Robin Williams: In Truth, We Will Never Know

John McManamy Health Guide
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    I have been off the grid for most of the last two weeks, and thus missed the media commentary into the suicide of Robin Williams. I hesitate to add my own voice. Like you, I feel a deep sense of grief and loss. This was a giant of a man who has been a close part of my life for four decades.

     

    A personality as unique and outsized as Robin Williams defies classification. To analyze him or fit him into categories is to diminish him, to take away his humanity. Yet, here I am, an expert patient who writes on bipolar. Duty calls. Let’s look at some of the issues ...

     

    Mania, or not?

     

    “Manic” is the term most used to describe the late comedian’s rapid-fire delivery. So much so, that when people used to ask me to describe mania to them I would simply mention Robin Williams by name.

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    Say no more.

     

    Robin Williams’ public persona was clearly born of inside knowledge, the kind that couldn’t be faked. Dean Martin could “act” drunk, Lucille Ball could “act” goofy. You can’t “act” manic. You are either born with it or you are not.

     

    The assumption is that if you experience mania or hypomania (mania lite) then you must have bipolar. Life, however, is a lot more complicated. Let’s break it down ...

     

    Bipolar, or personality?

     

    Bipolar is very much a Zen illness. Thus, if you manage your bipolar well, do you truly have it? It’s very easy (and dangerous) to equate checkmarks on a symptom list to mental illness. The real test is two-fold: personality and functionality.

     

    I used to frame the personality issue as such: Two women are dancing on tables. One of them is Marilyn Monroe. Marilyn, I would argue, is operating within her “normal.”  

     

    In relation to hypomania, the DSM-5 notes that the symptoms “must represent a noticeable change from usual behavior.” To freely translate, it is perfectly “normal” for Marilyn Monroe to act like Marilyn Monroe. As for the other woman dancing on the table, if you are her friend, you may have good cause to fear for her safety.

     

    This raises the issue of “state” vs “trait.” Hagop Akiskal of UCSD talks of “hyperthymic” temperament, a heritable personality characteristic that may overlap with bipolar. Kay Jamison of Johns Hopkins wrote a book called “Exuberance.” 

     

    So, back to Robin Williams. Keep in mind, even in the midst of his most frenetic onstage cadenzas, the late comedian maintained perfect control. As crazy as he came across, he was operating well within the parameters of his personality.

     

    Creativity, the personality complication

     

    Kay Jamison was one of the first to write on the link between creativity and bipolar. Her book, “Touched with Fire,” explores that connection. Recent brain research is yielding a trove of new insights.

     

    To vastly oversimplify, both creative individuals and those with mental illness appear to lack the ability to filter out a good deal of their external and internal environment. We compensate by working the “thinking” parts of our brains a lot harder. Those who score low in “executive function,” however, are easily overwhelmed.

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    Creative people have a rare capacity to synthesize both “divergent” and “convergent” thinking. Their brains process an unusually wide range of inputs, make novel connections, then shift to laser focus to arrive at insights that both dazzle and confound the more mundane.

     

    We are a long way from definitive answers, but it is easy to conceive of bipolar as the downside of creativity. Vincent Van Gogh would be Exhibit A. But can the same be said for Robin Williams?

     

    Functionality

     

    Unlike Vincent Van Gogh, who led a troubled life and died at age 37 without ever having sold a painting, Robin Williams maintained a successful career - at the top of his game, in a very demanding and competitive field, well loved - for four decades.

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    We associate individuals with bipolar as those who seem not to manage their lives well. For mania, the DSM-5 is very clear: “The mood disturbance is sufficiently severe to cause marked impairment in social or occupational functioning.”

     

    For hypomania, even though the symptom list is exactly the same, the DSM-5 paints a very different picture: “The episode is NOT (emphasis mine) severe enough to cause marked impairment in social or occupational functioning.”

     

    Again, the Zen illness, which raises another issue ...

     

    Treatment, or not?

     

    If an illness or condition causes no apparent impairment, should it be treated? Like our two women dancing on tables, context is everything. In the field Robin Williams worked in, his mania - whether born of bipolar or personality or both - was a clear advantage. If there were any downside, clearly it was not enough to derail his career or his social life.

     

    As for some of the characters he played, well maybe John Keating in Dead Poets Society would have kept his job as a teacher had he toned down his act a bit, with the help of, say, lithium. 

     

    In this context, we are talking about simply taking off “the edge,” in effect slowing down our fastball just enough so we don’t bean the mascot. But teaching school and acting in Hollywood are two entirely different realities, and here we have no evidence of Robin Williams ever beaning the mascot.

     

    No dramas on the set, no epic battles with producers or directors or fellow actors. This was a man who showed up for work, loved by those he worked with. Why would you treat that?

     

    Alas, the depressions

     

    Mania gets all the attention, but depression is by far the most debilitating and lethal part of our illness. People with bipolar I spend three times more days in depression than in mania. For bipolar II, where hypomania is the threshold, the ratio is a lot more lopsided.

     

    Now we are hearing a side of Robin Williams we previously heard little about, a man plagued by personal loss and depression. 

     

    Despite all we hear from the psychiatric profession on how treatable depression is, in truth the success rate is very much overstated. Even those of us who manage to cope know we are living under a Damoclean sword. All it takes, we know, is one minute of the wrong combination of environment and biology dropping down on us like two tons of bricks.

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    We know what it’s like, clinging to life by a thread. We know what it’s like, experiencing a psychic pain so intense that the one way out seems like the only choice. We know. That’s all we need to know.

     

    Last word

     

    Again, in writing a piece of this type, it is very easy to lose sight of the man. One who touched our hearts, got us thinking, made us laugh. Bless you, Robin Williams. We will miss you. 

     

    Photo: Creative Commons via Wikipedia

Published On: August 17, 2014