Science and Sensibility

A psychological potpourri

What Can We Learn from Comedian Robin Williams' Suicide?

Perils of depression and substance abuse

Comedian and actor Robin Williams died on August 11, 2014. According to local law enforcement authorities, he died by suicide.

Williams had it all: a rare talent, a great career, family, and friends. However, talent, wealth, fame, family, and friends can mean nothing when you suffer from an acute, deep depression, and believe you have no way out. Indeed, you may believe that others will be better off without you.

When depression crashes down, escaping this dulling, toxic pain may be all you can think about doing. Some in depressive pain often want to end the pain, but not necessarily themselves. However, death may seem like the only way out, especially when they believe they can no longer endure what they feel. Was this how it was for actor and comedian Robin Williams? Only Williams knows for sure. 

Williams’ death was tragic. It was needless. What can we learn?  Suicide is a belief-related death. What if the belief is wrong? Depression is not terminal. Suicide is. When depressed, this is among the worst of times to make major life decisions, except, of course, how to constructively overcome depression. There are many sound and scientifically validated ways to address depression and its complications.

Stigmatizing Is Senseless

There should be no stigma for depression. The ancient Egyptians and Greeks saw this condition as a correctable affliction. Both cultures reportedly showed tolerance.  Today, enlightened people view depression in much the same way. 

What Elevates Suicidal Risk?

People who knew Robin Williams reported that he had sunk into depression just prior to ending his life. He also exhibited anxiety. If this is so, I can only guess what was going on at the decision point when he ended his life. I believe he felt great emotional pain. I suspect that in his mind, he saw no way out. In this sense, depressive thinking distorts reality.

Along with depression, Robin Williams had periodic drug and alcohol abuse problems and had tried many times to kick his habits. A depression and substance abuse combination can be bidirectional: drugs to smother depression, alcohol and drugs as an accelerant for depression. We don’t know if Robin William was involved with drugs and alcohol prior to his suicide. His widow says that he was not drinking at the time he died. 

Substance abuse is a risk factor among depressed people who commit suicide. Ruminative and negative self-criticism is another. Intolerance for tension is another. Some think that by dealing with substance abuse, depression will take care of itself. Depression, negative self-criticism, and trying to smother depressive pain with drugs or alcohol are addressable simultaneously. In fact, they would best be addressed simultaneously in a professional setting.

Robin Williams was in the early stages of Parkinson's disease. About 14 percent of people with Parkinson’s disease think about dying. However, the occurrence of suicidal behavior among people with Parkinson's disease is low.

In combination with multiple stresses, and the prospect of a new chronic illness to contend with, may have added to Robin William's mental stresses and strains--sort of a final straw effect. As you'll see later in this article, such misery-generating exaggerations are highly correctable.

We Need to Take Suicidal Thinking Seriously

Wanting to die may reflect a passive thought about how badly you feel when depressed. That's different from actively thinking about suicide. While passive thinking about dying is important to keep in context, suicidal behavior needs to be taken especially seriously.

The suicide rate among the general population is about 10-12 per 100,000, or .00011 percent. (These numbers vary by study and country.) Among those who are depressed the suicide rate can be as high as 2 percent. This later statistic includes people hospitalized for depression who are at higher risk.

Risk does not mean inevitable. Suicide is statistically rare. Although depression is complex, and normally includes unpleasant coexisting conditions, most people can and do learn to overcome depression and to prevent depression from coming back. 

Suicide is a highly preventable cause of death. For example, effectively addressing hopeless and helplessness thinking is a promising path to suicide prevention.

Depressions Are Not Alike

Not all depressions are alike. Some occur for visible cause: You have a painful and unwanted divorce. Some are mild: You limp through the day for weeks or months, and eventually depression lifts. Some depressions are predictably unpredictable. When they come, they are consuming.

When pessimism is pervasive, you may think it is impossible to break free. However, this inflexible form of thinking doesn’t mean that depression is eternal. You may think it is, but what you think reflects how you temporarily feel.

Depression often has a visible trigger: a loss, a series of setbacks. However, it may reflect the result of a gnawing, pressured perfectionism where you believe you can’t do things right, pressure yourself to do better, and overwhelm yourself trying to do what can't be done. This pressured approach to life can negatively affect your self-esteem

Anxiety precedes depression about 60 percent of the time. Depression precedes anxiety about 18 percent of the time. By addressing anxiety, you can reduce your risk of depression. (Perfectionism is a common trigger for anxiety.)

