In his piece on Robin Williams, Andrew Solomon of the New Yorker states that every 40 seconds, someone commits suicide. Actually, it’s every second of every day, as people choose the action, or inaction, that will end their lives sooner. When the patient with metastatic melanoma, who is quite capable of getting to the refrigerator, refuses to take food or liquids, she is taking her life. Her body will get the job done for her by starvation and dehydration. Battling mental illness but physically intact, depressives must come up with active methods to end their lives.
Solomon calls Williams’s suicide a “permanent solution to a temporary problem.” Chronic/recurrent depression, however, is not “temporary.” People with chronic/recurrent depression struggle every day to get to the emotional levels of their more normal peers. Depressives expend their life forces to stay on an even keel, with the result that they suffer increased heart disease and other physical ailments. The number of suicides is small in comparison to death by these other causes. Suicide among the middle-aged and the elderly is an admission they have exhausted their vitality — and perhaps all their temporary solutions (therapy, medications, addictions, creativity, marriages, and self-help groups) are no longer adequate to balance their permanent problem.
Over 20 years as an emergency physician, talking to those who attempted suicide but lived, I heard people who accepted death as an inevitable part of living. They had booked their departure and missed their connection. Depressed, they had won the daily fights, until overwhelmed, their final action was to abandon the battlefield. Their spirits were broken; their will was gone.
It is not that the “same qualities that drive a person to brilliance may drive that person to suicide.” Actually, depressives find relief demonstrating their talents — art, writing, making movies, drugs, sex, or risk-taking. When engaging in their chosen line of expression, they restore some of the energy that would otherwise be lost in the daily drain. Great art (or bad cocaine unfortunately) can be equivalent analgesics.
There are some young, impulsive Romeo and Juliet episodes (like prom nights), but suicide notes from the middle-aged and elderly are quite practical and selfless. Consider poet John Berryman’s:
O my love Kate, you did all you could. I’m unemployable & a nuisance. Forget me, remarry, be happy.
That is not the last plea of an isolated man, but that of one concerned about his loved one. Indeed, suicides in many societies arise from the notion that the family and the community are better off without the presence of a particular individual. Perhaps, as in Berryman’s “Dream Song 14,” he lost his “inner resources.” With no joy in anything anymore, he needed his rest. Robin Williams, who brought mirth to millions, at the end, may have perceived a family and a world that would have been happier without the Robin Williams he percived, an exhausted shell of a man.
My regret is that his last act had to be solo, with no one there to tell him what a great job he had done in spreading joy to millions. We all have a role in this isolation at the end — assisting suicide is criminal offense. So when Williams was possessed of the fatal moment, he acted alone, first trying a pen knife, before succeeding at slow suffocation. Maybe if he had a chance to consult a doctor/counselor about “how to do it,” there might have been an adjacent conversation about “why do it?” and a chance to change his mind. As for those who look for a “reason” in his final days, rather you should consider the 10,000 days of struggle before the final day, and marvel at his ability to give so much to the world while engaged in that daily battle against sadness.
James Katz is an internal medicine physician and co-founder, Age Management Boston.
