Charlie Sheen: What's Next, Who Can Help?

Rehab, jail and death are all realistic fates for the fired actor, experts say.

ByKATIE MOISSE, ABC News Medical Unit
March 8, 2011, 12:36 PM

March 9, 2011— -- Actor Charlie Sheen last night took to his online program, "Sheen's Korner," to lament his recent firing from "Two and a Half Men" and blast his former bosses. Sheen has dismissed widespread suspicion that addiction or mental illness might be fueling his antics, claiming earlier to be on the drug "called Charlie Sheen" and not bi-polar but "bi-winning."

But his increasingly erratic behavior, which cost him his job Monday on the hit CBS comedy, has many health professionals concerned about his well-being even as skeptics say it's all for show.

"When addicts are high on drugs, or a manic person is high due to the biochemical changes in his brain, they reject help because they truly believe that they are 'winners' who know better than everyone else what is best for them," said Dr. Carole Lieberman, a psychiatrist at the University of California, Los Angeles.

But the job loss and the removal of his 2-year-old twins, Max and Bob, from his home last week might signal the end of Sheen's "winning" streak.

Eric Braun, a friend of Sheen's, told GQ magazine "there are just three options" left for the fired actor: "rehab, jail or death."

Mental health experts agree.

"Frankly, we really don't know what leads one person to a specific end," said Dr. Eric Caine, chair of psychiatry at the University of Rochester Medical Center. "No doubt, this man is a mess and his 'destiny' may not be a happy one."

While Sheen's conduct in media interviews and in his online show has shocked viewers, psychiatrists say they've seen it all before.

"There is nothing so unusual about what we are seeing -- for those of us in the mental health field -- just that we are seeing it so publicly," Caine said.

Sheen's long track record of offenses -- from drugs and violence to rumors of trouble on set -- might have hinted at mental health problems in the past. Yet he has consistently avoided major repercussions that could have "tempered his grandiosity," according to Alesandra Rain, co-founder of Point of Return, a nonprofit organization in Westlake Village, Calif., that helps people escape pill addiction.

"Now the consequences are beginning to hit him, but he is still working from the perspective that he is untouchable," Rain said. "His media blitz is being misinterpreted as public support and he is not in the frame of mind to realize the damage he is doing."

Supporting Sheen

To repair the damage to his health, his career and his relationships, Sheen will need a dedicated network of support; one that will likely include many of the people he has publicly offended.

"This may require ex-spouses, family members, friends and colleagues who don't always work together or even get along, to present a uniformed front and work together," said Joshua Klapow, a clinical psychologist at the University of Alabama, Birmingham School of Public Health.

Having everyone on board is critical, Klapow said.

"This is a huge undertaking in a situation like Charlie's," he added. "He has huge social networks."

The long-term effects of what might be a public decline for Sheen are uncertain.

"The world can be very forgiving, especially if his behaviors are viewed by others as victimless," Caine said. "Having a powerful negative impact on the people around him would tip the balance. Short of that, many are allowed to recover from being fools or buffoons."

Sheen reportedly threatened to cut off ex-wife Brooke Mueller's head and send it to her mom. He also called "Two and a Half Men" creator Chuck Lorre a "clown," a "stupid, stupid little man" and a "p***y punk that I never want to be like."

But acknowledging past mistakes is part of the recovery process, said Martin Binks, clinical psychologist and CEO of Binks Behavioral Health PLLC, citing the 12-step program from Alcoholics Anonymous. Sheen's media frenzy might therefore aid in his recovery, said Binks, such that "he will have lots of data to look back on and remind himself of his bottom."

Sheen called Alcoholics Anonymous a "bootleg cult" with a 5 percent success rate in a Feb. 24 interview on "The Alex Jones Show."

As for Sheen's future, learning to live with the consequences of the past is part of recovery, said Mark Williamson, a psychiatrist at Memorial Hermann Prevention and Recovery Center in Houston.

"It is often quoted in treatment circles, 'You cannot save your behind and your face at the same time,'" Williamson said. "With appropriate treatment, people will be informed by their past behavior as it relates to their everyday lives moving forward."

Sad Reality or Reality TV?

Although Sheen's behavior on TV and online might appear to be his last act, they could be his best performance ever, according to Randy Roberts, author and distinguished professor of history at Purdue University in West Lafayette, Ind.

"Beyond rehab, jail or death, I think there's a fourth option here," Roberts said. "A realty-TV show."

Roberts said Sheen "pressed the limits of what can be done on TV and now he'll press the limits of realty TV.

"Everybody's playing their part in this made-for-TV drama," Roberts said, adding that the tape of the police taking his kids away should have tipped everyone off.

George Santo Pietro, another friend of Sheen's, said Sheen is still in control.

"There's a method to his madness," Pietro said. "There's a bigger story to Charlie than everyone has seen."

The University of Alabama's Klapow said it is possible that Sheen's behavior is calculated.

"We don't know what is orchestrated, we don't know what is drug induced, and we don't know what are his demons coming to the surface," Klapow said. "All we can do is sit, watch and hope and pray that we are seeing a performance and not the real Charlie Sheen."

ABC News Live

ABC News Live

24/7 coverage of breaking news and live events