How Clinicians Should Respond to the Death of Robin Williams

August 13, 2014

When Robin Williams committed suicide this week, he shocked a nation who had delighted for years in the bright light of his rapid-fire, witty humor [1]. Many were left asking: “How could this funny man be suffering so profoundly?" And how should we as mental health professionals respond to such a public suicide?

I suspect that part of what gave Mr. Williams such a universal appeal was not just his humor, but his humanity. Mr. Williams brought a sense of pathos to his work on the screen. Pathos is the actor’s ability to convey emotion, particularly the shadowy feelings of sadness and shame, in such a way that it evokes compassion from the viewer. It is the ability to communicate an aspect of our shared human experience of suffering.

Pathos is also the root of “pathology,” and there has been much speculation about Mr. Williams’ mental state in recent years and at the time of his suicide. His struggles with substance use and recovery were well known. He was more circumspect about other mental health problems, admitting battles with sadness [2].

The actual diagnosis wasn’t (and still isn’t) important.  People with mental illness often remain in the shadows about their struggles because of shame. This shame leads those effected to feel isolated in their experience, fearing judgment from others [3].

Despite the best efforts from anti-stigma advocates and from biological psychiatry, many people continue to feel shame for having a mental illness. On the one hand, we try to de-stigmatize mental illness through public awareness campaigns. On the other, we criticize those who speak too much or too publicly about their struggles as being attention seeking, even histrionic. It is as if we encourage transparency but then reject it when it makes us uncomfortable.

So what is the appropriate response from us as mental health professionals? As sad as Mr. Williams’ death is, it is also an opportunity to have a more candid dialogue about mental health and suicide, not only publicly as a society, but also more importantly, among the people we know personally.

How do we use our positions, our titles, the esteem that others have for us as clinicians, and our knowledge about mental health to advance the dialogue about mental suffering in our culture? Our friends, our families, and our social networks look at mental health professionals as leaders in these matters. How do we want to direct the conversation?

Cultural changes happen from one individual to another. Acceptance of previously stigmatized issues in American culture—same-sex relationships, racial integration, women’s equality, the list goes on—did not change writ large but rather with small, incremental changes in attitudes that were passed, person to person until acceptance became a new norm and intolerance became stigmatized.

What if, when we speak of Mr. Williams’ suicide, we speak not of something that happens to other people, but to people that we know and care about?  

Part of the force of shame is to make people feel like they are separate, that they are an “other.” What if feelings of depression and thoughts of suicide were viewed as something that can happen to us and to those who we love, not just to “other” people?  What if we used the platforms of social media and the conversations that we have with our colleagues in the hallway as a means of conveying an attitude that these experiences of depression, and even suicidal ideation, can happen, and then modeling an openness and willingness to discuss these experiences?

Even with the bright light that Robin Williams brought to the world, he also had his demons sequestered in the shadows. We all do. He used humor to cast light into these shadows, to drive the demons away.

His humor, often outrageous, made us laugh because he said the things that we all were thinking but that we thought were impolite or impertinent to say. We laughed together, with him, and at ourselves. By laughing at those demons, he took the power away from them, but sadly, not for long enough. Eventually, they rallied around him and destroyed him. We can’t change that. But we can change the tone of the conversation around mental illness, nudging it slowly but tirelessly towards acceptance, so that others need not suffer the same solitary fate.

 References

1)      Fimrite, et al. Investigators: Robin Williams hanged himself. San Francisco Chronicle. http://www.sfgate.com/bayarea/article/Investigators-Robin-Williams-hanged-himself-5683229.php  Updated August 12, 2014.

2)        Fresh air http://www.npr.org/2014/08/12/339823090/robin-williams-in-looking-for-laughter-you-have-to-be-deeply-honest 

3)      Brown, BI Thought It Was Just Me (but it isn’t). New York NY: Gotham; 2007.

Andrew Penn was trained as an adult nurse practitioner and psychiatric clinical nurse specialist at the University of California, San Francisco. He is board certified as an adult nurse practitioner and psychiatric nurse practitioner by the American Nurses Credentialing Center. Currently, he serves as an Assistant Clinical Professor at the University of California-San Francisco School of Nursing. Mr. Penn is a psychiatric nurse practitioner with Kaiser Permanente in Redwood City, CA, where he provides psychopharmacological treatment for adult patients and specializes in the treatment of affective disorders and PTSD. He is a former board member of the American Psychiatric Nurses Association, California Chapter, and has presented nationally on improving medication adherence, emerging drugs of abuse, treatment-resistant depression, diagnosis and treatment of bipolar disorder, and the art and science of psychopharmacologic practice.

The views expressed on this blog are solely those of the blog post author and do not necessarily reflect the views of Psych Congress Network or other Psych Congress Network authors. Blog entries are not medical advice.