In the month since the death of Robin Williams, there has been a lot of social and mainstream media discussion about depression and suicide. This is a good thing. The more we talk about it, the more likely that we might move towards a position where mental illness is seen as the commonplace yet debilitating experience it is, the more likely we are to better manage these conditions as a society and the greater the hope that meaningless deaths and the devastation they cause can be avoided.
But as with any move towards greater awareness, there are a lot of messages floating around which aren't necessarily helpful, which simplify illness and risk re-enforcing assumptions about mental illness. Emma wrote about the simplistic message that folk just need to tell someone, and I want to talk about other dominant narratives of suicide and depression.
The world at large cannot know what was going through Robin Williams’ mind when he decided to take his life. We know about some sources of stress in his life (a cancelled show, potential bankruptcy, a Parkinson's diagnosis). We know that he had bipolar disorder and a history of alcohol and substance abuse. However, there is no neat story to tell – not right now and maybe never – about what he was thinking and why he did what he did.
However, that doesn't stop us pretending there is.
“This is what depression feels like.”
I’ve seen so many articles with this kind of title since the death of Robin Williams and you know what? That’s not what depression feels like. My experience of depression isn’t exactly extensive – it’s probably about eighteen months, all totted up, but even I can tell you that it feels like physical pain, also numbness, also total emptiness, also like all the colours have been toned down, also utter blackness, also a menacing figure in the corner of the room, also complete indifference, also a bell jar and a black dog. Not all at once, you understand, but it changes. Meanwhile, symptoms vary hugely between individuals; how much a person can do, how sociable they are, whether they're sleeping all day or not at all, whether they're eating all day or not at all, and so forth.
I think it’s immensely important to talk about our personal experiences of depression – the biggest barrier for people seeking help is the fear of judgement and misunderstanding, the belief that they are the only person who has ever felt like this (or at least the only person they know). So it really is great that people have the courage to write about their darkest experiences.
However, framing anything as a definitive account (perhaps especially when it’s beautifully written) plays into the idea that this is a condition which looks one particular way. That readers of such accounts can know exactly how Robin Williams, or any person with depression, must have felt.
This is especially dangerous when it comes to perceptions of functional impairment; the idea that someone with serious depression can't get out of bed, or will withdraw from the world altogether. There's a danger of assuming our friend who is having dark thoughts but still making it into work each day will be just fine.
Fortunately, it's possible to be both respectful and compassionate without having to know exactly how a person is feeling at any given moment in time.
Yes, depression lies. Depression can make people believe things about themselves, their lives and other people which are not true. A truly wonderful person can come to hate themselves because of this trick. A very fortunate person surrounded by love and material comforts may hate their life because of this trick.
Some people experience depression for random chemical reasons, as with post natal depression, but many others have depression caused or compounded by abuse, trauma, discrimination, isolation, physical illness, poverty, heartbreak, bereavement and very often, a combination of these things. Meanwhile, depression makes a person more vulnerable to negative life events, to poverty, to exploitation, to losing supportive relationships and to other physical and mental health problems. In other words, people with depression are likely to have some very real problems in their lives.
And people with depression are not believed. It is much harder for people with mental ill health to get the benefits they’re entitled to. When someone with depression takes a physical symptom to the doctor, it will often be put down to depression. When someone with depression takes a criminal case to the police, they may be told that they are an unreliable witness. When someone perceived to have a mental illness speaks out about politics, an elected official may advise them to "refrain from commenting in the public domain" as if a diagnosis discredits a person completely.
People who live with these experiences often wind up with problems trusting themselves, rendering #depressionlies a far more complex message than can be done justice to in 140 characters.
Meanwhile, all chronic illness lies. Chronic pain is a lie – the point of pain is to warn you of injury or illness, so you can respond accordingly, recover and avoid whatever made you hurt in the first place. Chronic pain says that there’s a crisis now, when (often, at least) there’s no crisis at all and nothing you can do. Chronic pain tells you to stay still when you need to move and to move when you need to stay still.
“People don’t die by suicide. They die of depression.”
Suicide is a physical act, not an internal experience. People take their lives in a great variety of circumstances. One person might plan their death a year in advance. Another person, in the absence of any mental health problem, finds themselves in a difficult situation, panics and departs. Suicide is not, as one commentator has it, a symptom of depression.
