Psychiatry and Hope: Thoughts After Robin Williams’ Death

“You treat a disease, you win, you lose. You treat a person, I guarantee you, you’ll win, no matter what the outcome.”

I wholeheartedly agree with that statement. However, I cannot take credit for those words. Those are the words of Robin Williams, or more specifically, the words of his character in the film “Patch Adams.”

As psychiatrists, we are trained to view the patient as a “whole person.” When we conduct an evaluation, it includes all of the biological, psychological, and social aspects of a patient’s life. We listen carefully for the psychological and social factors that can contribute to disease. Often, the “whole story” can be more telling than only focusing on specific symptoms of a given disease. You have likely heard the saying that “most patients have not read the textbook.” In other words, patients usually do not present exactly as the textbook says they should. We know that stress and psychological factors can present with symptoms such as chest pain, shortness of breath, gastrointestinal problems, and a whole host of other disorders.

If we do not step back and get the whole story, we can miss the root cause or the exacerbating factors of many manageable diseases that are rooted in the mind.

Our specialty has come a long way in the last decade. We are in a time of continued discovery and increasing public awareness about mental illness and how it can be treated. APA President Paul Summergrad, M.D., stated in his address at the APA annual meeting in May that we as mental health professionals are under a microscope these days. I agree that we are, and I also strongly believe that we are up to the challenge.

School shootings as well as celebrity suicides and drug overdoses have increasingly put a focus on mental health. Dr. Summergrad’s address led me to reflect on our field. Psychiatry has significantly improved the outcomes, treatment options, and prognosis for patients with mental illness. However, we still are unable to decrease the prevalence of the disorders we treat or to prevent them. We know that the brain changes during an episode of depression and that our treatments help it to return to normal. Although we are getting closer, we still do not have widely accessible blood or imaging tests that can confirm our diagnosis or localize the area of disease.

We know that many of the diseases we treat, such as depression, are chronic illnesses that require lifelong treatment. And we know as well that our treatments can improve patients’ mental health and coping skills and decrease their symptomatology and substance use. We know through decades of research that there are modifiable risk factors for one of the most troubling consequences of mental illness, namely, suicide, and that as psychiatrists, we have the training and tools necessary to decrease a patient’s suicide risk.

We can thus be confident in the knowledge that our treatments have the potential to not only improve the lives of our patients significantly, but also to improve the lives of their families and everyone who comes into contact with them. Anyone who makes statements to the contrary is misleading, misinformed, or both.

We need to spread this message and give our communities and our patients hope. Mental illness can include symptoms that can be devastating and complications that can be life-threatening. However, it is important to remind our patients and the public that mental disorders are treatable. It is time for everyone to understand that there is no shame in getting help for depression, much as there is no shame in getting help for diabetes or high cholesterol.

Together we can raise awareness by spreading a message of truth and hope. I know that if we spread knowledge and shed a light on psychiatric diagnoses like depression and schizophrenia, we will lift the veil and social stigma that deter so many people from seeking help. That is how we can best honor those we have lost. That is how we can best prevent the next death from mental illness and addiction. ■