608). Hence, Spears is seen as transcending from teen pop star to "vamp." Some of her fans refer to her as "slore" (the combined words "slut" and "whore") because of her move from teen cuteness to adult soft core pornography. Although it is possible, it doesn't seem likely that Spears suffers from schizophrenia. In his book, Dr. David Barlow lists the diagnostic criteria for schizophrenia, and while Spears has shown "grossly disorganized…" behavior, to our knowledge she does not have disorganized speech, delusions or hallucinations. There is nothing in the literature about Spears that indicates she has had autistic issues or psychotic lapses, but again, schizophrenia is a remote possibility (Barlow, et al., 2008).

What interventions may be appropriate for Spears, given the widespread believe among those close to her and professionals that she has psychological problems?

Does Spears suffer from a bipolar condition? According to Medline Plus (part of the U.S. Government's National Institutes of Health) people who experience "dramatic mood swings" and who go from "overly energetic" to "irritable" and then to "sad and hopeless -- and then back again" may be bipolar. The "up feeling" is called "mania" and the "down feeling" is referred to s "depression" (Medline). Bipolar conditions often start in "late adolescence or early adulthood" and if not treated can lead to "suicide" at the worst and "damaged relationship, poor job performance" in the least.

The Mayo Clinic reports that while a bipolar condition can last for months or years, there are new approaches / interventions for those suffering from bipolar. First of all, there are mood stabilizers (medications) that have been proven effective at dealing with the "manic phase" of the illness. However, treating the depression side of bipolar is not as easy, the Mayo Clinic fact sheet explains (www.mayoclinic.org). The antidepressants given for depression "can trigger a rapid mood switch" from depression back to mania; this phenomenon is called "treatment-emergent mania" (TEM). When a patient is diagnosed with TEM it is considered a very serious, and even "volatile adverse event" so working with Spears would be problematic because she is on the move a lot due to her career in music. Unless she agreed to go into a rehabilitation situation, which she should do, treating bipolar and avoiding TEM will be difficult.

The research at Mayo Clinic shows a new understanding of bipolar; the disease does not occur in "two near, clear-cut phases, but rather a mix of the two," said Dr. Mark Frye, a clinical psychiatrist at Mayo Clinic. The latest research study -- in which 176 patients with bipolar were participants -- showed that patients with "minimal manic symptoms" were at greatest risk for experiencing the TEM condition, Frye concluded.

Does Spears suffer from "Dual Diagnosis"? What intervention is appropriate?

The psychiatrist quoted earlier in this paper suggested that Spears may be bipolar and also have a substance abuse problem. Certainly the substance abuse possibility is very real given her erratic driving and nights out with Paris Hilton and that crew of wild starlets in Hollywood. Let's say person with dual diagnosis is having a bout of mania from the bipolar condition -- and mania makes the mind rush very rapidly and unnaturally. In order to slow that mania down, it is often the case that a bipolar patient will drink alcohol to "cover up or mask symptoms of a mood disorder" according to the Depression and Bipolar Support Alliance (DBSA) (a feature tied to the National Institutes of Health, www.nlm.nih.gov). The patient experiences a slow-down of the mania and believes he or she has "self-medicated" and it worked successfully. However, the self-medicating process "actually makes things worse than ever," the DBSA site explains.

Using drugs or alcohol to slow down the mania and help the depression usually results in masking the problem rather than solving it. The recommendations vis-a-vis proper treatment for Spears -- if indeed she struggles with dual diagnosis -- is as follows. She needs to reach out for treatment of both bipolar and substance abuse. And it is vitally important for her to stay away from alcohol and recreational drugs while being treated for dual diagnosis. The only drugs she should be taking are prescribed medications (DBSA). Treatment for her mood disorder might include "counseling or psychotherapy, medication and DBSA support groups" where she can share candidly with other patients. Treatment for...

