I just wanted you all to know . . .

I’ve surprised myself with how affected I’ve been by Robin Williams’ death. After thinking about it since yesterday, I’ve finally realised why.

I cannot bear the thought that people can be so sad, and see the world coloured so darkly, that they feel there is no one who can help. Or that their sadness and darkness is too much of a burden for others, and needs to be ended. That others would be better if they weren’t around any more. 

I cannot bear the thought that someone reading my blog might feel this way. 

So I want you to know – no matter how alone you think you are, no matter how much of a burden you think you are, and no matter how incontrovertibly correct you think you are, it’s not that way.

If you feel alone, or if you can’t lean on people around you, for whatever reason, please let me know. Send a comment – I won’t publish it, but I’ll get in touch. Please.

I’m no shrink, and I’m not even particularly good at running my own life. But I’m (allegedly) a fellow human being, and this is what we humans do. We help each other. We’ve been doing it since the savannah thousands of years ago, and it’s what makes us what we are. Send me one word – just one – or type me half a novel, it’s fine with me – and you won’t be alone. Just one other person who actually cares. And for whom it’s NOT a burden. Please.

Nobody should die thinking there’s no way out.

113 thoughts on “I just wanted you all to know . . .

  1. Dear Gary, all
    I only discovered your blog today, courtesy of the Saillant bastardry being mentioned on Joe Saward’s blog. Having time on my side, I decided to have a peruse.
    And, I found your entry in response to Robyn Williams’ suicide.
    I speak as one who was a Registered General & Mental Health Nurse for 25yrs, who worked for all but 3 of those years in Mental Health, on Crisis Teams, Community Teams, and, in acute admission wards. I have dealt with hundreds of suicidal people, and, courtesy of a little bit of skill, and a huge amount of ‘by the grace of God’, I never had to attend a Coroner’s Inquest.
    I am no longer an RN- courtesy of 6 buggered discs in my back, from dealing with violent patients, and, Post Traumatic Stress Disorder, from dealing with violent patients. I know what it is like to feel suicidal.
    I also know umpteen methods for achieving successful suicide. Courtesy of the suicide of a family friend, I know what suicide does to the loved ones who remain. I know that if I suicide, my pshrink, my therapist, my GP wil all end up being crucified in a Coronial, despite their benevolent intentions. And, I remind myself of all this, of all the good things I have done, and, the good things that remain to be done, if I stay around, and ride it out. So, I do, though the hurt & despair are crippling.
    I want to say this- as ex professional, and someone who is diagnosed with a form of mental illness.
    You may not be a pshrink, but, never have I seen a pshrink reach out to a sufferer with such beautiful, touching, loving words.
    I have been saying for years that health, and especially nursing has lost its Soul, as care is used more as a noun, an adjective, and an adverb, and less as a verb. And, yet, what every patient wants to perceive in the health professional who is treating them are the words and actions that say ‘I care….about you, about your well being, about your humanity’. That which you wrote is beautiful, and cannot but enrich every person who reads it.

    • And thank YOU, Mark, for your beautiful words. Guess what? Today is the shortest day of the year – so starting tomorrow days get longer! There’s hope! Stick around, 2015 is going to be really cool.

  2. A major part of the reason Robin choose the path he did, IMHO, was the Parkinsons. When I was in pharmacy school my landlord suffered from it and it was a terrible thing to see what he went through. He died just days before I graduated. Robin, seeing his friend (?) Michael J Fox go through the bull sh*t
    he went through from what that maroon Rush Limburger ignorantly said about him, decided not to live through it himself.
    At this point in time I, personally, am dying from a case of hepatitis C. Add in Crohns disease with an ileostomy that is not functioning properly (TMI I know , but you need to know where I’m coming from in that regard ), and severe stenosis of L4/L5 and the pain associated with that and I have decided that when my eyes start to yellow I will end it. I WILL NOT lie in bed in pain being a burden on my wife. All I can hope for is that I will go out like my favorite author, Robert A Heinlein. A local paper said that; “he died surrounded by his beloved cats.”
    No, I am not depressed. Nor am I ignorant of the prognosis I live under. A slow and lingering death his all I have to look forward too. I went through that long period in the hospital with the, at that time misdiagnosed ulcerative colitis; and the decline in my health in 1970. Surgery, ironically enough on Mothers day, 10 May 1970. 2 months more in hospital never able to feel the sun on my face, except for once ( and spiking a temp of 105º F ( 40.6ºC ) and a second surgery only 2 weeks after the first ( and 5 more since ). You should see the midline scar I have it would truly amaze you.

    • Hi Phil. Thanks so much for your very powerful comment.

      My belief in the primacy of individual autonomy means that I believe that a person’s decision to end his or her life is valid,many must be “accepted” as such. And in some, rare, situations, understood as much with our rational as with our emotional minds.

      Because of the irreversibility of suicide, and because of the evanescence of the phases of our lives, we just need to make sure that the decision to do so takes this into account.

      Thanks for being here for us.

    • I would not be so arrogant as to comment specifically on Phil’s situation because I honestly believe I could never truly understand his situation without having lived his life and felt his experiences.

      But I will make a general speculative comment stimulated from reading his comment. It seems to me that it is part of the human brains ability to imagine the future that gives rise to some aspects of suicidal thought. If one were able to live for the now and not think about the future then maybe this aspect of suicidal thought might lessen.

      On the other hand, some peoples “now” might seem unbearable and hence give rise to suicidal thoughts. In this instance the human brains ability to imagine a future, in particular future in which the unbearableness has receded or vanished, might lessen this aspect of suicidal thought.

      • Mimi and Hear: I did make the comment “when my eyes turn yellow.” For anyone who knows ANY medicine that means the hepatitis C is in its final stages. Death is inevitable and soon. At no time did I say it would be soon; with luck I have maybe 1 or 2 years left. And I WILL live them to the best of my limited ability. I learned to sky dive after my initial surgery, and I have a post on youtube about running rapids on the Suwannee river. I have not given up, nor will I, until I know there is NO HOPE left.

  3. When I was a teenager, like many teenagers, I had loads of family rows because I was very different to the rest of my family and didn’t want to do the same things as the rest of them.. But there was one good thing about my family which was that they never stopped me going off on my own. I used to walk for miles and miles on my own to get away from people.

