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Hollywood DSM: Industry Shrinks Reveal What’s Wrong With Actors, Producers, Agents and More

Every job in town, from studio exec to screenwriter, actor to agent, has a dominant dysfunction — and diagnosis. For THR's annual Doctor's Issue Hollywood's top mental caregivers share insights straight out of their session notes.

This story first appeared in the Sept. 4 issue of The Hollywood Reporter magazine. To receive the magazine, click here to subscribe.

The Executive: The Pressures of the Golden Handcuff
By Dr. Larry Shaw

The pressures are different for male and female executives. The guys I’ve worked with recently have father issues, which means they had very powerful fathers, so there’s an aspect of living under the father’s shadow. In one week, I had three guys come in and say, “My father’s the most powerful man in Hollywood.” In certain cases, they had really Great Santini abusive fathers. They’ve got this inner dialogue that’s really their father’s voice saying, “You’re not good enough.”

The women who have made it to the top still have to be in a room full of the good ol‘ boys when decisions are made. Think Donald Trump. You put a woman in there and they make really, really sexist jokes, and they don’t respect her. The women work harder, I think, and there’s less appreciation.

There isn’t one consistent factor in the women’s upbringings except they had unique childhoods. They grew up in the ‘60s, so think of everything from communes to tons of LSD. There wasn’t a traditional consistency in their upbringings.

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A certain kind of personality enjoys the chaos of the entertainment industry. One guy told me about an early memory in which he remembers hanging onto his crib and seeing his executive father run in and out of the house, constantly running here and there. So they find something that’s familiar, but they can feel physiologically that it’s wrecking their system. This one guy was telling me, he was in Nepal and he had his cellphone with an international signal, and he said he literally was hanging off a mountain trying to make sure a deal went through.

Everyone I’ve worked with, they all want to get out of the business. They’re at the top of their game and they’re miserable. One guy called it the golden handcuff. Another guy I worked with said when he was in Cannes, he was looking down on the red carpet and thinking, “I just feel so alone. Why am I here and why am I doing this? This has no meaning.” He left his hotel room, skipped some parties, walked to the top of a hill and looked out over the ocean. Then an old farmer came by with an apple, looked at him and cut off a piece of apple for him. He just went, “That’s what life is about, being able to be at peace, and all you need is an apple.” — As told to Austin Siegemund-Broka

Larry Shaw, Ph.D., is a psychotherapist who has practiced for 35 years with offices in Beverly Hills and Topanga Canyon. He specializes in treating trauma.

The Agent: An Asshole (But Not on the Inside!)
By Dr. Jenn Mann

I’ve seen dozens of agents over my two-plus decades as a therapist. A lot come in because of relationship issues and stress, but the agents don’t even realize that what they’re coming in for is a Hollywood version of “caretaker fatigue.” People think of agents as being assholes. (This doesn’t seem to bother them.) But agents are caretakers. They’re finding people jobs, dealing with problems, babysitting, handholding, escorting on the red carpet, taking care of people’s feelings. When most people in this town have a problem, they call me — the therapist — or their agent. Agents are the problem solvers. The symptoms that I see in “agent caretaker fatigue” are agitation, anxiety, depression, burnout. Agents can get very burnt out by the constant crisis management. They’re seen as assholes because agents tend to be type A negotiators. They are their clients’ protectors, and their job is to be the bad cop. Being driven, aggressive, perfectionistic and obsessive: Those are the traits of the person who is drawn to this work and succeeds at it. A lot of agents come from chaotic households, where there was unpredictability and where they became a parentified child in some way. They had to grow up prematurely and take care of people, and they learned to be good at it at a very young age. — As told to Rebecca Sun

Mann has a private practice in Los Angeles and hosts VH1’s Couples Therapy, which returns for its sixth season on Oct. 7.

The Actor: Fame Really Does Suck for (Some of) Them
By Dr. Jeff Blume

There’s a misconception that actors are narcissists. Yes, there’s a subgroup of people who love being in the limelight and it’s often born out of wanting attention. But for the majority of my clients, acting is driven by a deep creative need. If they become successful stars, though, fame may collide with the work itself. They may get overwhelmed by Hollywood politics or by fans who idealize them. The pressure to live up to expectations — to be funny, attractive, young, stylish — can be exhausting. Often they don’t feel safe going out. People try to find out where they live or follow them. They may have false lawsuits thrown at them and dangerous exploitation. People project their anger and envy, and that can be disorienting.

It’s hard for people to believe that, amid the accolades, many people in the spotlight don’t feel seen. There’s often a disconnect with how they’re treated and who they really are. The constant scrutiny adds to that experience. If they’re quiet, they’re depressed or hiding something or their marriage is on the rocks. If she has a drink, she’s an alcoholic. If he has dinner with someone, he must be having an affair. It takes a lot of energy to locate themselves amid this projection.

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Many actors yearn to let down their guard. When people pretend too much, they often become very depressed. But when they allow themselves to be vulnerable in public, they can be blindsided. Here’s one example: Somebody completely makes something up about them — in this Internet age, rumors and lies are spread to tens of millions of people. If they defend themselves, it can feed the media like fuel on a fire. If they do nothing, the story can grow and then they feel trapped and exposed to ridicule. So they often live very guarded lives. Sometimes they don’t feel they have anywhere they can be real. And who is going to have empathy with them for how they feel? They are making millions of dollars and there are incredible advantages in society with being a celebrity.

