What is and What is not a Choice in Depression

Robin Williams’s suicide has sparked many fascinating debates, from the need to break the stigma behind depression to just treating others with kindness. The debate I was surprised by and even a little cynical about was the debate regarding whether the act of suicide is a choice or not.

I feel for Robin’s family; they have lost a father, a husband and here are complete strangers arguing whether or not his suicide was a choice. I wish I didn’t have to take part but I have this compulsion to set people right, and I hope I can delicately put forward my argument and share some facts about my ongoing struggle with depression.

I’m grateful that people are being more open minded about depression but in doing so I think some people have confused the hopelessness in depression with a lack of willpower. I’ve actually been able to achieve many impossible feats while under severe mental illness or neurological disorder symptoms when exercising the muscle of willpower. I’ve managed to delay meltdowns, seizures and push myself through blood sugar crashes. I’ve stood up to crippling anxiety – although, I usually do fall victim to it – and I’ve avoided giving into impulses. My willpower has never been more needed than during intense and continuous suicidal thoughts.

A few years ago I discovered a book about cognitive behavioural therapy which is basically replacing negative and irrational thoughts with more positive ones. I took the information to heart and began to change the way I thought. Now it is a much needed defense in my fight against my mental illnesses. However, there are times when I’m more focused on the negative and am incapable of thinking more positive thoughts. The longer I’m in my depressed or anxious thoughts the more likely I will become aware that I need to utilize some CBT thoughts to help deal with my feelings. Now when I am starting to doubt myself or even when I am angry at someone and I think I hate them, I can backtrack and decide, no, I’m just angry at them.’ That is all CBT is.

I have felt some deeply intense suicidal thoughts since 2008 and even though I’m on anti-depressants they won’t go away. During the day I may be ok but when the medication wears off the thoughts seep through. The medication does nothing to control my mania and if I give completely into it and allow it to overtake me and make me spend impulsively and do all those other self-destructive habits one does in the middle of a manic episode then I will become deeply depressed again, and often suicidal. Even when I’m in a good mood I know that I have a suicidal plan. When into the middle of a depressive episode it just feels like the plan will go into effect any day now.

But time and time again I have decided to not go forward with that plan. This isn’t moderate depression, this is severe hate and loathing and misery and no one loves me and my life is hopeless and it’s just easier if…It’s serious stuff. But I go through the pain and I come out better on the other side. Sometimes after my mood lightens I’ll still be thinking mild to moderate suicidal thoughts, unless I blank those thoughts out of my mind.

So, how can suicide not be a choice when I’ve made the choice to keep living? Do you want to know what I’m still living for? Most times it’s so I can see and photograph a band. Seems silly but many times when I’ve seriously considered suicide I will then think ‘but I’ll never get to see so and so again.’ Other times it’s been my nephews. I’ve actually written out notes apologizing to them why I did it. Sometimes the physical pain is too much for me to go through. But there’s always been something else, a need to keep pushing on. I’m not in best situation. I’m unemployed and I’m unsure how much longer I’ll be eligible for the disability pension. Obviously, I need to stay on it but I’m not sure if my government will agree. I struggle with social skills and feel doubtful about getting into a romantic relationship which is what I focus on a lot when I’m depressed. And I’m living with family members and don’t know if I’ll ever be completely independent to live on my own. I’ve also got physical health problems as well as mental, and without my ADHD medication I feel stupid and that I can’t reach my potential. So, when I become severely depressed I’m focused on all those issues and I just feel it’s too much – and tell myself ‘I have a good reason to kill myself.’ Then I come down from depression and just keep going on with life.

Now I am in the ‘suicide is a choice’ camp but I feel there are certain moments in depression where one has less of a choice. There’s the extreme tiredness and lethargy, not to mention apathy you get where you can’t even get out of bed. You lose your appetite and so can barely eat. Positive thoughts become harder if not impossible to achieve. When you can eat it’s hard to make a big healthy meal for yourself so you stick with what takes the shortest time to prepare. Around people you give short terse replies and may even snap at them. And then when you feel overwhelmed you can’t stop the meltdown. You might have planned going out weeks ago with friends but now you just don’t care and can’t psyche yourself up to go or even want to go.

