By Eric Kelsey and Nichola Groom
LOS ANGELES (Reuters) - James Gandolfini, the beefy American actor who died on Wednesday in Italy at age 51, cut an unforgettable figure on screen and stage, earning a reputation as an earnest performer who would go to extremes to prepare for a part.
But Gandolfini's sudden death and famous work ethic also have made evident the physical and mental stresses and time demands many actors endure for their roles.
The cause of death for the star of HBO's "The Sopranos" has yet to be determined and an autopsy was to be conducted in Rome on Friday. HBO said he may have suffered a heart attack.
Gandolfini had spoken of the punishing routines and rituals he put himself through in his eight years playing Tony Soprano, a conflicted New Jersey mob boss who suffered from panic attacks and saw a therapist to work through anxiety and mother issues.
"If the guy had to look good and be handsome and happy, the hours we worked would certainly not help," Gandolfini said in an interview with the Associated Press in 2007, the same year the series ended.
"They (the hours) helped me a great deal... I was allowed to be grumpy and tired and look like (crap)."
He won three Emmys and a Golden Globe for the role.
Judith Orloff, a Los Angeles psychiatrist who counts many actors as clients, describes the stresses actors suffer as "deadly," often manifesting in addictions, such as drugs, alcohol and sex or in simply ignoring doctors' recommendations.
"Their stress levels are extremely high and what that means is adrenaline and cortisol are rolling around in their bodies, which decreases immunity and increases all kinds of health problems and anxiety and depression," Orloff told Reuters.
It was not known if Gandolfini had any health problems. In 2002, a representative for Gandolfini confirmed to the New York Daily News and other media organizations that Gandolfini had struggled in the past with substance abuse.
But his weight, a defining characteristic in his portrayal of Tony Soprano, was an issue. Gandolfini said he gained weight steadily over the 86 episodes he played the character and afterward, too.
In 2009, he told Vanity Fair magazine that he had once described himself as a 260-pound Woody Allen and then said, "And now I'm a 285-pound Woody Allen."
Since "The Sopranos," Gandolfini starred on Broadway in the dark comedy "God of Carnage" and had worked on several films, including last year's thriller "Zero Dark Thirty."
'INCREDIBLY PUNISHING ROLE'
Gandolfini's peers considered him a dedicated actor who stayed in character between takes. He insisted on wearing Tony's trademark heavy bathrobe under the hot studio lights, said Brett Martin, a GQ correspondent who has written about Gandolfini.
"It required a descent into Tony's psyche to give the performance he did," said Martin, whose upcoming book, "Difficult Men" examines the legacy begun by Gandolfini's portrayal of the deeply flawed Soprano. "It was an incredibly punishing role physically."
Actors like Gandolfini who channel their characters' habits and psychology - notably "method actors" - have difficulty letting go of the role after leaving the set, Orloff said.
"I've seen patients get the illness of their characters," she said. "They are so creative, they are so talented they become one with their characters. And if you are playing Hannibal Lecter it's a bit difficult unless you really know yourself."
"Sopranos" cast members grew accustomed to Gandolfini whipping himself into an emotional frenzy of grunts and curses before shooting a scene or hitting himself in the head if he forgot any lines, Martin said.
"The sheer physicality was the problem," he said. "Underneath this was a genuine sweet and shy guy.
"He'll always be Tony. He was probably always going to be Tony one way or another, which I can understand being a burden."
(Editing by Mary Milliken and Bill Trott)