methods, including the pros and cons, see the American Cancer Society’s Guide for Quitting Smoking at www.cancer.org.

CHECK YOUR INSURANCE For Ms. Guess, the fact that her insurance covered much of the cost of her smoking-cessation regimen definitely contributed to her success, she says.

Many insurers are willing to cover the therapies for obvious reasons: nonsmokers file far fewer medical claims than smokers. It’s always a good idea to read your policy carefully to find out what your insurer offers.

LOOK FOR DISCOUNTS If you decide on a regimen that includes over-the-counter nicotine replacements, be sure to check Wal-Mart, Costco and other big discounters. They often offer patches and other products for significantly less than pharmacies and drugstore chains.

USE SUPPORT GROUPS Sometimes nothing can substitute for good old-fashioned support, Ms. Guess said. “The combination of support and medicine is what finally worked for me,” she added.

Ms. Guess used Mary Quits, one of the many online support groups. Others include the American Lung Association’s Freedom from Smoking Online and becomeanex.org, which the American Legacy Foundations helps sponsor. Another is Quitnet.com.

Your local hospital, or a local chapter of the American Cancer Society or American Lung Association may also sponsor free in-person support group meetings in your area. Check with your doctor’s office for more information. Or, try a local Nicotine Anonymous group.

And always check with your employer’s human resources department. Big companies often sponsor on-site groups to help employees stop smoking.

Happy pills don’t work, the story quickly became, even though, boiled down to that headline, it was neither startling nor particularly true.

It sounded true. After all, any number of experts have argued that antidepressants — and selective serotonin reuptake inhibitors like Paxil in particular — are overhyped and oversold. And after years of hearing about shady practices within the pharmaceutical industry, and of psychiatrists who enrich themselves in the shadows by helping the industry market its drugs, we are primed to believe stories of psychiatric trickery.

Yet in all the excitement about “startling” news and “sugar pills,” a more nuanced and truer story about mental health care in America was all but lost.

That story begins to take shape when you consider what the new study actually said: Antidepressants do work for very severely depressed people, as well as for those whose mild depression is chronic. However, the researchers found, the pills don’t work for people who aren’t really depressed — people with short-term, minor depression whose problems tend to get better on their own. For many of them, it’s often been observed, merely participating in a drug trial (with its accompanying conversation, education and emphasis on self-care) can be anti-depressant enough.

None of this comes as news to people who have been prescribing or studying antidepressants over the past 20 years. Neither is it all that likely to change the practice of treating depression — at least as it’s carried out by responsible doctors.

After all, people who are depressed for the first time, or have been depressed for only a short time, or are upset after a personal setback, aren’t considered ideal candidates for immediate drug therapy. And, contrary to popular belief, there’s no evidence that most psychiatrists regularly prescribe pills straight off to people who can get better by reading about depression, exercising or doing nothing. What numbers do exist, said Peter Kramer, who has written extensively on antidepressant use in books like “Listening to Prozac,” indicate that relatively few people with minimal depression leave psychiatrists’ offices with a prescription.

That people have come to believe otherwise may be in part because most patients with depression are treated by general practitioners, not psychiatrists. Studies have shown that these primary care doctors don’t strenuously enough screen their patients for depression before prescribing drugs, or closely monitor their care afterward.

And here the truer story about mental health care in America begins to unfold. The trouble is not that the drugs don’t work; it’s that the care is not very good.

Inadequate treatment by nonspecialists is only a piece of the problem. In fact, most Americans with depression, rather than being overmedicated, are undertreated or not treated at all. This might have been big news this week, too, had anyone noticed another academic study, a survey of nearly 16,000 people published this month in The Archives of General Psychiatry, which looked more broadly at the picture of depression in America. The survey found that those who did get care were given psychotherapy more often than drugs. That finding might give heart to those who would prefer to see more alternatives to psychiatric drugs — if it weren’t for the fact that so much psychotherapy is so bad.

In 2008, a team of psychologists brought this point home in blunt terms in the journal Psychological Science in the Public Interest. “Despite the availability of highly effective interventions,” they wrote, “relatively few psychologists learn or practice these interventions.”

This is the big picture of mental health care in America: not perfectly healthy people popping pills for no reason, but people with real illnesses lacking access to care; facing barriers like ignorance, stigma and high prices; or finding care that is ineffective.

It is a societywide concern that a co-author of the new antidepressants study readily acknowledges. “What we reported on was a very small piece of a very large problem,” Robert J. DeRubeis, a professor of psychology at the University of Pennsylvania, told me. “Those kinds of things are not being sorted out in this country because there’s no system. Nobody’s asking these questions.”

With health care reform almost certainly on the horizon, perhaps now we can hope they will start asking.

Judith Warner, a former columnist at nytimes.com, is the author of the forthcoming “We’ve Got Issues: Children and Parents in the Age of Medication.”