Robin Williams’ suicide on Aug. 11 will be one of approximately 39,000 suicides in the U.S. in 2014. Like Williams, millions of Americans struggle with depression.
The National Alliance on Mental Illness (NAMI) estimates that between five and eight percent of adults in the U.S. are affected by depression annually. Of the approximately 25 million Americans that will have an episode of major depression this year, NAMI estimates only one-half receive treatment.
The recurrent theme in every discussion of depression and suicide is the need for people to communicate. Williams had been open for decades about his struggles with depression and substance abuse, but society at large, while having made more progress when it comes to discussing mental health issues, has been slower to open up about a disorder that affects many people.
Knowing the signs of depression and asking for help or being willing to check on a friend or loved one are the first steps in addressing a condition that while one is affected seems hopeless, can be quite the opposite if treatment is sought.
Losing a Loved One to Suicide
“Everybody’s experience with suicide is unique, but mine is I think a little atypical because there was no warning that anybody read,” said a source who prefers to be identified as Janet. Janet agreed to speak with the Inweekly under the condition that her actual name be withheld due to the sensitivity of the subject.
“He was a retired military officer. It was very, very unexpected—I call it a mind attack, sort of like a heart attack,” Janet said. “I think most people who knew him would’ve characterized him as a person who loved life. That was the incredible contrast to his manner of death.”
Janet’s late husband was 53-years-old at the time he ended his life a little over ten years ago. To her knowledge, he had no history of depression and had not previously attempted suicide.
“A person that has a loved one that does commit suicide is going over, replaying that film from as far back as they can remember going, ‘What did I miss?’” Janet said. “This is a person I loved and thought I knew very well. We grew up together, so to speak—we met in college, married shortly thereafter, and had a very busy and fulfilling and, to me, a happy life and he seemed to be on the same page.”
After learning that her husband had taken his own life, Janet recalled her concern for her grown children in the immediate wake of the news, as well as an outpouring of support from friends including a few who had personal experience with losing loved ones to suicide. Hearing their stories helped her in the following months and years.
“I did a lot of introspection. I had wonderful support from friends and family, and I did a lot of reading trying to make sense of what I and what our family experienced and what my late husband may have been going through or thinking or not thinking.”
Janet reached out to two local support groups she estimates nine or 10 months after her husband’s death.
“It was helpful sharing people’s early reactions, where they went with those and how they learned from them,” Janet said of the fellow survivors she encountered in the support groups, which she viewed as a helpful forum to discuss feelings with others dealing with loss of a loved one by suicide.
“The pain you’re feeling, the questions you have are a commonality that kind of bonds you. Sometimes your nearest friends and family members don’t want to talk about it, they don’t know how to talk about it or they’re afraid to,” she said she learned in reading and listening to the experiences of others. “In some cases, they may have struggled with depression only nobody knew it and this is too close to home and they cannot talk about it.”
Like many who lose a loved one to suicide, Janet was left with more questions than definitive answers. Doing research, she learned that certain health conditions, such as an underactive thyroid, can cause depression. For this reason, Janet stated she advocates anyone experiencing depression to not only speak to a mental health professional, but also have a thorough physical exam completed.
“Because my husband was a military pilot he learned to compartmentalize very efficiently, so that I don’t think helped him—if he was feeling depressed, he did not share it,” she said.
“You can’t get inside another person’s mind,” Janet stated. And in the instances of those feeling depressed, those who have suffered a traumatic loss, and those around them, her conclusion is the same as many professionals who treat depression each day: “People have to reach out.”
The Link Between Depression and Suicide
In 2011, the most recent data available through the Centers for Disease Control and Prevention (CDC) Data & Statistics Fatal Injury Report, 39,518 suicides were reported that year, making suicide the 10th leading cause of death in the U.S.
“Some people complete a suicide and have never been treated for even a single episode of depression, and they would’ve done fine in treatment,” said Dr. Donald Winslett, a licensed clinical psychologist in private practice for 33 years, adding that often times there are indicators including previous suicide attempts or self-inflicted injury: “Very few people end their life on the first attempt.”
