The Suicide of Robin Williams Revisited

PSYCHIATRIC VIEWS ON THE NEWS

Over a year ago, the suicide of Robin Williams received a great deal of attention in the media. I suspect my article, “A Psychiatric Eulogy for Robin Williams,” was popular, not for what I wrote, but because Mr Williams was a beloved figure who died so tragically.

His death was once again featured prominently in the news.¹ The widow of Mr Williams, Susan Schneider Williams, suggests Lewy body dementia as a major cause of the death.² It is the challenge not to miss a general medical cause when addressing symptoms that look like they are psychiatric, especially when looking at an already diagnosed psychiatric disorder.

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There are many symptoms reflecting illnesses that could be either psychiatric or strictly medical (including neurological). For example, Composer George Gershwin started to show some bizarre behaviors that many people-including his doctors-believed to be attention-seeking or “hysterical.” Not long after that (incorrect) conclusion, he was admitted into the hospital unconscious and found to have a fast-growing malignant tumor. Soon after, he died.

Mr Williams had been seeking treatment for many years with what was said to be some kind of depressive disorder and intermittent substance abuse. At the end of his life, he was also diagnosed with Parkinson Disease (PD). Some speculated that his depressive symptoms resulted from PD, which is treatable to some extent.

Before his suicide, Mr Williams’ medical doctors were working up his PD diagnosis and searching for any other neurological disorders. It was his psychiatrist who reportedly wanted to hospitalize him for more extensive neuro-psychological testing, but Mr Williams refused. Now, a coroner’s report reveals Lewy body dementia, a fairly rare condition that is difficult to diagnose. It can also resemble PD.

In slow developing dementia of any type, the most distressing period for the patient is the interval between more “normal” cognition and no longer realizing that her thinking is impaired. This is the interval of recognition that she is literally losing her mind or, really, part of the brain.

If Mr Williams realized he was losing the ability to access his unusually sharp and creative brain, his suicide risk likely increased. If so, perhaps his decision to take his own life could be considered a “rational suicide.”

Assuming this new information about Mr Williams is accurate (or even if it is not), there is an important educational message for both the public and clinicians. Accurate diagnosis can be lifesaving.

If a patient’s psychiatric symptoms worsen for reasons that are not clear, it is essential that we consider other medical causes. That means using expert medical consultation and keeping up with our medical knowledge. We need more integrated systems in which psychiatric and medical problems can be assessed all in the same place.

If Lewy body dementia was diagnosed before the death of Mr Williams, would the suicide have been averted? Of course, this is unknown. The ethical principle of competent care requires comprehensive evaluation, which has become increasingly challenged in these days of limited time with patients. To honor him beyond his professional skills, let us learn some important medical lessons from the life and death of Robin Williams.

References:

1. Itzkoff D, Carey B. Robin Williams’s Widow Points to Dementia as a Suicide Cause. New York Times. http://www.nytimes.com/2015/11/04/health/robin-williams-lewy-body-dementia.html. Accessed November 18, 2015.
2. Gallman S. Robin Williams’ widow speaks: Depression didn’t kill my husband. CNN. November 4, 2015. http://www.cnn.com/2015/11/03/health/robin-williams-widow-susan-williams/index.html. Accessed November 18, 2015.