That a "universally beloved" entertainer like Robin WIlliams could commit suicide "speaks to the power of psychiatric illness," mental health experts say.
Robin Williams, who died Monday at age 63, had some of the risk factors for suicide: He was known to have bipolar disorder, depression and drug abuse problems, said Julie Cerel, a psychologist and board chair of American Association of Suicidology.
People who are severely depressed can't see past their failures, even if they've been as successful as Williams.
"With depression, people just forget," said Cerel also an associate professor at the University of Kentucky. "They get so consumed by the depression and by the feelings of not being worthy that they forget all the wonderful things in their lives."
They feel like a burden on their family and that the world would be better off without them.
"Having depression and being in a suicidal state twists reality. It doesn't matter if someone has a wife or is well loved," Cerel said.
Williams was certainly beloved, as shown by the outpouring of grief and sympathy on social media outlets last night.
Ken Duckworth, medical director of the National Alliance on Mental Illness, agrees the impact is "shocking" when it involves a "universally loved character" like WIlliams.
He caught the news while watching TV with his children. "They all said, 'Nooo, not Robin Williams.'" It's hard to hear that successful people like Williams, who was a genius of comedy, could also have this vulnerability, Duckworth said. "You'd like to think they're immune from heartache and suffering of mental illness and that isn't true."
"It speaks to the need for better treatments and the need for society to be more welcoming to people who have these conditions," he said.
About 90% of people who commit suicide have some kind of psychiatric illness that's typically untreated or "undertreated," he said.
Cerel said the impact of suicide ripples far beyond immediate family members.
"Friends, people in our social network, even when it's people on TV, it really affects us all," she said. "Even though most of us don't know him directly, he's someone who's entertained us, and (his death) will have an effect on us and will make us think of others who've died."
The fact that someone as successful as Williams could kill himself shows that suicide is "not about objective markers of happiness and success," said Dost Ongur, an associate professor of psychiatry at Harvard Medical School and chief of the psychotic disorders division at McLean Hospital outside of Boston.
The deep psychic pain that drove Williams to suicide, "must have been part of his experience all along," Ongur said. "It was part and parcel of his gregarious, funny, so intelligent, so special outward persona – but on the inside it seems like it wasn't always happiness."
In addition to previous problems with mental illness, Williams was also in a demographic that is particularly vulnerable to suicide, Ongur said.
White, middle-aged men with medical problems are at the highest risk for suicide, he said. It's not entirely clear why that is, but Ongur said "this idea of control and virility and being able to deal with the world in a certain way – as that starts to slip away, there's often a sense of loss of control and threat to one's manhood, and that seems to be associated with higher rates of suicide."
Although depression can last for years, suicidal thinking is "a temporary state of mind and it will pass," Ongur said. If someone is deterred from a suicide attempt, they are likely to get over their urge to kill themselves, he said, so it is crucial that people who are suicidal get help.
Advocates for people with mental illness say they hope Williams' death will motivate more people to get help for depression, and spur the USA to treat suicide as a public health crisis. Suicide claims more than 38,000 American lives each year -- more than the number killed by car accidents, according to the Centers for Disease Control and Prevention -- and the rate hasn't budged in decades, says Jeffrey Lieberman, professor and chairman of psychiatry at New York's Columbia University College of Physicians and Surgeons
"We know what to do to prevent suicide," Liebeman says. "We just don't do it."
Williams could put a human face on a problem that often gets little attention, Lieberman says.
"He was such a charismatic and beloved figure, that if his death can galvanize our society to act instead of just grieve, it will be a fitting memorial to him."
Contributing: Liz Szabo
Some numbers on suicide:
– 39,518 people died by suicide in the U.S. (2011)
– 108.3 per day
– 1 person every 13.3 minutes
– 3.6 male deaths for each female death by suicide
Comparison to other highly publicized causes of death per year:
• Homicide 16,238
• Prostate Cancer 32,050
• Motor Vehicle Accidents 35,303
• Suicide 39,518
• Breast Cancer 39,520
Middle age (45-64 years): 18.6 per 100,000,
Elderly: 15.3 per 100,000
Teens (15-24) is 11 per 100,000.
(The rate for middle aged has been increasing and surpassed the rate for elderly a few years ago.)
Source: American Association of Suicidology
The national suicide prevention lifeline can be reached at 1-800-273-8255 or www.suicidepreventionlifeline.org