Last night, the sad news broke that Robin Williams, actor and comedian, had been found dead. At the time of writing, the circumstances are still being described as ‘apparent suicide’, though apparent enough that assorted journos and commentators are already making a connection with Williams’ long and troubled history of alcohol abuse and depression. We can only hope that someone will make an intelligent attempt to decide whether he drank as self-medication for depression, or became susceptible to depression as a consequence of the booze. And perhaps, too, someone will have the decency to point out that not all suicidal people are clinically depressed, and that not all people who suffer from depression become suicidal.
Take me, for example. I have been in and out of depression episodes for years, and take daily medication to keep more or less on top of it. Contrary to depressive stereotype, I do not have a murky past of recreational drug use, despite having grown up in Margate, and do not abuse alcohol, other than exclaiming “This beer’s bloody awful” from time to time. It is just one of those things that happens, a combination of genetic inheritance (probably) coupled with life experiences. The daily medication I regard in the same way that other men of my age take daily medication for blood pressure or diabetes. But then someone in the public eye ‘comes out’ about their depressive illness or, worse, dies in circumstances in which that condition can be held responsible, and it is difficult to be quite so breezily casual about it.
I am amongst those cynical depressives who do not become actively suicidal. I say cynical because I suspect what makes the difference is automatically thinking “I would probably cock it up and wake up in hospital feeling really stupid”. For a brilliant summation of that mind-set read Dorothy Parker’s poem Resumé, with its closing lines “Guns aren’t lawful/ Nooses give/ Gas smells awful/ You might as well live”. Sadly, though, many do not have that mental safety catch. I have known a few depressives who have taken their own lives: amongst others a lonely archaeologist who never met Ms Right, and a gentle and brilliant lab technician who was left damaged by an undergraduate breakdown. Oddly, their ends seemed to come after the worst of an episode, as if triggered by the thought that “I cannot face going through that again”.
But what is it exactly? The honest answer is that an episode of depression will manifest differently in different people. After all, the brain is a complex tangle of connections, each brain having its own unique clutter of pathways, so an imbalance in neurotransmitters will result in distinctively individual symptoms. People who have never experienced full-blown clinical depression, with symptoms lasting for weeks rather than days, tend to characterize the condition as ‘feeling down/sad’. Certainly, some depressives, including me, have a tendency to sadness, a capacity to be emotionally moved too readily by events or music. It embarrasses me to recall sobbing quietly on the train to work many years ago, shattered by a newspaper photo of the bridge at Mostar in ruins at the height of the Yugoslav civil war. I am not sure quite what triggered my reaction, whether it was the destruction itself, the symbolic breaking of links between the two communities that had lived in Mostar, or simply the memory of having stood roughly where the photo was taken a couple of years previously, enjoying the bright, fragrant souk, warm sun, and cool air rising from spring meltwater flooding down the gorge. However, that is emotional over-reaction: depression is quite the opposite. The best description I can think of is ‘a complete loss of enthusiasm’. That sounds banal, but imagine having no interest in work, family, relationships, music, food, life….
Our society, by which I mean Western industrialised societies as a whole, is a particularly bad environment for chronic depressives. We are brought up to believe that it is essential to be a functioning, productive member of society, measuring our worth in largely material form. Without that normative framework, capitalism would collapse, but don’t take to the barricades just yet. For someone whose mental state means that they can no longer believe in themselves as validated by their work and relationships, and who no longer has the necessary enthusiasm for material wealth and comfort, there is no other socially-acceptable niche. Add to that the stigma implied by the qualifier mentally ill, and you have a really nasty place to be. Some people deal with the problem by developing self-validation through very focused work, narrowing in on a specific field of expertise within which life is less complicated, however complex the intellectual challenge. I have often wondered whether the high prevalence of depression amongst university academics was a consequence of the academic life, or at least in part because academia offers the possibility of a cloistered life of the mind in which the greyness outside can be temporarily ignored. Others deal with their depressive tendencies by going into careers such as the performing arts, in which it is possible to ‘put on’ a different persona at least for a while, and to be reassured and validated by the audience reaction. Which brings us back to Robin Williams, but please let us avoid any ‘tears of the clown’ twaddle. There are plenty of comedians who are stable, happy people with no dark side whatsoever. Williams just wasn’t one of them.
More to the point, perhaps, it brings us back to the considerable, though probably unquantified, number of people whose lives are made horrible and sometimes shorter by depression, but whose intellectual talents and life opportunities mean that they do not have the option of an obscure Fellowship or a weekly open-mike therapy session. Somehow they have to deal with the condition whilst working in retail or manufacturing, or not working at all, probably unable to give articulate voice to how they feel and reluctant to try because they are frightened of being labelled ‘mental’. For every celebrity who comes out or who comes to a sad end, there are dozens of other people who grind on until one day their chronic over-drinking sees them off, or they drive the car into an oncoming truck, or simply empty the medicine cabinet into themselves. Their families then try to cope with the twin stigmas of mental illness and suicide, and so the pattern is likely to repeat. It is for those people that we need a far better understanding of depression, its causes and treatment, and a far more accommodating society, not only talking about depression like any other illness, but providing the space that people ill with the condition need if they are to stand any chance of long-term remission. Society is getting better at accommodating people with impairments of sight, hearing and mobility: the next challenge, and it is an urgent one, is to accommodate those of us with impaired brains.
So if you know someone who suffers from depression, here are a few points of advice.
Don’t say “Ooh, I know how you feel”, because you don’t and they will know it.
Don’t offer them chamomile tea: it doesn’t alleviate depression and it tastes of grass cuttings.
Don’t take them out to dinner: if you can’t enjoy life at all, choosing from a menu becomes an insurmountable challenge.
Do try saying “Can I do anything practical to help?”: the answer will probably be “No”, but at least someone asked.
Posterity will untangle the circumstances of Robin Williams’ premature death. Whatever they were, the best that can be made of a tragic end is to use it as a reminder of all the others who are going through the same difficult, up-and-down lives out of the public eye, and to see what can be done to make things better for them.
And if that’s all a bit too heavy, consider this: the name of the widely-used anti-depressant Citalopram is an anagram of ‘Crap to mail’. Coincidence? I think not.