I’ve dragged myself out to live music gigs when depressed. On the bright side I wasn’t terribly anxious as usual, but was angry, impatient and was so absorbed in my own ruminating thoughts that I almost got hit by a car. I would look at the crowds of people especially those in groups and just be annoyed. I would drink alcohol and get even more depressed. I’d become paranoid and feel abandoned and yet I would still drink more. I may come out of it if my photos were turning out the way I was expecting, or I’d remain depressed and leave the gig early.

Even then I would have a choice to not drink, to distract myself and turn my thoughts to something more positive. It’s difficult but not impossible. I was actually at a gig where I chose the foolish decision to drink but it did cheer me up, but my friend stayed depressed, and so only one of us enjoyed ourselves.

The only time depression has seemed impossible to control was depression brought on by a hormone imbalance. I had one of the worst weeks with getting up every morning to make sure my cat didn’t defecate in the shower, and then I had to put up with people arguing while trying to fight my own chronic feelings of depression. I actually came very close to committing suicide because I just wanted it to stop. I have been through worst periods of depression though. Having to deal with a mood disorder and a hormone disorder is like a double threat though.

I deal with other symptoms that seem uncontrollable. I have bipolar mania which makes me terribly impulsive. During the last episode I spent too much money and gave into the mania too much so when I did crash into depression it was brutal, but it passed. I actually wasn’t sure when it would end. I even considered suicide too. It was strange to me because I was taking anti-depressants. This time I’m controlling my mania by not instantly giving into impulses, even something as simple as craving food. That’s where it all starts. I be very careful when deciding my next purchases. Yes, there have still been times where it feels my brain is into control of me but I’m still able to fight against this. When I do slip though I try not to be angry at myself. I tell myself, ‘Yes, you got a bit out of control there, said some things you’d probably regret, but just stop here before it gets any worse.’

I used to lose a lot of control of my emotions too but now I take my time to respond to someone or not before I lose them for life. I used to cut ties with friends to save them from my manic rants. I’ve got better control of my anger now, or rather, I can avoid exploding at them and keep those thoughts in my head, then the little CBT officer in my head will try to soothe the angry irrational side of me.

While I do think suicide is a choice it’s more a choice people make when they feel they have no other choice left. Right now I’m choosing to keep my depression at bay while slowly releasing my mania or hypomania and not letting it out all at once or letting it do whatever it wants, so I don’t crash so hard again. And even if I do crash hard again I probably won’t end up killing myself, even when it’s the only thing on my mind.

I think I understand where people are coming from though. Suicide is a very emotional topic especially if you have experienced it. What I’ve seen a lot of lately is people reading into the statement ‘suicide is a choice’ in their own way, and it probably brings up memories of people once telling them or others it’s a selfish act which then makes them think of what most of us think of when we say someone is selfish – narcissistic really – but the selfishness in suicide is far from that. It’s like saying an autistic person is selfish. I’m autistic and I sometimes feel like I’m selfish because I don’t consider peoples emotions at first. But that is the way I’m wired. I work hard to gain more empathy but even when deeply depressed and thinking of suicide that empathy is hard to reach. What I really think people do is focus on those words and only interpret them in the way they’ve always been told them.

So, I hope now people understand by what we mean when we say suicide is a choice. Just being factual really. I’m more of a logical person than an emotional one. Like a Vulcan really. You have to make an act to kill yourself, usually when you just want to end your pain, but it’s still involves making the decision to take those pills, hang that rope or cut with that knife. When deeply depressed my choice has always been: watch a comedy until you start feeling better.

