Why did Robin Williams commit suicide?

Turn to the news, and the answer is easy to find. The money wasn’t rolling in any more. Antidepressants killed him. (This from Marlon Wayans.) It was the “seeming link between creativity and mental illness,” from Maria Puente at USA Today. The help that he sought failed him. His alimony payments were more than he could bear. The recent news that he had Parkinson’s disease was too much. Some news sites reported tweets that said his daughter drove him to it. (Twitter suspended some accounts as a result.)

Even reports that he has “been battling severe depression of late,” which came from his publicist, are suspect. Maybe he was battling severe depression, or maybe he wasn’t; but how does the publicist know?

Depression is likely the correct answer to why Williams committed suicide. It almost always is. Not lost loves, money troubles, a creative personality, or Parkinson’s disease. We all want to find reasons, but it’s probably true that whether or not Williams was actively “battling depression,” it was depression that killed him.

In a thoughtful post at The New Yorker, Andrew Solomon, who has written extensively about his own depression, put it this way yesterday:

When the mass media report suicide stories, they almost always provide a “reason,” which seems to bring logic to the illogic of self-termination. Such rationalization is particularly common when it comes to the suicides of celebrities, because the idea that someone could be miserable despite great worldly success seems so unreasonable. Why would a person with so much of what the rest of us want choose to end his life?

Yet reporters–part of what Solomon calls the explanation industry–persist in finding reasons. And this isn’t new.

Looking back through Tracker archives, I find that in May, in a page-one story on sharply rising suicide rates in middle-aged Americans, Tara Parker-Pope of The New York Times blamed “years of economic worry and easy access to prescription painkillers” for making baby boomers particularly vulnerable to suicide.

In February, The New York Times ran a long story on page one by Alan Schwarz headlined, “Drowned in a Stream of Prescriptions.” It was about a 24-year-old college graduate named Richard Fee who was “getting dangerously addicted” to the ADHD medication Adderall. It’s impossible to know whether taking Adderall contributed to the man’s subsequent suicide; but Schwarz seemed to be sure.

Note whom we have not heard from in these stories, or in the coverage of Robin Williams’s death: A psychiatrist, psychologist, or social worker who examined and diagnosed, and treated the person who committed suicide.

Only someone who has done a thorough examination of Williams has any claim to tell us why he ended his life–and even those professionals ought to be very careful about what they say, because none of them knows what he was thinking when he died.

Thomas Insel, a psychiatrist and the director of the National Institute of Mental Health wrote a sympathetic post on his personal blog noting that Williams had to struggle with two kinds of mental illness–depression and addiction. Insel kindly praised Williams’s “long history of successful struggle to be productive, generous, and authentic in spite of an illness that ultimately prevailed.” So many people, he wrote, who “have had access to the best available care still, too often, die from depression.” This was a better bit of journalism than most of what I read, and it came from a psychiatrist. Reporters should be watching their flanks…

The expression “die from depression” doesn’t roll off the tongue, but it should. Reporters, in particular, should get used to it, and should use it, just as they write that people died of cancer or died of heart disease.

Much of the coverage avoided these pitfalls. I do think that reporters have become wiser about this in recent years, partly due to the efforts of groups such as the American Foundation for Suicide Prevention, which offers reporters guidelines on how to report suicides.

But some of the coverage of Williams this week was dangerous and could cost lives through a phenomenon sometimes called “suicide contagion.”

Many news outlets reported this tweet sent on Aug. 11 by the Academy of Motion Picture Arts and Sciences:

This is lethal. Caitlin Dewey of The Washington Post talked to Christine Moutier, chief medical officer at the American Foundation for Suicide Prevention, who said that the starry sky from Disney’s Aladdin, and the written implication that suicide is somehow a liberating option, presents suicide in too celebratory a light.

Reporters who aren’t aware of the recommendations for covering suicide should read them before writing another word. I rarely advise reporters not to say something, or not to write it. But when saying the wrong thing can kill people, I make an exception.

And maybe we can learn something else from Robin Williams. In the 1960s, when Barry Goldwater was running for president, numerous psychiatrists presumed to comment on his mental state. The American Psychiatric Association responded by issuing a rule saying that it was unethical to diagnose a patient without examining him or her. It became known as the Goldwater rule.

We might adopt a similar rule: It is unethical for a journalist to speculate–or allow others to speculate–on the diagnosis of a patient without a thorough examination.

Let’s call it the Robin Williams rule. And let’s stick to it.

-Paul Raeburn