(McClatchy-Tribune Information Services) -- Nothing like having the whole world watching to increase stress levels. And more stress means more troubles: mental breakdowns, physical illness, relationship woes.

The latest examples of the wreckage of over-exposure: Susan Boyle's admission to a psychiatric clinic and the apparent unraveling of Jon and Kate Gosselin's marriage.

Boyle's fairy-tale journey took her from a small Scottish village, where she sang in the church choir, to the acclaim and Internet sensation from her stunning performance in April on "Britain's Got Talent." But it veered off the happily-ever-after track last week, when Boyle lost her temper and dropped the "f-bomb" on several occasions and then finished second on "Britain's Got Talent." Shortly after the performance, she was delivered to London's Priory for treatment for "exhaustion."

The TLC show "Jon & Kate Plus 8" had its beginnings two years ago as a reality show about a super-sized family. After having twins, the couple had sextuplets in 2004. The show seemed to portray a wholesome, mostly happy family until this year, when the marriage began to implode with accusations of cheating on both sides. Needless to say, ratings have soared with this turn for the worse.

Which raises the question: What is it about fame and public scrutiny that so often causes people to come undone?

Robert Trestman, a professor of medicine and psychiatry at the University of Connecticut Health Center, likened it to winning the lottery. Often those who win the lottery spend or lose it all in a few years if they don't have the skills to handle millions. Those living quiet lives may yearn for fame, but if they are suddenly plunged into the limelight, they often don't have the skills to deal with it.

"All of a sudden, everything is exposed to public scrutiny," said Trestman. "It's a huge shift in the way someone views themselves. Not everyone is cut out for that."

There can be insomnia, anxiety, depression. "Now, everything you say or do matters. ... Now making a mistake is much more costly. ... You start second-guessing yourself. ... Every day is jam-packed. You're having to make many, many more decisions than you're used to."

James DeGiovanni, director of training and psychology at Hartford Hospital's Institute of Living, said that for Boyle, the message was particularly double-edged. What made her April performance on "Britain's Got Talent" a must-see on YouTube.com was less about her magnificent voice and more about the disconnect between her frumpy appearance and that voice.

"There were all these implicit messages," said DeGiovanni, "that who she was as her own person wasn't good enough. ... The message was: We love you, but why don't you get a new hairstyle? Everyone wanted to fix her in some way."

Dr. Michael Silverman, a psychologist and assistant professor at the Mount Sinai School of Medicine, said he has treated many celebrities who say, "People don't want to know me for who I am. They want me to be the celebrity that they think I am. I can tell you in all honesty, this alone has sent people to the hospital. They have to reconcile who they are with, in a sense, who people want them to be."

In the case of the Gosselins, DeGiovanni said, ordinarily a couple's private thoughts or actions are usually kept within the confines of the relationship. If one member of a couple shares those actions with a single friend, it can strain a relationship, he said. Now imagine having those problems shared with an entire television audience. "A lot of our self-esteem is based on what others think about us. ... As you enlarge the circle of who I have to worry about, it puts additional strain" on a relationship, DeGiovanni said.

In addition, there is the destructive incentive for the Gosselins: The more they fight, the higher the TV ratings.

In an interview with Rolling Stone in 2006, Nick Lachey talked about how the television cameras of the "Newlyweds" reality show affected his former marriage to Jessica Simpson. In the article, Lachey said, he found himself playing to the audience, having the kinds of arguments that he knew would interest fans.

"Jessica and I began playing these parts even when we were by ourselves," Lachey is quoted as saying. "It became a blurred line. There was a question about what truly was our reality."

What are the chances for recovery for Boyle or the Gosselin marriage? Mental health experts don't want to guess, but Frank Farley, psychologist at Temple University and former president of the American Psychological Association, said of Boyle: "She may have more resilience than people are giving her credit for. ... She did audition. That's gutsy, and it's a form of risk-taking, and she did it."

Copyright (C) 2009, The Hartford Courant, Conn.