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The Elephant in the Room is Bipolar

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In the wake of Robin Williams’s suicide something surprising has happened; sufferers of depression have come out of the shadows to share their struggles with this terrible illness. Even before this the stigma that has surrounded depression for many decades has begun to slowly be erased with sport athletes opening up about their struggles with depression. And now acceptance for depression as a real mental disorder is higher than ever and it coincides with ABC TV Australia’s announcement about a new initiative to raise awareness and end the stigma surrounding mental illness, which will happen in October. People have not only started to share their stories about living with depression but those who have been untreated for so long have finally gone out to seek help. Lifeline has been inundated with calls of people who may have been on the very brink of suicide. Real lives have been saved.

This is fantastic and I’m very happy to see the stigma of depression disappearing but I only wish the same would happen for sufferers of bipolar disorder. It’s well known that Robin Williams fits the description of someone with bipolar disorder. You just have to watch him in interviews. He himself has also called himself manic a number of times. Few who have that much hyperactivity rarely have bipolar disorder, unless they have ADHD but it begins in childhood and Robin was shy as a child, as was I – I’m actually glad we have that in common. One other I can think of on the bipolar spectrum who was shy as a child was 60s folk singer Phil Ochs who took his own life at 35.

Out of all my reading up of news articles about Robin Williams’s death only one says he was suspected to have bipolar. Now I’m not saying I know for sure what the cause of his depression was – we now know he had depression from having heart surgery and Parkinson’s disease – but I still think bipolar needs to be properly explained. There are still people out there who can’t understand how someone so funny could end his own life. And from some programs I’ve watched they have tried to find a link between comedians and depression. I used to think such things myself but it’s more likely the depression is manic depression.

I can understand why people would rather leave the bipolar issue out, because they want to remember the man as a man, not as a diagnosis or label. We can still say he struggled with bipolar as much as we are saying he suffered from depression. I just think it will help those confused by his suicide understand his choice a lot better. Soon I will talk in detail about bipolar, especially the depression as it manifests as a comedown from mania. First I want to talk about who Robin Williams was to me and how I will remember him.

The first memory I had of becoming familiar with the name ‘Robin Williams’ was from watching Aladdin. It was my favourite Disney film at the time. I love him as Genie and soon began to quote him every chance I got. Kids like me just loved the energy he gave to the role, the switching between personalities and I even got a bit choked up around his emotional moments. To adults on the outside I looked like an emotionless kid who didn’t have a clue what was going on around me. Later I would be diagnosed with autism. But when I could really connect with a character I began to empathise more, even if on the outside I was as solid and as expressionless as a rock.

I watched a lot of Robin’s family films in the 90s. His soft gentle voice made me think of him as either that favourite teacher or a father figure. Father figures would come in many forms for me as I didn’t see a lot of my father. I’m glad I didn’t see any of his stand up or his more adult movies because given my Christian upbringing I may have been turned off of him by it, but now that I’m an adult and have a pretty dirty mind myself and I had to push those thoughts deep down inside me while I attended church, I enjoy all that stuff now. I think his best film for me was Dead Poets Society even if my young eyes were focused more on the shy character Ethan Hawke played. I have not seen the film in years so I may have to revisit it. I just remember watching that movie over and over again and loving it. I loved Jack too because I loved how believable he was as a 10 year old. I was probably around that age myself when I saw the film. An adult that had the personality of a child was something I aspired to be, although I really didn’t have to put much work into it.

Like I mentioned before I was a shy child and I’m still surprised by how much I’ve changed. I used to tag along behind my friends and now I’m like the class clown. Sometimes I think my humor is a little bit too weird, too crude and about things no one can relate with, but people seem to like me. Now, I suspect I may have bipolar and the reason why I talk like I’m sure I have it is I don’t think I’ll ever be diagnosed or medicated for it properly. Doctors are either too biased so shut down my suggestions for an assessment just to rule it out, or unqualified, or their fees are too steep. It makes it hard for me to get help. And lately I’ve been wrestling with the thought that mania could actually be a bad thing. Last time I was constantly on the move for two days, I spent over $300 and I crashed so hard and it was my first depressive episode since being on anti-depressants but I’m always so energetic, the creative ideas come so fast they are spilling out of my brain, I’m more social, more willing to take risks and I just know people think I’m a lot of fun.

