Suicide is a terrible thing. It may – or it may not – end the suffering of the severely depressed person, and we are in no position to criticize. What Robin Williams did by hanging himself was a shocking thing, a horrible outcome, and yet, we don’t know enough to criticize him. That is a cliche.
But there is another reason to not criticize.
Williams, while clean and sober, recently checked into Hazelden. He was looking for help. Some clinicians will criticize him for that, since Hazelden is an alcohol / drug treatment center.
“Why not go to a top psychiatrist? Why not try . . . (insert your favorite treatment approach here)?”
There is a sad truth here. Treating depression is very unlike treating pneumonia or a broken arm. There isn’t a clear cut approach that always works. Many approaches work, and we don’t have a way to know ahead of time which one will work with which person.
Now some will be incensed at that statement. There is some justification. Not much, however.
Certainly there is some evidence in favor of using antidepressant drugs for severe depression. Did Williams get those at Hazelden? We don’t know.
What about ECT for refractory depression? That can help. Was it offered at Hazelden? We don’t know.
We do know that Williams looked for help. We don’t know much about what kind of help he was getting, so we cannot judge him.
But what we do know is that, unlike other areas of medical science, our treatments are not getting better over time. We can judge ourselves. With any treatment, whether psychotherapy or medical, when it comes to depression and other emotional disorders, about one-third to a bit less than one-half will get better. That means that on the Beck or the CES-D their score is below 10. On the Hamilton, they will score below 8.
Now, to be fair, about another third will improve. Their score at the end of treatment is at least half of what it was at the beginning. But they aren’t recovered, just improved.
Perhaps twenty percent don’t seem to improve, no matter what we do.
The truth is, that is the same pattern as it has been for at least the last quarter of a century. Cancer treatment improves. AIDS treatment has improved. In other areas things are getting better.
Our treatments aren’t improving.
There is one bright spot. Feedback Informed Therapy (FIT) does improve those base rates. Scott Miller is doing the most in that area.
What does FIT mean? It means that when therapists continually measure a patient’s score on a good rating scale such as the OQ-45 or something similar, the base rates are improved. We still have patients we cannot help. Fewer, but some. In the best therapies, the patient continually measures where he or she is functioning.
This is a good time to reflect on these facts: Depression is treatable. Continual measurement is the only modification to therapy that has been able to improve outcome. If you are a psychiatric or psychological patient and your therapist doesn’t measure progress each session, you need to ask why not? Or, perhaps, find one who does.
At the same time, bear in mind: suicide may or may not end suffering in the patient, and it certainly creates much more suffering in the survivors. Don’t fall for the idea that it is a solution. We cannot criticize Williams, but we can criticize those who are thinking that suicide is a solution. As Joe Banks asks in the movie, “Joe Versus the Volcano,” when Angelica Graynamore talks about suicide, “Why would you do that?” Angelica responds, “Why not?”
Joe says, with inspiring wisdom, “Well, because some things take care of themselves. Some things are not our business.”
It is not your business to decide when your life is supposed to end. That decision belongs to someone else, someone above your pay grade. Robin made the decision that seemed right to him. It isn’t my job to judge that. But I do take a position that suicide is never an option, and that there is always another way to do things. I have decided to believe that. Others do not. I have decided I do not own my life, it belongs to my family, my community, and, if you will permit it, to God. The playwright, John Patrick Shanley, who wrote Joe Versus the Volcano, is currently going through his own trials. Will he heed the wisdom he put into the mouth of Joe Banks in 1990? So far, the answer is “yes.”
Shalney doesn’t talk about his own physical (vision) problems in this NYT essay, but he continues to enrich our lives by confronting his own limits and pushing back against despondency and futility.
Life can be hard. Depression can cause incredible pain. No one knows which treatment will work with you. It is wise to keep trying, to not give up. Some things are simply not our business. Some things take care of themselves.
Stay alive.
32 Responses
Sally Wiliams
I attended one of your workshops and have found many of your emails and books helpful. However , I was extremely disappointed in your post about Robin Williams committing suicide. I’ve strived to find a kind way to explain my reaction and I can’t. I felt confused and angry and hurt. I’ve spent over 40 years working with people struggling with severe depression, etc. I felt like your email minimized the way that severe depression leads to dangerously poor judgements. I also felt like it was a marketing tactic for another way to promote one more technic that treats a client as an object to be fixed, rather than as a suffering human being. You said to not judge Robin, but you did. You judged the treatment he may or may not have received in the past. You implied that your way could have saved him. I agree with Ken Harwood as the field is getting worse instead of better. I went for help a few months ago to a new therapist because my previous mentor had retired. The new therapist spent all the time trying to get me to pinpoint a symptom that he could diagnose in psychobabble. And when I started to get weepy , he thrust a paper toward me to fill out and kept pushing me to tell him how I would know when I had reached my goal. Fortunately , I’ve had wonderful therapists/mentors in my life and I went looking for someone I could safely speak my truth and pain to. Btw, I filled out the assessment papers for the diagnosing / measuring therapist in a way that left him feeling like he had been successful in resolving a specific symptom. I suggest you watch Robin Williams in Good Will Hunting. Robin Williams obviously had fantastic therapists in the past, to be able to make such a human to human contact with the young man portrayed in that movie. I was initially only going to unsubscribe from any future emails from you. However , meeting you at one of your workshops, I decided that you sincerely wanted feedback on your email. I wish you the best and I know your intentions are good. Just maybe a little naive. Take care.
