Williams’ death reminds us that a patient’s relief might be a warning sign

By
H. Steven Moffic, MD

One
of my favorite movie moments is when Robin Williams signs on as an edgy D.J. by
exclaiming "Good Morning, Vietnam" from the 1987 movie of the same name.
Sometimes, I played the audio over and over, as if it could promise a good day.
As he did so often, he found a way to not only lighten the sadness, but to do
it in such a way that might be constructively critical.

Surely,
the real life mornings were not often happy ones, as so many of our troops died
or ended up with post-traumatic stress disorder (PTSD) from that war. It is a
lesson we are still learning, so that movie and his role is worth seeing again
soon.

Now,
after his reported suicide, that good morning seems more like a final good
night.

Although
he is probably best known for his manic comedy, he also played many serious
roles. Most ironically now, he won an academy award in 1997 for playing an
empathic therapist in the film “Good Will Hunting.”

Indeed,
beloved entertainers like Robin Williams have a therapeutic role of sorts for
society in the sense that they provide some relief—even if briefly—for the
grief and stress of everyday life. For playing that societal role, such people
become a repository for our hopes, dreams and demons. As we know for so many
famous entertainers, it is not easy for them to have a successful private
life—a private life that the public also tries to invade, as if they were
related to us.

What
we do know publicly is that Williams suffered from chronic depression and
intermittent substance abuse. It is reported that he received treatment,
including entering rehab just last month. Obviously, money to get the best
treatment was not an issue, though how good the treatment was will remain
unknown. We do know, however, that wealthy VIPs often receive treatment just as
poor as low-income folks without resources. We also know that occasionally
depression is a terminal illness, though that ending is not predictable.

Beyond
the public information, and despite the understandable curiosity, this is not
the time, nor should it ever be the time, to speculate about his diagnosis and
reasons for committing suicide. In fact, the so-called "Goldwater
Rule," called that for the inappropriate professional speculation about
presidential candidate Barry Goldwater, ethically prohibits such speculations
on the part of psychiatrists like myself.

Given
this professional ethical principle, as well as the family's request for
privacy, is there anything we can still learn from this apparent tragedy? The
most intriguing detail that caught my attention was his last tweet and
Instagram on July 31. Reportedly, he had wished his daughter a happy 25th
birthday.

Why
might this positive communication be of importance to us?

It
reminded me of the only patient I ever had who committed suicide, long ago,
when I was a resident in training. In the second session, the depression of
this elderly man seemed to be less severe, but after that session he walked
into Lake Michigan and drown. In the psychological autopsy, I never forgot the
warning that when a depressed patient starts to seem better, they actually can
be at higher risk for suicide.

Risky
time

Why
is that time of apparent improvement a risky time? The person can have more
energy, then plan and complete a suicide. They may also feel relief at their
decision, causing others to paradoxically feel relief. That is one of the
reasons why it is so common to hear of the genuine surprise that the suicide
occurred, as the person seemed to be happier.

What
this means, not only for professionals, but for the public, is not to take at
face value if a depressed person seems better. Be sure there is a sound
explanation for the apparent improvement.

Our
only consolation must be that entertainers like Robin Williams keep on living
in the form of their life’s work, like the movie “Good Morning, Vietnam,” that
is so ubiquitously available nowadays. Even so, it would not be surprising if
at the times we laugh once again at Robin William's humor, that the laughter
will also be accompanied by some tears of grief.

Bio

H. Steven Moffic, MD, is a Life Fellow of the APA. Currently, he blogs regularly for Psychiatric Times, Behavioral
Healthcare, and The Hastings Center's Over 65.

This blog was originally published in Behavioral Healthcare.