    To this day I like to walk on my own and look up at the sky and the trees. I hate noise, parties, screaming babies and the sound of traffic. Sometimes getting away from people is as good as being with them and I am convinced that being able to walk away from situations has prevented me from ever suffering from depression because I feel in control of my life.

    This costs nothing and has no side effects. I recommend it as a cure for minor ills. It even has physical and mental health effects. When I am walking on my own my brain goes into a kind of dreamy, default mode and new ideas often pop into my head. I am convinced it even helps to ward off dementia.

    • You know, Jane, what you’re describing sounds a lot like what’s called mindfulness. A state of focus on the sensory (outer or inner) experience of RIGHT NOW. The sights or sounds or rhythm of your breath. And crucially rejecting, or rather letting pass through unnoticed and un commented-upon, all extraneous thoughts and feelings.

      I’ve recently become very interested in this type of mental activity, and the numerous benefits (physical, mental, emotional, spiritual) of setting time aside, each day, for this kind of exercise.

      I can only encourage those of you who are interested to start reading about this. I’m pretty sure you’ll be fascinated.

      Thanks again Jane!

      • Thanks so much for this fascinating reply Gary. I found this out for myself when I was very young so value it as a kind of personal treasure. Discussed with my two grown up children. My son says he feels the same way and he calls it ‘space dementia’ – he is a great Muse fan and this term comes from Matt Bellamy. It’s something like the majesty of the universe and the insignificance of human beings which puts all our problems into perspective.

        Also, very sad to hear that Michael Schumacher is out of hospital so much sooner than I hoped. I had hoped he was making slow progress in rehab and we wouldn’t hear anything for ages. You were right to warn everyone of the likely outcome months ago. I was surprised how sorry I felt when I heard this yesterday.

      • Hello Jane,
        I think we read several months ago that an area in the house was being prepared for him. I suspect this entails living quarters for the nurses and other medical assistants – perhaps two people a work shift? Having observed what it is to provide long-term medical care for a family member, I can tell you it was a sad weight that hung over the house. Maybe it will be different for the Schumachers, but as we are all human beings I suspect there isn’t that much difference in our response to the basic experiences in life.

  4. I think it comes down to personalities and weaknesses, some people blame others while others take responsibility, got former riding the latter too weak to grow up.

    I had a friend like that, who in knowing I’d been abused as a child blamed and attacked me for not being free like she was able to be, I too concerned for mental breach..

    She drove me nearly insane, this to her mental weakness on my part, not on hers for being so ignorant.

    We live in a world where people are expected to suffer to their death in silence so everyone can ignore what happens, the suffering living in an undeserved he’ll, something middle class morons need to feel superior.

    When that’s your life, the assault is on you, but people are so greedy for their pretence of superiority, they feel attacked (become narcissistic) so attack, and it goes on until one finds a way out.

    When dealing with people like that, (it being your fault because they’re too weak to take on the abuser but need someone to blame), you need a solid reason and mind to get away or they’ll follow you and continue the assault unable to face what they were a part of, they too egotistical to see anyone else’s suffering, as is a requirement to speculate your life into abuse in the first place, propaganda that you should be ashamed keeping the abusers free and the victims silent – who is that??

    To some life is a struggle, to others such an attitude in the western world is an insult.

    As an economics student I can’t disagree, as a writer I’m curious, as a musician I’m vulnerable, only one path good for me and more importantly given my child is a boy, good for him lest I let him grow up where defaming women is a male right.

    It’s taken 12 years to realise that stopping abuse, whether against women or as in my case even female children, is a new thing called feminism, something mental health is also a part of (anything above the theft of a car).

    There is nothing more unattractive in a man that ignorance of order, but to be fair to men, there aren’t many real women in the western world.

  5. Here’s an introductory piece on Robin William’s last days in Rolling Stone:

    Martin Short recalls Williams’ joy at the success of Mork & Mindy, when the show became an instant sensation, Williams’ salary jumped from $15,000 to $40,000 an episode and his life was transformed. “He couldn’t get enough,” Short says. “He loved it.” In the years before Mork, Williams’ party-animal side was under control, but the series offered him full access to Seventies debauchery. Browne writes about the night in March 1982 that gave the young comic a wake-up call: He’d stopped by John Belushi’s bungalow at the Chateau Marmont hours before Belushi died of an overdose.

    The success of Good Morning, Vietnam, which earned Williams his first Oscar nomination, re-energized his post-TV career, and he continued to be a major draw on the road. “You can’t look at any modern comic and say, ‘That’s the descendant of Robin Williams, because it’s not possible to be a Robin Williams rip-off,” Judd Apatow says. “He was doing something so unique that no one could even attempt their version of it. He raised the bar for what it’s possible to do, and made an enormous amount of us want to be comedians. He looked like he was having so much fun.”

    But Williams’ on-character fun was always tempered by his demons. “He was so addicted to entertaining people and making them laugh,” says Mark Romanek, director of the serious One Hour Photo, “that he needed to be funny between takes to get that out of his system, so when he went into character, he could be completely free of that urge.”

    In 2011, Williams seemed on the verge of a new beginning, and turned to television for the first time since Mork & Mindy for a David E. Kelley show, “The Crazy Ones”. But when the show was canceled, Williams took it hard. He returned to rehab to “fine-tune” his sobriety. And he learned he’d been diagnosed with Parkinson’s disease. Friends say in the last few months, the actor was sad and unhappy. “We were all worried about him,” friend Peter Asher says.



  6. The path of life leads in many ways. I have been down several paths in my time. They all twist and turn yet like most of us they never go that dark that we can not see the way. We are the luck ones!
    God bless the ones that can not see.

  7. Doc
    Having just spent some time reading and re – reading your blog and the comments it seems to me that, once again, you’ve been the one to stick your head above parapet.
    Society has become self absorbed in technology (ironically as I write this on my smartphone) and simply has “lost” the ability to speak to each other and keep regular real life contact/communication with our relatives, friends and neighbours.
    We should all make an effort to take the time to listen to others with both ears and eyes. (I do volunteer my time and often end up helping people in crisis).
    Finally, before you and your readers doze off people should never ever underestimate the power of hope. My father was diagnosed with aggressive bone cancer and given 3 months to live 6 months before the birth of his first grandson’s. Not surprisingly he told his doctors that he’d live to see his grandson. Not only did he see the birth but he managed to create some special memories for another 6 months before he sadly passed away. Hope and family are surprisingly powerful.
    Thanks for reading and writing such insightful articles.

