Medical lessons from Robin Williams

Medical lessons from Robin Williams

Dear Robin,

You were such an inspiration.  You showed us courage in the face of adversity, making us laugh while your own soul was broken.

Even now, at the time of your death, we find ourselves in a recently forgotten place where all people — regardless of faith, color, or country of origin – stand united, sending out love to you and your family.

You once said, “The worst thing in life is not to end up all alone. The worst thing in life is to end up with people who make you feel alone.”

Even in death, you have united the world and brought us together again. Even from beyond, and for years to come, you will continue to make us laugh. That is a sign of a great man.

By the way, we will always cherish the medical lessons you taught.

On psychopharmacology: “Reality is just a crutch for people who can’t handle drugs.”

On psychiatry: “You’re only given a little spark of madness. Don’t lose it.”

On pharmacology: “Cocaine is God’s way of telling you you are making too much money.”

On pharmacokinetics: “Cricket is baseball on Valium.”

On genetic engineering: “We’ve had cloning in the South for years. It’s called cousins.”

On genetic counseling: “When you look at Prince Charles, don’t you think that someone in the royal family knew someone in the royal family?”

On surgery:  “Ah, yes, divorce … from the Latin word meaning to rip out a man’s genitals through his wallet.”

On circulation:  “See, the problem is that God gives men a brain and a penis, and only enough blood to run one at a time.”

Thank you for showing the world that “comedy is acting out optimism.”

Afshine Ash Emrani is a cardiologist and can be reached at Los Angeles Heart Specialists. This article originally appeared in the Jewish Journal.

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  • http://laheartspecialists.com/ Afshine Emrani MD FACC
  • Patient Kit

    So sad. And such a loss, way too young. And because someone has to say it — Laughter really is the best medicine — and Robin Williams helped many by giving them that precious laughter medicine. RIP! :-(((((

  • querywoman

    Robin was hyper with his nutty smile.

  • http://laheartspecialists.com/ Afshine Emrani MD FACC

    My captain, o captain.

  • http://laheartspecialists.com/ Afshine Emrani MD FACC

    Genie you’re free.

    • James O’Brien, M.D.

      Sorry, but as a psychiatrist I don’t find romanticizing suicide (or escapism) helpful. There are millions of suicidal people out there. They do not need to get this message of suicide as liberation. Sentimentalize something and don’t be surprised you get more of it. Camille Paglia talks about epidemics of romantic suicides in the 19th century related to romantic notions of self loathing. Treatment for mental illness should not be stigmatized but killing in a civilized society should be. There is plenty of collateral damage. His family will spend the rest of their lives wondering if they were somehow responsible.

      • Mi Bear

        A pill couldn’t help RW, he was a great man from the outside but someone should have been looking at the inside. I have PTSD from childhood abuse, I have actually had a psychiatrist put me on an antidepressant that did not help, actually I almost killed myself by trying to jump from a car going 70 mph because I could not handle what the person driving was saying to me. We need more safe spots, people need to stop using our illness as a way to make us feel bad about ourselves like the word cray cray that was just added to our dictionary and sometimes the only thing that matters is not feeling at all. I don’t think you should be able to get a degree in psychiatry unless you are a little nuts yourself, because no body knows better how you feel unless they have stood in your shoes, so cut the crap, stop administering drugs and help with some support groups. Not likely since this does nothing to fatten your wallet. Look at the benefits compared to the side affects of Mr. Prozac. I am weening myself now and plan on finding easier ways to deal with my problems on a daily basis then drugs
        .

        Antidepressant medications are used to treat a variety of conditions, including depression and other mental/mood disorders. These medications can help prevent suicidal
        thoughts/attempts and provide other important benefits. However,
        studies have shown that a small number of people (especially people
        younger than 25) who take antidepressants for any condition may
        experience worsening depression, other mental/mood symptoms, or suicidal
        thoughts/attempts. Therefore, it is very important to talk with the
        doctor about the risks and benefits of antidepressant medication
        (especially for people younger than 25), even if treatment is not for a
        mental/mood condition.

        Tell the doctor immediately if you notice
        worsening depression/other psychiatric conditions, unusual behavior
        changes (including possible suicidal thoughts/attempts), or other
        mental/mood changes (including new/worsening anxiety, panic attacks, trouble sleeping,
        irritability, hostile/angry feelings, impulsive actions, severe
        restlessness, very rapid speech). Be especially watchful for these
        symptoms when a new antidepressant is started or when the dose is
        changed.

