The suicide of comedian Robin Williams this week has left us reeling. Whenever someone so successful takes his own life, we’re reminded that mental illness doesn’t discriminate. Even celebrities aren’t immune to its ravages. In fact, being rich and famous may even heighten a sense of despair for someone who seems to have it all.
On TV, in the newspapers, and online, commentators, journalists, and the general public are speculating about what led to Williams’ final expression of hopelessness. Almost certainly, they are wrong. Even those of us in the mental health profession can’t always say what pushes a person over the edge. And we definitely can’t draw any conclusions about the inner torment of someone we know only from his public persona.
Even so, ignorance hasn’t stopped many from weighing in with their opinions, as a Facebook post I saw this morning highlighted. It said,”Pharmaceutical companies are evil.”
I don’t even know where to begin. Is the poster suggesting Williams was taking psychotropic meds, which led to his death? Is she alluding to the Black Box warnings on some antidepressants about the potential side-effect of increased suicidal ideation (usually among teens and young adults)? The only thing we know for sure is that whatever treatment Williams was receiving, it failed.
I doubt similar accusations would be lobbed at Big Pharma if someone with uncontrolled hypertension were to die of a heart attack.
Misconceptions about medications used to treat depression unfortunately keep many people who could benefit from psychopharmacology from taking full advantage of the range of options available to them. I don’t know if Robin Williams was on antidepressants. But he was in and out of therapeutic programs over the years, both for depression and for alcohol and drug abuse. He suffered from a mental illness, and it ultimately killed him.
Let’s stop all the commentary by self-proclaimed experts and simply mourn the loss of a beloved entertainer who brought happiness to millions but couldn’t find it for himself.
Much of the advice I dispense daily in my clinical practice involves guiding people beset by negative thoughts and feelings to respond to emotional discomfort in counterintuitive ways. Anxious? Approach your fears. Depressed? Get moving. Impulsive? Ride out your urges.
It all sounds rather simplistic. Yet changing behaviors in this fashion can improve your mood relatively quickly. Even more important, moving towards what feels scary or hard can help you build a protective core of confidence, making it easier to cope with the difficult times you’ll inevitably have to face in the future.
I won’t ask my patients to do anything I wouldn’t agree to do myself. Some of the “approach behaviors” I work on with them—touching a public toilet seat, say, or limiting themselves to only one glass of wine—don’t present personal challenges. But I certainly generate enough of my own worries to give me ample opportunity to practice what I preach.
Here’s an example: I just signed up for an eight-week course on Mindfulness-Based Stress Reduction (MBSR).
Silly that a program designed to reduce stress should significantly increase mine, right? But just thinking about it makes my mouth dry up and my heart beat faster.
I’d been looking for an opportunity to deepen my meditation practice for some time now. Periodically I’d google “Mindfulness Meditation in DC.” The Insight Meditation Community of Washington (IMCW) always came up. I’d pore over the course offerings and then reject them because the timing wasn’t right or the center’s Buddhist orientation made me uncomfortable.
I had many of the same automatic thoughts and a few new ones yesterday when I found the listing for an MBSR course given through the Insight Meditation Community starting in just two weeks. “Maybe everyone will be a Buddhist. I hope they don’t expect me to practice Buddhism.” “I won’t know what to do.” “Will there be chairs or cushions? Should I bring my own cushion?” “Seven to nine-thirty on a Thursday night . . . I’ll be so tired after work, I won’t feel like going.” “I won’t have time to eat dinner and I’ll be starving.” “I won’t get home until after 10 and I’ll be so wound up I won’t be able to sleep.” “It might be lame, like that last mindfulness course I took.” “I might not be able to find parking.” “I won’t be able to walk the dogs or exercise on Thursdays.” “I don’t know what to wear. Should I wear yoga pants?” “I’’ll have to bring a change of clothes to work.” And even, embarrassing though it is to admit, “We’ll have to take off our shoes. I hope we can wear socks because I won’t have time to get a pedicure in the next two weeks.”