  8. I have a paper here called ‘The locked-in syndrome: what is it like to be conscious but paralyzed and voiceless?’ co-authored by Steven Laureys, Coma Science Group, Liège University Hospital. This is fascinating as it shows how people can adapt to situations which to outsiders seem intolerable. It took an average of 2.5 months for these patients to prove that they were aware and in 55% of cases it was a family member who first spotted the signs rather than a physician in 23% of cases. These patients were very angry and even suicidal in the early stages but once they were medically stable, had survived over a year and could communicate via blinking 17 patients completed a survey on their quality of life. They rated their own mental health only slightly lower than ordinary, matched control subjects. A previous survey of 44 locked-in patients found that 48% reported that their mood was good v 5% as bad. 73% enjoyed going out and 81% met with friends at least twice a month.

    Requests from such patients to die were very rare and the main conclusion was that these patients had a right to live as much as a right to die.

    This is surely relevant for a patient like Michael Schumacher, who is even more vulnerable, as it is quite likely that he has major cognitive damage as well as being virtually paralysed. To kill someone in such a state,or even passively allow then to die, because someone else considers that they might be better off dead is equivalent to murdering a baby or a young child. Doctors save lives and then must be responsible for their failures as well as their successes.

    I would remind everyone that at the very least Michael Schumacher is minimally conscious and no-one can possibly know what it is like to be inside his head.

  9. To those of you who still expect Michael to emerge more or less normal, i.e. standing, walking, speaking, communicating otherwise properly, laughing, jogging, riding, driving any motor vehicle except for maybe an electric wheelchair using his mouth/eyes or fingers; please grasp the reality: “he ain´t never, ever coming back” (quote from song Cadillac, Hep Stars, 1965).

    I already said (read: wrote) farewell to Michael in one Finnish social media site I used to comment extensively in may of this year. He will never appear in public broadcasts nor pictures nor in anything alike unless Corinna Schumacher will decide to start a career as as spokeswoman for brain injury patients.

    To lulumoretti: check http://www.finland.org/public/default.aspx?nodeid=40999. I will start refreshing my French skills in 2,5 weeks from now.

    • Jussi – I’ve been meaning to thank you for ages for your posts about minimally conscious state and yes, I clicked on your ‘time to say goodbye’ many months ago.

      But I would like to say this in particular on a thread to do with suicide. The old Michael Schumacher died last December but the new Michael Schumacher is still alive and Corinna loves him and wants him to go on living.

    • Beware those claiming to be in possession of the absolute truth.

      Jussi: Although you may be right – you are certainly not absolutely right. Also who are you to stop the hope of others – you do know that hope is one of the most important ingredients in helping to counter depression? Hope allows people to continue in the face of not wanting to continue.

      • Hope? Interesting word. I have hope that I hit the lottery which is totally ridiculous. Is that the hope you are talking about? How do you have hope for impossible things? My chances of getting struck by lightening are better than me hitting the lottery. But should I still have hope? Michael’s chances of a full recovery are the same as my lottery chances. How do you have hope for the almost and I repeat almost impossible out come.

      • Brava, Mimi. Hope is a very expensive and illusive commodity. I much prefer basing decisions on the odds of a particular desired situation having a realistic chance of succeeding. In those dark days of winter when, in the face of very very long odds, the internet was full of blind ‘hope’ for Schumacher, it was Gary Hartstein alone who kept his wits about him and spoke rational words based on experience and logic. I think it was his determination to speak truth to power that attracted us to his blog. It’s always so refreshing to be addressed as intelligent adults.

      • “Michael’s chances of a full recovery are the same as my lottery chances.”

        You are basing this on your years of training and experience in the medical profession … plus your knowledge of gambling statistics?

    • Jussi,
      You are such an interesting person . . .”I will start refreshing my French skills in 2,5 weeks from now.” is the first time this blog brought a laugh from moi. . .
      Thank you for the link to speaking Finnish. I make no promises.

    • Jane A
      Better late than never. You are most welcome.
      I did study the subject of TBI quite a lot in winter and spring and have written on the subject maybe 20 times as much as Gary has here on his blog.
      Time to say goodbye is a beautiful song indeed. My post was in May.

      You have full right to your own opinion. Whether the truth is universal or relative can be discussed, though. I suppose you are one of the relativists. Anyhow, I am usually right. Believe, or not!

      Bob Hope was indeed very good medicine against depression. So depressing he no longer is with us. I do not know much about absolute truth, but there is Absolut vodka. In Sweden. Recommend, although Finlandia vodka is better, of course. Both products are very good when you feel only a bit depressed, otherwise, consult your doctor.

      Yes,I will start studying French (intermediate level) at Adult Education Center in two weeks time. Last time I studied any French was 30 years ago. I shall see how it goes, but I feel thrilled. J¨et aime!
      Be brave, aloita suomen kielen opiskelu San Franciscossa heti.

      Take care. All of you, wherever you are. Merci.

  10. My heart and prayers go out to all of you who are wading through the darkness. I wish there was a magic wand that could be waved and it would all go away.
    I’ve had dark days but have never ever considered ending it all. I just seem to always bounce back and for that I am grateful.
    Can we focus for a moment on Michael Schumacher? Has anyone heard or seen anything that would possibly update his condition?

    • The trail appears to have gone completely cold but I read on one fan site that his prognosis should be clearer in one year’s time and that if we haven’t heard of any improvements by August next year we can assume that the news is bad. This timescale fits in with all I have read about recovery from prolonged disorders of consciousness. If people are going to improve at all they show positive signs by 18 months after injury.

      • Actually the patient’s status one year POST INJURY predicts, with roughly 99% accuracy, the patient’s permanent status.

        As a colleague of mine, an eminent specialist in prolonged disorders of consciousness, said, “Basically no one wakes up after one year.”

    • Mimi, not a thing. I check the internet everyday but there is nothing new out there.

      I too wasn’t aware of how common and truly debilitating real depression is, the postings here have been a real eye opener and I too am grateful that so far I have not been effected by this awful condition.

      But there but for the grace of God go any of us.

