Judging by the very large number of status updates in Facebook about Robin Williams that I saw each of the last two nights, his death had a profound effect on many. As my friend Rich pointed out, it was not so long ago that Philip Seymour Hoffman also passed away. Drugs were part of the picture in both cases. For the bulk of us who didn't know these artists personally, it is impossible to distinguish root cause from symptom as we learn what transpired.
But it may be a good time for us to reflect more broadly about depression, because it is a subject we tend to avoid entirely unless immediately confronted by it, yet if we were more aware about it we might very well be able to lessen its likelihood, in ourselves as we confront challenges that at first may seem overwhelming, and possibly in our friends and colleagues, the ounce of prevention being worth a pound of cure the operative consideration, even if our impact on others is at best a tertiary effect. Indeed, my friend Dave posted a link in Facebook aimed at educating readers about the difference between depression and sadness as well as on the connection between depression and suicide. There is a similar such explanation about clinical depression at the WebMD site, especially valuable if you are looking for a reference not tied to the current events about Robin Williams.
These links are helpful. Nonetheless, I found them less than fully satisfying. They said not a whit about the antecedents to depression. If there is to be prevention, that is where it needs to be situated. In particular, ask the following question and do so about yourself, assuming you are mentally okay now. How would you react if you then found yourself in circumstances where you felt the situation was quite harmful to you yet you also felt in over your head with no obvious way out? Suppose, after that, that the situation persisted for some time. Would you then get depressed?
Some people would not. They'd fight it and they'd keep fighting it. They might get angry. They might turn bitter at others, particularly those they believed to be the source of the stress. To bystanders, fighting it and getting depressed might look similar. In both cases the person is unhappy. Yet they are not the same. Fighting it means you have a sense of agency about yourself. Depression means you feel it is hopeless and you are impotent to do anything about it.
Personally, I don't like the "fighting it" metaphor. Where possible, I much prefer reason to brute force. I think of the issue as problem solving. If you are working toward problem solution then there is no reason to be depressed, as you may very well come up with an answer. Having the ability to solve problems and being aware of that ability definitely does give a personal sense of agency. Depression then might be found in getting stuck on solving the problem, knowing it is imperative to find a solution, but not seeing any path toward that solution.
My friend Chris posted a link to this piece in Slate, which refers to depression as mental illness. I obviously don't know the author's circumstance. In this piece she is writing mainly about Robin Williams and the issue of whether he knew others loved him. She is right in asserting that even that knowledge is not sufficient to overcome depression. Yet I was not happy with her insistence on using mental illness as a label. Part of depression is the person's mindset, sure. But the environment where the person finds himself matters too. It matters a lot. That is not captured in the expression mental illness.
Many people have shame about their self-perceived inabilities. Shame is itself not a signpost of depression. But it can serve to block potential preventatives to depression because often one won't find those by oneself. One needs to solicit others for suggestions or have others present those suggestions like manna from heaven - no solicitation required.
I had depression when I was in tenth grade. My life seemed to be getting out of control. I also started to find the "good student" thing very artificial, but I had no alternative to take its place. And my weight ballooned upward. I was overeating like crazy. It may have given some immediate comfort, but it was also part of the downward spiral. I never told any of my friends and classmates, so they didn't know at the time. But I believe one day my mother stormed into the school and yelled at some of the teachers. How could they let this happen? The irony is that at core my relationship with my mother was the reason for my depression.
I sensed the makings of another round of depression in the fall semester of my second year of college. It didn't get as far. The prior experience in high school helped me understand the early warning signs. I did find a way out. I transferred from MIT to Cornell. Sometimes we label people who give up as quitters and perhaps in some of those cases the label is apt. But it is important to understand that what is fundamental is that the person not quit on himself. Going down with the ship may be what the captain is duty bound to do. Yet it is foolhardy to think that staying at a place is the responsible course of action, particularly if suicide will become a likelihood as a consequence.
When I was at MIT it "led the country" in student suicides. One consequence of that fact, there were no grades during the freshman year. Instead, all courses were pass/no credit and students received written evaluations from their instructors about the quality of the work they produced and, in some cases, about their in class performance. This is the most humane institutional response to the issue that I am aware of. It clearly was meant as a preventative, one given in a high touch manner. I wish I saw more such interventions.
During my years as a graduate student at Northwestern, there was a documentary produced by PBS called College Can Be Killing. It contrasted student life at Northwestern (in some cases not healthy) with student life at Wisconsin (a more normal environment). If I recall correctly, the film took to task the concept of a single room in a dorm. The argument was made that interaction with roommates was crucial for the mental health of the student. A loner by nature who becomes isolated socially has a much larger chance of going over the deep end. This, in itself, means that introverts are more likely candidates for depression than extroverts. But let us not confound this. Introverts can be full of vitality and enthusiastic about their own prospects. It takes other factors beyond the introversion for depression to manifest.
Eric Hoffer, the working man's philosopher, observed that past success by an individual offers no guarantee of success in future endeavors. Where we may have displayed our brilliance before, we may be consigned to mediocrity henceforth. We don't know. And we won't know unless we give it a try and see what happens. The issue can vex young people, who see expectations about their performance continue to rise, as that rise in performance had been the pattern, yet they themselves feel they've plateaued, unable to climb any higher, or are frightened by the prospect of transcending themselves. The issue can also vex older people, who see evidence that their own capacities are diminishing and who come to expect that they will never again attain the heights of performance that they've previously achieved.
If one's sense of self worth is wrapped up in one's ability to perform, that coupled with Hoffer's observation can then be a potential source of depression. This may catch others off guard, as they view the person as highly talented and quite capable. But the individual himself may perceive he is in decline, with no way out of the hole.
I was in that trap in tenth grade. It took between five and ten years beyond that to discover a personal philosophy that was more sustaining, even if the ingredients for that philosophy were already there the entire time. I needed to give myself a break and get away from this focus on performance as the definer or self worth. What I learned is to see that more as emerging from personal idiosyncrasy, goofiness, and lighthearted play. I have found solace in that view since.
One's personal philosophy must match one's personality. It therefore can't be ready made by others. It must be discovered for oneself. In some sense, then, depression is a consequence of not finding a suitable personal philosophy when the environmental stress is especially strong.
Let me close with a disclaimer. Much of my writing should be classified as intelligent speculation, steeped in my own experience and prior thought. I am not a health care professional. I don't know that those who are would agree with everything I've said. Others in my position might err on the side of caution by not giving their opinions publicly. I have chosen not to do so because I believe preventatives do exist, so having some sense of what causes depression is useful. The operative mantra then - be kind to others and to yourself.