The elephant in the room

There will be a lot of talk in the coming days in the media about depression's version of the elephant in the room -- suicide.

As most of you already know, Robin Williams, the immensely funny comic and gifted actor, took his own life yesterday at the age of 63.

I've enjoyed his work since he shot to fame in the late '70s playing a manic alien in the sit-com Mork and Mindy.

Although he was initially known for his comedic work -- his stand-up routine once being referred to as Dostoevsky on acid -- he moved seamlessly into serious acting. I still find his role as the boarding school teacher Mr. Keating as one of the best performances I've ever seen.

After one of his students commits suicide, Williams sits at the student's desk and opens one of his books before crumpling with grief.

It turns out the grief he displayed in that scene was not far off from his real grief that lay inside, mostly invisible to the general public. (It starts at 2:30 of this clip)

 

Williams struggled with substance abuse (mostly alcohol but also cocaine in the 1980s) and depression for more than three decades. He recently spent time in rehab, once again for alcohol.

And for reasons that would only make sense to his shattered brain, Williams decided enough was enough. He hanged himself with a belt after making what appears to be an unsuccessful attempt to slit his wrist with a pocketknife.

Williams' riches, fame and talent were not enough to keep his depression at bay. And this should serve as a sharp reminder of how insidious mental illness is -- it can destroy someone inside while the person on the outside seems relatively normal.

So let's talk about the elephant. 

This may not be easy for some of you to read, but it's important we talk about it, mostly because it is hardly talked about at all. For example, when was the last time you saw an obituary list suicide as the cause of death? It happens all the time but the stigma and shame attached to it are so strong, it's usually not listed as a cause of death in obituaries but you can usually figure it out if the family requests donations for mental health agencies like the Centre for Addiction and Mental Health (CAMH).

I've been told point-blank by some people when I've broached the subject, I shouldn't talk about it. They think it's fine and good to talk about my depression but if I admit publicly to thinking about suicide, that would damage my reputation permanently and make people think differently of me.

To that I say I've been open about my illness to try to reduce the stigma attached to it. To ignore suicide would only serve to paint a partial picture and it would also be a disservice to everyone who has lost their battle with depression. Those who survive have to tell the stories of those who don't.

Statistically, there are about 3,500 suicides in Canada each year, and it is the 10th leading cause of death for both sexes and seventh for Canadian men. It falls just below colon and breast cancer in terms of overall causes of death.

That means that depression and/or substance abuse-related depression kills 3,500 people each year. If these deaths were caused by, for example, a new type of virus, you can bet there would be screaming headlines and a concerted effort to find a cure or at least try to treat the symptoms in an effort to save lives.

However, the stigma attached to depression -- let alone suicide -- is so strong, many (if not most) people don't want to talk about it.

I have had recurrent major depressive and generalized anxiety disorders for most of my life, accentuated by four major breakdowns at the ages of 18, 22, 29 and 39. The first one lasted several weeks, the second and third ones for several months and the third one for more than two years.

Despite that I have never attempted suicide. 

But I have thought about it, thousands of times over the years, going so far as to plan how I was going to do it. This is referred to in psychiatry as "suicidal ideation." In fact, it was the overwhelming desire I had to kill myself as an 18 year old that lead me to finally admitting to my parents how sick I was. It was the first time I asked for help.

Luckily, I was still thinking just clearly enough to know I was a danger to myself and that I needed immediate crisis intervention.

The same scenario played out in October of 2011, leading to my first hospitalization for depression.

You will no doubt hear in the coming days from those who don't understand that Williams committed a selfish act.

How could he be so selfish, the old refrain goes, and do that to the ones he loves?

For those of you looking for some sort of complex reason, I'm here to tell you there isn't.

People with mental illness kill themselves for very simple reasons.

The main one is to stop the pain they feel to the very core of their being.

Because, you see, depression is not just about mental suffering, it is also accompanied by physical suffering. At my lowest point, a week after being released from hospital, I looked like I had aged 20 years. I walked with a stooped shuffle, drawn in on myself, the lines of pain etched on my face.

When my brother saw me then for the first time in months, he burst into tears, my transformation was so dramatic.

Those of us seeing the world through the prism of depression see death as the only release from our pain. 

'I've tried medication, therapy, exercise, everything,' we think. 'I'm never going to get better. I'm tired of putting my family and friends through this.'

These thoughts are easily counter-balanced when we're feeling better (You won't always feel this way. It will lessen, just as it has in the past. You would hurt the ones you love, not relieve them of any burden.) but when depression has us in its jaws, these more realistic thoughts don't come easily, if at all.

Then there are the times a person with a mental illness will pass through a crisis in which they have talked about suicide and then rapidly improve and seem normal to others. They may even seem happy. 

This is a very dangerous and deadly sign. It can mean the person, in a moment of clarity, has decided they can't go back to feeling depressed.

British author Virginia Woolf touched on both of these reasons -- ending the pain and avoiding yet another relapse -- in the note she left for her husband.

Dearest, I feel certain that I'm going mad again. I feel we can't go through another of those terrible times. And I shan't recover this time. I begin to hear voices, and I can't concentrate. So I am doing what seems to be the best thing to do. You have given me the greatest possible happiness. You have been in every way all that anyone could be. I don't think two people could have been happier until this terrible disease came. I can't fight it any longer. I know that I am spoiling your life, that without me you could work. And you will I know. You see I can't even write this properly. I can't read. What I want to say is I owe all the happiness in my life to you. You have been entirely patient with me and incredibly good. I want to say that everybody knows it. If anybody could have saved me it would have been you. Everything has gone from me but the certainty of your goodness. I can't go on spoiling your life any longer. I don't think two people could have been happier than we have been. V.

After writing this note, she went outside, filled her pockets with stones, and waded into the River Ouse.

She was 59.

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If someone you know has talked about suicide, take it seriously. They are not looking for attention, nor are they trying to be overly dramatic. Talk to them about it and, if you feel the person is a danger to themselves, call your local mental health crisis line or 911.