When they come into therapy, however, they get a chance to be who they really are. I’ve had people who were so depressed, they have withdrawn from the world, people who have stopped working for years. These are people who love to work. I help actors find strategies for surviving and navigating that world without shutting down. Sometimes there is a period of grieving, giving up the illusion of what celebrity was going to fill. They gain perspective on who they really are and whom they trust. What’s most important is that they start to feel real again. — As told to Degen Pener

Blume, a licensed psychologist in Beverly Hills, has worked with creative talent for 25 years.


The Producer: Break Out the Xanax and Klonopin!
By Dr. Philip Pierce

While producers often display outward confidence, they seek therapy for anxiety issues and a sometimes crippling sense of over-responsibility, heightened in Hollywood because of its competitive nature and uncertain stream of income. Producers fear losing face from a project bombing or sending out a script that someone might think is bad. They can become so nonfunctioning that they avoid calls or stop going to industry gatherings because they’re afraid of getting a panic attack. They often have popped Xanax for years. I also see a lot of marijuana used to avoid anxiety. Short-term meds they take are usually Klonopin or Ativan; long-term, an antidepressant like Lexapro.

It’s not surprising that anxiety is exacerbated in Hollywood. Anxiety is basically making negative predictions about the future. And being dependent on what happens in the future is baked into the business. My patients are preparing things that critics will review, that executives will judge. However, it’s not useful to predict that the public is going to hate it or the pilot won’t move to series. All it does is freeze you. Cognitive behavioral therapy — which confronts unhelpful behavior — can help producers spend less time predicting outcomes that mostly never happen. I try to have patients notice when they are fortune-telling. When they do, we say, “Wait, I actually don’t know that bad thing will happen.”

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For over-responsibility, we make a pie chart to look at how responsible you are for the success of a movie. To a producer suffering from anxiety, it feels like 100 percent. We have them write down how much the actors, writer, director are responsible for perspective. It’s important to see that anxiety is not a bad thing. It’s only a problem when it gets past the place at which it encourages effective work. They assign numbers from one to 10 to stress levels. When someone gets an eight or a 10, they are not functioning. People want to be in the three to five range. If it’s one or two, and you are on a beach, that’s fine. In Hollywood, that’s not where you want to be. — As told to Degen Pener

Philip Pierce, Ph.D., is a clinical psychologist in Beverly Hills and a UCLA lecturer and specializes in treating anxiety issues.

The Writer: Yep, Self-Confidence Issues Here
By Dennis Palumbo

This industry wouldn’t operate without writers and yet they’re treated worse than anybody else. They have so little power that they can become infantilized. They come up with an original idea, but then are sitting with producers, the director, studio execs and the star, and everyone has script approval except the writer. Many writers begin to transfer strong parental feelings onto people in positions of power. When writers hand in a script, people will judge it — and these people will love you or they won’t. That can chip away at self-confidence. People come to Hollywood in search of an approving parent and it’s the worst place in the world to find one. The hurly-burly of show business, the fast and dirty part of it, can be overwhelming; the political, financial and competitive aspect is at odds with the thoughtful, reflective way that writers process information. Successful writers, people who win Emmys and Oscars, are the ones who develop a self-affirming relationship with their writing, the ones who understand that trends, agents and managers come and go, but your job is to stay in touch and have a quiet love affair with your writing process. When you’re a writer in Hollywood, the machinery of the marketplace tries to disempower you all the time — the only thing that empowers you is your relationship with your creative self. — As told to Degen Pener

Palumbo, a former screenwriter (My Favorite Year), is a licensed psychotherapist specializing in creative issues.

Read more from The Hollywood Reporter‘s Top Doctors Issue:

Hollywood’s Top Doctors 2015

Hollywood DSM: Industry Shrinks Reveal What’s Wrong With Actors, Producers, Agents and More

Stars and Their Doctors: Seth MacFarlane With the Man Who Saved His Voice for the Oscars

Stars and Their Doctors: A ‘Fifty Shades of Grey’ Producer and the Man Who Knows Him Inside Out

Producer Nigel Lythgoe Pays Homage to the Doctor Who Saved His Baby Grandson

Stars and Their Doctors: Charlie Sheen and the Man Who Gives Him Stem Cells

How a Showtime PR Exec’s Daughter Was Cured of Debilitating Scoliosis

Yes, You Can Turn 100 in Hollywood and Still Work

Former CAA Partner: Why I Became an Agent for the Sick (Guest Column)

Dr. Fredric Brandt’s Suicide Sparks Frantic Scramble for His Celebrity Patients

Nancy Snyderman Breaks Silence on Ebola Nightmare, NBC News: “People Wanted Me Dead” (Exclusive)

Hollywood Psychologist on Reasons Why A-List Couples Fail

Hollywood’s Top Doctors 2015: The Dentist List

Want to Get “Expensive Urine”? Look at the Hollywood History of Health Fads

L.A.’s Westside Mystery: Higher Cancer Rates in One Zip Code, Longer Lives in Another

Manopause and Male Aging: Gavin Polone Says Just Say No to Those Drugs (Guest Column)

Ken Jeong: How to Ditch Medicine for a Career in Comedy and Diagnose Castmates (Guest Column)

Why There’s a Medical Crisis for Transgender Youth (Guest Column)