What Can We Learn from Comedian Robin Williams’ Suicide? Perils of depression and substance abuse

[This is a re-posting of an article was published on August 11, 2014 by Bill Knaus, Ed.D. in Science and Sensibility http://www.psychologytoday.com/sites/all/themes/pt_www/images/logo.gif]

The original post can be found at http://www.psychologytoday.com/blog/science-and-sensibility/201408/what-can-we-learn-comedian-robin-williams-suicide]

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

Williams had it all: a rare talent, a great career, family, 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. Some end themselves to end the pain.

Was this how it was for actor 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.

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. 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, depression warps reality. However, something else may have affected his judgment.

We know that along with depression, Robin Williams had periodic drug and alcohol abuse problems and had tried many times to kick his habits. Both depression and substance abuse may have been 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 at this time. Nevertheless, this combination is a high risk factor for suicide.

Substance abuse is a risk factor among depressed people who commit suicide. Ruminative and negative self-criticism is another. Fleeing from pain 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.

We Need to Take Suicidal Thinking 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 significantly depressed, the suicide rate can be as high as 2 percent. People hospitalized for depression are at higher risk.

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 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 perfectionismwhere 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 the pattern. There are ways off this not so merry go round.

Changing how you think about depression is one. For example, 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. 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.

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.

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

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