In the end, I recognized my reservations for what they were—excuses designed to avoid an unfamiliar situation causing me trepidation. I don’t like being a newbie, and this class raises all those old first-day-of-school insecurities (probably dating back to the start of kindergarten, when I wet my pants because I was too shy to ask my scary new teacher where the bathroom was and, humiliated, ran to hide in the coatroom when she asked the class who was responsible for the puddle on the floor).
So I did what I’d tell anyone else to do. I signed up.
To be continued . . .
It’s that time of year again. No, I don’t mean the holidays, although their approach certainly can make you want to crawl into a dark cave to escape the strains of White Christmas and the twinkling lights reminding you of how behind you are with your preparations.
I’m talking about the winter blues.
Lots of us go to work before sunrise, sit all day in a windowless office, and drive home after sunset, never seeing daylight. The hours of prolonged darkness can wear on you and even—for those individuals whose biological clocks make them susceptible—cause what’s known as SAD (Seasonal Affective Disorder). It most commonly occurs in late fall and early winter and diminishes as the days grow longer, but SAD also can affect some people in spring and summer, causing agitation and anxiety rather than the lethargy typical of winter SAD.
Symptoms of winter SAD, like other forms of depression, include a loss of interest in normally pleasurable activities, irritability, withdrawal, lowered motivation and drive, changes in appetite (either overeating and carbohydrate cravings or loss of appetite) and sleep patterns (either excessive sleeping or insomnia), muscle tension and pain, feelings of heaviness in the limbs, lack of energy, poor concentration, and negative thinking.
Winter SAD is most prevalent at Northern latitudes and among women. Its causes are still speculative, with hypotheses suggesting imbalances in melatonin, circadian rhythms, and serotonin.
As with all neurobiological conditions, brain chemistry may make the symptoms unavoidable. But how we respond—our behavior and thoughts—can mitigate the distress we experience.
For instance, if you focus on how tired you feel in the morning, you’re likely to pull the covers over your head and give into the urge to hibernate. But if you can manage instead to drag yourself out of bed and take a brisk walk outside, you’ll feel more energetic and motivated for the rest of the day.
One of the best antidotes to a depressed mood is to engage in a variety of pleasant or competence-inspiring activities. Go out for a leisurely meal with friends or family, or stay in and cook one to share. Play with a pet. Get some exercise. Learn a new language. Practice a musical instrument. Listen to music. Solve a crossword puzzle. Knit a sweater. Peruse Pinterest or Houzz to get ideas for a redecorating project. Clean out a closet. Visit a museum. Go to a movie or play. You may need to adjust your activities to accommodate the weather, but you can still find plenty to occupy you.
Modifiying your attitude is another way to boost your mood. Instead of focusing on the shortened days and punishing wind chills, find enjoyment in a steamy mug of hot chocolate or a crackling fire. Try to accept the moment instead of wishing for it to be different.
Maybe as a consequence of my regular mindfulness meditation practice (which helps cultivate acceptance), I haven’t dreaded the advent of winter as much this year as in the past. But I do sometimes catch myself slipping into old thinking habits, as I did one day at my last CSA pickup of the season. Inundated with apples, I felt the negative thoughts starting to build: “I don’t like apples very much. I wish it were still summer. I want peaches. I’m sick of apples. I want watermelon.”
You don’t need to sell me on the merits of an apple a day. But it wouldn’t be my snack of choice, except as an occasional vehicle for peanut butter. On the other hand, apples in dessert form—gussied up with cinnamon and nutmeg, topped with a crust or a crumble, and served with a scoop of vanilla bean ice cream—are an entirely different story. So I decided to adjust my attitude and stop complaining.
You know the old saw about what to do when life gives you lemons? Well, the season was giving me apples.
So I made apple pies.
This blog is intended solely for the purpose of entertainment and education. All remarks are meant as general information and should not be taken as personal diagnostic or therapeutic advice. If you choose to comment on a post, please do not include any information that could identify you as a patient or potential patient. Also, please refrain from making any testimonials about me or my practice, as my professional code of ethics does not permit me to publish such statements. Comments that I deem inappropriate for this forum will not be published.