Dr.J
I think you have misread my post, likely because you had a pretty traumatic experience with an unskilled therapist.
It should be self evident that Williams didn’t get the treatment that would help him. We don’t know why he wasn’t helped, but he did try to get help and therefore we cannot criticize him, nor anyone who suicides. Our interest is – or at least should be – helping those who are vulnerable, those whom we can help save. The larger question is whether we are getting better at helping people. Have outcomes improved since the 1960s when researchers began to measure them?
No, they have not. There is no evidence that Ken is right, but I did appreciate his thoughtful analysis. Things are not any worse in terms of percent of people who are recovered or improved, but they clearly aren’t better.
So what is wrong?
A recent study showed that after the first year or so in our field, our outcomes do not get better. We hit a plateau. Only with careful measurement of what we are doing do professionals improve. Because your therapist was not empathic but rather driven by his own agenda, doesn’t mean that measuring outcomes doesn’t work.
Thanks for your heartfelt comment. I deeply hope you can find someone who is kind and empathic and good hearted.
By the way, long ago, outcome researchers started using the terms: “shrink,” “super-shrink” and “pseudo-shrink,” the last being someone who actually harms people. I suspect you may have experienced the third. I am sad for your painful experience. May you find your way to joy and peace.
Ken Harwood
I don’t see it as a field not improving. I see it as worsening. I have seen the deterioration as I supervised pre- and post-doctoral psychologists over the decades. I respected my early supervisees; they were persons I could have gone to them with my own problems; at that time psychotherapy was an intimate conversation between human beings; it was struggling to make sense of one’s life and find a way out of the woods. In recent years, supervisees came to me indoctrinated with manualized treatments, teaching coping mechanisms and admonishing (what it really is!) patients to change their ways of thinking.
I had, in my own life, experiences of sometimes lengthy periods of “treatment” with persons from various schools, e.g. one accomplished analyst and one well known cognitive therapist. My life was saved by someone with no school. She was very observant and very caring; she was emotionally there for me in a way no one else was. She accomplished, for me, far more than medications and techniques, neither of which helped. If it weren’t for her, I would likely not be alive.
Coming from graduate school in physics, to clinical psychology, the concrete, recipe-driven, one-foot-in-front-of-the-other thinking of this field was glaring, this only to be reinforced when, after taking only three courses in psychology, I scored in the 95 percentile on the Graduate Record Exam in psychology, something no one could do in physics.
This is a barren field, with rigid, small concepts. As long as it is based in quickie treatments that allows university professors to crank out several EVT studies (not hard to do) per year and as long as practitioners want simple methods that can allow them to be sure of themselves, it will not change.
Dr.J
You have made some wonderful points, powerfully stated. I wish we could hear more from you; my impression is you have a lot of give.
Many thanks
Lynn
Catherine
He joked, he laughed, he deflected and when that stopped working the pain was unbearable. I hope he has found some peace.
Lee Ann
I love Robin Williams and I have loved him for most of my life. I love his fast effervescent verbal energy which was laced with the truth and I love the fact that he has had the courage to speak it. Many times his bright light-hearted remarks have lifted my spirits and I can still laugh like a child when I think of him in his various roles portrayed in the media, especially in his role involving Mrs. Doubtfire. Obviously, some forms of pain cannot be laughed off and perhaps the habit of trying to do so is pathological in itself.
I am noone’s judge and I cannot know another’s pain. I do know that depression is a very complex emotional, physical and mental state which seems to defy treatment in many situations. Regular measurement on a trustworthy scale by the treating professional is certainly ideal and I recommend it. When people stop coming in for treatment, however, the family or friends are then left to be the eyes and ears of the helping professional. Communication breaks down around privacy and confidentiality laws/HIPAA. Getting release of information forms signed up front in treatment to facilitate open communication with the caregiver/family members is also very helpful.