  11. Hello Mr. Hartstein
    I recently finished reading your entry and the comments by everyone.
    I want to say thanks to everyone for sharing their thoughts and care, that was neat.
    And you doc, you deserve a pat in the back, that was just great, your entry! (like all of them, really).
    I fell like I want to go up there, shake your hand and say hi. That’s how I feel.
    Merely by reading it I felt better; imagine. . Apart from that, I felt proud.
    So, doc, if work and time allows it, and you still feel like it, please keep up the good job on this blog, because I like it very much as most of us do here I’m sure.
    So thank you.
    Best regards to all bloggers here.
    Greetings from Colombia,

  12. Doc, thank you for this blog. To me, and to many many other people that are aflicted by depression – those that suffer with it, and the people that have to look on in heartbreak at their loved ones in pain – I can only say thank you again for bringing it to peoples’ attention.

    This is what I put on my facebook page a couple of days after Robin Williams’ death. Please feel free to share it with whoever you think it might help. And enjoy your Spa-Francorchamps weekend (I’m a bit jealous.

    * * * * *

    From the Guardian on Robin Williams:
    “He must have known that. He must have known his wife and kids loved him, that his mates all thought he was great, that millions of strangers the world over held him in their hearts, a hilarious stranger that we could rely on to anarchically interrupt, the all-encompassing sadness of the world.”

    the author really doesn’t understand depression. It’s a dark, deep, miserable, lonely, bottomless pit. You can know to your heart’s content that you have a great job, a loving family, amazing friends and people that love you.

    You know that there are people and institutions that can help you. All you have to do is say the word and there will be people that will try to support you.

    And it doesn’t make the slightest bit of difference.

    That’s not what depression is. Depression is not something logical, it’s not something that is situation specific and it’s not something you can get over.
    Depending on who you are and how it affects you, depression can be the following, and it’s in no way an exhaustive list, but these are my personal experiences of it:

    – you turn off your phone and don’t interact with anyone, because you’ll end up crying if you do
    – you don’t shower for two or three days at a time because the effort is to great to unwrap yourself from the duvet on the sofa and from playing countless DVDs one after the other without actually knowing or remembering what you watched; but the smell of the BO is overpowering enough that you have to do something.
    – you remember that you haven’t eaten for forty-eight hours and then binge on pretty much everything in the fridge
    – you sit in what people would call a state of melancholia, because you don’t have the energy to cry
    – but you summon the courage to go out and then be the life and soul of the party because that’s easier than letting someone in to the hell that you think your life is
    – when you talk and talk and talk, but you don’t say anything and you hope people think you’ve said a lot when you’ve really said nothing at all
    – and you contemplate suicide but you’ve only reason for not doing it is that you don’t want to hurt the people that you love. but you make a list of who you think would miss you if you did commit suicide and you think there’s nobody on that list.

    Depression isn’t rational. It isn’t really definable. It is what it is. And for those of you that don’t suffer from it, all you can do is this:

    Don’t dismiss it, it’s as real a disease as cancer or apendicitis
    Don’t pressure people when you think something is wrong.
    Don’t brush your concerns under the carpet.
    Talk to people.
    Let them know they can talk to you if they want to talk

    But most of all, be nice to one another. It means a lot more to people than you think.

    • “the author really doesn’t understand depression”

      It’s not just depression. I mean its a lot more general … that people don’t understand other people. Some have difficulty even understanding themselves let alone other people. But humans tend to prejudge and presume – it’s a mechanism by which sense is made of the world. 🙂

    • Mike, you managed to put in to words something that is so hard to describe when you are in the depths of depression. For me, it doesn’t matter how much other people think of you, it’s how you think of yourself. There is something with depression that flicks a switch, that makes us lose the ability to believe in ourselves, to like ourselves, to be kind to ourselves.

      I didn’t want to speak to anyone, in fact I found it impossible to verbalise my feelings of despair. How I felt just didn’t make sense, I just couldn’t make sense of my feelings or why depression had grabbed hold of me. Staying in bed, in my room, felt the safest option – I didn’t have to see anyone, speak to anyone or try to pretend that I was doing OK.

      Of course I knew there was help out there, but ‘out there’ was a frightening place, a place far removed from where I had found myself. To seek help, one has to have a spark of motivation to do so but I didn’t have that spark, not for many months. When I did eventually try to seek help, it felt that the help available was ‘one-size fits all’ which wasn’t what I wanted. I didn’t want pills, I didn’t want to go to group therapy, I didn’t want to talk about my childhood or the rest of it, I just wanted to be understood and accepted. Sometimes it felt that the help available was to make others feel better, not me. I felt pressurised to undertake ‘something’, like it was a tick-box exercise. I felt pressurised to be well, to be ‘normal’, to talk. I didn’t need the pressure, I just wanted to try and find my way, in my own time and in my own way, not to fulfil the expectations of someone else.

      What can you do when a loved one, friend, family member is suffering?

      – let them know you are there for them.
      – don’t put pressure on them to undertake treatment.
      – don’t expect a conversation, let them talk when they are ready.
      – don’t get upset when they don’t respond to calls, texts, emails or letters but keep doing these things to maintain contact, just so they know you care.
      – give them a hug, hold their hand but don’t have any expectations.
      – don’t tell them how they should be feeling, or how great their lives are, how loved they are – they know these things already but it doesn’t make them feel any better, believe me.
      – don’t blame yourself – it isn’t your fault, it’s no ones fault, it just is.
      – don’t give up on them or walk away – you are needed even if the person can’t tell you so, or tells you to go away.

      This isn’t an exhaustive list, just examples of what would have helped me.

      For those who commented on my earlier post – I’m OK, really I am. I just keep moving forward and further away from the blackness, which is all I can ask.


  13. Medical Question to Prof Hartstein (not related to this topic)

    If someone has a pacemaker set at 70 with no underlying beat activity: if you overexercise that person can you cause brain damage? The theory would be that having the pulse fixed to 70 the overexercising person would not be getting sufficient oxygen into the body and to the brain and hence could cause brain damage – especially if summed over a period of several years. Let’s say the pacemaker was first installed aged 65.

    Thanks very much for any comment on this. Separate to this are there any issues in the medical profession concerning pacemakers and onset dementia (using the same theory that summed over a period of time their would be periods when the brain is receiving insufficient oxygen).

  14. Nice Doc.

    I lost a best friend at 19 and never saw the signs, only afterwards – finding out from his family of the years long struggle with depression – did much of it make sense, and still to this day almost 30 years later it’s painful to be left behind.

    Selfish? Yes. I lost my best friend and I never got a chance to try and help.

