Critics of the popular reality TV show, Celebrity Rehab, are claiming that Dr. Drew Pinsky exploited the show’s participants and thereby contributed to five untimely deaths. Mindy McCready’s recent suicide marks the fifth celebrity death from the show and has generated a nationwide media discussion about blame.

I never watched the reality show and have never met Dr. Pinsky, so I can’t attest to his motives or the show’s ethics but presumably he and the show acted in good faith. I can say that people who have “dual diagnoses” (i.e. mental illness and substance addiction) are at very high risk for suicide regardless of whether they appear on television or not. This makes speculation that Dr. Pinsky’s show had anything to do with these deaths unlikely.

 The deceased were victims of serious mental illnesses that put them at high risk for suicide. Forensic psychiatrists have studied and defined the risk factors for self-injurious behaviors. These can be divided into non-modifiable and modifiable risk factors.

Risk Factors for Suicide

Non-modifiable risk factors include things like; sex, age and race. Men are more likely to complete suicide while women are several times more likely to attempt suicide.  There is a bimodal peak for suicide found in young adults and elderly individuals over the age of 65.  And Caucasians represent the highest risk demographic.

 Past behaviors predict future behaviors, so any person who has a history of making a suicide attempt is that much more likely to try it again. In addition, if a close family member attempted or completed suicide, that puts their relations at an elevated risk.

Modifiable risk factors; mental illness, substance abuse, ownership of guns, and lacking social supports, are things that professionals can help to treat or change. Prescribing medicine and referring someone to therapy can help get signs and symptoms of major mental problems under control. If someone has substance addiction, doctors would recommend complete sobriety and refer that individual to programs that can assist with recovery. Since violent methods, like shooting or hanging, are the most likely ways to be successful at suicide, doctors strongly recommend that patients have no access to weapons and screen for their presence during routine interviews. While professionals can’t give someone a social life, job, or education (all things that are protective), they can suggest day treatment programs, group therapy, or vocational programs that can contribute to a person’s sense of connectedness to society.

Although it might seem counterintuitive, recently leaving a psychiatric hospital, or even a doctor’s appointment, automatically puts people at risk for suicide. Studies have shown that completed suicides often occur within weeks of seeing a physician or leaving the hospital.

As doctors, we make recommendations to patients relying on evidence-based medicine and clinical judgment. It is up to each individual patient, however, to take action and commit to treatment. One thing that people must realize is that they are their own agent of change. Nobody else, including their psychiatrist or therapist, can control their lives or save them. Sure, we can make a diagnosis, prescribe medicine, and in some cases lock people in the hospital against his or her will for a short period of time. But ultimately, when someone is free to live in the community, it is up to them to make choices and own the consequences.

Ms. McCready, 37, who reportedly had a tumultuous personal life and suffered from substance addiction and depression, was at high risk for suicide even without ever appearing on Celebrity Rehab. Statistically it makes sense that shows like this, which run for a handful of seasons and have “high risk” participants, will have some bad outcomes.

Why Do People Blame During Grief?

Suicide is a permanent solution to a temporary problem. This makes it so challenging to understand why anyone would choose it. During these times of death and sadness, it is normal to go through a grieving process that includes anger and blame. In this case, fans are mourning the loss of a singer and the widely publicized reality show is an easy target.

Elisabeth Kubler-Ross hypothesized that there are “five stages of grief” in her 1969 book On Death and Dying. She theorized that when faced with death, the human mind will experience a series of emotional “stages.” In no specific sequence these are: denial, anger, bargaining, guilt, and acceptance.

It is inevitable that after a tragedy like suicide the nation will grapple with all of these emotions. Acceptance can begin when people start to understand the multiple risk factors that contributed to this terrible event and increase awareness of mental illness and its terrible outcomes.

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