Robin Williams and the prevalence of later-life suicide

Sunday, August 17, 2014

Unabridged from my Bonus Years column in the Lifestyle section of The Sunday Capital, Annapolis, Maryland

In life, Robin Williams made us laugh.  Now, in death, at age 63, he makes us think.

Robin Williams in death makes us think because he died by his own hand.  "How could he," we ask.  He had everything – including four Oscar nominations and one win, for "Good Will Hunting in 1998.  In addition, he garnered nearly 70 other nominations and many wins for coveted awards such as the Emmy, Film Critics, People's Choice, Screen Actors Guild and other major honors and accolades.

More importantly, Williams enjoyed the love of his three children and the affection, admiration and respect of millions of fans and many close friends.  His legacy also includes giving back – for example, mentoring people like Ben Affleck and Matt Damon and entertaining American troops in far-off places.

But, like the rest of us, he also had demons.  Admittedly, the demons that haunted Robin Williams – such as alcohol and drug abuse as well as depression – were more serious and destructive than what most of us struggle to contain.  Still, he had a history of recognizing his demons as he engaged in trying to manage them.

Rather than think of Robin Williams' suicide as an aberration, those of us interested in successful aging should see it as a reminder of facts of life that we sometimes would rather forget.  So let's remember:

  • We don't like to talk about suicide, but according to the Centers for Disease Control there are twice as many deaths due to suicide than HIV/AIDS, reflecting the attention and resources we devote to the issues around the latter.
  • According to CDC data, suicide is a major bonus years issue.  In fact, older Americans are more likely to commit suicide than any other age group.  
  • Suicide rates among the elderly are highest for those who are single, widowed or divorced – probably reflecting the negative effects of social isolation and bereavement – while marriage appears to be a protective factor.

·    Later-life men are nearly four times more likely to commit suicide than later-life women.  Silvia Canetto, a Colorado State University psychology professor specializing in gender issues in suicidal behavior suggests that's because women are more experienced and comfortable with managing and adapting to major changes in their life: "Women are capable of more complex and flexible coping strategies than men [because] women experience more changes in roles and body functioning during adulthood, perhaps preparing them for physical changes in later life. In contrast, men are socialized to be in control and shape the world according to their needs [so] men arrive at later life with unrealistic expectations and a limited range of coping strategies."

  • The highest risk is among white men age 85 and older, where the suicide rate of 65 per 100,000 is more than five times the national average of about 12 per 100,000.
  • Unlike younger people – where an attempted suicide is frequently a "cry for help" – adults who attempt suicide usually succeed.  "The elderly are usually more intentional about what they're doing," says Dr. Elisa Thompson, a specialist in human development and aging issues. "They also tend not to leave notes."  But when they do, the contents reflect despair, a desire to escape suffering, economic and financial problems and a fear of burdening family members. 

According to reports, Williams did not leave a note.

That leads to perhaps the most important reason for reflecting on the passing of Robin Williams – and that reason is a disease called depression.  

Williams suffered from clinical depression and, according to the CDC, depression is the strongest risk factor for suicide in later-life Americans – another fact of life that we too often suppress.

According to Howard Cattell, a specialist in later-life psychiatry, "Comprehensive studies are consistent…depressive illness is the most important predictor of suicide…Major depression was diagnosed in almost 60 percent of the most elderly suicides, with other mood disorders accounting for between 10 and 20 percent…"

Cattell also notes that "…precipitating life events appear to be different in the elderly population compared with younger and middle-age groups," noting that younger and middle-aged suicides are associated more closely with interpersonal and relationship problems or with financial, legal and occupational difficulties.

By contrast, later-life suicides are more often associated with physical illnesses, bereavement or fears – fear of being trapped in a bed or a wheelchair, of being a burden, of losing our ability to think and reason, of being alone.

As Cattell says, "The good news is depression is treatable."  However, we must have the courage to talk about it which will give us the ability to know it when we see it – both among lay people as well as among health care professionals.  

We can hope that increased awareness and interest in identifying and treating depression , especially in later-life Americans, will become another element of Robin Williams' legacy.   In fact, I'd bet he is urging us to "lean in," to "seize the day" – Carpe diem – just as he urged his students in "Dead Poets Society" 25 years ago.  

In the 1991 adventure-comedy film, "Hook," directed by Seven Spielberg, the adult Peter Pan (Robin Williams) says in the closing scene, "To live... to live would be an awfully big adventure." And, for sure, the adult Robin Williams lived big.

But he also had a vision of another life.  When asked in an interview what he would like God to say when he arrived in heaven, Williams answered, "There's a seat in the front."  Carpe cathedra, Mr. Williams.  Seize the seat and watch us learn.

Reboot

Reboot!

It’s better to wear out than rust out.”  That is the message of Reboot!  While American culture glamorizes the “Golden Years” of endless leisure and amusement, Phil Burgess rejects retirement, as he makes the case for returning to work in the post-career years, a time he calls later life.

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