While many people who kill themselves have been experiencing the extreme distress we might think of as depression, that’s not always the case and is rarely the whole explanation. This article originally appeared on the Guardian Science Website on the 18th of August 2014 and is reproduced here with permission.
As the tributes to the actor and comedian Robin Williams continue, so too do the arguments over the meaning of his death. Suicide is a profound act that touches many, and it would be surprising if it didn’t raise strong feelings. On the one hand we have Shep Smith of Fox News calling Williams a “coward” (he has since apologised). On the other we have a range of articles defending the star, usually along the lines of “don’t blame the guy – he had a mental illness.”
Most of the coverage has encouraged us to see his anguish as a symptom of a sickness as real and biologically based as measles or a broken leg. Just like those afflictions, we’re told, depression can strike anyone out of the blue. A piece by Guardian science blogger Dean Burnett offered a variation on this theme, asserting that depression is an illness and attacking any suggestion that suicidal acts might involve anything but desperation and a wish to escape. While we’re sure that the piece was written with the intention of defending someone in pain, we worry that it contains ways of thinking about mental health that oversimplify complex issues and can be unhelpful.
The most pervasive of these ideas is the suggestion that the way depressed people behave is a result of faulty brain chemistry. On the face of it, this is a good alternative to blaming them for being weak in some way: psychologist Mary Boyle has called this the “blame or brain” approach to troublesome emotions, behaviours and psychological experiences. However, what we often lose sight of is that calling certain emotional states or ways of thinking and acting “mental illnesses” is just one way of thinking about them, rather than the only way.
It may well be that some of us are more vulnerable than others to feeling desperate, but this is likely to be a result of things that have happened in our lives rather than, or perhaps sometimes in addition to, our genetic makeup. All we really know is that people sometimes feel or act in certain ways. The rest is down to interpretation.
If you feel sad and hopeless, and stay in bed all day staring at the ceiling, you might well be diagnosed with depression. Being told that you have an illness has its advantages. You can go to your GP and hopefully find a sympathetic ear, make some sense of what’s going on, get medication to take the edge off things and perhaps be referred to a specialist you can talk to. If you can’t work, you can take time off sick.
But there are downsides too. Thinking of yourself as mentally ill might well be a huge blow to your self-confidence. You might conclude that there is little you can do to help yourself except to keep taking the tablets. You might even worry that you are genetically inferior in some way. Mental illness still has many negative associations in the public mind. This can lead to what psychologist Rufus May has described as “us and them” thinking – the idea that there are two groups of people in the world: those of us who are well, and those who are mentally ill and therefore different in some way.
Lurking in the background is the spectre of the Mental Health Act: people with “mental disorders” are the only group that can be locked up without trial and medicated against their will, even if they are deemed capable of making decisions for themselves.
Perhaps the biggest problem with the illness idea, though, is that it can stop us trying to understand the broader context: the events and circumstances of our lives and how we respond to them. The truth is that we’re all vulnerable to mental health problems given the right circumstances. And we never know when those circumstances might befall us, pitching us towards a tipping point that we hadn’t perceived to be there.
Those who live ordinary lives may find it hard to fathom that someone like Robin Williams could be miserable enough to want to die. We forget that celebrity inevitably brings its own problems. And once you’ve reached a star-studded pinnacle, there’s nowhere to go but down. Even before we learned that he had been diagnosed with Parkinson’s disease, we didn’t have to look far to find possible causes of profound sadness in Robin Williams’ life. He had acknowledged difficulties with both drugs and alcohol, the latter being a factor in one of his two divorces. And he was in financial difficulty, something that had him taking TV and film roles he would have preferred not to have taken.
The truth is that suicide is complicated, and the combination of circumstances, emotions and motivations that precede a suicide attempt will be different for each person. While many people who kill themselves have been experiencing the extreme distress we might think of as depression, that’s not always the case and is rarely the whole explanation.
People have been known to kill themselves as a consequence of intense shame, or because they see no way out of a moral dilemma or a future that appears bleak. Many who attempt suicide may not really want to die, but seek instead to escape unbearable psychic pain. There are those with ongoing difficulties who may, in part – and perhaps misguidedly given the often profound effect of a suicide on the person’s family – be seeking to release another from what they see as a burden.
And although it may be uncomfortable to think about, for some people the motivations may involve anger as well as desperation. It is important to be open to the range of meanings of a suicidal act and to acknowledge that those left behind may also experience complex and sometimes bitter feelings.
Invoking the idea of illness can sometimes be helpful, but it isn’t the only way of connecting to people’s despair and of offering compassion and help without making value judgements. An alternative is simply to recognise that people can have a tough time. Surely that should be enough.
The authors work at the Salomons Centre for Applied Psychology, Canterbury Christ Church University. A longer discussion of issues related to the idea of mental illness can be found here. An audio slideshow about the complexities of suicidal risk is available here.
Dean Burnett (mentioned in the article above) also wrote a response here. In the US, the National Suicide Prevention Hotline is 1-800-273-8255. In the UK, the Samaritans can be contacted on 08457 90 90 90. In Australia, the crisis support service Lifeline is on 13 11 14Dean Burnett (mentioned in the article above) also wrote a response here.