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By Olivia Rose-Innes
Alexander McQueen, acclaimed fashion designer, 40.
Robert Enke, Germany goalkeeper, 32.
Garth Stead, top South African photojournalist, 37.
Isabella Blow, magazine editor and style icon, 48.
Kabelo 'Sello' Duiker, award-winning SA novelist, 30
David Foster Wallace, lauded as one of the best writers of his generation, 46.
Leslie Cheung, Chinese film star and musician, 46.
Nicholas Hughes, biology professor, son of Ted Hughes and Sylvia Plath, 47.
Ralph Rabie (Johannes Kerkorrel), ground-breaking musician and activist, 42
These high-profile suicides of the past decade elicited widespread sadness and sympathy from the public. But there were some less seemly reactions too: disapproval, annoyance, resentment, bafflement.
The cliches that invariably arise when a famous suicide makes the news (But why did he do it? He had everything going for him. How could he hurt his family / fans like that?) reveal an ongoing ignorance about its primary cause.
I can't be certain why these talented people took their lives, but I can make a pretty good educated guess that it was because they were clinically ill, in great pain, and had lost all hope of ever getting well.
The majority (around 90% or more*) of people who kill themselves do so as a result of mental illness, most likely an episode of major unipolar depression, or major depressive disorder (MDD). The “But Whys” in the wake of suicide are usually extraneous: the suffering caused by this crippling disease is reason enough. Certainly there may be life events that contribute to its onset, but often there are no obvious external factors.
The fact that both media and public still indulge in speculation (Couldn't cut it any more. Lot of stress in that line of work. His mother had just died.) suggests that, even in the 21st century, many people don't give depression its dreadful due as a real, life-threatening disease, which, with its hallmark mental anguish and obsessive morbid ruminations, is quite sufficient to bring sufferers to the edge of the abyss.
Nearly everyone has experienced depressed mood to some degree, but the occasional bout of the blues spent under the covers eating chocolates and refusing to answer the phone (for example) compares to major depression rather as a five-minute tension headache does to days of blinding migraine, or a slight sniffle to pneumonia.
Many healthy people can't relate their own experience of 'feeling depressed' to the full-blown clinical illness, not least because the term 'depression' (like 'headache'), is too vague and generalised, and is confusingly used to refer to all forms of the mood and disease, from mild to severe. It is especially inadequate in conveying what depression is like at its worst. Writer William Styron, who also famously suffered from MDD, suggested that 'brainstorm', had it not already acquired a quite different definition, might have served as a more suitable label.
The milder forms of depression are not to be taken lightly: they can ruin lives effectively too, and even, in some cases, especially after years spent enduring their subtler ravages, lead to suicide.
But major depression involves emotional pain of a different order, almost unimaginable to those who have not experienced it. The World Health Organisation (WHO) considers the disability depression causes comparable to blindness or paraplegia, yet the state it resembles most closely is that of acute grief. Unlike the normal grieving process, however, it does not resolve with time, or it may resolve only to recur, sometimes even more severely than before.
Top disease burden of the near future
The profound impact of depression, coupled with its prevalence (there are some 150 million sufferers worldwide) makes it one of the top 10 causes of the Global Burden of Disease (years of healthy life lost to premature death and disability). In 2004 unipolar depression was rankedthirdglobally after lower respiratory tract disease and diarrhoeal disease; by 2030, WHO projects that the top three causes will be depression, heart disease and traffic accidents.
The tragedy of suicide is compounded by the fact that its primary cause is highly treatable, however much it feels to those in depression's grip that cure is impossibly out of reach. When patients diagnosed with the disorder receive appropriate treatment, they have an excellent chance (60-80%) of full recovery.
But to realise this hopeful prognosis, depression (and mental illness in general) must be recognised in the first place. Instead, it is woefully underdiagnosed, and will remain so as long as we persist in viewing it as imaginary or some sort of shameful personality weakness that can be overcome with a bit of true grit and positive thinking.
Other heavy hitters on the Global Burden of Disease list like TB and diabetes don't receive such disrespect because their symptoms are more patently physical, and laboratory evidence of their existence is readily available. We should remember that not long ago we couldn't see the TB bacterium or measure abnormal blood glucose levels. But they carried on claiming millions of lives just the same.
(- Olivia Rose-Innes, Health24, February 2010)
Notes
*Mental illness is underdiagnosed throughout the world, and suicide and suicide attempts are under-reported. Of suicides diagnosed with mental illness, around 50% males and 60% females have depression; some estimates are higher. Other mental illnesses that increase risk for suicide include substance abuse, bipolar disorder, schizophrenia and personality disorders. More than one condition may be present in suicides: mood disorders frequently co-exist with substance abuse, for example, the latter often an attempt at self-medication.
References
Arsenault-Lapierre,G., Kim,C., Turecki,G. 2004.Psychiatric diagnoses in 3275 suicides: a meta-analysis.
World Health Organisation. 2008. Global Burden of Disease 2004 Update.
