A few weeks have passed since we learned of the death of Robin Williams, who touched his audience with every emotion except anger. As a golfer, my personal favorite is his description of the invention of golf by the Scots. It’s off color, but over the top hilarious, especially for those of us who get the inside joke and frustrations of the game. The reporting on his death by suicide and his struggles with addiction and depression moved so many other important events off the front page at first. But the teachable moments are profound, and since a bit of time has passed, I thought it would be prudent to discuss some of what we should learn from Williams’ life and death.
As an observer of his career, it is easy to describe his persona as manic due to the energy in so many of his performances. And it is reported that he suffered from periods of depression, the last so deep that he saw death as a viable option to solve his emotional pain.
We have all heard the term “manic depressive” and should be aware that the current terminology for this brain disease is “bipolar disorder.” Though there are variations, the common theme is periods of low mood and energy alternating with periods of high mood and energy. While we all experience fluctuations in mood, the extremes are more profound and less connected to circumstances with bipolar disease.
Both emotions, in their extreme, are risky for death. Severe depression can end in suicide; severe mania and its associated impulsivity and risk taking can result in death due to poor judgment or impairment, which can sometimes look just like suicide.
Both extremes of mood are commonly associated with self-medication. Manic episodes increase the use of alcohol and other sedatives to “slow things down.” Depression can increase the craving for stimulants to overcome emotional downturns. Therefore, this brain disease is associated with addiction, further complicating management and recovery.
Treatment with medication is often very effective, but having even keeled emotions can interfere with creativity, an essential for an artist. Medication side effects often hinder adherence to treatment. Those who treat and love those with bipolar disease are often frustrated by the poor judgment, non adherence and self medication.
Stigma is decreasing, but it still exists. Inadequate resources and poor coverage for treatment of brain disease (I try to avoid the term mental illness) is getting better, but it is expensive, time consuming and very prone to relapse.
When treatment fails, those who care feel powerless and guilty, especially if the result is suicide. When cancer wins, we blame the disease. The same should be true with brain disease.
While we mourn, don’t lose the opportunity to learn. If you identify with what you are hearing about this icon, get help. If it reminds you of a loved one, be supportive and help them get professional treatment.
Best of Health,
Craig A. Backs MD