    My biggest take-away was the importance of being available – as you said – the importance taking the time and being available to listen.

    But sometimes people don’t reach out, mental illness is a personal struggle, and its important to be sensitive to the unspoken words and actions of those around you and not be afraid to confront and reach out through that pain and suffering to those who need it – as painful as it may be for both.

    • I agree with you – being available and having that person know you are available with absolutely no pre-conditions attached is probably the best you can do. We have to respect the wishes and the thoughts of those that may be suffering, but we should never withdraw from them. This also means regularly contacting them (in an unobtrusive manner) just to know that they are aware you are still around and contactable.

      It’s difficult but I think when it comes to trying to help others we need to recognise our own limitations in providing the help that person may or may not need.

      • I agree totally. As a columnist just recently said, being a friend to a depressed person is one of the hardest things to do, but certainly one of the most important . . . and rewarding!

  15. Gary,
    Our Marin Independent Journal has responded to Robin William’s death with detailed coverage because he was a familiar personage in the area. This is a link about Williams’ Parkinson’s disease contributing to his depression: http://www.marinij.com/marinnews/ci_26336685/robin-williams-wife-actor-had-parkinsons-disease?source=pkg
    This morning’s Independent features a cover story on various comedians’ memorial to Williams held in Mill Valley last night. Go to http://www.marinij.com.

    On a personal note: We’ve had business that has taken us past Williams’ Sea Cliff house four times this week – with two more appointments scheduled tomorrow. I was overwhelmed when I first heard of his suicide, but driving past that large pink house on these foggy San Francisco days has deepened the sadness. We can take another route, and maybe we should for awhile, but the dawning comprehension that he’s truly gone from the world won’t go away that easily.

  16. Dear Dr. Hartstein,

    this message is mainly to you personally, but you may publish it here in your blog as well if you wish.

    Underneath is a link to – in my opinion – one of the best sketches in Finnish TV-history depicting Finnish melancholy, alcohol overuse and addiction, stubbornness, suicidal behaviour as well as, despite the aforementioned, love towards the family and neighbourly help and attitude towards suicidal behaviour.

    I wish, you will watch this short video (4:16) and think along watching it. After seeing this video you may at least understand more of the behaviour of Finnish racing drivers and Finns in general, if not anything else.

    Here is the link: https://www.youtube.com/watch?v=nUyFg9xoPKk

    Best of regards & thanks for your blog and your new Vblog.
    Jussi (from Finland)

      • Thanks Lulu for taking the time to use Google translate service! Your message is understandable. Actually, Russian http://www.yandex.com is far more better and accurate in certain language combinations.

        Yes, I really do think that this sketch is a good key opener into understanding Finnish mentality. The sketch is hilarious but very serious at the same time, actually a very multifaceted story told in only four minutes. I recommend to watch it at least twice in order to grasp the wider message.

      • Jussi,
        It seems worth it to try to speak in your language rather then you having to use English all the time. I have tried to put sentences together on my own in Finnish and it’s always embarrassingly poor. I appreciate your making the effort. I’ve taken German, Russian, Italian, and French in college, but find when traveling in Europe the native speakers prefer I use English because they can understand that better then my fractured French, Italian. . etc.. . .

  17. Hello doctor,
    thank you for your words. All of them. I was never a big fan of Michael Schumacher, but I felt very comforted by what you wrote about the state of his health – because the truth console better than any false hope. Now, I feel warm again and embraced by his lyrics because I am fighting against depression for 9 years and it’s always lovely to meet new people who want to help who is needing.
    Sorry for any english mistake, I am a Brazilian who is still learning.
    A hug!

  18. Thank you, Gary for the care and compassion that you show, and offer us.

    When I was at my very lowest though, if I’d have read your offer, I would never have believed that someone as eminent as you would have had the slightest interest in helping me. How could I when I couldn’t drag myself out of bed and wash and feed myself?

  19. When we want to visit the Legion of Honor (one of the Fine Arts Museums of San Francisco) we take the Golden Gate Bridge south, then the first right after the toll booth, past the bridge maintenance buildings, along Lincoln Blvd. (a beautiful drive edging the headwaters of SF Bay), and onward where the street becomes El Camino Del Mar through the Sea Cliff neighborhood and then changes it’s name to Lincoln Highway wending through eucalyptus trees to the museum. Incredibly beautiful – if you’re ever in San Francisco I recommend the drive. (You can trace the entire route via Google maps.)

    Our every visit to the Legion takes us by Robin William’s house, an enormous pink stucco structure placed on a corner lot jutting out between two streets (both named El Camino Del Mar) and surrounded by a low wall. This morning the curved entrance to his front door was lined with bouquets of flowers dominated by sunflowers. Lots of sunflowers. The street poles had paper ‘No Stopping’ signs attached. But other than the sunflowers and the signs you’d never know anything had changed.

    • That’s lovely to hear. I’ve been advocating a legal end to suicide but not hard enough, I’m very upset and angry about it.

  20. Good for you Dr. H!
    What a wonderfully generous gesture. The tremendous outpouring of feeling surrounding Robin Wiliams’ death does have an upside; it has put conversations about depression front and centre. I hope it isn’t short lived and that we start having a sensible conversation about mental health. Amongst all the coverage it’s heartening to see an offering of support.

    I’m really enjoying your blog, particularly the anecdotes about Sid Watkins. I’ve signed the petition on lids, in no small part because riding a motorcycle I have a vested interest.
    Thanks for making the time to write.

  21. Just because I don’t think anyone else has put it: in the UK, ROI and Australia (and perhaps elsewhere) the Samaritans organisation provides a 24-hour helpline for people who need to talk, whether in danger of suicide or not. (They are not a religious organisation). They also provide very helpful information sheets for people who are worried about someone else, and for journalists about how to avoid causing suicide “contagion”, in which a description of suicide triggers it in others at risk. http://www.samaritans.org

  22. Doc

    That’s a deeply altruistic and genuine offer, no doubt. Like all medical professionals, you’re a selfless sort and we’re all so lucky that people like you and your colleagues – regardless of relative seniority – are here to attend so selflessly to us all. Truly, a fantastic vocation that I for one couldn’t handle.

    That said, I do think you’re at risk of over-extending yourself with your kind offer of help to those who genuinely need it. It’s to the current British Govt’s eternal shame that the National Health Service don’t/won’t direct anything like sufficient resources to mental health.

