At some point toward the end of the 2020 Oscars, my culture-shocked boyfriend turned to me, pupils dilated on glitz, glam, and a series of disturbed acceptance speeches, and asked, “Are the stars OK?”

Certainly not.

Taylor Swift struggles with disordered eating. Justin Bieber thinks he has chronic Lyme disease. Kim Kardashian’s hands swell with psoriatic arthritis. Ariana Grande is coping with post-traumatic stress disorder. Lady Gaga has fibromyalgia. Linda Ronstadt has a neurodegenerative disease. Demi Lovato overdosed on heroin. And all of them—at least if you believe the most recent wave of celebrity documentaries—are infected by fame.

Celebrity documentaries have always fed on pain. All documentaries do, to a certain extent. It’s there in the first celebrity documentary, 1965’s Buster Keaton Rides Again. Ostensibly a black-and-white behind-the-scenes look at the making of his strange slapstick film The Railrodder, the 55-minute movie delves into the silent film star’s earlier battle with alcoholism, which cost him his family and fortune. And it’s there in the most recent, Justin Bieber’s Seasons, a 10-part YouTube series promoting his new album—and spelunking into the dark depths of his neuroses, addictions, and infectious diseases.

But the way that pain is framed has changed radically in the last half-century. Celebrities used to experience illness like the rest of us, albeit with access to seemingly better care. But celebrity itself is now a disease—an affliction that curdles the mind and batters the body all while coating you in gold. The outside world may not be able to see your pain, but the last decade of celebrity documentaries has made clear that fame feels a lot like sickness.

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In a recent piece for The New Yorker, Amanda Petrusich wrote, “Perhaps the biggest downside of being rich and famous is that no one will ever feel sorry for you again.” But eventually you get rich and famous enough you can fund a rehabilitative documentary.

In January, Taylor Swift released Miss Americana, a film about her stunted adolescent development and delayed political awakening. While the Netflix film covered a decade in the spotlight, for many skeptics, perhaps the most moving part of the documentary is when the singer discusses her body image issues and disordered eating. Alone with a cameraman in the backseat of a car, Swift says that when she saw herself in a paparazzi shot she found unflattering, “that would just trigger me to just…starve a little bit. Just stop eating.” She would also push her body to its limits in the gym. “I would’ve defended it to anyone who said, ‘I’m concerned about you.’ I was like, ‘What are you talking about? Of course I eat. It’s perfectly normal. I just exercise a lot.’ And I did exercise a lot. But I wasn’t eating.” Now, she says, when she catches herself thinking this way, she tells herself, “Nope, we don’t do that anymore. We do not do that anymore.”

It’s a small moment, but one that reverberated. For years, Swift saturated the media with images of herself appearing impossibly skinny, flanked by other supermodels. In Buzzfeed, Anne Helen Petersen, a vocal critic of this era of Taylor Swift’s career, praised the singer’s honesty about the personal issues that drove her public persona. Petersen wrote that “what [people with disordered eating] need, and what Swift does, is show that we’ll still be OK—even valuable and beloved—if we leave those behaviors behind.” With a single well-lit scene, Swift pivoted from a perpetrator of unattainable beauty standard to liberator of the masses, and humanized herself in the process.

Celebrities have documented more physical pain, too. In 2017, Lady Gaga released Lady Gaga: Five Foot Two to promote her then-forthcoming album, Joanne. It’s an unwieldy film. It seems to cover more ground than any other celebrity documentary—there are tantrums and tears. Gaga, who has built her career around a Warholian performance of fame, sees the camera as much, or perhaps even more, than it sees her. In one scene, she submerges herself fully-clothed in a pool as part of a photoshoot. As the water warps her image, hot mic audio of Gaga crying to her assistant plays: “All these people will leave. Right? They will leave. And then I will be alone. I go from everyone touching me all day and talking at me all day, to total silence.” And then she resurfaces—composed, professional, in control.