Americans make approximately one million suicide attempts each year, or, as the American Foundation for Suicide Prevention notes, surveys suggest that for every one death by suicide reported, “…approximately 12 people harm themselves (not necessarily intending to take their lives).”
Winslett is also an ordained minister and now serves as the Director of Clinical Pastoral Education and also the Director of the Center for Clergy Care and Education at Baptist Hospital, working to educate clergy—often among the first group people in a crisis turn to—and patients on depression and its treatment.
A myriad of factors can contribute to initiating an episode of depression. Left undiscussed and untreated, depression and accompanying feelings of isolation or what Thomas Joiner, a psychologist at Florida State University and author of “Why People Die by Suicide,” identifies as “perceived burdensomeness” and “thwarted belongingness” can compound.
“Someone who is depressed typically is not thinking positively or even neutrally…so it’s easy to get into thoughts of ending your life,” Winslett said. “In the constellation of symptoms that we use to make a depression diagnosis, one of the nine is about suicide. The studies are telling us now that 50 percent of all suicides are carried out by people who are depressed.”
At particular risk of suicide are Euro-American men over 65 who are, according to Winslett, the least likely to sit down with a therapist or psychiatrist.
“They are most vulnerable,” he said, explaining that many in that demographic are also veterans, another group particularly at risk. “Of the approximately 700 suicides completed every week, 120 are vets.
“We have a will to live. We are born with a predisposition for life. When someone ends his or her life, it goes against the grain of how we understand life to be,” Winslett stated. He stressed that death by suicide is comparatively rare. “Today, 100 people will end their life, but 1,900 people will die with cardiovascular disease, 1,700 people will die of cancer.”
Like other medical conditions, depression is treatable. The earlier a person seeks help, the better. However, a range of factors can make people reluctant to speak about their feelings.
“There’s a lot of language about mental and nervous disorders that’s very condescending and negative,” Winslett said, pointing out euphemisms such as ‘‘You’re crazy as hell,” “You must be off your meds today,” “You’re nuts” and the like.
The derision inherent in such statements (intended or not) contributes to the continued stigmatization of the disease. Fear or embarrassment about experiencing depression affects a person’s willingness to seek help, which compounds the problem.
“There’s still a lack of accurate information and good education. There are still people who believe you can will yourself out of depression or believe you can pray yourself out of depression when you would never attempt to will or pray yourself out of diabetes,” Winslett stated.
Moving Forward from Depression
Those experiencing depression and/or suicidal thoughts are often living with an unrelenting, “pervasive sense of hopelessness” as Winslett described. Holding his hand directly in front of his face, Winslett illustrated the ever-present nature of depression: “You go to sleep and it’s right here; you wake up and it’s right here. It never leaves you.
“The hopefulness is that there is treatment,” Winslett emphasized. “The hopefulness is that people can work through these issues and get to a good place in life.”
For patients who are clinically depressed, a combination of medication and psychotherapy, or “talk therapy,” has proven to be most effective.
“There are studies that tell us that there’s a 90 percent cure rate for a major depressive disorder when both treatment modalities are used,” Winslett said.
“Simply using the medicine does not always mean that three weeks later the person is going to wake up and life is going to wonderful, because they’ve gotten into bad patterns—there has been negative thinking, bad decisions and they have to unravel all of that, which is where the talk therapy comes in,” Winslett said. “But if someone is clinically depressed and they come to see me, we can talk until the cows come home, but they aren’t going to get better.”
That is where the relationship between psychologists and psychiatrists comes into play—if psychologists are speaking with someone who they’ve identified as clinically depressed, they refer that person to a psychiatrist who is familiar with and able to prescribe medication.
“The medicine gives someone the energy to do the other work,” Winslett said. “Normally when someone starts meds and they are working, they’re on the meds for nine to 12 months, even if they feel like a million bucks. After nine to 12 months, many people come off the meds and never deal with depression again. For some people it creeps back in, they get treated, they go off the meds and it goes away.”
For those who experience recurrent bouts of depression, a psychiatrist or general practitioner may recommend staying on medication, as with diabetes and other diseases. “And that’s not so bad,” Winslett said.