Sometimes depression comes unexpectedly. In The Bell Jar, poet Sylvia Plath described her depression as descending upon her like a bell jar over a candle. The jar descended even when her life was going well.

All depressions are serious. Some are more disabling. All merit addressing.

What Can We Learn from Robin Williams’ Tragedy?

If you, or someone you know, find yourself in a vicious circle of going in and out of depression, and in and out of abusing addictive substances, you don’t have to stay stuck in this pattern. There are ways off this not so merry go round.

You can reduce or end depression through self-improvement activities. Learn to change depressing negative thinking patterns and you can eventually achieve relief from the pain of depression. When you strengthen brain structures associated with making realistically positive changes in your thinking, both changes are sustainable. You can progress by learning to reduce insomnia. Physical exercise is a good antidepression activity.  Although some forms of depression are recurrent, you can reduce their frequency, intensity, and durability by doing something as simple as routinely following a positive, structured, activity schedule. 

Accept depression as you would mononucleosis, and you are likely to avoid secondary symptoms, such as feeling depressed over feeling depressed. However, unlike mono, you can act to speed your recovery through refusing to accept depressive thinking as valid, viewing depression as transitory, and engaging yourself in constructive change activities. This is admittedly challenging to do when you lack energy and find it challenging to start. However, consider the alternative of focusing on how bad you feel and telling yourself that you can do nothing to change.

Vague overgeneralizations commonly accompany a depressed mood. You may think that you have no future, or you are a failure. (You wouldn’t be thinking this way if you were in a good mood.) This form of generalized thinking can both reflect and amplify depression. I call it abstract upset. (You can better deal with specific events than abstract upset.)

Clarifying abstract upset can help demystify the extra depressive distress that accompanies this thinking. For example, what does having no future mean? By getting specific with yourself, you can take targeted actions to relieve yourself of this excessive burden.

If you view yourself as a total failure, because you make a mistake, this doesn’t mean that that you’ll continue to make the same mistake. If you find yourself in this trap, use the where’s the evidence intervention: “Where is the evidence that I cannot improve and will continue making the same mistake?” Well, where’s the evidence?

Activity is a remedy for depression, and this includes the activity of examining your thinking or the act of allowing yourself to let the thoughts fade in their own time. By actively working to disrupt negative thinking, you can gain relief from depression.

People differ enormously in the conditions that trigger depression, vulnerability for depression, beliefs about depression, and tolerance for the emotional pain, physical symptoms, and social issues that commonly accompany a depressed mood. Social issues can include a real or imagined loss of status.

The majority who suffer from depression learn to override depression, or learn to live with a melancholic state of mind and body, and suffer less.Evidence-based psychological methods, used to reduce depression and prevent relapses, include cognitive behavior therapy, cognitive therapy, interpersonal therapy, and manualized therapies written by licensed experts and based on empirically-validated methods. These, and other  evidence-based methods, are effective in reducing depression and in preventing this condition from coming back. 

Cognitive-behavioral methods for addressing depression apply to many other challenging situations, such as combatting substance abuse, improving relationships with others, and getting along better with yourself. For example, learning to overcome repetitive negative thinking is associated with reductions in anxiety, depression, and substance abuse. By learning to build tolerance for tension, you are likely to have less negative affect to tolerate and more resources to cope with the inevitable hassles of life.

If you feel seriously depressed, and have a plan for ending your life, pause. Get help. Buy yourself time to learn and use antidepression methods, and then pass them on to others who suffer from depression.

When you can think of nothing else to do, call 911.

If you have a friend or relative who talks about life not being worth living, provide as much support as you can and strongly and compassionately encourage your relative\friend to get help.

One final thought: Prevention is the best protection against depression, substance abuse, suicide, and other tragic forms of human distress. We have the means to prevent much needless emotional misery. Unfortunately, the national will to do so is weak.

For more on overcoming depression, click on: The Cognitive Behavior Therapy Workbook for Depression (Second Edition).

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                                                                2014                                                

                                                          Dr. Bill Knaus

                                                     All Rights Reserved

Bill Knaus, Ed.D., is the author of more than 20 books; one, "Overcoming Procrastination", was co-authored with Albert Ellis.

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