But over the course of the film, Gaga’s physical limitations come to light. In the opening scene she moves from her California kitchen to a room upstairs where a masseuse is waiting to gingerly release tension from an old hip injury. But 30 minutes later, Gaga is sobbing in her Central Park apartment beneath towels and ice packs. This time, a different masseuse mounts the fainting couch to forcibly stroke Gaga’s face. “Do I look pathetic?” she asks, crying. “I’m so embarrassed.” Fifteen minutes later, she’s back in LA in the doctor’s office for trigger point injections. As she sits on the exam table, naked except for a thin hospital gown, her team tries to get her to do her makeup.

Watching Gaga, her excruciating pain is undeniable. But she’s performing it nonetheless—this time, as a penance for the fans who are embittered about the shows she’s cancelled for medical reasons. And she knows it. “Look, the truth is that there’s a fair amount of reality to the fact that some people really relish in the pain of famous people…there’s an element of humiliation, like we’re just court jesters,” she told the Los Angeles Times. “And it’s very exhausting to live in that when you’re already feeling like you have to live up to a standard for others. I guess what I’ve learned is that everybody’s gonna have an opinion, but it’s important for me to know that I’m who the [hell] I am. And you can take it or leave it.”

Justin Bieber took celebrity medicine to new heights this year when he released Seasons. In the serialized documentary, we meet Beiber’s collaborators and his wife Hailey Bieber. But the real supporting cast is a network of doctors, behavior specialists, health coaches, and medical devices.

Bieber confesses he began smoking marijuana at the age of 12 or 13. More recently, he was addicted to lean. At one point, he says, his team would come into his room in the middle of the night to check that his heart was still beating. He has been diagnosed with chronic Lyme, a controversial form of the tick-borne illness that most doctors do not recognize as a valid diagnosis. He also has “Epstein-Barr”—the technical term for mono—which lives in your cells forever once you’re infected and can occasionally recur. While Bieber clearly loves to spend time in the studio, laying down tracks with a few close friends, he quickly becomes overwhelmed on set or in public. At one point, shooting the video for “Yummy,” he’s reduced to crying and crouching in the corner, furiously rubbing his eyes and hair to stay calm. A psychiatrist diagnosed Bieber with bipolar disorder, but his “brain doctor,” the widely-discredited Daniel Amen, says he’s seen scans of Bieber’s brain and knows that’s not true. The kid’s just worked too hard and taken too many drugs—he’s tired.

As part of his recovery, Bieber keeps hyperbaric oxygen chambers—a legitimate treatment for the bends, and a much less legitimate treatment for all other kinds of issues, like fatigue, anxiety, and depression—at home and in the studio. He carries around a little IV bag, which administers nicotinamide adenine dinucleotide, or NAD+, a molecule that Hailey Bieber says, sans evidence, will “repair the pleasure centers in [his] brain.” He talks constantly about “toxins” and his attempts to flush them from his body. He takes many unspecified supplements, presumably to do the flushing. At one point, Hailey Bieber acknowledges this sounds like “some rich people shit.” But everyone on camera expressed a wide-eyed belief in the healing powers of these drugs and devices—he couldn’t have made “Yummy” without them.

Seasons was meant to prove that Justin Bieber, popstar-prankster extraordinaire, is finally “settling down.” But it’s a profoundly unsettling documentary. When the final credits roll, the viewer is left with the distinct impression that Bieber is surrounded by sycophants, and they’re all drinking the snake oil. His pain is real, but the treatments he’s seeking are not. Instead of addressing his clear psychic distress, his team focuses on the physical, and offers him pricey placebos.

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These tropes—the car ride confession and the soul-sucking photoshoot—were honed years ago. Swift, Gaga, Bieber, and their respective directors drew from earlier documentaries, like Beyoncé’s Life is But a Dream from 2013 and the 2015 biopic Amy about the late Amy Winehouse, for stylistic and structural support. Both films subverted the traditional music documentary—typically built around a concert tour—and created something darker.

Life Is But a Dream debuted in 2013 on HBO. The film, which Beyoncé executive produced, narrated, co-wrote, and co-directed, emerged from the vlogs she began recording as a quasi digital diary. It documents her miscarriages, eventual pregnancy with Blue Ivy, and the production of her album 4, the first she made outside the influence of her father-manager Mathew Knowles. It also rails—quietly, in Beyoncé’s signature, ASMR-adjacent rasp—against fame, fandoms, and anything else that disrupts the creative process.