I also know I come up with questions people never want to answer, like would Robin Williams be the same without his mania? People who have received treatment for bipolar always seem to avoid talking about the good parts of mania and I tried my best to name it as a negative force, just a part of the mental illness, but I fell behind in my productivity. I’m a very logical person. I can put things together. It’s still a question I don’t want to answer. One could say if Robin Williams didn’t have mania he wouldn’t have killed himself, but maybe even without there would still be depression. I just remember when I was coming off Ritalin because it was basically speed to me and I knew it would take a whole lot away from me. I even warned people I might not be as social as I was on the meds. That didn’t exactly happen. The change was permanent. The only difference was I didn’t speed through my sentences. Now I’m not saying everyone’s experience with Ritalin will be like this but it’s more likely to be if you have bipolar or a family history of it.

The most important part I want to touch on is the depression that follows mania. There are the usual symptoms of depression; they sort of bleed through while still manic. You can start to doubt yourself after having so much confidence about yourself, or something in the environment can trigger you; someone giving you negative feedback or hearing some sad news, or simply being unable to sweep your disappointed about something under the rug. I usually choose to ignore the trigger but once it happens depression is going to rear its ugly head and may stick around for some days, or for the most common types of bipolar, many weeks and months. For me, the positive kind of mania begins to disappear and is replaced with this monstrous angry monster, sometimes known as dark mania or agitated depression. I would get in some very ferocious fights with friends that when my mood returned to normal I would decide it was best if I got those people out of my life to save myself from them. I did this once a month and almost decided to end it with my best friend, but she wasn’t having it, so I had to learn to really empathise with her a bit more and things have been fine ever since. Once the mania is over you are left with exhaustion. Both cognitive and motor functions slow down. You barely get to complete a thought, your memory worsens, and it’s a lot harder to get a coherent sentence out of your mouth. You can barely get out of bed or make your own meals. You’re either full of intense and painful melancholy or extreme anger.

You don’t want to be around people. They anger you for just being there, particularly if they’re in a cheerful mood. You begin to feel guilty for the way you acted during the manic episode, especially the money you spent. There’s a lot of memory loss about what you got up to. Sometimes you want that memory so you can remember how happy you were because happiness seems the hardest emotion to achieve right now. You’re full of self-doubt, hate and may become cynical. Eventually, the lingering thoughts turn to how difficult everything is suddenly for you and it’s just too hard to go on. Then the suicidal thoughts start. For me and my highly vivid imagination they always end up being graphic scenes involving the moments before the attempt and the reaction of people after it. Blame my imagination and lifelong obsession with film and desire to be a screenwriter, but I can always turn these thoughts and images around to lead to a positive conclusion and the whole depressive episode ends.

What I’m trying to illustrate here is that the depression in bipolar is different than just stand alone depression. All depression is really serious but that added exhaustion and guilt has really made an impact on my own plans for suicide. There is more hope for those of us who cycle from one mood into the other: the depression will end, but when?

Robin Williams’s death is a real tragedy and for a few of us with bipolar disorder who have more of a handle on our depression we’re now unsure of our own future. Not only was Robin Williams more successful than us (some of us don’t even have jobs or have any hope to get into another romantic relationship) but he was older than us and I was led to believe the more experience you have with depression the more you have a handle on those thoughts, but that’s not always the case. Maybe it was simple matter of having depression x3 including a chronic illness that just made him give up, but we’re all just so shaken by it.

Whatever the reason he is gone now and that hurts a whole lot of people. From the 90s kids who enjoyed his family movies, to the older generation who loved his stand-up, even got so influenced by it it shows up in their own comedy routine (Jimmy Fallon), to those who enjoyed his later more mature films.

But he’ll always be my Captain.