the sorrow of Robin Williams’ death

Have to admit this blog is motivated entirely by sympathy I’m feeling for those now mourning the death of Robin Williams. I’m taking off my pastor hat this a.m. and putting on my therapist one simply to offer reassurance that depression, the illness widely blamed for his suicide, is not typically fatal. This is not to take away anyone’s expressed sorrow and other emotions. It is only to attempt a possible “help” for those wondering why depression sometimes kills. “Why” questions are normal with any amount of mourning. The normal curiosity of why someone would take his or her own life if “depressed” can easily lead to faulty beliefs about depression as an illness, after which people begin feeling more depressed and anxious themselves than is at all necessary, even in a state of mourning or bereavement.
It may possibly help to understand that depression is the common cold of mental illness. We all get it from time to time, and strangely there is some element of contagion represented in both. Genetics play a factor, as does lifestyle, in both a sinus “cold” and in mental “depression.” Mostly, these common ailments make us miserable for a few days and then go away, sometimes lingering longer than we’d like in terms of symptoms. However, for some persons depression can linger for months on end causing us to need a doctor, who can prescribe medication that effectively treats our symptoms. For others, the depression becomes chronic, not unlike the person who often catches cold, sees it turn into bronchitis or even pneumonia, and may need hospital treatment at some point(s). Rarely does a cold, or depression, turn fatal. Both are highly treatable with therapeutic medication, although I’m biased in believing counseling/psychotherapy is also important for depression sufferers.
Robin Williams is said to have suffered from bi-polar depression. Here’s what is so important to understand about this disease in particular. The person who dies from pneumonia does not just have a bad cold. Nor the person with bi-polar disease a bad case of depression. A bi-polar major depression is so severe as to require medication often managed within a hospital setting. It is often co-morbid, coexists with, substance abuse or self-medicating of one’s suffering moods. For instance, too much (hyper) mania and its insomniac state is often self-medicated with copious amounts of alcohol (a depressant drug). Bi-polar depression is, like severe chronic pneumonia, not going away without proper and adequate medications, many of which have negative side effects – though less risky than the side effects from alcohol and other OTC drugs.
In my own practice with bi-polar patients over the years, I’ve noticed that the period of highest suicide risk seems to be not within the depressive episode itself, but when leaving depression and entering a new manic episode. This may or may not explain Robin Williams’ own death, but for those where suicide does occur, their manic energy empowers them to carry out the very thing their depressed mood repeatedly told them to do: “Just kill myself and get it over with.” Then they were too exhausted to even craft or carry out a suicide. Now they finally have the energy to do exactly that. Of interest to many clinicians like myself over the years has been the tendency anti-depressant medication has itself in triggering an end to depression and a new beginning of mania. Also, sobriety from alcohol, a depressant drug, aids to lifting depression and ascending one’s mood into mania IF ONE TRULY HAS BI-POLAR disease. This is why I’m more inclined to recommend bi-polar patients have a therapeutic level of some mood stabilizing drug (usually an anti-convulsant) in their systems as they work at their mood management and sobriety. It’s counter-intuitive but intensive counseling is most important when depression begins to ease off some and sobriety is continuing.
I have no way of knowing what drugs and medications Williams may have had in his system yesterday, but I would contend that death from bi-polar disorder is entirely preventable. The key is the patient’s own compliance with a realistic treatment plan. And the treatment had better be not for just “depression” any more than the treatment for Chronic Obstructive Pulmonary pneumonia should be for just a “common cold.”

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