Robin Williams, bipolar disorder?——II

I’ve studied and its variants all my life—as a psychology major, as a med student, and as an observer of those around me. I’ve chosen to weigh in on the debate over for that reason, and also because depression is an important theme in my memoir, Cleft Heart.

Before delving further  into the Williams case,  I’ll address some of feedback I’ve received regarding my assertion that Williams suffered from bipolar disorder. And since there have been new revelations about factors that may’ve influenced Williams’ decision to commit suicide, I’ll address these, too.

Robin Williams

Robin Williams WikiCmns

Unipolar vs .

One reader asks: “Are we presuming Williams was ‘manic’  because of his energy as a comic?  Everything I’ve read seems to indicate that he struggled just with depression making no mention that he had manic swings.  Just curious.”

Response: My conclusion about Williams’ disease is based on his self-medicating, his risky behavior on occasion, and other factors—not just on his famous manic, speeded up comic delivery. 

Unipolar and bipolar depression diagnoses don’t go hand-in-hand. In fact many of the comedians mentioned in the media as depressives—including Dick Cavett who is usually left off the lists—are just that: depressives, not manic depressives.

Williams said he he didn’t have bipolar disorder.

Another reader: “I have been reading some news online. One article said that Robin Williams stated he did not have bipolar disorder.”

Response: If true, this isn’t surprising. Most celebs, their publicists, and their retinue of hangers on understand that most Americans stigmatize those with mental illness. So, it’s generally a bad career move in their minds to cop to having an issue more severe than “the blues, ” SAD (seasonal affect disorder) or dysthmia (mild depression). Unfortunately, those in the limelight are not readily willing to talk about serious depression, bipolar disorder, or any number of other mental illnesses that they or their loved ones might have. Williams was one of the celeb exceptions, but he drew the line at serious depression, not admitting to manic depression.

The revelation of Parkinsons.

Parkinson’s disease certainly added to the burdens Williams carried. An interesting question arises: did the Parkinsons predate his serious depression and cause a lot of it or was the depression there and Parkinsons only added to it? I’d opt for the latter.

It is not clear whether the early-stage Parkinson’s disease affected his ability to work. Comments from around the web:

“Friends and family can usually detect changes in the Parkinson’s patient including poor posture, loss of balance, and abnormal facial expressions,” according to the National Parkinson Foundation.

During this initial phase of the disease, a patient usually experiences mild symptoms. These symptoms may inconvenience the day-to-day tasks the patient would otherwise complete with ease. Typically these symptoms will include the presence of tremors or experiencing shaking in one of the limbs.

Williams used exercise and cycling to manage his stress and depression, and the prospect that the illness would prevent him from doing that was extremely upsetting, adding to the depression, the person familiar with his family said.

“[M]y father was bed ridden for almost five years before dying, if robin was suffering from that, it would certainly be very hard to face.”

“[M]y dad was pretty much in a coma by the time he died after a multi-year fight with Parkinsons.”

Williams’ heart disease.

Williams had open heart surgery in 2009 to replace a faulty aortic valve. He often joked about being part pig, but seemed at peace with the lifestyle changes it triggered. He rejoiced at the newfound energy he had, just as he celebrated his new lease on life when each time he finished rehab stints.

Williams’ financial woes.

As reported widely, Williams may’ve been troubled by economic and related career issues of late.  CBS cancelled his TV show, “The Crazy Ones,” last year after its first season. He may’ve been counting on the income from the show and various movie deals to help him get on his financial feet after two pricey divorces over the years. (He often joked that “alimony” really meant “all my money.” Allegedly he paid out $30 million to his two exes.)

He may’ve taken on movie roles just for the money and been depressed about it. According to RadarOnLine

“Robin slipped into a deep depression. He felt embarrassed and humiliated that the show had been a failure. It was very hard for Robin to accept. Here he was in his sixties, and forced to take a role on television for the money. It’s just not where he thought he would be at this point in his life … Doing sequels was never Robin’s thing, and he wasn’t that excited at having to reprise the role of Mrs. Doubtfire, which was scheduled to start filming later this year.”

Williams’ estate in Napa Valley remains on the market after he put it up for sale earlier this year, asking almost $30 million for it.  

Still, bipolar disorder underlies all.

Clearly, Williams had a lot going on in his head in recent months, and some factors alone might’ve done in a lesser man. None of these factors, however, would have caused me—were I a medical examiner in this case, facing a negative drug panel report—to enter anything other than “bipolar disorder” as the major contributing factor causing Williams asphyxiation from hanging.

Nassir Ghaemi, M.D., M.P.H. , a psychiatrist at Tufts Medical School, wrote a piece for Psychology Today recently that’s so compelling that I’ll quote freely from it:

“Was it ‘depression’ that killed Robin Williams, as most media reports say? Or depression mixed with alcohol and drugs?  

The disease was manic-depression, or bipolar illness, as some reports acknowledge; depression occurred as part of that disease, and, in all likelihood, it led to Williams’ suicide. Alcohol and/or drugs may have precipitated the timing and the exact end, but the disease which afflicted him, over and over with repeated mood episodes, was manic-depression. 

Depression” is somewhat acceptable; manic-depression is still mostly taboo. Even mental health clinicians, including many on the PT site, downplay or denigrate it. 

But it exists; it provides great gifts; and it kills. 

The gifts: creativity in mania certainly helps comedians and actors;  the mind runs in a million different directions, and new and funny and smart ideas pour out.  Williams was a walking manic episode in many of his interviews and skits. …

Many persons with manic-depressive illness have [a manic] temperament all the time – so they’re creative and productive and funny, and sometimes famous – and then they have repeated depressive episodes, usually lasting weeks to months, usually happening once a year or two – and, in about one in ten persons, leading to suicide.

So Robin Williams’ “depression” should be called what it was:  manic-depression. And we need to start taking this bipolar illness more seriously and respectfully, and acknowledging its existence, and treating it correctly –rather than misnaming it and mistreating it (as happens with “depression”, where antidepressants often worsen the bipolar illness, sometimes leading to suicide), or, worse, simply ignoring it. 

Tragedy is sad if not preventable, but truly terrible when a cure exists, such as lithium, which is proven to prevent suicide in multiple gold-standard randomized studies.  And, more importantly, it is the ONLY medication proven to prevent suicide in randomized studies. . . . “

 

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