Unlike other medical conditions however, physicians and psychologists can’t conduct a blood or urine analysis to determine if someone is suffering from depression—the diagnosis is only able to occur if someone is willing to talk about what is going on.
“We see a lot of people who use alcohol or other drugs to tamp down the depression and the anxiety—it just doesn’t work,” Winslett said. “It reaches a point where they don’t know what to do with the pain.”
Many symptoms of depression (see sidebar) are also common in those experiencing grief as the result of a loss. Feelings of sadness or anxiety that persist for longer than three or four weeks and are not associated with a bereavement experience—a breakup or divorce or loss of a loved one, for instance—is something a mental health care professional should assess.
“When I say ‘normal’ losses, that’s not meant to minimize the loss. A job transfer, a fifth grader having to be pulled out of a school he loved to move five states over, your house burning down—those all produce similar emotions,” Winslett stated. “We have to be careful with grief and loss—grief in and of itself does not mean that a person is depressed, but the person can ultimately move into a depressive disorder.”
An important step for anyone suffering from depression is contacting a family physician, clergy member, mental health practitioner, or asking friends and family who have seen a counselor or psychologist if they’d recommend a professional to discuss the feelings they are experiencing.
For those who pick up on signals that a friend or loved one may be struggling with depression or suicidal thoughts, Winslett reiterates the importance of simply asking the question. While some fear that asking may drive a person away, Winslett said often the opposite is true. “The person feels listened to, cared for—they feel like you’re paying attention.”
If a person is concerned about a loved one, but worries about how to approach the subject, he suggests that individual contact a professional for the best way to begin a conversation.
“If you’re concerned about a friend or a loved one, get help for yourself. Speak with someone,” he said. “Don’t ever hesitate to ask someone if they have thoughts or plans to end their life.”
The National Suicide Prevention Hotline, which receives calls through a national center and 160 local crisis centers throughout the U.S., is the most commonly recommended contact for those facing extreme depression and/or suicidal thoughts. Local treatment centers (such as Lakeview Center) and mental health groups can also connect people with mental health professionals and support groups.
“If someone who is suicidal reads this, I want the person to feel a sense of hopefulness. There is a lot of help out there. You don’t have to do this,” Winslett said, adding that for every suicide, at least six people are dramatically impacted by that person’s death.
“It’s traumatizing—to say otherwise is to delude ourselves,” Janet said. “You can come out the other side, but it takes work.”
After her husband took his life, Janet said she realized she might face depression as a result, but asked family members to approach her if they recognized the symptoms.
“I never really got that far, but I knew I could. Everybody has that potential. You’ve got to reach out—you have to have people around you that say, ‘I’m going to help take care of you.’ You may not think you need help, but you do,” she said.
Lakeview Center Crisis Services
Help Line: 438-1617
TeenLine: 433-TEEN (433-8336)
National Suicide Prevention Lifeline
Dial 800-273-TALK (800-273-8255) to reach a trained counselor.
Use that same number and press 1 to reach the Veterans Crisis Line.
National Alliance on Mental Illness
Information HelpLine: 1-800-950-NAMI (6264)-Monday through Friday, 10 a.m.- 6 p.m., EST.
Florida Suicide Prevention Coalition
The following are common symptoms of depression. For more information related to the symptoms and treatment of depression, visit: mayoclinic.org
• Feelings of sadness, emptiness or unhappiness
• Angry outbursts, irritability or frustration, even over small matters
• Loss of interest or pleasure in normal activities, such as sex
• Sleep disturbances, including insomnia or sleeping too much
• Tiredness and lack of energy, so that even small tasks take extra effort
• Changes in appetite—often reduced appetite and weight loss, but increased cravings for food and weight gain in some people
• Anxiety, agitation or restlessness—for example, excessive worrying, pacing, hand-wringing or an inability to sit still
• Slowed thinking, speaking or body movements
• Feelings of worthlessness or guilt, fixating on past failures or blaming yourself for things that are not your responsibility
• Trouble thinking, concentrating, making decisions and remembering things
• Frequent thoughts of death, suicidal thoughts, suicide attempts or suicide
• Unexplained physical problems, such as back pain or headaches