Our hearts are heavy amidst tributes to Robin Wiliiams, including Billy Crystal's touching words at last night's Emmy Awards, and the shock of Williams' passing is so hard to understand.

Like the rest of us, Dr. Russ Ferstandig is attempting to make some sense of the tragedy. He writes,

A Positive Message From Robin Williams’ Suicide

Russell Ferstandig, M.D.


News of Robin Williams’ suicide has become the main topic of discussion on the news and amongst most people during the past several days, superseding major world events and problems. This focus on Williams’ suicide is so extreme because it is incomprehensible that a person who has made virtually all of us laugh uncontrollably, could feel so empty and void of emotion that he was unable to fully consider the terrible impact of his suicide on his survivors, regardless of whether they are family and close friends, or merely acquaintances or fans.


While all suicides are tragic, suicide by hanging in one’s own home is particularly tragic because of the visual and emotional impact it has on the survivors who will be forever burdened with the image and shock of finding the aftermath.  Also the place the family once called “home” and where they felt emotionally safe has now become a negative and extremely painful environment.  The fact that many people are still uncomfortable 55 years after the apparent suicide of Superman star George Reeves suggests that fans who let Williams into their hearts will forever be altered by his hanging himself.


From my perspective as a psychiatrist who has to deal with suicides, the question that I feel should be asked is how did such a kind, sensitive and funny man decide to suicide by hanging in his own home, because this is probably the most disturbing method of suicide for his survivors?  Clearly, Robin Williams was terribly depressed, but most people who suffer from depression or even severe bipolar disorder do not take their own lives and are still somewhat sensitive to their negative impact on others.  Similarly, his life-long struggle with substance abuse that appears to have become an active problem again recently is not sufficient to explain his lack of concern about the consequences of his actions on his family and friends.  Even the recent disclosure that Williams was struggling with early Parkinson’s disease does not fully explain his actions.


So what is the missing piece that very possibly led to this tragedy for such a kind man?  The possible and likely answer is actually quite simple.  Although simple, it is rarely spoken about, despite the fact that it is at the center of the current alcohol and drug problem in the United States.


More than likely what happened to Robin Williams is what happens to many people who suffer from acute and chronic depression, especially when combined with substance abuse.  Recurrent and/or chronic depression of any sort in combination with ongoing substance use and abuse progressively alters an individual’s sense of reality, producing somewhat cold and emotionless relationships with people they once loved and protected.


As is frequently the case with mental health, it is likely that multiple factors contributed to Mr. Williams’ out of character conclusion that death by hanging was a “reasonable” action.  It is certainly possible that his former cocaine use in combination with emerging Parkinson’s Disease could have seriously depleted the amount of dopamine, nature’s pleasure substance, present in his brain, producing moderate to severe feelings of negativity, helplessness and reduced connections with loved ones.


Although we do not yet know about his sobriety at the time of his suicide, it is very likely that his chronic substance abuse in combination with recurrent depression slowly and invisibly stripped him of his humanity and sensitivity to others and possibly made him feel that he would never overcome his addiction problems.  The single most common comment I hear from the families of my substance-abusing patients is that while the abuser typically looks like the person they once knew, virtually all positive aspects of their personalities seem to be gone.  They almost always state that the abuser’s thoughts and behaviors are void of emotion and concern for others.


While it is clearly too late to help Robin Williams regain his very positive feelings about people and his desire to help essentially anyone in need, especially those who suffer from depression and/or substance abuse, it is not too late for all of us to start paying more attention to the severe negative consequences of substance abuse of all types on a substance-abusing individual’s thinking, emotions and the resultant behaviors.  Although hard, it is important not to have lasting anger at what sounds like irrational, insensitive and cold thoughts, emotions and behaviors that are all too common with substance abusers and depressed people.  Instead, it would be more constructive if we remember that the perceived reality of these troubled individuals is highly and negatively distorted, leading them to formulate inaccurate conclusions that lead to cold and insensitive behaviors.


Perhaps one of the best tributes we can pay to Robin Williams is to use his tragic death as a powerful reminder that we must pay more attention to how people think and feel when they are depressed, under the influence of alcohol and/or drugs.  It is critical that we work hard to refrain from merely judging them.


Greater compassion and awareness on this front amongst friends, family and the medical profession is very much needed to help psychiatric and alcohol and substance abuse treatment become more effective.  If this happens, then Mr. Williams’ life-long efforts to improve awareness of this problem will continue to help other suffering