In the wake of the sad news of entertainer Robin William's recent suicide, news and social media outlets were flooded with a predictable flurry of stunned reactions and commentary.
How could a man with such fame and wealth, admired and loved by millions, be unhappy enough to actually want to kill himself? If only Williams had "reached out" in his final moments, some despaired. Others reminded us of the availability of suicide hotlines, anti-depressant medications, and counseling. Everyone was shocked, and puzzled.
It's always struck me how incurious many people are after someone commits suicide. How incurious to delve into the roots of pain. It's as if something so inexplicable has occurred that it's too uncomfortable, too futile, to even attempt to understand. Indeed, even with the upheaval of news that followed William's death, there has been little in the way of a coherent picture to emerge of just how to explain his final, desperate moments.
In fact, Williams had reached out in the final weeks of his life. In July he returned from several weeks as an in-patient at the Hazelden Addiction Treatment Center in Minnesota. It was not his first visit to Hazelden, which offers treatment programs that utilize a mix of psychotherapy, 12-step programs, and medications. Williams was reportedly there not because he was using drugs or alcohol again, which he had done as a young man and again from 2003 to 2006, but for help in maintaining his "long-term sobriety."
At the time of his death, Williams was said to be struggling with several issues, including a diagnosis earlier this year of Parkinson's disease. Certainly the news of the diagnosis must have been hard to take. Like tremors and rigidity, clinical depression itself can also be a symptom of Parkinson's. Williams had also undergone open-heart surgery in 2009 for aortic valve replacement, mitral valve repair, and to address an irregular heartbeat (possibly atrial fibrillation). For many reasons, it's not unusual for lingering post-operative depression to occur following open-heart surgery. Finally, Williams was reportedly weighed down by the financial obligations of multiple divorces, enmeshed in an expensive lifestyle he could no longer quite afford.
The Roots of Pain
Much of the commentary in recent weeks on Williams' psychological troubles has focused on references to the impact of "brain disease," how chemical imbalances in the brain, low levels of neurotransmitters, will often precipitate depression. With his manic stage presence, some have also wondered if Williams had ever been diagnosed with bipolar disorder? Perhaps there were other medical problems? Like Parkinson's, a thyroid disorder or chronic inflammation are among medical conditions that can negatively affect mood. Sometimes even just chronic lack of sleep in an elderly person can push them into a hopeless mental state.
And yet often there is another story, a hidden story unfolding a chapter at a time over the course of many years. For some it is a story told in the pages of unresolved early childhood trauma. In one study, the Centers for Disease Control (CDC) found 58 percent of suicide attempts in adult females linked to adverse childhood experiences. The latter included physical and sexual abuse. Overall, 54 percent of cases of adult depression had roots in traumatic childhood experiences. The consequences of early adverse experiences include a host of unfavorable health outcomes, from depression and heart disease to diabetes, cancer, and early death.
Obviously, it's difficult to trace a coherent line in a person's life story or health history all the way back to the beginning. Outside of more obvious traumas, such as remembered sexual abuse, how do you show current health problems are rooted in early childhood experiences, or even in the womb? Among psychotherapists a few maverick thinkers such as Alice Miller and Arthur Janov have probed more deeply into these issues. In "The Drama of the Gifted Child" and other books, Miller's sensitive gaze saw psychological trauma in much of what many considered "the normal childhood." In particular, the traditional practice of spanking children as a disciplinary measure was strongly condemned by her.
To the extent he talked about it, William's gave the impression of a somewhat emotionally remote upbringing in an upper-middle-class home. As he once told People magazine, in his family "the ideal child was seen, not heard." He described himself in childhood as "short, shy, chubby and lonely."
Writing on his blog (Aug. 14), Janov, the founder of primal therapy, remarks that Williams' recent return from "another round of in-patient care at a rehab center should inform us of the ineffectiveness of rehab but it doesn't. Rehab is big business and it goes on uninformed by strict science so that anything goes."
Since the 1960s, the now 90-year-old Janov has treated mental health problems with therapy that looks for the imprint of early trauma, including pre-birth trauma. From there the therapy seeks to dislodge repressed feeling locked in the body, and hopefully gradually resolve its hold on the individual. "Clearly Mr. Williams had deep-lying imprints that could overwhelm any later imposed ideas such as 'see or focus on the positive,'" Janov writes.
In fact, there's new evidence to suggest that very early trauma can significantly influence later patterns of ill health in adults. From Yale University comes research exploring the role of a single gene, called HSF1 or heat shock factor, that works to protect brain cells from prenatal injury. Affected by traumatic or environmental stressors during pregnancy, researchers see indications genetic changes related to HSF1 are associated with later psychiatric disorders. A Science Daily report from 2012 describes how the trauma of child abuse creates risk for long-term dysregulation of the stress hormone system. Interestingly, there is evidence post-traumatic stress related to early childhood trauma can exist even without conscious memory of the trauma.
Feeling Man, Unfeeling World
Paradoxically, when it came to battling mental illness, perhaps Williams' success in life in the long run may have worked against him? After all, what dreams remained for this man who had already achieved so much? Was there any material possession, any grand accomplishment, left for him to pursue? You have to wonder what did he think of himself, having such a privileged life and yet still finding himself so unhappy.
In interviews I always found it hard to get a sense of who Williams really was. The wired mania was always lurking nearby, like a thief of the true self. Who was this person in real life? But in this case the thief was also a talented professional entertainer, and so for the most part we all just went along for the laughs. In a 2010 interview with The Guardian's Decca Altkenhead, Williams comes across as a man whose "overwhelming impression" is one of sadness. He describes his three-year relapse into alcoholism that began in 2003, hinting that his behavior was at times "shameful" and "hard to recover from."
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