  • querywoman

    I wonder if Robin was bipolar? Gosh, I just despised the movie, “Popeye the Sailor Man.” I practically never watch TV at home.
    When my mother was alive, I used to see Robin sometimes on late night TV with her. He could be so funny, but he was always kind of wound up.
    He must have had highs and lows and could really give in his highs.

    • Kristy Sokoloski

      I was just watching one of the segments of one of the morning shows with one of the medical correspondents that was kind of interesting. She kind of hinted that it’s very possible that Robin Williams may have been bipolar. A number now are saying that maybe this will finally be the thing that helps make mental illness a subject that it is not a taboo subject. I have my own doubts on that but we’ll see.

      • querywoman

        I am a unipolar chronic low energy depressive type. Bipolars in the manic stage drive me crazy.
        Sometimes when seeking psych treatment, I’ve been asked if I ever felt wired or compelled to do stuff. I respond, “Are you kidding? I couldn’t get of out of bed long enough to have a manic spell!”
        Robin always looked wired and kind of possessed, kind of insecure behind his smile.
        I used to have a close friend who was bipolar. I always knew her to be medication compliant. I couldn’t have been around here if she were really wired.
        Because of her various treatments, she used to gripe about those “manics’ when she got around the really wired ones.
        Bipolars can be really gifted. They have an intense drive and can be successful. Then they go really low.

  • QQQ

    Personally, I never cared for his type of humor! However, its still a loss of a life and if you read his personal struggle with the demons within (especially with drugs & alcohol), Its catastrophic no doubt!

  • http://laheartspecialists.com/ Afshine Emrani MD FACC

    Please share your favorite quotes from him.

  • James O’Brien, M.D.

    Inspiration? I’m thinking more along the lines of cautionary tale.

    “Reality is just a crutch for people who can’t handle drugs.”

    Not as funny now as when he said it….

    • querywoman

      He didn’t invent that. I’ve heard it lots.

    • DeceasedMD

      Seems like most people are fooled by this man. His humor i always thought came from his contagious mania. From outward appearance it does not appear he was on a mood stabilizer. I am saying this from a laymans POV since he just looked manic to me when he performed. i found it odd he went to some unknown treatment center in Minnesota. Who knows if there was a psychiatrist involved. My guess is a lot of these so called addiction centers do not address underlying mood DO as there are internists involved instead of psychiatrists. Do you know in general if this is true?

      • querywoman

        Yep. I already said he was probably bipolar. So wired!

  • http://laheartspecialists.com/ Afshine Emrani MD FACC

    “The opposite of depression is not happiness, but vitality, and it was vitality that seemed to seep away from me in that moment.” In a talk equal parts eloquent and devastating, writer Andrew Solomon takes you to the darkest corners of his mind during the years he battled depression. That led him to an eye-opening journey across the world to interview others with depression — only to discover that, to his surprise, the more he talked, the more people wanted to tell their own stories. http://www.ted.com/talks/andrew_solomon_depression_the_secret_we_share#t-261292

    • DeceasedMD

      He was manic not full of vitality. Most people seem to miss that vital point. It’s importance is that his mood disorder had highs and lows and did not appear never under control which most likely lead to his suicide.

  • http://laheartspecialists.com/ Afshine Emrani MD FACC

    For those of you such as Chip Stone who find this article offensive, here is my previous feeble attempt at highlighting depression: http://www.kevinmd.com/blog/2014/05/depressed.html

  • querywoman

    Dr. Emrani wrote a nice memorial for a comedian whom he happened to like. Why blast Dr. E for this? In the photo he chose, Robin looks both insecure and sweet behind the smile.
    I do think he was bipolar. Virgina Wolfe was probably bipolar also. This illnesses has bad and good sides, and many bipolars are very gifted.

  • Maria Bowmer

    I don’t see anything wrong with what Doctor E wrote. He was remembering a man many loved, including me.

  • http://laheartspecialists.com/ Afshine Emrani MD FACC

    Please read and share: 1- Every forty seconds, someone commits suicide. In the United States, it is the tenth most common cause of death in people over ten years of age, far more common than death by homicide or aneurysm or AIDS.

    2- Nearly half a million Americans are taken to the hospital every year because of suicide attempts. One in five people with major depression will make such an attempt; there are approximately sixteen non-lethal attempts for every lethal one.

    We lionized Robin Williams for the manic gleam in his performances; at his best, he was not only hilarious but also enchantingly frenzied. It often seems as if those who are most exuberant experience despair in proportion to their joy; they seem to swing wildly about the neutral average.

    When the mass media report suicide stories, they almost always provide a “reason,” which seems to bring logic to the illogic of self-termination. Such rationalization is particularly common when it comes to the suicides of celebrities, because the idea that someone could be miserable despite great worldly success seems so unreasonable.

