Thursday, August 14, 2014

Through Early Morning Fog I See

On Facebook, someone wrote that Robin Williams' death this week felt like a "gut punch." That is how I would describe my reaction, too. It is like losing a good friend or relative. And a friend who could make me roll about on the floor laughing. Reactions to his suicide range from grief to judgement to outright mockery (think "fat radio personality"). Having dealt with depressed patients in clinical practice and with attempted suicides in the ER, I want to add something to the conversation. In addition, there is my own personal experience with depression to draw on.

In this country, we are so fiercely independent that even thinking of asking for help is considered a sign of weakness. If there is just one take-home message you get from me today it is this: depression is an illness. A person with pneumonia didn't ask to get sick. A person with Crohn's disease shouldn't be embarrassed about having the illness, asking for help, or taking medications. Yet we treat people with mental health issues like they are pariahs at best, criminals at worst. Stepping off my soapbox for a minute, I now want to get clinical with you.
Psychiatrists characterize depression as a Mood Disorder, meaning that it depends on the person's own internal state. In this case, it is an overwhelming state of sadness. Other internal feelings include worthlessness, hopelessness, and guilt. External signs and symptoms (you do know the difference, don't you?) include insomnia/hypersomnia, increase/decreased appetite, early morning awakenings, and anhedonia or the loss of pleasure in life. There may be other associated factors including problems with memory and increased anxiety. To sum it up, a person with depression is in emotional pain.
Suicide is the ultimate attempt to end the pain. As illogical as it seems to those of us on the outside looking in, this course of action is perfectly logical to the person contemplating it. Those internal feelings of worthlessness, hopelessness, and guilt seem overwhelming and permanent. If the person has had periods of severe depression in the past, he may not want to go down that path again so suicide is like taking the nearest exit ramp off that road. To those who have never experienced severe depression, suicide appears to be an act of the weak and cowardly. Trust me: the pain is so overbearing that suicide becomes a form of treatment for that person. A desperate treatment but desperate people do desperate things.
As usual, I like to end these posts describing what you can do to help people with depression and thoughts of suicide. First of all, the highest risk factor for suicide is a previous suicide attempt. So if  you know someone who has tried it before, be especially vigilant for any of the signs or symptoms I described before. For anyone, if you suspect suicidality ask them one simple question: "are you thinking of hurting or killing  yourself?" That question has saved thousands, if not millions of lives.If you get a "yes" answer, do what you can to get that person help. Immediately.

It's not a bad thing to lament anyone's death. People felt close to Robin Williams and grieve as if someone they knew had died as do the friends and families of anyone who has committed suicide. It's a sad tragedy no matter who you are.