If you've never been severely depressed this may seem a ridiculous question. It certainly would not have been a ridiculous question for Robin Williams.
Consider the following. To paraphrase comments frequently made by members of our Greenwich Depression Bipolar Support Alliance (DBSA) support group: "I feel like cancer is easier to face than depression. Cancer may be terrifying but it is tangible to other people. They're usually not judgmental when you tell them you have cancer. They understand the severity of cancer and are often instinctively compassionate, kind, and supportive. Depression is a different matter. I've had cancer, I've had surgery, and I've had chemotherapy. My depression was worse in many ways because people just didn't get it! Tragically, many people still thought of me in my clinical depression as being lazy, unmotivated, and selfindulgent and not trying hard enough."
When you are caught in the grip of a severe depression it can seem as bad as any life-threatening condition, because it does threaten your very existence. There is little doubt that Williams must have felt this way before he tragically and violently took his own life.
All of this was also put into bold relief just a few weeks ago when a much beloved and highly respected member of our Greenwich DBSA support group became progressively more and more depressed. He descended rapidly into a severe depression, like someone going down a steep icy decline where the brakes simply don't work.
This severely depressed man had now reached a place where he was living in sheer terror, with no vision of the future other than hopelessness.
When he looked in the mirror he felt as though no one was there. He had disappeared. He had reached a seemingly impenetrable place where nothing anyone said made any difference. In effect, he had become unreachable, even to those he loved. This gifted and caring man had reached a place where he saw nothing of value in himself. It was as if he were locked into a terrifying, dark and empty space with no way in and no way out.
This must have been the way Williams felt.
After visiting our group member in the hospital, I recalled what members of our DBSA group had repeatedly mentioned: that unremitting depression was worse than cancer. People with cancer generally do not lose their identity or their self-esteem. Most people who have cancer do not want to die and certainly do not want to kill themselves. Most believe in themselves and fight courageously to stay alive.
None of this was possible for our beloved and respected group member, nor for so many others who are profoundly depressed. One's connections to the self and to the world disappear. Words simply do not and cannot penetrate. It is hard for a deeply depressed person to even explain to others what is going on because there is a profound feeling that others could not possibly understand.
I have to believe that despite all he had achieved, this was the way Robin Williams felt before he took his own life.
There is, however a huge difference between the story of Robin Williams and that of our group member.
After two weeks of inpatient Electroconvulsive Therapy treatments, commonly referred to as "shock therapy," our group member was smiling, conversant, curious again, engaged in conversation, pleased to have visitors and ready to leave the hospital. He now is well on his way to recovery.
In contrast, we hear that although Robin Williams spoke of his depression and went for treatment for his addiction there has been no mention in the news or newspapers of his taking appropriate psychotropic medication for bipolar illness, no mention of his having attended a support group for depression or bipolar illness, no word of his being treated in a psychiatric hospital and no mention of ECT. Perhaps the residual stigma of mental illness made it easier for Williams to seek treatment of his addiction.
Although he spoke courageously and openly of his depression and he certainly "talked the talk" in the terminology of AA, I wonder if he "walked the walk." What Williams made dramatically clear is that people in general and family members in particular need to recognize that severe depression may be as devastating as any disease, including cancer. If all treatment fails, and all hope is lost people like Williams, who remain severely depressed, often, sadly, see suicide as the only option.
Suicide takes the lives of nearly 30,000 Americans every year. Studies have revealed that 15 percent of those who are clinically depressed die by suicide. In the instance of our group member, as archaic and primitive as many people still believe ECT to be, it worked brilliantly. It restored this man's life.
He again became the person he had been before depression attacked him and stole his identity, robbing him, like Williams, of his passion, his purpose, his energy, his spirit and his soul. All of this returned following the ECT treatment with virtually no side effects.
Had Robin Williams he been hospitalized and received ECT, perhaps he, too, might have had a dramatic recovery. Robin Williams's shocking suicide should be a wake-up call. Depression Bipolar Support Alliance (DBSA) is a resource for people who are hurting, and our local chapter is one of 700 similar groups that meet around the 50 states.
It meets at no cost and is a unique but not well known resource for people struggling by themselves with the pain of depression. DBSA is a safe place to visit and find kindred spirits.
For more details visit our Greenwich group website: www.dbsagreenwichct.com and the national website: www.dbsalliance.org
Dr. John S. Tamerin lives and practices psychiatry in Greenwich. He is a Clinical Associate Professor of Psychiatry at the Cornell/Weill School of Medicine