Tuesday, August 12, 2014

Suicide: A permanent answer to a temporary problem. Rest in peace, Robin Williams.

The news last night was tragic, Robin Williams has died of an apparent suicide of the early age of 63.  I saw the news and felt overwhelmingly sad.  Really?  He was a tremendous actor, a creative genius by any account, a man who I imagined had everything -- talent, wealth, fame, the wonderful ability to make people laugh and to brighten lives. Such people also get draped with love and admiration, though certainly at a price.   For what it's worth, Robin Williams has been open about the fact that he's struggled with both depression and addiction, but the complete story is never the one that gets told by the media.

Twitter started with 140 character links to Suicide Hotlines and suicide awareness, to statements about how depression is a treatable illness -- Is it always? -- and I hit re-tweet on a comment stating "We’re never going to get anywhere till we take seriously that depression is an illness, not a weakness" and several people retweeted my retweet.  I'm not sure why I did this; I don't think that most people still think of mood disorders as a "weakness," or that those who do might change their minds because of a tweet.  And I don't think that suicide does anything to reduce stigma.

One shrink friend tweeted a comment about how one should never ask someone why they are depressed, I guess because the "why?" implies something other than because biology dictated it, but if you've ever spoken to a person suffering from depression, you know that it comes in all shades of severity and that people often write a story to explain it.  Sometimes that story is right -- I'm depressed because of a break up, or because I don't have a job now, or because of on-going work stress -- and indeed, the person suffering often feels better after talking about the situation, after getting a new boyfriend or a new job, or after their boss moves to Zimbabwe.  I'm convinced that treatment works best when psychotherapy is combined with medication (if indicated) and while medicines are a miracle for some, they aren't for others.  As psychiatrists, we certainly see a good deal of treatment-resistant depression.  And yes, the anti-psychiatry faction may postulate that it is the treatment -- the medications, specifically - that cause people to kill themselves and others, but I will leave you with the idea that the science just doesn't support that.  Certainly, they aren't for everyone, but clinically I have seen medications do more good than harm in clinical practice overall. Please don't send comments about how treatment kills, I won't be publishing them. 

I know nothing about Robin Williams beyond what I've read in the media, and I know that the media presents it's own version of what happened.  I do imagine that Mr. Williams had the resources to get good care and that he may well have had treatment for depression since he was open about his struggle.  His story will be used to say "Get Help" and if you're feeling suicidal and aren't getting help, please do.  If you're feeling suicidal and "help" isn't making you feel better, please consider getting a second opinion or a different kind of help.  

The tragic thing about suicide is that it's a permanent answer to what is often a temporary problem.  People commit suicide for a variety of reasons -- unbearable psychic pain of the type that comes with Major Depression or Bipolar Disorder or any other psychiatric disorder, being just one reason.  Being in a bind (financial, love, legal) that one can't think of a way out of is another.  And tragically, on an impulse, with the barrier lowered by drugs or alcohol.  The truth is that when psychic pain --from depression or grief or heartbreak or anything else-- is bad, intoxication offers a quick relief for a fleeting moment, and when that moment of relief passes, a person's mood often drops violently and then suicide offers another way out, with the usual obstacles removed by the intoxicant.  If you're feeling sad, don't drink or use drugs to alleviate the pain, and if you must, don't do it alone and don't do it where there is easy access to a lethal means of ending your life.  

Sometimes, I imagine that there are people who have tried and tried to get help and that their pain remains so unbearable for so long that suicide offers them the only possible relief -- if such a thing is even to be had given that we don't what comes next and some religions will say that suicide leads to nowhere good.  Even if it provides relief to the person involved, it comes with the cost of leaving those who remain in horrible pain.  Sadly, depressed people sometimes imagine that the world will be better off without them, and often that idea is just not true. 

I hope that Robin Williams is in a better place, for his sake.  I hope that before he ended his life, he tried every possible treatment option, and that this wasn't an impulsive decision, or one based on an episodic relapse of either depression or substance abuse -- a relapse that may have resolved and let him live for decades more.  I hope his wife and children and all the people who knew and loved him will eventually find some peace.  His death, however, is not simply a personal one because he touched us all with his talent and his charisma.  What a tragic loss. 


Milo said...

He was beautiful

Moody Mommy said...

I'm not one to really follow celebrity news. I'm not one to be upset by the death of a celebrity...it is sad as it is anytime there is a premarture ending to a human life, but I don't know the person. But Robin Williams' death has left me shaken and in a really weird mood (and I feel kind of stupid and silly about that but it's true).

The thing that stands out to me is, as you said, I imagine he had the resources to get the best of care. And despite that, it wasn't enough to help him.

I struggle with bipolar depression. And medications that once worked for me, aren't really helping any more. I'm currently unmedicated because drugs fall into one or both of two categories...side effects intolerable and/or don't really help. I've worked with a great psychiatrist for a long time and he's at a loss for anything different to try at the moment. At his urging, I've made an appointment with a different psychiatrist...a second opinion, if you will...to see if they have some idea or insight that he might be either unaware or overlooking. I know how diligent my current psychiatrist has been and I don't hold out a lot of hope that a different psychiatrist will offer anything more or better. And finding a new psychiatrist has been an overwhelming and daunting task...I finally made an appointment with one, that appointment is next week. We'll see how it goes.

