The Washington PostDemocracy Dies in Darkness

Robin Williams’s death shows the power of depression and the impulsiveness of suicide

Suicides are the 10th-leading cause of death in the United States and eighth among people in the 55- to 64-year-old age group. Comedian Robin Williams, who died Monday of an apparent suicide, was 63.  In 2010, 38,364 people died this way.

Many suicides are the result of undiagnosed or untreated depression, often masked by self-medicating behaviors such as alcohol and drug use. Though we don't yet know the exact circumstances of Williams's death, we do know that he long battled addictions to cocaine and alcohol and, according to his publicist, was struggling with "severe depression."

But unlike many people, Williams had the resources and the motivation to seek treatment, at least for his addictions. According to this report, he had undergone rehab at the famed Hazelden Addiction Treatment Center in Minnesota two months ago, and had sought treatment in 2006 when he began drinking again after 20 years of sobriety.

How, then, do we explain the death of someone who appeared to recognize the danger he faced and was trying to address it? Here are some thoughts:

Suicides are often impulsive acts:  People who kill themselves are not thinking clearly, have trouble solving problems and weigh risks differently from us, Jill Harkavy-Friedman, vice president of research for the American Foundation for Suicide Prevention, told To Your Health in March. If thwarted in their first attempt, they often do not try again immediately, she said.

“In a suicidal crisis, it’s all about time,” she said. “They’re going to grab whatever is available. They don’t change gears if that is thwarted, because they have rigid thinking in that moment. They’re not thinking about dying. They’re thinking about ending the pain."

Depression's hold, even on people in treatment, can be very powerful: Antidepressant medications, counseling and other forms of therapy are not always cures. Depression can occur once, can happen intermittently or can be a chronic condition.

The latter condition was perhaps described most eloquently by 19-year-old comic Kevin Breel, who delivered a TedxYouth Talk in May 2013, as noted in this post by my colleague Soraya McDonald: "“Depression isn’t chicken pox,” Breel said. “You don’t beat it once and then it’s gone forever. It’s something you live with. It’s something you live in. It’s the roommate you can’t kick out. It’s the voice you can’t ignore and the feelings you can’t seem to escape, and the scariest part is, the scariest part is that after awhile, you become numb to it.”

Baby Boomers are killing themselves at alarming rates:  It’s long been true that elderly people have higher suicide rates than the overall population. But numbers released last year by the Centers for Disease Control and Prevention show a dramatic spike in suicides among middle-aged people between 1999 and 2010. The largest  increases were among men in their 50s, whose suicide rate rose by nearly 50 percent, and women in their early 60s, who experienced a nearly 60 percent increase.

For white men, the rate increased by nearly 40 percent, to 34.2 suicide per 100,000 people. Government researchers say possible factors are the Great Recession; baby boomers' higher suicide rates as adolescents; and a rise in intentional overdoses from prescription opioids.

But the trend started a decade before the 2008 recession, and some psychologists and academics say it may stem from a complex set of issues particular to a generation that grew up during the 1950s and '60s, when the country seemed to hold a limitless array of possibilities.

• Many people suffering depression and addiction go untreated: They sometimes end up in jails, prisons and homeless shelters. Families struggling with mentally ill relatives often do not have anywhere to turn for help. Community mental health centers are overwhelmed. People without insurance have no access or inadequate access to drugs and treatment.

Two recent laws were designed to address this: The Mental Health Parity and Addiction Equity Act of 2008 required company insurance plans to treat mental illness and substance abuse problems the same as physical illnesses such as heart disease or cancer. The 2010 Affordable Care Act extended that same protection to the individual insurance market. It also allowed adults up to the age of 26 to stay on their parents’ health plans.

Read more:

Official: Robin Williams hanged himself with a belt.

Mothering with mental illness.

The suicide contagion effect.