She will need to be under a doctor's care during the physical withdrawal period of her new-found sobriety.
Along with those suggestions, the DBSA recommends: a) "talk therapy" as part of psychotherapy (verbalizing her feelings and frustrations); b) prescribed medications and keeping a record of how she feels each day, what medications she took, who she talked to, etc.; and c) don't be discouraged because the medications give constipation, weight gain, weight loss, dizziness or temporary sexual dysfunction (DBSA).

Has Spears suffered from postpartum depression? What are the remedies?

Having two babies fairly close together and being a busy recording artist with little time to really enjoy the children may have created a postpartum problem for Spears. According to the American Congress of Obstetricians and Gynecologists (ACOG), while most others get over the postpartum "blues" in a few days after childbirth, about ten percent of new mothers have more serious problems. In fact a mother with postpartum depression experiences strong feelings of "sadness, anxiety, or despair" to the point that they have problems coping with their daily tasks (ACOG). Given that Spears already was having career problems -- and possibly substance abuse along with bipolar symptoms -- the postpartum depression may have contributed to her downward spiral.

The ACOG site has published three "myths" that in some way contribute to postpartum problems. Myth #1, "motherhood is instinctive" (it's not; skills need to be developed); Myth #2, "The Perfect Baby" (what the infant looks like when it arrives is often not what mother thought it would look like); Myth #3, "The Perfect Mother" (most women want to be perfect and when they realize they have flaws they have a difficult time balancing the responsibilities of having a new child with work) (ACOG). Given the pressures on a pop music star (studio time, writing songs, scheduling tours, meeting marketing obligations and fan interactions) it is not at all beyond reason that Spears did indeed suffer from some form of postpartum depression.

The suggested remedies (ACOG) include: a) get plenty of rest (not likely for Spears with her schedule) and "try to nap when the baby naps" (difficult if not impossible for Spears); b) ask for help from family and friends (Spears could afford to hire full time nannies, but that doesn't help her bond with her babies); c) "Take special care of yourself. Shower and dress each day and get out of the house" (it seems evident that Spears did not take the best care of herself); and d) "Tell your partner or friend how you feel" (nice suggestion but in Spears' case she has been in and out of several relationships, few of them offered her stability and peace it seems).

In conclusion, the weakness of the various hypotheses as to what Spears is suffering from is based on the fact that no reliable clinical descriptions of her medical and psychological issues are forthcoming. Much of the discussion of Spears' problems is based on speculation and hearsay.

Works Cited

American Congress of Obstetricians and Gynecologists. (2009). Postpartum Blues. Retrieved Dec. 16, 2009, from http://www.acog.org.

Barlow, David H. (2008). Abnormal Psychology: An Integrative Approach. Florence, KY:

Cengage Learning.

Celizic, Mike. (2008). Spears Suffering from "Bipolar Disorder." MSNBC. Retrieved Dec. 16,

2009 from http://www.msnbc.msn.com.

Depression and Bipolar Support Alliance. (2008). Duel Diagnosis and Recovery. Retrieved Dec.

17, 2009, from http://www.dbsalliance.org.

Hawkins, Stan, and Richardson, John. (2007). Remodeling Britney Spears: Matters of Intoxication and Mediation. Popular Music and Society, 30(5), 605-629.

Mayo Clinic. (2009). Study Suggests New Treatment Approach May be Needed for Management of Depression in Some People with Bipolar Disorder. Retrieved Dec. 15, 2009,

From http://www.mayoclinic.org.

Medline Plus. (2009). Bipolar Disorder. Retrieved Dec. 16, 2009, from http://www.nlm.nih.gov.

Thomas, Karen. (2007). Spears Creates Shear Confusion. USA Today. Retrieved Dec. 17, 2009,

From http://www.usatoday.com.

Wihlbord, Ulrica. (2008). Friends: Britney Suffers from "Psychological Disease." People

Magazine. Retrieved Dec. 15, 2009, from http://www.people.com.