“I always battle with: How much do I reveal about myself? How do I keep my humility? How do I keep my spirit and the reality? And how do I continue to be generous to—to my fans and to my craft? And how do I stay current? But how do I stay soulful?” she says. “And it is the battle of my life.”

Fans loved the film, which they felt gave them an unvarnished look at their idol. Critics did not, seeing Life Is But a Dream as less a documentary and more like a 90-minute-long experiment in low-fi propaganda. But the movie—like the rest of Beyoncé’s cold new media strategy—offered an updated template on celebrity myth-making (or, more often, myth re-making) that still circulates. Built around selective silence, a vocal struggle with iconography, evidence of a perfectionist’s relationship to the music, and an emphasis on physical or psychological illness (in Beyoncé’s case, it was fertility issues), the film promises to reveal, while really cementing the celebrity’s power to conceal as they see fit.

Beyoncé’s story of sacrifice was reified by Amy, which used mostly found footage to document the late singer’s downward spiral. It debuted to near universal acclaim—a “profoundly tragic” work, critics wrote, full of “worthy insights about the damaging effects of celebrity on psychologically fragile individuals.” But it was also treated as a necessary “challenge to public complicity.” At one point, Winehouse says, “I don’t think I’m going to be at all famous. I don’t think I could handle it. I’d probably go mad, do you know what I mean?” The audience, stomachs sinking, knows how right she is.

Compared to Beyoncé’s carefully orchestrated self-disclosures and the unvarnished pain of Amy Winehouse, earlier celebrity documentaries suddenly looked disingenuous. Were the boys of One Direction really enjoying themselves in 2013’s This is Us? In hindsight, Justin Bieber was certainly struggling with inner demons in 2013 while making Believe. And no fairytale aged as poorly as Michael Jackson’s This is It, which projects a shining image of a once-in-a-lifetime talent, despite the fact that by the time it premiered Jackson was dead in what the LA County Coroner had declared a homicide. If he were a different singer, from a different generation, Jackson would have made a very different film—with Conrad Murray as a talking head.

As good PR became carefully honest PR, artists found new value in their physical struggles, which often operated like fame itself. For a celebrity, fame is, in many ways, like an eating disorder or a tick-borne disease—one day, you’re you, and the next day you’re a worldwide brand. And like tuberculosis, which the Romantic poets believed made its youthful victims incandescent, celebrity will kill you, but first it will make you beautiful. The illness metaphor works its seductive magic on viewers, too. Disease has always functioned as a great equalizer. Fame and wealth can’t shield you from body image issues or the pain of fibromyalgia, which makes sharing these issues an easy shorthand for “authenticity.”

Of course, not every celebrity uses these metaphors, or pursues this level of myth-making. But it’s no surprise that those who do choose to document their struggles on camera are often singers—even without the capitalist logic of an album release. For many singers, music is a way to process their personal experiences and the full range of their joy and suffering. Popular music seeks universal appeal, but it is fundamentally rooted in the embodied experience of the individual performer, onstage and off. Documentaries serve as an extension of that self-expression. In addition to their traditional artistic outlet, entertainers have found a more explicit means of communication, too.

This is especially true for artists who can no longer practice their craft. In CNN’s 2019 documentary Linda Ronstadt: The Sound of My Voice, the filmmakers chronicle Ronstadt’s long and varied career at the top of the charts and her forced retirement from a degenerative disease—in the film, she says it’s Parkinson’s—that stripped her of her legendary singing voice. The same year, Liza Womack executive produced Everybody’s Everything in 2019, a documentary about her dead son, the rapper Lil Peep. While Peep, who died just after his 21st birthday from an accidental overdose, can no longer make music, dozens of his friends and family members had something to say, and the ability to say it. In these films, illness moves from a beat in an ever-advancing plot to the very reason for filming.

It’s probably not healthy for celebrities to prostrate themselves for the public—or for the public to consume their pain, like moths drinking an elephant’s tears. But this sub-genre is unlikely to disappear anytime soon. Justin Bieber’s mono may go into remission and Taylor Swift will continue to beat her eating disorder into submission, but our collective illness—our insatiable idolatry, and the demand for “authenticity” at all costs—is chronic. At least some of these films come close to the truth: that we, the audience, are the virus.