Psychopathology

Psychopathology

British singer/songwriter Amy Winehouse shot to thetop of the charts in 2006 with such international hits as “Rehab,” “Love Is a Losing Game,” and “You Know I’m No Good.” Awards quickly followed, including a record number of Grammys and several big prizes in Great Britain. Meanwhile, Winehouse’s beehive hairdo, dramatic eye makeup, vintage dresses, and elaborate tattoos caught the imagination of the public and fashion designers alike.

But as her career took off, Winehouse’s life spun out of control. Her hospitalizations for overdoses of heroin, ecstasy, cocaine, and alcohol; arrests for possessing drugs and assaulting fans; no-shows at concerts; and bizarre public behavior filled the tabloids. Her increasingly skimpy clothes revealed dramatic weight loss and self-inflicted wounds.

The media has focused on Winehouse’s drug and alcohol problems, but is substance abuse her only woe? She has talked about struggling with depression, as well as eating disorders and self-harm. Some observers suggest that she may have bipolar disorder, an illness that causes people to cycle between deep depressions and extreme manias, often with intermittent stretches of relative calm. Many creative people throughout history—from composer Ludwig van Beethoven, to artist Vincent van Gogh, to writer Virginia Woolf, to scientist Isaac Newton, to politician Winston Churchill—have shown symptoms of bipolar disorder, and Winehouse’s eccentric flair and haunting lyrics may bear the marks of this condition. Her substance abuse may be another sign, as nearly 60% of people with this illness abuse alcohol or drugs.

Winehouse’s behaviors are also consistent with borderline personality disorder, a diagnosis that shares many symptoms with bipolar disorder, including mood swings and impulsivity. Unique to borderline personality disorder, however, is a profound fear of abandonment, which Winehouse has expressed in songs such as “Rehab.” Cutting, which Winehouse admits to, is also a symptom of borderline personality disorder.

As we scan the list of possible explanations for Amy Winehouse’s behavior—a list that could also include attention-deficit/hyperactivity disorder (ADHD), anorexia nervosa, an eccentric personality, or some combination of all these—you may wonder why it matters which disorders she (or anyone else) may have. One reason is that the correct diagnosis of mental illness can lead to correct treatment, while an incorrect diagnosis can exacerbate mental problems. The antidepressants that ease depression, for example, can fuel a manic phase in a person with bipolar disorder. Diagnosis also gives us clues about the origins of mental disorders. As you will learn, most mental disorders arise from a complex interplay of nature and nurture, biologies and environments, diatheses (vulnerabilities) and stressors. Understanding these many interacting factors can help us not only to treat mental illnesses more effectively but also to try to prevent them.

But there is one other reason to care about Amy Winehouse’s struggles. In her we sense the familiar: most of us know someone with psychiatric problems and perhaps have a few of our own. Almost half of Americans will have at least one mental disorder during their lifetimes. The information about psychopathology that you are about to encounter may hit close to home and may, we hope, instill a deep compassion for people living with mental disorders.