How Much Did the Stigma of Mental Illness Harm Robin Williams?
Addiction treatment routinely fails people with mental illnesses, while mental health care often ignores addiction. And everywhere, stigma is rife. Can a tragic death prompt a more intelligent approach?
Robin Williams has long been a hero to people in recovery. His drug humor always had the bittersweetness that comes from painful experience and his sheer brilliance and exuberance made many recovering folk proud to claim him as “one of us.” Watching him improvise, the presence of genius was visceral.
This makes his death—and some of the knee-jerk attempts to draw lessons from it—even more painful. We know that he had just left Hazelden when he died; we also know that he had publicly acknowledged struggling with addictions, even if we don’t know how this affected the beloved comedian.
What surprises and saddens me, however, is that while you could use some of Williams’ monologues as textbook illustrations of the “pressured speech” and “racing thoughts” that characterize hypomania and mania, he does not seem to have been diagnosed with or at least, come out about, having mental illness. In fact, he told Terry Gross of NPR in 2006 that his manic antics were merely a performance and he’d never had “clinical” depression.
After appearing on a magazine cover for a story about medication, Williams said, “I was branded manic depressive. Um, that’s clinical, I’m not that. Do I perform sometimes in a manic style? Yes. Am I manic all the time? No. Do I get sad? Oh yeah. Does it hit me hard? Oh yeah.”
Stigmatizing mental illness is dangerous—and can be deadly. When headlines about addiction and mental illness refer to struggles with “demons,” you know that stigma remains strong.
Of course, he may have been trying to keep the highly stigmatized diagnosis private—or he may have refused to accept it. He may also have feared that accepting a diagnosis would mean taking medication that might affect not just his lows, but his art and his highs. As Dr. John Grohol, the psychologist who founded PsychCentral, put it in an editorial note in his piece on Williams, “We acknowledge Williams himself has never stated to our knowledge that he was formally diagnosed with bipolar disorder or depression. Yet given his behaviors and symptoms, it seems far more likely that he suffered bipolar disorder—of which depression is a significant component.”
Now, of course, we’ll probably never know what—if anything—Williams had. But if there are any lessons to be learned from this wretched tragedy, two seem clear to me.
First, stigmatizing mental illness is dangerous—and can be deadly. If someone as accomplished and acclaimed as Williams cannot publicly acknowledge “clinical” depression or bipolar disorder, we have a long way to go in making the world safe for people who suffer from these illnesses. When even today’s headlines about addiction and mental illness refer to struggles with “demons,” you know that stigma remains strong.
Whatever else is true, Williams’ gifts were clearly on the manic spectrum. Even if he never crossed the line into “clinical” problems, it’s worth acknowledging this. Understanding that conditions like bipolar, depression, schizophrenia and autism are not out of the realm of human experience—and can produce talent and creativity, not just disability—is critical to reducing stigma. If we know that these conditions—including addiction—are exaggerations of “normal,” not alien “craziness,” we will be a lot better at accepting those who are affected.
And when we see the gifts that can accompany these conditions, we tend to be less prejudiced and more understanding. Research clearly links mental illness, autism and addiction with creativity across the arts and sciences. Of course, disabled people shouldn’t have to prove they are also gifted to be accepted. But it remains true that public acceptance of disabled people often follows when those whose gifts we have loved or benefitted from—Paralympians, for example—are open about their struggles. It’s sad that the typically kind, empathetic and open Williams may have felt unable to either accept his own mental illnesses, or to disclose them.
Second, we need to end the division of services and even of language between addiction and other mental illnesses. Around half of all addicted people—and up to 80% for women and teens—suffer from an additional mental illness. While the prevalence of addiction in mentally ill people varies by condition, again, 40-50% overall are affected.
Unfortunately, most addiction treatment programs—despite claims to the contrary—are not well-equipped to handle “dual diagnosis” cases. Even at well known programs like Hazelden, some patients report difficulty getting specialized treatment for mental illness.
Some 12-step focused counselors and members still try to convince clients that medication or other help for mental illness is unnecessary and that all the answers are in the Steps.
For example, Isabella, who is 55, attended Hazelden’s Springbrook facility in Oregon while Robin Williams was receiving treatment there following his relapse in 2006.
“I suffered from severe depression and excessive alcohol use, culminating in my swallowing a bottle of Xanax and ending up in the hospital,” she says. “I was then accepted by Hazelden into their 28-day program. They knew I was suffering from depression and about my history.”
Isabella describes how she was only permitted to see the facility’s psychiatrist for 15 minutes for an initial evaluation—and says that she asked repeatedly for further visits to discuss her depression. But throughout the rest of her stay, she only received an additional half hour with the doctor, who simply added a new antidepressant to her existing meds, she says.
“The focus was on forcing me to participate in 12-step-based activities—if I stayed in my room to read or work on assignments, I was dragged out to the group,” Isabella adds. “I was told I wasn’t allowed to isolate. I feel that they ignored obvious signs of my depression.”
Of course, other patients have reported better experiences, and it is always hard to know what the best course of action is in any particular case. And Hazelden now may be different than it was in 2006. But it’s clear that even now, many treatment providers remain either biased against the use of medication, or unskilled in treating mental illness, or both.
Some 12-step focused counselors and members still try to convince clients that medication or other help for mental illness is unnecessary and that all the answers are in the Steps. To make matters worse, many programs still rely for evaluations on people who do not have the training to understand and diagnose mental illness—or on overly brief encounters with actual physicians.
On the other side of the coin, mental health programs also frequently fail to deal adequately with addiction—sending away those who need help if they are still using drugs, or leaving addictions untreated in hopes that the treatment for the mental illness alone with suffice. This is also unacceptable: Treatment needs to be fully integrated.
I hope Robin Williams was not harmed by the outdated barriers that still exist between addiction and mental health care; I hope he was not advised to rely only on the Steps or to avoid medication. I hope whoever treated him took into account both his frequently manic behavior and his depression. If any of these factors played a role in his death, it’s truly shameful.
But I also think we have to acknowledge that even the best treatments for both mental illness and addiction still fail far too many patients. Even if Williams did receive optimal care, what we have now isn’t good enough: We need more research, more options and better pathways to get evidence into practice.
Addiction and mental illness are not demons. Let’s stop acting as if prayer is the main answer.
Maia Szalavitz is one of the nation’s leading neuroscience and addiction journalists, and a columnist at Substance.com. She has contributed to Time, the New York Times, Scientific American Mind, the Washington Post and many other publications. She has also published five books, including Help at Any Cost: How the Troubled-Teen Industry Cons Parents and Hurts Kids (Riverhead, 2006), and is currently finishing her sixth, Unbroken Brain, which examines why seeing addiction as a developmental or learning disorder can help us better understand, prevent and treat it. Her last column for Substance.com was about how the New York Times‘ coverage of drugs other than marijuana still doesn’t cut it.
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