Like I said, finding a different psychiatrist has been overwhelming. Definitely insurance and finances have played a role in who I have access to for care. And I don't feel hopeful that a new psychiatrist will offer new insight. Then I learn of Robin Williams suicide and know that presumably he didn't have the same kinds of limitations in access to care that I have. And if despite his resources he was still unable to find effective treatment...if despite all his resources death was still the only way that he could find relief... Well, let's just say it doesn't make me any more optimistic about my chances of finding help.

Anonymous said...

I hope my link below works. We have to reach out to those who are suffering instead of expecting them to reach out to us. The reason I still exist on this planet is because people reached out to me when I was unable to express how dark it was. They just seemed to know.



Anonymous said...

Thanks Dinah. I am amazed at how much his death has affected so many. It shocked me (though I knew about his struggles) and any suicide always makes me sad. I do hope at least one person gets help because of his death.

Dinah said...

Moody Mommy -- Hang in there. Sometimes it takes a lot of trying, and sometimes illnesses remit for unclear reasons. Wishing you the best.

P-K -- thank you, an important read.
Milo: Agreed
Anon: me, too.

Anonymous said...

this death is horribly tragic, as are so many... deaths like robin williams' scare me, because it reminds me that the struggle is never totally over-- i have done well for years now. to think that in 30 years, when i am sixty, i could feel as bad as i did in my early twenties, that's terrifying. i hope i remember that it gets better. i am so glad i am alive, i'd like to stay that way. liz- i've posted here many times.

Manuel Mota Castillo said...

Thank you Dr. Miller for this scholarly written commentary on a topic that very likely was painful to put together. Everybody loves Robin Williams and we are greatful for the happy moments that has given to us.
From a diagnostic perspective, I am disturbed by the media and certain psychologist only talking about depression. He had bipolar depression and their treatment are different. Most people can understand that a Chevrolet Impala is different from a Chevrolet Malibu but don't seem to realize that BIPOLAR DEPRESSION is not MAJOR DEPRESSION DISORDER.
Robin Williams used to make fun of his manic antics and even had a HBO special "R.W. Unmedicated" and more recently "The Crazy Ones."
Anybody who saw him been intervieved by Larry King or at the Actor Studio could realized that he had the classic symptons of hypomania: pressured speech, fly of ideas, impulsivity and, of course, superior creativity.
We have to wait to have more information but I hope he was not another victim of prescribing antidepressant to bipolar individuals. By the way, finally the FDA put a warning on the newest antidepressants that extend no only to people with bipolar but also to close relative of them.

Manuel Mota-Castillo, M.D.

Tawny said...

I am one of those people who has been in psychic pain since I was a child. I see a psychiatrist/therapist twice a week and have for 16 years. It doesn't help. I regularly find myself in such agonizing pain that I feel that suicide is the only way to stop it. I've made several attempts, although not for 20 years. I've been involuntarily hospitalized several times, both in DC and Maryland. Since I live in Maryland I can't buy a gun or I definitely would be dead by now. I saw my brother suffer with quadriplegia caused by his drug use and I can't take the risk that I will fail at suicide.

I am on lots of meds. I think they probably help a lot, but not enough. I have a great education, great company and no financial problems. I am 57 years old, with no hope for the future. I have listened to everyone say, "It gets better," but it hasn't. I've pretty much given up hope and I am just counting the days until my mother passes and I can off myself without guilt. It will be a rational decision, not a reactive one. I'm so sad right now.

Thank you for allowing comments, Dinah.

RIP Robin said...

I grew up with Robin Williams as the Genie and Peter Pan. He brought so many kids so much joy. He was the childhood buddy I never got to meet. He was every child's fantasy of an adult friend. Funny, imaginative, a real playmate. I love the scene in Hook where the children say, "You're playing with us Peter! You're playing with us!" after he imagines food onto the table with the lost boys.

"Genie, you're free!" as Aladdin would say. Be happy in Heaven and we will see you there someday.

Also, I just want to add that I don't think there should be any speculation about Bipolar with him. He was never diagnosed with that, or at least he never revealed it, and he had many issues that I'm sure we don't even know about. The early Parkinson's diagnosis was a total surprise to me. Poor guy. That would be hard for anyone to take.

jesse said...

@Moody Mommy: totally agree with Dinah. The consult is an excellent idea, and often one doctor has an insight that has escaped the other. Psychiatry is very individualistic. No two psychiatrists are the same, as no two people are the same. So even if the prescription is similar the different insights can be important.

elbee said...


I'm sorry you're so sad. I can't speak to your specific situation but I have tried suicide several times and have been involuntarily hospitalized as well. For me things did change but they are not perfect. However, there are many things I enjoy now such as simply picking blueberries. Things got better for me as a combination of luck, self-advocacy, and family support. I can't suggest what will make you feel better just know there is a lot to enjoy out there and I don't want you to miss out. I hope you find your blueberries.