Reflections on the Spade and Bourdain Suicides

When Kate Spade died by suicide on June 5, 2018, and Anthony Bourdain 3 days later, I felt shock and grief, as if I had lost people close to me. After all, I—along with millions of others—owned Kate Spade bags, dreamed in Kate couture, and experienced more of the globe with Anthony Bourdain than with anyone else. They were cultural icons and role models and epitomized the American dream. Kate Spade made her first prototype hand bags out of scotch tape and paper and went on to launch a brand that would define New York fashion in the 1990s (1). Anthony Bourdain started as a dish washer and transformed himself into a world-renowned chef and writer, hailed as the "Hemingway of gastronomy" and someone who spoke truth to power and delighted in marginal subcultures (2). Both had mythic beginnings and fabled careers. Their lives were stories that people loved to tell. In the vernacular, they were "living the life."

Both also suffered from mental illness. Bourdain was public about his, writing openly about his previous substance use disorders, including cocaine, heroin, LSD, alcohol, and tobacco use (2). He was also frank about his depression. In the 2016 Buenos Aires episode of Parts Unknown, he expressed a fascination with Argentina, a country with one clinical psychologist for every 696 people in 2012 (3, 4). Compare that with the United States, which according to 2014 World Health Organization (WHO) statistics, had one psychologist for every 3,376 people (5). It is one of Bourdain’s best episodes, weaving together the tango, midnight soccer matches, and paeans to red meat to create a nostalgia so authentic and serious that even the first-time viewer feels homesick. The vibrantly colored scenes of Buenos Aries life are interspersed with black-and-white cuts to Bourdain sitting in the office of his psychoanalyst. The camera returns obsessively to an airplane landing strip, where families gather to watch planes take off and land. It is an idyll of the rustics that Bourdain cannot take part in. Just as persistently, the camera returns to the psychoanalyst’s office, where Bourdain says, "I feel like Quasimodo." When I first watched the episode, the psychotherapy was darkly jocular, with more than a touch of theater, but in rewatching it, Bourdain’s courage at self-disclosure and his not fleeing from the vulnerable act of seeking help bring tears to my eyes.

Kate Spade also suffered from depression. In a statement released after her death, her husband revealed that she had been under medical care for depression and anxiety for 5 years (6). In an e-mail interview with the Kansas City Star on the day after her death, Spade’s sister stated that she "refused to seek help lest word get out and sully the brand’s upbeat reputation" (7). The viral Facebook tribute by Claudia Herrera posted on the day of Spade’s death captures a lot of my own bewilderment. Herrera posted, "I knew when Patrick Swayze was battling pancreatic cancer. I know that Cynthia Nixon is a breast cancer survivor. I know that Selena Gomez has lupus and recently had a kidney transplant. I know that Lance Armstrong is a testicular cancer survivor. But I didn’t know that Kate Spade suffered from depression. [S]omehow society has made it more acceptable to talk about breasts and testicles than about the mind" (8). Unbelievable as it sounds, there is much truth to Herrera’s indictment. Mental health stigma runs deep in American culture.

The Spade and Bourdain suicides have rendered a tear in the fabric of the everyday, and I ask you, my fellow psychiatry residents, not to let their deaths be in vain. Spade and Bourdain have ignited a national conversation about death by suicide, and we as psychiatry residents have the opportunity to do meaningful work here. This opportunity comes not a minute too soon. On June 7, 2018, sandwiched between the two suicides, the Centers for Disease Control and Prevention published a press release showing that suicide rates increased across the United States by 25.4% between 1999 and 2016 (9). According to data from WHO, a death by suicide occurs every 40 seconds globally, and 
"[t]here are indications that for each adult who died of suicide there may have been more than 20 others attempting suicide" (10). In the United States, suicide is the tenth leading cause of death; globally it is the 17th (9, 10). This is a crisis.

What can we as psychiatry residents do? First and foremost, we can become better clinicians, increasing our knowledge base about how to take care of patients with suicidal ideation. As the deaths of Spade and Bourdain make clear, a person’s appearance is an unreliable index of his or her suicide risk. We can hone our skills in detecting self-harm potential, becoming experts in the causes as well as in risk and protective factors. We can become more aware of stereotypes to avoid and myths to dispel and forge therapeutic alliances with vulnerable populations. We can help patients and families recognize warning signs and create safety plans. We can advocate to restrict access to lethal means of suicide. All of us can continue to improve our listening skills. All of us need help in walking the fine line between destigmatizing mental illness yet not normalizing suicide. The mind gets sick like the body, and there is no shame in either.

Finally, there is urgent need for research. Much needs to be learned about genetics, etiologies, management, and prevention. Tasks on our front burners should be improving screening tools, developing algorithms for predicting risk, and determining biomarkers. Communication is not limited to academic journals. Psychiatry residents of today don’t just publish: we post, we Tweet, and we Insta. We need to be mindful of our social media presence, which can reach a much larger audience than our published papers and commentaries. Even seemingly trivial acts such as liking posts about people with suicidal ideation who sought help and did not attempt suicide can reach vulnerable populations and make a difference.