    While I’m in no doubt that you really can help individuals who read your blog (or who are directed to it), you can only do so much. You’re probably already spread too thin in your “day job” along with all the other activities you’re probably engaged in – medical, motorsport and others no doubt. I imagine you also have family and friends that require your good time………

    Saving one life would be amazing and I’m in no doubt you could save dozens, if not hundreds, in the direct fashion you’ve selflessly offered. However, please consider – if you haven’t already – adding your considerable weight to the efforts of charities such as MIND in the UK and put pressure on governments to properly fund the research and treatment of depression and other mental health issues. We all know this requires a huge change and if you can put “X” hours in to this effort per month instead of ministering to those whose own mental health agencies should provide it, I think this would multiply the positive outcome of your efforts exponentially. You really do have a loud voice (in the best possible sense) so please get stuck into ’em Gary. If you can make headway here, perhaps you won’t have to spend so much time ministering personally to those who deserve a more structured, tailored and measurable treatment than you’re in a position to give. That’s NOT a criticism of course – you know that!

    Some of the posts above have been absolutely heart-breaking – Michelle and Martine particularly stung my eyes – and I take my hat off to them for expressing so clearly how awful severe depression is. I genuinely hope they continue recovering and that high profile, highly respected doctors like you, together with OUR politicians can make some real advances here.

    If we’re going to use the unexpected sense of loss millions of us feel about the amazing Robin Williams to any advantage, lets improve our care for mental health and depression in particular. As we know, “Pull yourself together” just doesn’t cut it does it?

    Hope you don’t mind me suggesting that. Thanks so much for being a great Doc and bloke.



    • I think that Gary has already provided a wonderful free service to the vast majority of people reading this blog who will realise by reading accounts such as Michelle’s and Martine’s that real clinical depression is a completely different and devastating condition and is very unlike what people term ‘depression’ in every day usage for feeling a bit down or being in a slightly gloomy mood.

      If only the people with real clinical depression contacted the overstretched services of the NHS and equivalent health services in other countries it would allow resources to be targeted where most needed.

    • Society needs to change, these soft, it’s difficult for normal people, campaigns need to stop. People are not listened to, they are treated pathetically, everyone’s allowed to theorise because everyone feels sorry for everyone, and the games continue.

      • I can’t tell you how much I agree with this. One of the things that infuriates me most is the charities that quote ridiculous statistics like 1 in 4 people suffer from mental illness. They don’t! True, devastating mental illness is rare and is completely different – more like 1 in 100 I should think.

        Lots of people are sensitive, slightly lonely, shy, gullible etc. This doesn’t make them mentally ill – just human!

  23. Gary,

    I’ve lived with depression for the last ten years and have had only one truly low point when I parked my car in a lay by and walked up the pavement to a large road bridge crossing the River Clyde. I was contemplating ending everything there and then, but the thought of leaving my family to deal with the inevitable ‘knock at the door’ proved too much and I wandered back to my car, and drove home.

    The fact that I didn’t step over the barrier and end it that evening tells me that things were bad, but the fact that my thoughts turned to my family proves to me that there must have been a glimmer of something left inside to make me turn around.

    I’d ask anyone reading this who’s suffering from any form of mental health issues to speak to your GP, friends, family or colleagues whilst the glimmer of something good ahead remains. Do it whilst your head still has an element of control.

    I shudder to think of all the things that I would have missed had I have chosen to end everything back then. However, for me, depression is a shadow which follows me. My family is aware and help me remain one step ahead by highlighting when I’m heading down my road to depression.

    Gary, thank you for your words and actions on this blog and for being a thoroughly decent human being.

  24. Dr. H.
    I am not sure I have ever seen such an outpouring of feelings so publicly expressed by so many disparate groups as I have on the news of Robin Williams suicide. His short time on the planet certainly had a tremendous effect on millions of people. Personally, I feel a very strong sense of loss, as have many.

    I hope that the readers of your blog appreciate the kind and most generous offer of your time, the most precious commodity, to help those among us who are struggling with depression.

    If anyone reading this now would like to know more about Dr. Hartsten , I strongly urge them to go to uTube and search for ” I was just a doctor”. You will see what kind of guy this is that makes such a wonderful offer of help.

  25. Dr, Gary,

    I read your most recent thoughts yesterday, on what would have been my youngest son’s 26th birthday. He died six years ago from what was described by his psychiatrist as depression and despair. We have since learned that suicide is the third leading cause of death among teenagers (I’m not sure if that is only in the United States or worldwide) but it is another part of this issue which is not widely recognized.

    The impact of suicide, especially of a child, cannot really be described. It also never goes away.

    Thank you very, very much for what you wrote. It meant a lot to me.

  26. The sincerity of this makes it valuable, rather than the words themselves. It also feels really personal.

    Sometimes when you hear a celebrity has died of cancer, for instance, you think of someone you know battling cancer and worry some, but hope for the best. When someone dies of depression, and you have it, maybe dormant, you can feel a kind of inevitability. Everyone has to die of something, I suppose, and to measure a person’s life by their death is an injustice. Most people beat depression with the life they life, suicide or not.

    • I have depression diagnosed as 98% permanent, death is a terrible thing to decide about in life and severely damaging to the nature of a person when before one’s time so to speak, but such is the nature of depression, everything cloud has a dark lining.

      Some say depression is a state of mind, something to get over, they don’t realise it’s a part of your view and that a person with depression can’t not see the darkness or see it as minimally as others.

      They think this is deserved, they don’t realise it’s caused, because people do not take responsibility for the affect they have on others, those good or innocent or pure or intelligent picked on for their superiority, and these days by older people jealous of youth.

      Too much freedom in the 60’s and far too little Law.

  27. There is another person who committed suicide who I would like us all to remember on this site. He or she is the unnamed person who hanged themselves last week in a Swiss police cell having being arrested on suspicion of trying to sell Michael Schumacher’s medical records.

    I immediately thought of the scientist David Kelly, who committed suicide 10 years ago in the UK having been outed as the source of the weapons of mass destruction leak to the BBC.

    So many wasted lives …….

      • A very valid point. Suicide is active checking out and is not necessarily associated with depression – in fact depressed people are more likely to kill themselves when they are getting better mostly because the type of real depression described so vividly in several accounts here leads to people being far too apathetic to kill themselves. What about suicide bombers? Suicide goes against something deep within most people. I heard an amazing anecdote about a man who was trying to commit suicide by swimming out to sea when he was bitten by a jelly fish or a shark (can’t remember which). Instantly the survival instinct kicked in and he started to swim for the shore to escape.