As a parent and licensed social worker, I have spent my life teaching coping mechanisms and problem solving skills to help individuals live life sober while feeling capable and joyful as possible. My abusive ex-husband routinely threatened suicide each time I left him for my own safety. I never knew when or if he would actually follow through. I finally realized his life belonged to him and mine was being destroyed until I found the courage to leave for good. He refused treatment and I informed his family of his condition. Suicide and threats of suicide are poison to the soul of the individual and her/his family. I love living and I thank God for Dr. Lynn Johnson as well as others who are giving their lives to benefit others. May God bless you, Dr. Johnson.
christine
I am a psychotherapist. I lost my brother last September through suicide. He was diagnosed Bipolar with psychotic tendencies. I myself suffer from Major Depressive Disorder. Both my brother and I have been through what conventional medicine has to offer and it did not work for us. My brother lost hope and would not do the things he needed to do to get better. I chose to go the natural route and am off all the medications and feeling 200% better! – that’s why I decided to study clinical nutrition and use it with my psycho-therapy patients along with the frequent monitoring Lynn speaks of above. I have been using it since 2008. They are all doing much better. I see a clinical nutritionist in Houston at Whole Health Associates- I do not treat myself. Robin Williams could have had access to this new approach if he had known about it. We need to do a better job to raise awareness that there are different ways to treat depression and to keep looking until you find one that works for you! Never give up hope!
Claude Lapointe
Don’t think of a blue tree.
You have now a blue tree in your head, don’t you ?
Don’t judge…
Same result in my head.
Other words for your title, maybe ?
Claude
Donna Gill
Thank you for the article. Well put. I am using this situation as a learning tool for our group members. Williams was known by so very many people for his many gifts. His passing in this way affected all of us. I ask our members to remember that the choice to live or die may be open to us all but it will affect so many of the people who care about us. I cannot judge Robin Williams. I can only hope that wherever he is, he is aware of how much he is loved. And missed.
Sandra Starrett
Yes, suicide can be said to be a long-term “solution” to what is a short-term problem, but if those “demons” Robin Williams talked about had returned once again, after a life-long battle and many determined efforts to overcome them, I can only imagine the hopelessness he must’ve felt about ever being free and whole. May he rest in peace, and may his loved ones receive the peace that passes understanding.
Dr.J
As mental health professionals, we have great empathy for Robin Williams, and at the same time we must dissuade those who want to do something similar. Our focus must be with those living.
Janet Winward
Depression manipulates the mind. We can’t judge even if we don’t understand but if we have some touch of understanding, as I do, we would never consider such a thing. It is very sad. There are SO many suicides, SO many young people who die needlessly because no one cared enough to recognize the problem and help them get help. Too many people think it is something they can control themselves. It’s not. AND there are so few trained professionals out there who really have the ability to listen and help. There are, in fact, many who make the problem worse by the way they ‘help you’.
Dr.J
I hear reports that Mr. Williams was worried about financial issues. That’s an excellent example of how depression does manipulate the mind. Thanks for your wisdom.
Carla
Depression is something that we all deal with at some level. My father was depressed and nothing that we did would change that, life just got him down. He eventually committed suicide when I was in my early 20’s. Not a week has gone by in these last 25 years that I don’t think about what he did and how things would have been different if he had gotten “professional help”. Would it have just extended his misery?
What becomes rational to someone contemplating taking their own life will never be rational to others. However, I do feel that once the thought of exiting this life gets in someone’s head it is something that consumes them.
Mr. Williams was in turmoil, searching for an end to his misery. When he didn’t find it through drugs, alcohol, or professional treatments, he had exhausted his resources and took matters into his own hands. He has been so many different characters over the years that we tend to forget he might have been having trouble just being Robin Williams….he will be greatly missed.
Nick Gallo
I appreciate your thoughtful comments. We all advise our acquaintances not to judge but it is done all day long, knowingly or not knowingly. I am thinking of one of his movies in which he plays a robot. I cannot remember the Title. As the movie progresses the robot so wants to be a human. It was only after his death that he was declared “human”. Somehow prophetic. How much joy he gave to the word. His genious will be misssed.
Nick
Cynthia Berman
Suffering from a dual diagnosis is complicated. Robin Williams lived with both addiction and bipolar disorder. many individuals with Bipolar use alcohol as a “self medication;” in order to try to feel normal.
it is my hunch that Robin, was using alcohol that night, was in enormous psychological pain, tried to slit his wrists, that didn’t work. While becoming more intoxicated, judgement more impaired, became more depressed and hopeless, more reactive and impulsive; put a final end to his ongoing tourture.
Sara
Both my parents completed suicide. In 1970 and 1980 respectively. I myself struggle with depression. When we lose another one to this illness, it is disconcerting. We need to work harder to find treatment improvements, not only for the ill, but for the friends and family members left behind.
Wayne Sisson
Dr. Johnson,
My comment would be of sadness for his life; as well as an honoring for the many things he achieved, and how his acting, his movies, and his humor brought so much joy to so many people.