Suicide is a physical act at one particular moment in time - this is one reason why speculating on why Robin Williams, or any other person, died, is ridiculous. All these deaths tell us is that, at one particular moment in time, a person intended either to to gamble with their lives, to inflict severe self-injury or to end their life. Sometimes people die and those left behind have no idea what was going through their minds. Sometimes a person gets very drunk or stoned or desperate or angry and makes a dreadful mistake which would not have occurred to them the following day. The fact that a deceased person had depression doesn't mean they were in complete agony for months leading up to this event.These are tragic deaths.
I feel we desperately need to be honest about this because suicide is highly preventable. One of the great tragedies of suicide is the fact that, in very many circumstances, external events might have disrupted the act. Speak to people with a history of suicidal depression and you frequently hear stories of rescue; this event, this person, this pet, even a personal realisation that struck them at the right moment saved their life.
Depression is not a simple condition and occasionally, people don't get completely better. But it's often simple kindnesses, responsibilities and thin rays of hope which enable people to survive the worst periods and regain some quality of life.
Meanwhile, there is a hell of a lot we can do, socially, culturally and politically to help reduce the impact of depression on people's lives, so far fewer people ever get into a position of danger. Both depression and suicide are hugely influenced by sociological factors (including the way that famous suicides are reported).
Describing suicide as if it is something that just happens to depressed people is doing no-one any favours. It patronises people with depression and renders the rest of us helpless.
Fortunately, we're not.
If you're in trouble right now, these links may be useful:
a great post as ever!
as well as the myths about depression, I would also add "the sad clown" archetype! Ruby Wax did a fabulous blog post dispelling that here... http://www.theguardian.com/stage/2014/sep/04/ruby-wax-we-must-stop-linking-comedic-genius-with-depression
For some people there is no medical help for mental illness, I have friends who are depressed who have tried everything, and yet they still have it! There isn't always a perfect solution, you just have to live each day, day to day. Perhaps friends being compassionate is everything to them!
I don't agree with your point about suicide as an event. I mean it is literally an event but how many people just randomly decide to do something? From the people I know in that situation, it was a "state". A state of such despair and they had to be watched carefully for a period of time. I see it as an extreme hopelessness depression.
I have never been in that situation though but have had a very bad depressive spell and hope to never be in that again! I felt underwater and everything became so hard to do! It's a lot like worsening physical disability in so many ways!
Thanks Daniel - the Ruby Wax article is great. :-)
I think compassion matters a very great deal indeed.
I think I overemphasised suicide as an event. It is an event, but of course, suicidal ideation can go on for many hours, days or even weeks. Also, while it is true that someone can suddenly sink into that state, most people who do attempt suicide have been depressed for some time.
However, a person does have autonomy. They can't choose not to be depressed, and their choices can be greatly diminished by depression. Also, my experience was that it was something that would come and go - but I was still in a lot of danger, because it seemed entirely reasonable when it was there.
The sort of thing I'm thinking of where someone might attempt suicide without depression would include bankers who suddenly lost everything, a criminal suddenly facing justice or person who has been coping well in a crisis, but whose strength suddenly fails and the whole thing collapses on top of them. They reckon about 10% of people who die by suicide had no ongoing mental health problem.
Although I usually avoid thinking about suicide, this is one of the most cogent and insightful essays I have ever read on the subject...Thank you so much for posting. I've been in and out of depressive states for years - ranging from a bit dysthymic to totally dysfunctional - and sometimes I'm just fine, happy and content even!...Fortunately, I've learned to recognize, accept and cope with all these affects for what they are - passing states of mind. It matters not whether they are chemically or situationally induced - often they are a tangled mess of both. If one also has a fundamentally impulsive sort personality then yes, suicide IS a great danger...it helps to understand oneself and guard against it as much as possible - like not having firearms available and making up one's mind during the better periods to NEVER go down that one way street, better yet - having a plan to make the call for help first before turning the corner. Of course, when depressed - it's a struggle to cling on that self promise like an inflated life ring in a sea of despair. Most important of all I've found is to cultivate compassion for oneself through cultivating it for others...that has been the best medicine of all.
Anonymous - thank you for your lovely comment. All the best for enjoying the good times and keeping afloat in the bad times.
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