  28. Gary,
    your post – and the suicide of Mr. Williams – moved me to tears. I love his movies, his noiseless way of acting.
    And I appreciate your words. As I am sometimes getting a glimpse of being depressed a lifeline like yours could be the gamechanger.
    But. In late 2009 we had a similar case here in Germany: Robert Enke. He obviously saw no entry out of his dark world but suicide. He was loved, he had success, he was respected by his fans, but he also felt the merciless pressure of his profession (soccer goalie). After his death the german public seemed shaken awake, there was an open discussion about depressions, but today depression is a taboo subject like before. Sadly.
    I really hope that Mr. Williams death will shake us even more to a little bit more attention to our fellows. We all can offer such a selfless lifeline.


  29. Dear Dr. Harstein,
    I have been a follower since you first began offering insight into Michael Schumacher’s situation. I truly appreciate your expertise, compassion, and perspective. Thank you so much for today’s post.
    Depression is something that statistically everyone will experience at least once in their lifetime. That’s a staggering number of people potentially suffering with depression all at the same time! Some people experience it with more intensity than others. I have suffered the depths of despair brought on by feelings of insurmountable circumstances.
    Depression brings with it a feeling of being trapped with no hope or apparent means of help. It is a profound sadness that fills every cell in one’s being and disrupts their usual mode of conduct and thought processing. Depression is an enemy that waits at the door for all people and has no bias or prejudice as we sink under its persuasion. Depression makes a person feel ugly, useless, and unwanted. It is the ultimate form of loneliness encapsulated in shades of grey with an intense ache that does not want to budge. It grabs a person by the throat and makes swallowing and breathing difficult.
    In my teens, I teetered on the edge of taking my own life. It was a sense of self-preservation that took over and deceived me to believe it would save me from the deep sadness that stole my days and nights. Although I was told otherwise, I truly believed the lie that I was not worthy of breathing and that my existence consumed time and space that were better off given to someone else.
    Depression is a weight. It’s an overwhelming burden that people neither talk about nor want to hear about. It accompanies a person as they attempt to navigate their way through the maze of confusion and darkness. It is first to meet them in the morning and last to be seen before submitting to exhaustion at night.
    Robin William’s death has resonated deep in my spirit. It reminds me of how desperate I felt once and of how desperate others are feeling right now. The conversation has now been opened and it would be a legacy of epic proportions should Robin’s death evoke change and compassion among all of society for people with mental illness of any kind.
    I heard something profound the other day. “When our body is hurt, it bleeds. When our feelings are hurt, we cry.” Tears are the evidence that we are emotionally injured. Tears are not widely accepted in our society. We are told to be strong. To suck it up. To get over it.
    What if we all agreed to treat a person’s tears the same way we would treat a bleeding wound? People would be more compassionate and nurturing to one another in times of emotional anguish. We would have listening ears and strong shoulders to bear each other’s burdens and to support one another in our lowest times. We would be granted the privilege of helping despairing people before they would be driven to drastic measures.
    It is deeply sad that depression steals loved ones from us and equally upsetting that those people felt the need to merely survive while hiding behind the façade of a smile, a humorous remark, or a quiet desolation.
    Robin William’s death has caused a ripple effect that can be felt around the globe. I pray the world will immediately gain a new perspective and a proactive response to prevent such a tragedy from ever happening to anyone else.

    My deepest condolences to Susan Schneider, their children, their friends, and their family. Robin Williams impacted so many of us in so many ways. He was a remarkable man. He is missed.

  30. When I think of suicide it’s not because I feel alone, unloved, disconnected or anything else. It’s because I just feel done. I’m tired. Life has been great but I don’t always feel like doing it any longer.
    But then inertia takes over and life carries on.

  31. Doc, your words reduced me to tears, you are a good man and if ever, God forbid , one of us find ourselves in the depths of despair we will grasp the lifeline you offer so selflessly.

    Love and respect


  32. Hear, Hear. I was in a deep depression at one point for most of a year. I never reached the point of contemplating suicide, though I did engage in self-destructive behavior simply because it offered the promise of providing an escape from the pain. I was also very good at hiding it, and few ever saw the depth of despair lurking beneath the surface. In time, and with luck, I found my way out of that situation and these days I am never “down” for more than a couple of days. In general I am considered a positive person, and to my knowledge, in the years since, been able to save two others from suicide simply by doing what you offer to do, Gary, and be there to listen and offer positive reinforcement. So I applaud your comment, your attitude, and your approach, and wish you and everyone who might reach out to you, well.

    • Saving people is very important of course..But sometimes Money Works well.When you need some people ,some people especially you cant reach without Money you feel depressed..ı lived through it..and that people WHO are depressed but could buy the one they want ,they always showed their happiness…sometimes Money saves …

  33. Gary, you’re really a great person. I’m so happy I’ve discovered your blog, even in a so sad circumstances as Michael’s health conditions.
    I’ve never wrote here as I’ve not much to say (and other commenters always write better thoughts) but today is the right day to let you know you’re doing a great job. Sharing useful info, discussing the real stupid issues that are killing F1 and showing you’re much more than a (good) sport doctor.
    Thank you, and have a nice day. 🙂
    Andrea, from Rome

  34. Thank you Gary. An enlightening thought that a friend posted on Facebook, which she was told by one of her medical professors in college years ago: Suicide is the result of one’s inability of being able to forget about themselves.

      • As a sufferer vigilant about others, depression for me was caused by people who knew how to destroy/deepen hurt feelings to that level, (some women aged in their 40’s when I was <25). I've heard so many things suggesting mental or character weakness as the cause rather than serious unexplained loss or harm. The truth of course is that weak people cannot avoid doing what they know they shouldn't, termed as grievous mental harm by the Law. If only people would use the Law but most don't know/expect people don't do that sort of thing, most wouldn't kick a rapid dog, but see a superior person, and like an inverted Superman they're off.

  35. My husband found his brother hanged and I know that suicide casts a very long shadow. I now have 2 children of my own. I think it is impossible to imagine the darkness in someone else’s mind that causes them to take their own lives. But I’m sure you are right Gary that if people communicate with others in any way whatsover it is a lifeline and I suspect that social media could be a help for some people who can’t communicate with those around them and for this I thank you for this post.