Wayne
Dr.J
Well put!
Otto Zinser
Do not judge Robin Williams — until you have walked in his shoes. I cannot disagree with Lynn on this.
This suicide has drawn so much attention by the media already. How could he have done this to himself and his family? Well, first, his suicide is over and done with. But, believing that good things often come from bad ones, Robin Williams’ last act may help the rest of us with this very serious mental health problem. If his suicide continues to draw attention, maybe we will find ways to give this matter more attention and thereby reduce the suicide rate.
John Huddlestone
Thanks Dr. J for a sobering perspective. So well stated, “Some things take care of themselves. Some things are not our business.”
Barbaros
This is feedback regarding the apparent suicide of Robin Williams. This is a very sad situation not for just the Williams family but for others who find solution in suicide. I am happy to hear he was sober and clean and his recent treatment episode. His death should shed some light into suicide in older adults. This isn’t discussed as much. I believe that this conversation needs to take place in sessions with individuals who may present with life changing events which lead a person to a severe mental health state and worse, suicide attempt. Every human being life is valuable. Treatment is out there and so are good clinicians.
Dianne
Dear Dr. Lynn,
I wept when I heard the news of Robin Williams. I am a Psychiatric Registered Nurse and I see this all the time. Despite all our efforts and health teaching, medication noncompliance is truly a problem. If it was only as easy as your book Enjoy Life Healing with Happiness. I am heartbroken at this terrible loss. It is also getting increasingly difficult for me as a Health Care Professional to live in a state of constant total amazement. Time for me to do the Gratitude Diary. I really did enjoy your class and I have all your books. It was very kind of you to sign them for me.
Respectfully yours,
Dianne
Dr.J
What warm thoughts. Many thanks, I am nourished by your appreciation.
Robert Grant
I believe that what say is correct about any one treatment, but not as applied to all treatments taken together. I think there is a great deal of research that shows that when offerred a different therapy, after “failing” the first, a second approach often helps. What if those that don’t benefit are offerred a third, or a fourth different type of treatment? The problem is that we as therapists are too rigid, not trained in enough varied modalities, and we are not good at making referrals when we are not being helpful.
Dr.J
I do agree completely with your points. The practice of continually assessing how we are doing with our patients helps us be flexible. If this approach isn’t working, don’t continue. Try something else.
Marsha
A gifted man and the ending of his life is terribly sad. None of us have the human credentials to judge him. We can love him in memory…
Tom Zimmermann
As the present pope might say, “Who am I to judge?” I sure have, and now I am feeling more compassion. I was very angry some years back when a person I know committed suicide. I told some friends. One of them said, “Good.” I don’t express anger very often. Another friend gave me CD on Compassion. I was grateful then, but more so when I remembered that friend’s mother committed suicide when he was young. Sure, we hurt when someone we care about kills themselves, and then I think they must have been in an awful lot of pain to do such a thing. That compassion really works. Like Robin’s wife suggested we not focus on how he died, but the wonder and joy he created for so many of us by him being alive. We will take the best of this talented artist, and be more compassionate toward all the people who suffer.
Dr.J
Thoughtfully put. Thank you.
Traci Lowenthal
Thanks for sharing your ideas here, Lynn. While I agree with some and not others, I too see the need for outcome assessment in therapy. I am excited about the FIT method you share here and will be looking into it. Thanks for sharing your thoughts. May more people stay alive.
Best,
Dr. Traci
Marilyn Rogers
This whole business of making judgment over anyone else’s decisions is not our place unless we are a parent or caregiver of an underage child. And then we must approach the situation in a manner that is well thought out and will give the child/patient some tools for better decision making. Of course, in suicide, we may not have the chance. Therefore, we must see the patterns of behavior that are leading to suspected suicide especially if the person states his/her intention vocally. But again back to making judgment of others. If we are in the business of helping and giving service to others as teachers, counselors, therapists, etc., then our job is to help, coupled with our experiences and education in the field, we provide to the person in the depressed state what in our judgment (if we must put if that way) will provide an avenue to helping the person improve with a measurement.or assessment. How else can we know the success rate of the treatment? Look at how many drugs cause more problems which can include loss of memory among other mental and physical outcomes. That is where judgment is critical. We all make decisions based on what we know at the time until something else comes along to be proven better. Robin Williams must have thought he was making the right decision to check into the facility he thought would help him. Did it? No! So?
Helen Peterson
Suicide is such a sad means of trying to resolve the feelings that come along with depression. It does create so much sadness in those left behind. We often blame ourselves 4 not having done enough to recognize what was happening to our friend or our clients. While we can’t prevent all suicide we certainly can be more alert to the signs and symptoms. It behooves us all to care more about others.