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Diagnosing Charlie Sheen, from afar

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Last month, when actor Charlie Sheen was hospitalized with severe abdominal pain, his camp reported that he had a hiatal hernia.

This week, Sheen launched into a media blitz-slash-meltdown after CBS canceled his show, “Two and a Half Men,” for the remainder of the season. In interviews on ABC, CNN and other outlets, he spoke of “tiger blood” running through his veins, insulted his bosses and questioned the value of Alcoholics Anonymous in fighting addiction.

No explanations for his behavior have been forthcoming this time around, leading experts to engage in remote diagnosis instead.

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Discussion continues, of course, about the actor’s alleged substance abuse. On a recent radio show, Sheen -- who began an in-home rehab program for drug use soon after the hernia incident -- denied that he had a problem.

“I have a disease?” he said. “I cured it right now with my mind.”

Deni Carise, the chief clinical officer of substance abuse program Phoenix House, wrote that Sheen’s behavior indicates he may still be abusing drugs. “When people with a history of abusing drugs suddenly can’t control their words or behavior, it’s a strong indication that they may indeed be abusing drugs again,” she said.

Sheen’s mental health has come into question too. Psychologist Deborah Serani, writing at Psychology Today, joined the camp that thinks he might have bipolar disorder. (Last week, celebrity-addiction celebrity Dr. Drew Pinsky suggested that Sheen was “clearly manic.”) A lengthy analysis of Sheen’s recent comments on Time Magazine’s Healthland blog made a similar suggestion.

“His recent ranting behavior has led viewers to question whether the actor was still on drugs and denying addiction. Or whether he was exhibiting manic symptoms of bipolar disorder. Or some combination of the two. Sheen’s negative drug test suggests that addiction is unlikely to be his only problem,” wrote Maia Szalavitz.

“Although it isn’t possible to diagnose patients at a distance, Sheen’s case illustrates why it can be sometimes difficult for experts to distinguish between symptoms of a cocaine or meth high, drug withdrawal and bipolar mania,” she added.

The debate will likely continue Tuesday evening as Sheen appears on ABC’s “20/20.”

RELATED: A recent story in The Times about diagnosing children with bipolar disorder

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RELATED: More on mental health from The Times

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