Depression: A disease that conceals hope

Mental illness and susbstance abuse made Robin Williams especially vulnerable

Depression can mow down even the wealthiest, most creative people, and those with both mental illness and an addiction are especially vulnerable, mental health experts said Tuesday in the wake of comedian Robin Williams’ apparent suicide.

Joseph Cvitkovic, director of behavioral-health care for Jefferson Hospital-Allegheny Health Network, said it can be difficult for people who don’t have major depression to understand the “intensity of the pain” it causes.

“Because you can’t see it, and it’s not going to show up on an X-ray, there’s a tendency to diminish its significance,” said Mr. Cvitkovic, a psychologist.

U.S. Rep. Tim Murphy, R-Upper St. Clair, a psychologist who has sponsored legislation to overhaul the mental health system, said Mr. Williams, the star of television and movies, had the wealth to buy any treatment he needed. But money couldn’t buy what he needed most.

“It’s the disease that causes you to give up hope,” Mr. Murphy said in an interview. “It’s the disease that blinds you to understanding you can get better.”

Police investigators said Tuesday that Mr. Williams, 63, who had struggled with depression and substance abuse, is believed to have hanged himself with a belt from a bedroom door in his California home. He was last seen by his wife at 10:30 p.m. Sunday, and his body was found about noon Monday by a personal assistant.

Mr. Williams also had cuts on his left wrist. Near his body was a pocket knife with traces of what appeared to be blood.

Mental health experts said Mr. Williams’ death is a reminder that depression is a chronic disease, like diabetes, and that additional efforts should be made to diagnose, treat and de-stigmatize it.

“Treatment does work and can help,” said Neil A. Capretto, medical director of Gateway Rehabilitation Center, based in Moon.

Mr. Cvitkovic said professional literature suggests that entertainers and other creative types may be especially sensitive people. That sensitivity, he said, may be associated with down periods or heightened feelings of loss or anguish.

In the 1987 film “Good Morning, Vietnam,” Mr. Williams played the role of an off-the-wall disc jockey. Adrian Cronauer, the Wilkinsburg native whose wartime experiences were the basis for the role, said Mr. Williams was an elusive personality.

“He was kind of a hard person to get to know because you went to him and said hello, he started doing a routine,” Mr. Cronauer said Tuesday from his home in Virginia.

That seemed, he said, a way for Mr. Williams to keep people at a distance. “The only time that my wife and I ever saw Robin let down that facade that he had was when he was playing with his own little children, who gave him unconditional love.”

Suicide is a risk with certain mental illnesses, and family members should be alert to warning signs such as a person’s attempts to isolate himself or expressions of indifference, said Leo Bastiaens, a psychiatrist with Wilkinsburg-based Milestone Centers Inc.

“Suicide is clearly a risk in depression, bipolar depression, early on in schizophrenia and in substance-abuse disorders, particularly when more than one of these come together in an individual, which is quite often,” Dr. Bastiaens said.

About 40,000 suicides occur each year in the U.S., said Mr. Murphy, whose legislation in some cases would make it easier to force a mentally ill person into treatment and give families additional access to loved ones’ medical information. In a statement, Mr. Murphy said, “Perhaps Robin Williams’ greatest gift to us, if we choose to accept it, is a focused determination to help those with brain illness and finally take real action to stop the loss of one more precious life.”

Dr. Bastiaens said suicide is just one reason that people with mental illness often have shorter-than-average lifespans. Some die because they’re unable to care for physical maladies, he said, and there’s also evidence suggesting a shared genetic predisposition for certain mental and physical illnesses.

David J. Kupfer, professor of psychiatry at the University of Pittsburgh School of Medicine, said recognition of depression, early intervention and continuing care all are essential to treatment.

Dr. Kupfer — who played a leading role in the development of DSM-5, the latest version of the mental health profession’s guide to diagnosis and treatment — said patients “might need to continue to receive treatment for a longer period of time than they or their families think.”

Dr. Capretto added that a person who’s healthy for many years could experience new problems with depression or substance abuse because of a traumatic event. “Your guard is down. It might come back and clobber you again,” he said.

Adding substance abuse to a mental illness, Dr. Capretto said, is “like putting lighter fluid into a fire” and could cause a person to act more impulsively than usual.

While mental illness and substance abuse often go together, he said, it isn’t always clear which came first. A person with mental illness may try to medicate with drugs or alcohol, while long-term substance abuse can contribute to mental illness.

Holly Harmon, a licensed clinical social worker and counseling center director at Robert Morris University, said Mr. Williams’ death shows that “appearances are deceiving” and that it’s difficult to know the extent of someone’s suffering.

But she said Robert Morris students and staff are encouraged to keep alert for those who are struggling and to “be the first step” in a chain of help. “It’s building up a culture that cares,” she said.

Associated Press contributed. Joe Smydo: or 412-263-1548.

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