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Re-examining mental health after Robin Williams’ death

Why would a seemingly successful person commit suicide? There’s no easy answer, say mental health experts

The tragedy of Robin Williams’ apparent suicide on Monday and word from his publicist afterward that the actor and comedian had “been battling severe depression of late” has once again thrust the issue of depression and more broadly mental health – its diagnosis, treatment and understanding – back into national headlines and public discourse. 

Williams publicly said in 2006 that he had not been diagnosed with clinical depression and it remains unknown whether that ever changed or whether he sought or received treatment for mental health issues. 

It is known, however, that Williams was worried about money – he said as much in a Parade magazine interview – and that he saw his career slowing down. There was a bit in his 2009 “Weapons of Self Destruction Tour” in which he battled with his car’s GPS system, which kept trying to steer him off the Golden Gate Bridge: “I said, ‘What? No can do, HAL. Not that depressed, really.’ And the car went ‘Really, Robin? I saw 'Bicentennial Man.’”

That depression, or at least sadness, often dogs funny people is a show business given. Another comic full of manic energy, Richard Pryor, admitted after the fact that he had attempted suicide in 1980 when he doused himself in rum and engulfed himself in flames with the flick of a lighter. One comedy club owner found the problem so acute he offered therapy. Kevin Breel is forthright about it in a TED talk. 

Beyond the stage, the possible correlation between depression and humor is so well recognized that the Journal of Personality and Individual Differences regularly publishes articles with titles such as “Humor styles impact the relationship between symptoms of social anxiety and depression,” and “The moderating effect of humor style on the relationship between interpersonal predictors of suicide and suicidal ideation.”

While speculations about Williams’ death and his accounts in years past of feeling “fear” and “trying to fill the hole” and bottoming out are just that, the suicide of someone so successful in his field who is remembered as a kind, generous man, nevertheless raises important points about depression: It can be unimaginably painful, it is often invisible and it is serious.

According the National Institute for Mental Health (NIMH), in 2012, “an estimated 16 million adults aged 18 or older in the U.S. had at least one major depressive episode in the past year.” That statistic represents nearly 7 percent of all adults in the U.S.

The “humbling reality,” said Dr. Ken Duckworth, the medical director at the National Alliance on Mental Illness (NAMI), a nonprofit education and advocacy organization, is that “depression is a very powerful opponent,” one that often brings with its own challenges, including “addiction vulnerability,” which can potentially lead to problems with drug and alcohol abuse.

Williams has spoken publicly about his repeated problems with both drugs and alcohol abuse and opened up about the topic during a 2010 interview with comedian Marc Maron on the WTF with Marc Maron podcast in which he talked about relapsing after 20 years of sobriety while filming the movie “The Big White” in Alaska in 2005. He described himself as feeling "isolated" and seeking some sort of “cure.”

“I started drinking like those tiny little bottles of Jack Daniels, the little ones like you get on a plane and I thought ‘this is fine’ and a week later, I was hiding a big bottle of Jack Daniels and it went quick,’” Williams said in the interview. 

“It’s a common co-occurring condition that people will be drawn to using substances and the thinking is this largely self-medication — changing the way we feel," said Duckworth. “If you were depressed, [drinking] might help in the moment, but obviously does not help your course over time."

On Tuesday, the coroner's office in Marin County, California, where Williams lived, said that a preliminary investigation indicated the 63-year-old died as a result of asphyxia due to hanging. 

An estimated 30,000 people commit suicide each year in the United States, according to NIMH. And over 90 percent of people who have committed suicide have been diagnosed with mental illness, according to NAMI. 

"Not all of those [people] had depression, but depression is certainly one of the more common [diagnoses], if not the most common one,” said Dr. Nadine Kaslow, current president of the American Psychological Association and chief psychologist at the Emory University School of Medicine. “So it’s a serious risk factor.”

While women are more likely to attempt suicide, men are approximately four times more likely to die by suicide, according to NAMI. 

Williams’ apparent suicide has also raised questions of why someone who has enjoyed such fame, career success and financial well-being would be so overcome so as to resort to suicide. But it’s not so simple, medical experts said. 

“One of things that I’ve observed is when people get depressed, their thinking patterns can get restricted, negative [and] limited,” Duckworth said, adding “tremendous psychological pain” may overpower any rational thinking. 

More than anything, experts say that identification of depression and other mental health problems is key and that while primary care doctors have the responsibility of screening and following up on patients and their symptoms, the responsibility goes beyond physicians. 

"There’s lots of people in our lives who we may have a lot more contact with," said Kaslow, referring to individuals such as family members, teachers, employers and clergy. "Most of us see our primary care doctor once a year if we’re responsible. They don’t know us that well necessarily, and there’s a lot of other people that need to step in and ask and help us get help.”

“We do know that [depression is] common, we do know that it’s usually treatable and we do know that if you stay with the treatment, you likely get better outcomes,” said Duckworth.

The National Suicide Prevention Lifeline is available 24 hours a day at 800-273-8255.

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