Death, Drugs, and Rock ’n’ Roll
The interesting paper of Dr Bellis and colleagues  reports strikingly increased mortality in rock and pop stars. A widespread opinion is that fame is the reason for the manifold psychological problems of the stars. These problems are seen as a consequence of the pressure of the fans, the media, the music industry, or obtrusive paparazzi. Also, the availability of drugs and alcohol and the problem of coping with obscurity after a period of fame are commonly stressed as etiological factors. The crucial question is, however, whether fame leads to psychiatric problems or – the other way around – certain psychiatric problems may be a prerequisite for getting famous. An analysis of the biographies of pop stars who died young showed that features of personality disorders were present before these stars got famous. The main reasons for premature death identified in the study were drug or alcohol overdose and/or chronic substance abuse. But also some other reasons for increased mortality, such as suicide, accidents and violence, point into the direction of a certain psychiatric illness: The features of borderline personality disorder include substance abuse, impulsive behaviour, high-risk behaviour (e.g. speeding), depression, suicidality, self-mutilation (mostly in women), unsteady interpersonal relationships, problems with sexuality, feelings of emptiness, and eating disorders. Etiological factors include traumatic childhood experiences and genetic contributions. In most studies with borderline patients, the mean age is around 27 years, which may be a possible explanation for the magic age of 27 at which Joplin, Hendrix, Morrison and Cobain died. Since Aristotle, who saw the association between melancholia and poetry, many scientific authors have investigated the relationship of “genius and madness”. A number of studies found significantly increased rates of psychiatric disorders in artists, in particular in performance artists (e.g. singers and actors).[3-5] The striking relationship between death, drugs, and Rock ‘n’ Roll may be explained by the dopamine reward system and the associated endogenous opioid system of the human brain. Borderline patients seem to have a dysfunction of these systems, which they try to compensate by using heroin and cocaine, drugs that stimulate these systems directly. Also, frequent sexual contacts, risky behaviours, aggression, self-mutilation or overeating increase endorphin levels, but one of the best techniques is to get attention by a large audience. Narcissism is one of the main features of borderline personality disorder, and this explains why the affected persons try harder to get famous and develop more creativity and fantasy as musicians, actors or writers. Due to their high emotionality, their performance is perceived as more touching and authentic by the public. Should we warn persons at risk to get famous? The answer is no. Performing on stage may be a more successful therapy than any psychiatric treatment, and without these exceptional artists, our culture would suffer great losses.
Prof. Dr. B. Bandelow Department of Psychiatry and Psychotherapy University of Göttingen von-Siebold-Str. 5 D-37085 Göttingen, Germany Tel. +49-551-396607 Fax +49-551-398952 E-mail: Sekretariat.Bandelow@medizin.uni-goettingen.de
1. Bellis M, Hennell T, Lushey C, Hughes K, Tocque K, Ashton J. Elvis to Eminem: quantifying the price of fame though early mortality of European and North American rock and pop stars. J Epidemiol Community Health 2007;2007(61):896-901.
2. Bandelow B. Celebrities - vom schwierigen Glück, berühmt zu sein [Celebrities - About the difficult luck to be famous]. 2nd edition. Reinbek, Germany: Rowohlt; 2006.
3. Andreasen NC. Creativity and mental illness: prevalence rates in writers and their first-degree relatives. American Journal of Psychiatry. 1987;144(10):1288-92.
4. Ludwig AM. Creative achievement and psychopathology: comparison among professions. American Journal of Psychotherapy. 1992;46(3):330-56. 5. Post F. Creativity and psychopathology. A study of 291 world-famous men. Br J Psychiatry. 1994;165(2):22-34.