  36. I recently suffered from a crippling bout of depression for about 18 months and I still teeter on the precipice of falling back in to it. I never had thoughts of suicide but I did have thoughts of just not being ‘here’. I know, from personal experience, that I felt far removed from my family, like existing in some sort of bubble where you know things are going on around you but you just cannot feel anything. Getting out of bed was a major achievement, never mind getting dressed and facing the day.

    I can understand how RW abused drugs and alcohol as there does come a point where you just want to be ‘you’ for a little while and not the depressive. Drugs/alcohol can give you false feeling of security where you are once again able to speak, feel and stop the awful feelings of nothingness, to at least pretend that you are ‘normal’. I never touched drugs (illegal or otherwise) but I would hammer the alcohol once a week, just to try and remove the numbness and be able to speak once again (even if it was drunken babble)

    I think there are lots of misconceptions with depression and some of the advice that is given is just twaddle – go for a walk, do some exercise, read a book, watch a ‘happy’ film – oh please…your concentration is shot to pieces, you don’t make it out of bed for days on end, making it downstairs is a frightening experience and getting out of the house just doesn’t happen when you are in the depths of an episode. One day is very much like another with no end in sight.

    You can be seen as the most loved person in the world but it doesn’t change how you feel about yourself. There are those who have said that what RW did was selfish, that he didn’t think of the effect it would have on his loved ones. If his feelings were even a tiny bit like mine then all he wanted was to stop feeling as he did – the despair, the nothingness. Whilst he may have known on some level the effect it would have, I think that it was the love for his family that was maybe preying on his mind (along with everything else) as you know, on some level, that your behaviour is causing upset and concern, and you just want to stop everything.

    Depression is seen as a weakness, which is why people don’t feel they can talk about it. I saw it as such – a weakness in myself. It took a long time to come to terms with the fact that it’s an illness, just like any other.

    I hope that the death of RW has the effect of people talking about depression and being more understanding about it. That would be a real legacy for RW to have left behind.


    • Honestly, I think the greatest misconception is that suicide stems from a lack of consideration for others. My best friend commited suicide and in his journals (which his family gave me) you would not believe the number of times he referenced it (suicide) being a way to lessen the burden on others. To eliminate this perceived negative impact they have on those around them.

      Depression completely alters you outlook on life – in no way, shape or form is it intended to be a selfish act, and people should be kinder to the memories of those who commit suicide, because it takes a lot to get to the point where you feel those around you deserve to be happier and the only way to do that is to remove yourself from their lives. No-one should have to feel that way… but unfortunately it happens all to often.

      Be kind to one another!

  37. I think that one of the problems is that, because “depression” is commonly used to mean “unhappy” or “or a bit down”, when someone has clinical depression they are often told to “pull yourself out of it” or something similar without it being realised just how different the two things are.

  38. As someone with Bipolar Disorder – and depression of varying degrees since my teens – I’ve seen a lot of the UK mental health system within the NHS. I don’t know if you’d agree with my (outstanding, and has kept me alive more than once) GP who says “our knowledge and understanding of neuroscience as it applies to mental illness is roughly equivalent to the knowledge of surgeons in the 19th Century”… I too am much moved by Robin Williams’ death. I read the reports asking how it could happen when he was so loved and know that, sadly, love is not enough

    • Your GP sounds like a man with perspective. Not to deride the surgeons of the 19th Century – they laid the foundations of what we do now. But obviously our intellectual constructs “too little serotonin”, “too much dopamine” etc are so ridiculously simplistic that they’re slowly fading away except in lay literature. We’ll get there, slowly, but we’ll get there.

      • Thank you for your reply and the kind words of this blog. I wonder if it is too much to hope that Robin’s death might be the catalyst that changes the language used about – and thus the stigma surrounding mental illness. Looking at the British tabloids today few, if any, adhered to journalistic guidelines (as widely distributed by the Samaritans and others) on what not to report on suicide.

      • F1fan – if you’re a criminal everyone cares, if you’er a victim, you’re weak.. what does that say about our society?

  39. As someone who has been in a dark place, I want to say thank you for this post. Some people seemed to forget the human side of what has happened. I argued with those who said he is selfish, or that depression isn’t an awful disease. We need to show more care for each other.

  40. You are a good man, Mr Hartstein.

    And yes, as one who has been so affected, just thinking of another human who hasn’t managed to hang in there really hits home. But also, I find it hard to blame him – he is now at peace.

    I have never asked for help. My outlet has been motorsport and driving on the edge. I tell people that when I am trying to brake that bit later into a corner I am not thinking about work or other worries. I use motorsport as my alcohol or drugs – but as with alcohol or drugs it is the withdrawal that hurts the most.

    As someone said about Robin Williams, it is a pity we couldn’t make HIM laugh.

    Hoping this finds you well.

  41. Thank you doc.

    This is slightly off topic – seeing that you are a neuro surgeon -, but I was wondering what you made of Robin Williams’ film ‘Awakenings’, which dealt with neurological disorders? Do you watch such films – if you do – as a medical expert? Do you ever despair about such tragedies [and in a way, MIchael Schumacher’s story is tragic, too]?


    • Actually I’m an anesthesiologist. I did see Awakenings and found it interesting. I often like medical stuff, but not always. I hate House, with a passion. This is not what we do, how we are, how we think, or how we behave. Grey’s Anatomy leaves me indifferent. Nurse Jackie is pretty amazing. Fave of all time was ER, before it got too . . . soapy.

      Michael’s story is immensely tragic. I see it literally every day in the hospital – have YOU signed the helmet safety petition?

      • Dr, for me House is brilliant because people they hear doctor and think 24×7, but don’t realise doctors are people who take massive risks with their own minds. The problem is that it lacks the violence doctors suffer such as in public system, medicine something like the Law people there have no idea about.

        It has brilliant diagnostics although I wish someone would teach him how to sing cos he’s got a really good voice but no-one helps an obvious problem.

      • FYI – I’ve been under 10 general anaesthetics, without explaining why the last time I was scared (neurological from biological exhaustion or other – in my case not knowing to begin with, trust underbased by fatal childhood illness rare a burst appendix at 3, hmmm mummy), I’d go under your anaesthetic, Germans have something different, but Latin/Greek is interesting…

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