Editorials

Death in Hollywood

Any relation between self worth and mortality is uncertain

Appearances are deceptive p 1491

Death in Hollywoodthe subject of a paper in this issue (p 1491)¹brings to mind the page turning pleasures of Kenneth Anger's classic tales of a contemporary Babylon. ^{2 3} The mixture of drugs, drink, sex, violence, monstrous egos, gangsterism, speed, and madness is often most starkly revealed in the premature deaths of (sometimes has-been) stars. The suicides can be particularly indicative of the roller coaster nature of fame: Albert Dekker wrote sections of the poor reviews from his last film in crimson lipstick on his body before hanging himself; Lou Tellegen stabbed himself with gold scissors engraved with his name, surrounded by film posters, photographs, and newspaper cuttings from his days of triumph; and Peg Enwistle jumped to her death from one of the giant letters of the Hollywood sign (setting off a spate of copycat leaps into oblivion). Among the better known suicides are (probably) Marilyn Monroe and her Oscar-winning co-star in All About Eve, George Sanders, whose note read "Dear World: I am leaving you because I am bored. I am leaving you with your worries in this sweet cesspool."

To these suicides can be added the long list of those for whom the road to excess led to premature demise. Among the stars of the silent screen were Wally Reid (morphine), John Gilbert (drink), Alma Rubens (heroin), Olive Thomas (barbiturates), Marie Prevost (drink), and Barbara La Marr (everything). More recently Oscar winner and heroin enthusiast Bobby Driscoll was found dead in a New York tenement and River Phoenix collapsed after his last speedball outside a club in Los Angeles. The overdose at 50 of Don Simpsonactor and producer (of Flashdance, Beverly Hills Cop, and Top Gun, among others)encapsulates the Hollywood version of it being better to burn out than to fade away.⁴ With his $60 000 a month drug habit, orgies, fights, and busts, we hear that "Don was never afraid of getting old. He was afraid of getting fat. . . . He died at a remarkably old age, given the way he was living."⁵

Despite their sometimes squalid nature, these Hollywood deaths retain their glittersurely this is a better way to go than to stagger on through to the boring three score years and ten? As a reader of a Don Simpson biography writes, "Why is it I love people who live their lives like sick maniacs and then burn out in a blaze of glory?"⁶ In this week's BMJ, however, the impossible is achieved, and Hollywood deaths are robbed of their glamour and excitement, by the simple expedient of being turned into epidemiological endpoints.

In an ingenious analysis Redelmeier and Singh have examined the mortality records of screenwriters who were nominated at least once for an Oscar to see whether those who win live longer than the also rans.¹ Their motivation was to test the hypothesis that socioeconomic differentials in health are largely determined by the psychological consequences of perceived social standing and the psychoneuroendocrinological sequelae of these perceptions.⁷

Some authorities consider that feelings of shame, humiliation, disrespect, and social anxiety are major determinants of population health and of health differentials in rich countries⁷ and that psychotherapy may be the solution to health inequalities.⁸ Winning an Oscar, it is reasoned, should have a positive effect on feelings of perceived social standing. Indeed, as almost as many Americans watch the Oscar ceremony as vote in presidential elections,⁹ it is difficult to think of many greater public validations of self worth in the USA.

The findings, however, ran in the opposite direction to the expected: the Oscar winning screenwriters have shorter life expectancies than the losing nominees. Why could this be? The obvious way to look at this is to see if it is a general finding or is specific to screenwriters. Clearly the Oscar ceremonies are largely about acting awards rather than writing creditsthis is what the vast audience is tuning in for. So why was mortality among writers rather than actors and actresses examined? The answer, unsurprisingly, is that the authors did examine mortality among actors,⁹ but, appropriately, since the acting Oscars are more prestigious than the writing Oscars, the findings about actors appeared in the Annals of Internal Medicine (impact factor 9.8) rather than the BMJ (impact factor 5.3). Acting Oscar winners had longer life expectancy than nominees who didn't win. There was no influence of being nominated but not winning on life expectancy: a matched control group of actors in the same film as each Oscar nominee had the same equal life expectancy as the unsuccessful nominees.

Thus there seems to be no general connection between the status enhancing effects of Oscar winning and either increased or reduced life expectancy. Is there something special about writers? Eminent creative writers have shorter life expectancies than other artists, ^{10 11} one suggestion being that writers receive less immediate reward or sensory stimulation than other artists, which leads to greater stimulation seeking and risk taking.¹⁰ However, tortured creative souls are probably more likely to write poetry or gnostic novels than screenplays, and screenwriting is often a collaborative activity.¹ The possible connection between creativity and psychopathology has long been discussed,¹⁰ and the role of alcohol and suicide in the deaths of writers highlighted.¹² However, the overall life expectancies of the screenwriters were closely similar to those of the actors, suggesting that the former were not being crucified by their oversensitivity.

Redelmeier and Singh suggest that screenwriters can behave badly, unlike actors whose lives are under external scrutiny. Readers of the National Enquirer might doubt whether this is true, a view again backed up by the similar overall life expectancy of actors and screenwriters. Perhaps the difference lies in the meaning of an Oscar for the future life and career of a screenwriter and actor. For an actor an Oscar "can do wonders for . . . negotiating a salary."¹³ While more income may not do much for already wealthy actors (although for some an Oscar has meant escape from periods of hardship), this will also translate into more secure future employment, a longer acting career,⁹ and the ability to negotiate the terms and conditions of work. Screenwriters are, notoriously, a heavily exploited branch of the movie industry and for a screenwriter an Oscar may give a considerable immediate psychological boost but will not guarantee future success or employment. This was particularly true during the anti-Communist witch hunt of the McCarthy era (which is covered by the present study), in which screenwriters, including many Oscar winners and nominees, were particularly persecuted.

While all Oscars are 13.5 inches tall¹³ and probably bring increased feelings of self worth, they may translate differently in actors and screenwriters into those factors that increase or decrease life expectancy.

George Davey Smith, professor of clinical epidemiology. 

Department of Social Medicine, University of Bristol, Bristol BS8 2PR(zetkin{at}bristol.ac.uk)

Acknowledgments

Thanks to Alexandra Allen for tracking down references.