It's been less than a week since Fredric Brandt, the New York City and Miami dermatologist, took his own life. The Miami police have confirmed that he hung himself in his home in Coral Gables, Florida. Because there was no suicide note that we know of, speculation is rampant among friends and devoted patients (not to mention the media) about what drove him to such a violent—and senseless—end. A prime suspect has been Martin Short's portrayal of a dermatologist in the Netflix comedy Unbreakable Kimmy Schmidt, which is widely believed to be a caricature of Brandt. Of course, the truth is far more complicated.

Those of us who knew Fred Brandt well can attest that he had been obsessing about this obvious portrayal of him. Brandt's publicist, Jacquie Trachtenberg, called it "bullying" (though she also told Page Six, "the show was not the reason...he would take his own life. He was suffering from depression, and it is so sad, because he was beloved by so many people.")

This certainly wasn't the first time Brandt had felt people were mocking his work and his appearance. He acknowledged in many interviews that he tested the tools of his trade—cosmetic toxins that reduce frown lines, wrinkle fillers, and more—on his own face. And his lineless visage coupled with his naturally fair complexion and bleached-blond hair made him a striking figure in almost any room and opened him up to attacks about both his appearance and his work. Just two days before his death, one commenter wrote in the Online Journal of Community and Person-Centered Dermatology, in response to a piece titled "The Great God Fred," that Brandt was in "denial of death, aging and mortality," and his patients represented "the rampant decadence that is our society." And the Internet is rife with far nastier and more personal attacks on Brandt.

His distress wasn't a secret to those closest to him. He was apparently seeing a psychiatrist daily, and last Saturday, a friend had stayed overnight with him on suicide watch. According to the American Association of Suicidology (AAS), humiliation and shame can heighten suicide risk in those already depressed and vulnerable, as Brandt had been for a few months, according to friends. But not everyone who is shamed or humiliated commits suicide, wrote Edwin Shneidman in Definition of Suicide (Wiley-Interscience). Experts warn against jumping to conclusions about another person's reasons for self-destruction. Such suppositions are "a measure of our moral judgment," not clinical insight, wrote Avery Weisman, the late emeritus professor of psychiatry at Harvard and a former president of the AAS, in his classic text, Dying and Denying (Behavioral Publications). According to the AAS, older white males—Brandt was 65—are at the highest risk for suicide. And there are usually many reasons, not just one. Any combination of shame, guilt, despair, humiliation, unacceptable loss of face, status, or fortune, health problems, and threats to one's reputation could be precipitating events. But the number-one trigger prompting "people to take their own lives," is probably "the threatening disruption of personal relationships," wrote Weisman. As Shneidman put it, "suicide is an escape from distress."