OPINION: Mental illness is deadly and people still don’t get it

By Dr Mark Silvert, Consultant Psychiatrist, The Blue Tree Clinic, Harley Street

Our “honorary Jewish” friend is dead. He made us double over with laughter playing a gay Jewish club owner in Bird Cage and made us cry in Dead Poet’s Society.

His death leaves us shocked and saddened. Reports surface of the violent way in which he may have died, we hear that he was suffering from depression. And it is clear that despite years of worldwide psycho-education about mental illness being as deadly as physical illness – people still don’t get it. 

It takes the death of a celebrity that was known for his beaming smile and constant laughter for the world to stop periodically and take note, again. 

“Did you hear the news that schmuck killed himself?”  A friend and fellow doctor text me yesterday.

“Yes but why do you think he’s a schmuck, that’s not very empathetic.” I replied having not expected this response but then not being totally surprised by it either. Even if you are a doctor that does not make you immune to the miscomprehension of the illness that is depression. 

But empathy is of course the wrong word here as not everyone has experienced or gone through depression so they have often have an aversion to the understanding of it and are sympathetic but left puzzled.

People are asking – why could nothing have been done to help or save Robin Williams?

 I am reminded of people that tell me when I treat patients with anorexia that those patients are “irritating,” and they “should just eat something.” 

A lot of the public are totally devoid of any awareness of the lack of control someone has when they are in the midst of a malevolent and uncontrollable mental illness. Being a fan of Robin Williams over the years, I have often thought that his depression is not unipolar but rather bipolar – in interviews he appeared to be elated and his speech would fire out at great speed. 

When a bipolar patient crashes and gets depressed that is when we know the risk of suicide is greatest, which is what I suspect happened sadly this week. 

 “He had it all, family, untold wealth, Hollywood lifestyle and was still relatively young with everything to live for. What was he thinking?” My friend continued on his rant. 

“Would you tell someone that is paralysed to just get up and walk?” I retorted.

We will never know what he was thinking, but we can guess his mind was full of thoughts of hopelessness, worthlessness and lacked any positive feelings for the future – the hallmark emotional cognitions of a profoundly depressed person. 

Being a celebrity would not have eased the pain. Depression knows not of whom you are or what you do, or have, it doesn’t much care for the details.

What scares and shocks us is that this man we felt we knew was for reasons we don’t yet know not able to find the help he needed.

He was not taken from us by war, crime or physical illness, he did this to himself. And that scares us, because depression is estimated to increase to becoming one of the most common illnesses (top three) of all illnesses worldwide in the next few years. 

Israel has no dome of protection from this particular affliction. In fact the epidemiology tells us that Israeli is 12^th on the list of countries with the highest rates of depression. (Number 1 being the USA). That’s a startling statistic.

Studies have shown that Jews may be more susceptible to depression through genetic inheritance, and much has already been said about the trans-generational effects of the holocaust upon the Jews around the world from guilt reactions to post traumatic stress.

So the question is if the studies are accurate and up to 1 in 3 of us will at some time have a depressive illness, why is it that no one ever talks about it? Why is it we don’t know which of our friends are unwell? And then how can we help?

People will retreat inwardly and lose contact with close friends and  family; creating a catch 22 situation. The more depressed you are, the less you want to see friends, the more depressed you get as friends will exhausted from their efforts finally and sadly give up on you.

And so the cycle of despair continues. We already know that Robin Williams’ friends have spoken out about how he called them less often and seemed to be retreating into himself.

At the same time, culturally we are told if we can’t get up put on a brave face and get to work then we are worthless. 

As a psychiatrist I hear daily from my patients that their co-workers and families have told them to just “snap out of it.” 

So they carry on as Robin carried on. The actor has no less than 4 films coming out over the next year – a huge amount of work by anyone’s standards. How could he have done this if he was not only depressed but depressed to the extent that he wanted to end his life? 

He was a comedian and an actor, it was a perfect way for him to put on his mask and just carry on with the façade that all is ok. And this was a man who was open and honest about his bouts of mental illness with alcohol, drugs and depression.

In Hollywood it is somewhat fashionable to have problems, addictions or breakdowns. For the rest of the world it is ironically completely the opposite.

 A lot of suicidal patients that I meet tell me initially that they thought that psychiatrists are only for the very mad, pills are a last resort and that seeing a therapist means you are weak.

And already the comments have begun in the media by commentators that Robin William’s suicide was the ultimate form of selfishness or cowardice. That it’s a long-term solution to a short term problem, that he must have been devoid of feelings for how it might hurt his family.

Which is to misunderstand it entirely. 

I would suggest that it was entirely the opposite, that in that state of depression every feeling is so painful that there seems to be only one thing left available to do.

Robin famously said “you’re only given one spark of madness – you musn’t lose it.” But I suspect he spent most of his life trying to.