Robin Williams and the Polarizing View of Mental Health
It's hard to not be swept up in the tragedy that was Robin Williams' death. The millions of people who were touched by his uplifting and powerful performances collectively mourned the departing of such a positive presence. Even if you were not one of those people, it was unlikely that you haven't seen the outpouring of responses from all over the world. A careful examination of the news coverage, blog posts, reader comments, and all the other responses reveals an unfortunately disturbing polarity in how people view mental health.
As often is the case in these types of stories, people implicitly use one of two models to explain mental health. Either mental health is a personal problem that lies within someone's power to change their life circumstances or it is a disease process manifested through external forces guiding someone's thoughts, feelings, or behaviors.
In the "personal problem" model, mental illness is viewed as result of the personal agency or choice. People have the ability to determine their fate and how things go for them is, in large part, under their control. Negatively, the person is "selfish," out-of-control, lacks will power, and a whole host of explanations that plants responsibility for the problem squarely at their feet.
The disease model is often quite the opposite. People are affected by an outside/exogenous force that affects their ability to properly think, feel, and behave. The person is beset upon by something outside of their control.
This question of who or what is in control is something that people find difficult to answer. Was it Robin Williams who chose to kill himself or was it a disease process that was responsible? Responsibility is a fundamental question in moments like this because people are uncomfortable with both the ideas that someone might choose to kill themselves or that they had absolutely no control over their behavior.
Splitting this question into an either/or category is what is the problem.
When we choose to explain his behaviors as "selfish" acts under his control, we fail to appreciate that depression and addiction (and all other mental illnesses) negatively distort and twist someone's thinking and feeling to the point that it negatively affects their behavior in self-destructive and self-maintaining ways. These issues are not entirely self-motivated, as a personal problem model might suggest. Helplessness and hopelessness are key features of depression that lead people to truly believe and feel that nothing can get better and they are incapable of doing so.
When we choose to explain his condition as a disease, we may inadvertently strip people of their autonomy. While this is tempting with things like genetic pre-disposition and heredity, it does not mean that there is no choice. We have to appreciate that there are very real things that can and should be done to try to stop the suffering as much as possible. Psychotherapy, medications, and social support are some of the many things that Robin Williams can and did engage in, unfortunately, to no avail.
Let's get one thing straight: depression, addiction, and mental illness, in general, can be a malevolent, destructive, unforgiving force. The dark, suffocating pall that settles over someone's life when they are depressed is enough to keep anyone in their room for days on end, isolated, alone, withdrawn, hopeless, and helpless. However, blaming the person as not being strong enough or saying they didn't have the right to (personal problem model) is destructive and offensive. Asking "What did Robin Williams Have to Be Sad about?" is a direct reflection of this attitude towards mental health. Additionally, suggesting that Robin Williams didn't kill himself represents another extreme explanation for what happened (disease model).
This fundamental question of personal problem versus disease process model harkens back to the annoyingly antiquated and simplistic question of "nature versus nurture." Psychology and psychiatry have put this question to bed a long time ago. It is not "nature or nurture," it is "nature and nurture" or "nature via nurture." Unfortunately, the public has not gotten up to speed.
The real answer, as is often the case in categorical questions, is that it's both. Depression, addiction, and all other mental illnesses very much have a disease model effect on people. Sufferers do not ask for this. They don't enjoy their suffering and therefore continue to revel in it to hurt those around them. Additionally, they have some choice and autonomy no matter how hopeless or helpless they feel. Seeking help through psychotherapy, medications, and social support are just such choices that have been proven to have a positive effect on many different mental illnesses, especially depression.
While talking about mental health isn't considered en vogue, as one Slate article aptly points out. The silver-ish lining that is sensationalized mental health-related tradegies is that just for a moment, people are realizing how important mental health issues are. We have the opportunity to strike while the iron is hot by trying to change the national conversation while it is happening and before we move onto the next thing in our Twitter/Facebook/Instagram feeds.
Maybe things are already changing. Certainly the outpouring of support for Williams and the discussion of the havoc that can be felt from loss related to depression, addiction, and suicide suggests that some people do understand. However, when we allow the conversation to only appreciate one side of this polarity of "personal problem versus disease," we aren't helping anyone. Especially those suffering from mental illness.