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Tuesday, August 12, 2014

Robin Williams: The Untimely Fall To Comorbidity



Millions are grieving the loss of beloved Oscar-winning actor and comedian, sixty-three-year old Robin Williams. His apparent suicide has sent shock waves around the world as people deal with the circumstances of the tragedy. He was a comedic genius, so easy to love in all his quirky behavior. Producers would even leave blank pages in scripts for him to do his thing.

One question is particularly troublesome: "How can such a successful person take his own life?" Many are dumbfounded without a clue for an explanation.

Williams was known for being open about his problems with cocaine and alcohol over the years. The actor had also been battling severe depression of late. In fact, this summer he returned to rehab to "fine-tune" his sobriety.

The actor spent time on a Hazelden campus in Oregon in 2006. He later explained that drinking had gradually become a problem again after 20 years of sobriety and reportedly played a role in his second divorce ...

"You're standing at a precipice and you look down, there's a voice and it's a little quiet voice that goes, 'Jump,'" the Mrs. Doubtfire star told ABC News in October of that year. "The same voice that goes, 'Just one.' … And the idea of just one for someone who has no tolerance for it, that's not the possibility."

(Ryan Parker, Steven Zeitchik, Lauren Raab. "Robin Williams Dies in Apparent Suicide; Actor, Comic Was 63." Los Angeles Times. August 11, 2014) 

Williams elaborates on his addiction ...

“One day I walked into a store and saw a little bottle of Jack Daniel’s. And then that voice -- I call it the ‘lower power’ -- goes, ‘Hey. Just a taste. Just one.’ I drank it, and there was that brief moment of ‘Oh, I’m okay!’ But it escalated so quickly. Within a week I was buying so many bottles I sounded like a wind chime walking down the street."

("Robin Williams Talks Divorce, Alcohol Abuse And TV Show In New Interview."  
The Huffington Post. September 13, 2013)  

Speculation about the reason for Williams' suicide has uncovered some clues.

Sources close to Williams' family say he struggled with professional pressures. He had been worried about his faltering career as well as suffering from survivor's guilt. One report revealed Robin was never really able to get over the loss of his three dearest friends in the entertainment world: Christopher Reeve, Andy Kaufman and John Belushi.

"Robin outlived them all. He was a sensitive soul who struggled with the unfairness of it all," said the source.

(Hollie McKay. "Robin Williams Worried About Faltering Career, 
Struggled with Survivor's Guilt, Sources Say." Fox News. August 12, 2014)


Shedding Some Light
The term comorbidity describes two or more disorders or illnesses occurring in the same person. They can occur at the same time or one after the other. Comorbidity also implies interactions between the illnesses that can worsen the course of both.

It is important to understand comorbidity as it relates to addiction and other mental illnesses.

Drug addiction is a mental illness. Addiction changes the brain in fundamental ways, disturbing a person’s normal hierarchy of needs and desires and substituting new priorities connected with procuring and using the drug. The resulting compulsive behaviors that weaken the ability to control impulses, despite the negative consequences, are similar to hallmarks of other mental illnesses.

Many people who are addicted to drugs are also diagnosed with other mental disorders and vice versa. For example, compared with the general population, people addicted to drugs are roughly twice as likely to suffer from mood and anxiety disorders, with the reverse also true.

Although drug use disorders commonly occur with other mental illnesses, this does not mean that one caused the other, even if one appeared first. In fact, establishing which came first or why can be difficult. However, research suggests the following possibilities for this common co-occurrence:

  • Drug abuse may bring about symptoms of another mental illness. Increased risk of psychosis in vulnerable marijuana users suggests this possibility.

  • Mental disorders can lead to drug abuse, possibly as a means of “self-medication.” Patients suffering from anxiety or depression may rely on alcohol, tobacco, and other drugs to temporarily alleviate their symptoms.
These disorders could also be caused by shared risk factors, such as ...
  • Overlapping genetic vulnerabilities. Predisposing genetic factors may make a person susceptible to both addiction and other mental disorders or to having a greater risk of a second disorder once the first appears.

  • Overlapping environmental triggers. Stress, trauma (such as physical or sexual abuse), and early exposure to drugs are common environmental factors that can lead to addiction and other mental illnesses.

  • Involvement of similar brain regions. Brain systems that respond to reward and stress, for example, are affected by drugs of abuse and may show abnormalities in patients with certain mental disorders.