    Nor is suicide an ultimate manifestation of “selfishness” or “cowardice,” as the reason-mongers often argue. Suicide is not a casual behavior; for all that it may entail impulsivity, it is also a profound and momentous step for which many people don’t have the force of will. Robin Williams’s suicide was not the self-indulgent act of someone without enough fortitude to fight back against his own demons; it was, rather, an act of despair committed by someone who knew, rightly or wrongly, that such a fight could never be won.

    The same qualities that drive a person to brilliance may drive that person to suicide. He played an alien so well because he was an alien in his own mind, permanently auditioning to be one of us. Suicide is a crime of loneliness, and adulated people can be frighteningly alone. Intelligence does not help in these circumstances; brilliance is almost always profoundly isolating.

    Williams’s suicide demonstrates that none of us is immune. If you could be Robin Williams and still want to kill yourself, then all of us are prone to the same terrifying vulnerability. Most people imagine that resolving particular problems will make them happy. If only one had more money, or love, or success, then life would feel manageable. It can be devastating to realize the falseness of such tempered optimism. A great hope gets crushed every time someone reminds us that happiness can be neither assumed nor earned; that we are all prisoners of our own flawed brains; that the ultimate aloneness in each of us is, finally, inviolable.http://www.newyorker.com/culture/cultural-comment/suicide-crime-loneliness

    • querywoman

      Thank you. I knew a whole bunch of people also committed suicide the same day.

    • SteveCaley

      Forsooth, the jester’s dead.

      All the world’s a stage,
      And all the men and women merely players;
      They have their exits and their entrances,
      And one man in his time plays many parts….

      Of many players we have seen and thus pretend we know
      something
      of whom, without the strings, they are,
      one rule on all the players forced -
      to play forever as we like it. We forbid them
      cry “exeo!” and quit the stage.

      For all the men and women are merely players;
      they are not real; we are not them;
      We play at kings; they play at fools;
      in post-production we shall change the play.

      It was serotonin, that’s the thing, I saw it, and
      the locus ceruleus did not stand
      its duty; high priests shall sussurate the Dies Irae:
      “nucleus praepositus hypoglossi, nucleus paragigantocellularis,
      Tu esto dormies in pace.” (A postmortem’s the thing
      wherein I’ll soothe the lunacy of the king.)
      We can accept all things, except
      when a player, playing, speaks only to himself.

  • http://www.CommunicatingWithPatients.com/ Edward Leigh, MA

    Thank you for reminding us of all the joy that Robin Williams brought people. He obviously had serious mental health issues, but he was also a gifted entertainer. He was also a wonderful humanitarian – entertaining our troops and visiting countless hospitalized patents. RIP Robin.

  • http://www.CommunicatingWithPatients.com/ Edward Leigh, MA

    I read many articles where people were puzzled why Robin Williams killed himself. Many people said, “He had fame, money, millions of adoring fans — why would someone like that commit suicide?” Clinical depression is a medical illness, just like diabetes. Fame, finances and fans do not cure medical illnesses. I worked in the mental health & chem dependency fields for many years. Clinical depression is not a character flaw, weakness or lack of will power. Telling a person with clinical depression to “pull yourself together” is not helpful and will make them feel even worse. It is important for people to understand the difference between everyday sadness and clinical depression. Over the years, I have seen many patients successfully treated.

  • itasara

    I felt right from the start when I heard about his death that he had to have a catylist to push him over the edge. Yes serious depression will do it, but I just felt it had to be something else like a terminal illness. So if it is true he had Parkinson’s then I think that would be more than devistating to this person who spent his life making others laugh and being happy.

  • paradocs21

    We were blessed to share his energy. A great medical lesson is being lost in the media commentary. As we all know his energy and its infectious nature was one more aspect of his bipolar disorder, as probably was his refusal to take meds which would have saved his life but truncated his career. The media mention his “depression” without one word about bipolar disease. You’d think it was the early days of AIDS. What gives?

    • Ladyimacbeth

      Was he ever diagnosed with bipolar disorder?

      • paradocs21

        Not that I know of, but he meets all the DSM criteria

        • querywoman

          Looked obvious to non-doctor me. The manic drive can make bipolars very successful. They can never medicate it enuf to make it totally go away.
          It’s there and just won’t go away.
          It’s just like what I am: a chronic, low energy, unipolar depressive. I do not have the energy for a manic skill. I get out of bed because I am curious and get tired of sleepy my life away.

  • querywoman

    Now we know he had Parkinson’s, and that’s part of the equation too.

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