Robin Williams: I am Pagliacci

Man goes to doctor. Says he’s depressed. Says life seems harsh and cruel. Says he feels all alone in a threatening world where what lies ahead is vague and uncertain. Doctor says, “Treatment is simple. Great clown Pagliacci is in town tonight. Go and see him. That should pick you up.” Man bursts into tears. Says, “But doctor…I am Pagliacci.”

Regular readers of my blog will attest to the genre regularly used in the medical stories that I post every month. However, this time I have decided to discuss an actual event surrounding real people. Many of you know that I was a community health psychologist and behavioral therapist for a number of years and left the field due to the increased pressure on practitioners to suggest Chemical alternatives to therapy. I wasn’t comfortable suggesting to parents that very small children should be prescribed methylphenidate at the advice of schoolteachers, and in fact continue to emphasize psychotherapy and behavioral approaches to mental health issues. 

Robin Williams died on the morning of August 11, 2014, at his home in Paradise Cay, California. Williams’s daughter Zelda responded to her father’s death by stating that the “world is forever a little darker, less colorful and less full of laughter in his absence”.

On Broadway in New York City, theaters dimmed their lights for one minute in his honor.

Legacy and influence as both a comedian and an actor of substance and serious drama.

Williams was, like so many of us, both a simple and complicated person. He was a member of the Episcopalian Church, yet felt free to lampoon religion, and once called himself an honorary Jew, appearing in time square with other celebrities to wish Israel a happy 60th birthday. At the same time he understood well the hypocrisy that exist in organized religion, and never made excuses for it. He was an avid video gamer and even named his daughter Zelda after a character in one of his favorite games. Williams was also a fan of role-playing video games and the multiplayer online game World of Warcraft. He was an often-sought celebrity at game expositions and appeared live at Google’s keynote session in 2006. Williams and several other celebrities participated in the 2007 worldwide dungeons and dragons game day in London.

Robin Williams was also an avid fan of science fiction, among his favorite books where the Foundation series by Asimov, and as a child he read and reread the C. S. Lewis’ The Lion, The Witch and The Wardrobe, which became a favorite of his children.

Williams was also a fan of professional cycle racing, and often appeared in cycle magazines.  A generous man, Williams teamed up with fellow actors Whoopee Goldberg and Billy Crystal to found Comic Relief USA, an annual HBO event devoted to the homeless. As of 2014, the relief effort has raised over $80 million. Williams actively supported literacy efforts, women’s rights, and appeared at many benefits for veterans. A strong supporter of fighting Men and Women, Williams was a regular on the USO circuit, having traveled around the world to perform at events. He founded the Windfall Foundation, a philanthropic organization to raise money for a number of charities, and once made a guest appearance for the charity Children’s Promise in 1999. Robin Williams donated all the proceeds of his Weapons of Self-Destruction performance to help rebuild the New Zealand city of Canterbury after the 2010 earthquake. Williams loved children and was a long-term supporter of St. Jude’s children’s research Hospital.

But behind the actor and comedian, behind the generosity and the smiles lay a blackness that would eventually engulf him.

In the late 70s Williams had become addicted to cocaine. A friend of John Belushi, Williams quit in the early 80s after the birth of his son Zak, and turned to cycling and exercise to help alleviate his depression. While working on a film in Alaska in 2003, Williams began drinking alcohol. In 2006 he checked himself into rehabilitation center in Oregon. Although he failed to maintain sobriety, he never return to using cocaine, stating that paranoia and impotency was not much fun. In early 2009, Williams was hospitalized due to heart problems, and underwent aortic valve replacement surgery at the Cleveland Clinic. Then in 2014, Williams again admitted himself into an addiction treatment center, this time in Minnesota for treatment of alcoholism. His publicist commented that Williams was suffering from sever depression prior to his death, and Williams’s wife stated that in the period before his death he had been sober but was diagnosed with early-stage Parkinson’s disease. Parkinson’s is treated using a series of medications including Levodopa or Sinemet, which according to the U.S. Food and Drug Administration, “should be observed carefully for the development of depression with concomitant suicidal tendencies.” The makers of Sinemet even warn that extreme caution should be used when prescribing to patients with a history of depression.

Although depression may occur only once or twice time during your life, most people have multiple episodes of depression at different times. Most often these episodes of depression are based on life events and are entirely understandable. Episodic depression can occur around the death of a loved one, a pet, or any other significant loss, for example the loss of a job. A diagnosis of clinical depression requires that the symptoms are not episodic, in other words, the person has not adjusted to the loss. Clinical depression can encompass entire lifetimes if not treated.

Depression affects us differently, and symptoms vary from person to person, but there are some symptoms that are universal. Imagine having entire days, weeks, even months when all you feel is sadness, emptiness or unhappiness? You are angry, yet you don’t understand why. You lose interest from the things you one enjoyed; you are exhausted but you can’t sleep. When you do finally sleep you wake exhausted. You have no energy. You feel anxious, excessively worried about what might happen. Your thinking can become slowed down, lethargic. You start to feel worthlessness, or guilty, that you are causing your loved ones to suffer because of it. Maybe you begin to focus on past failures, blaming yourself for things that have long since passed. You may experience severe limitations to your ability to concentrate, make decisions, or remember simple things. You may experience body pain or headaches. For some people, depression symptoms are so severe that anything seems better than to continue. You may begin to have thoughts of suicide. These thoughts may be overwhelming. The best way to beat depression is to be aware of it.

If you or someone you know is experiencing any of the following:

Can’t sleep or sleep too much

Can’t concentrate or find that previously easy tasks are now difficult

Feel hopeless and helpless

Can’t control your negative thoughts, no matter how much you try

Lost your appetite or you can’t stop eating

Much more irritable, short-tempered, or aggressive than usual

Consuming more alcohol than normal or engaging in other reckless behavior

Have thoughts that life is not worth living (seek help immediately if this is the case).


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