  • Drug use disorders and other mental illnesses are developmental disorders. That means they often begin in the teen years or even younger—periods when the brain experiences dramatic developmental changes. Early exposure to drugs of abuse may change the brain in ways that increase the risk for mental disorders. Also, early symptoms of a mental disorder may indicate an increased risk for later drug use. 

("NIDA InfoFacts: Comorbidity: Addiction and Other Mental Disorders." National Institute on Drug Abuse, U.S. Department of Health and Human Services, www.drugabuse.gov

Robin Williams' death offers insight into the all-too-familiar workings of comorbidity. Despite the reversible cause and effect -- Which came first, the drug abuse or the accompanying mental illness of clinical depression? -- the end can be the same. Addicts know the road of comorbidity leads to three possible outcomes: prison, rehab and treatment in an altered lifestyle, or death.

Of cocaine, Williams once admitted ...
"Cocaine for me was a place to hide. Most people get hyper on coke. It slowed me down. Sometimes it made me paranoid and impotent, but mostly it just made me withdrawn."
One of his jokes contends: "Cocaine is God’s way of saying you’re making too much money."


Opening Eyes and Changing Stereotypes

One irony in Williams' passing is clear. It often takes the untimely, calamitous death of a celebrity to bring people to understand reality. And, this reality is that mental illness is often stigmatized because the public misunderstands it. One widely held view holds that those who suffer from mental illness are weak, morally deficient, dangerous individuals. Robin Williams disproves this stereotype.

Here is a man who was nominated for the Academy Award for Best Actor three times. Williams received the Academy Award for Best Supporting Actor for his performance in Good Will Hunting. He also received two Emmy Awards, four Golden Globe Awards, two Screen Actors Guild Awards, and five Grammy Awards. One would be hard pressed to find fault in Robin Williams.


Yet ...

Combinations of illnesses can be volatile and life-threatening. Substances -- cocaine, alcohol, prescription opioids, heroine -- can lead to insurmountable addictions. Mental illnesses -- manic depression, schizophrenia, OCD -- threaten life.

Like substance addiction, severe mental illnesses cannot be overcome through "will power" and are not related to a person's "character" or intelligence. Mental illness falls along a continuum of severity, and when it becomes so oppressive that people lose the will to live, comorbidity causes suicides.

I have read Robin Williams was a very overweight child. As a result, nobody would play with him, and he started talking in different voices to entertain himself. This is one way a desperate child learns to cope. Of course, later in life, Williams' zaniness and unique "personality" became part of his comedic brilliance.

One report explained Williams' appeal like this:

"The Fisher King, Awakenings, What Dreams May Come, Death to Smoochy, Man of the Year, these were all films that capitalized on the way Williams shows humor masking pain, kindness masking madness, serenity masking danger, professionalism masking goofiness. On screen, Williams very often lived in the blurriness between those lines, and directors from Barry Levinson to Gus Van Sant to Steven Spielberg to Christopher Nolan were drawn to that."

(Joe Reid and Esther ZuckermanRobin Williams' Career Saw Him Find Laughter in Pathos and Darkness in Humor." news.yahoo.com. August 11, 2014)

Don't let anyone convince you that we have no clue to the reasons comorbidic people kill themselves. That would be a lie and a disservice to those who suffer from these complications. And, don't believe mental illness is a readily discernible fake.

In fact, evidence suggests that stereotyping of people who have a mental illness leads to stigmatization that influences prejudice experienced by people with a mental illness in terms of how they are treated by the wider community; the way in which people with a mental illness cope in society; and, the way in which society provides support for the mentally ill.

(Senate Select Committee on Mental Health, 2006, pp. 1-5)

For example, it is argued that stigmatization leads to discrimination against the mentally ill from various sectors of the community including health professionals, social organizations and the general population; stigmatization leads to inhibition of the mentally ill in terms of seeking treatment support, and seeking employment and workplace support; also, stigmatization creates "barriers to mental health promotion."

So, in my mind, perhaps the biggest tragedy concerning the death of Robin Williams is that the public may see the event as an "isolated mystery" or as some "Hollywood-celebrity martyrdom." The truth is far too many Americans are addicted and suffering from comorbidity. I love Robin Williams, but I must also love and care for those ordinary folks who need help fighting debilitating illnesses of the brain and of the spirit.

Maybe, just maybe ... great masses of those around the world will now see that taking it all for granted leads to isolation and stigmatization. Don't we really understand what happened to one we considered "our own"? His death should come as no surprise. Rest in peace, Robin Williams.

   
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