The doctor was in — but unfortunately for Britney Spears, the doctor was Dr. Phil.
For someone who was just held against her will for observation at Los Angeles' Cedars-Sinai hospital, only to be released before the full 72 hours of observation were up, the pop star is in dire need of "real" and "ongoing" treatment, mental-health experts tell MTV News. They say Spears is not going to get what she needs from a TV doctor who wants a televised "intervention."
But that real treatment can vary widely — from talk therapy and family counseling to rehab and medication — depending on what is actually troubling the singer. So what is the diagnosis?
"Britney is having a whole host of problems that no one can diagnose for sure," said Dr. Robi Ludwig, a New York psychologist. "Clearly, though, she is troubled."
Could Spears — who has two sons, ages 2 (Sean Preston) and 1 (Jayden James) — be suffering from, as she once wrote on her Web site, a form of postpartum depression? "It can occur anytime within a year of giving birth," said New York psychiatrist Dr. Gail Saltz. "And sometimes it can develop months after giving birth."
Symptoms would include difficulty sleeping and eating, feelings of hopelessness and guilt and, sometimes, suicidal thoughts. The flipside to postpartum depression is postpartum mania, where some women feel a heightened feeling of well-being, as well as agitation, irritation and excitement. "It's the beginning of a presentation of bipolar disorder," Saltz said. "Sometimes it never comes back, and sometimes it's the beginning of a psychiatric illness. But it's treatable." There's also postpartum anxiety, as well as an extreme (and rare) form of a post-pregnancy mood disorder called postpartum psychosis, which occurs in about one of every 1,000 births. It usually begins in the first six weeks after giving birth, and includes confusion, delusions, hallucinations, obsessive thoughts and rapid mood swings.
So could Spears be suffering from a bipolar disorder, as rumored? "One minute she wants to see the paparazzi, the next she's whacking them with an umbrella," Saltz said. "Being impulsive, being seemingly irrational and destructive, this is not necessarily just mania. You could be depressed and do bad things to yourself, too, because you've lost your sense of judgment."
"If she is self-sabotaging, it's probably unconscious anxiety," said Dr. Jean Cirillo, a psychologist with a private practice in Huntington, New York. "Look at what we know of Britney. She used to be cooperative with the press. But now she's running out of photo shoots that could have redeemed her image. She's late to depositions. It sounds like she couldn't handle it. It sounds like a panic attack."
The stress is understandable, considering she's gone through a divorce, has custody issues and is responsible for two small children — on top of her career. "Add to that that she's constantly under the microscope, and not just being evaluated, but being trashed," Saltz said. "That has to be stressful, being a woman who people think failed at marriage, failed at motherhood, [and is] failing at her career. You end up with a woman who has no identity, and that's traumatic."
So traumatic that she's suffering from a form of post-traumatic stress disorder? Cirillo thinks so, based on Spears' tendency to alienate and isolate herself from people in her life. "People who have divorce/custody issues do have some degree of post-traumatic stress," Cirillo said. "It's a temporary reaction to an outside situation, when you feel like you're suddenly in the fire. She has severe anxiety about being a performer and a mother, and the things she has to do as a performer — like be sexy — are at odds with what she has to do as a mother. It takes a really mature person to balance that."
Could it be that simple: Spears is just too immature? After all, she referred to herself as a "young girl" when defending her pantyless-partying ways a year ago — could that explain the neglect of her two young children, as the court-appointed monitor described in one report, or Spears' other erratic behavior? "It sounds adolescent, right?" Ludwig said. "I think in Britney's case, she doesn't know how to deal. She sounds like a teenage parent, who doesn't have the emotional wherewithal to think about anyone other than herself. She doesn't know how to be an adequate parent, even to get her children back. It's not computing, and she's acting in an oppositional, rebellious way, like she's stuck in adolescent mode."
Being too immature, or having a panic attack, or being stressed out, however, wouldn't have gained Spears admittance to Cedars-Sinai for observation. "If someone is involuntarily committed, that ain't just stress," Ludwig said. "Being committed is serious and significant. It's not a superficial assessment. You'd have to be a danger to yourself or others. A lot of hospitals would turn you away if you said, 'I need the rest, I'm stressed.' They don't have the space. Is stress a contributing factor? Yes. Is it the only factor? No."
Though Spears' behavior has been described as having a nervous breakdown or a meltdown, Saltz said that it's oversimplifying the case. " 'Nervous breakdown' is a layman's term," she explained. "It's not a psychiatric term, and it's not helpful to her, because there's no medication or talk therapy for that. You have to look at the very specific symptoms to make a clinical diagnosis, to have an evaluation. Were there depressive episodes? Is there a history of mania? A trajectory of substance abuse? Was there a traumatic event? It usually takes several sessions to look at all of that and say, 'Aha, that fits.' Not everything fits in a perfect box, though."
So the best thing the singer can do, mental-health experts agree, is to get professional help — even if the public is watching her every move. Ludwig prescribes a medical evaluation, with follow-up by a psychiatrist bimonthly for medication management, and psychotherapy two times a week. "That's while she's in crisis mode," she said. "Once things calm down, then once a week."
"There's a stigma and shame to these things that cause some people not to get help, to feel embarrassed," Saltz said. "Obviously, I don't know Britney Spears and I don't know what's kept her from getting treatment, but many people lack the education to know what's happening to them, or they feel it will mean, 'I'm bad, I'm weak, I'm crazy,' which is so sad, because these are biological illnesses, and [they are] not the person's fault. If you have diabetes, you get insulin, you get treated. Same here. I think we're seeing some serious, alarming symptoms that are dangerous, and things could go very, very badly if it's untreated. I would be very, very concerned about this woman."