“Sometimes I wonder how all those who do not write, compose or paint can manage to escape the madness, the melancholia, the panic fear which is inherent in the human condition,” wrote Graham Greene in his second autobiography, Ways of Escape, a book which the chef, author and travel show host Anthony Bourdain, who died on June 8 at 61, kept on his nightstand.
Bourdain’s suicide, which followed shortly after that of fashion designer Kate Spade’s, was a one-two punch to our belief that there are some people who are living the perfect life. That each of them chose to end an existence that, to outsiders, seemed so idyllic and enviable is a mystery to people — especially since these were not teenagers or lost 20-somethings, but two people who might reasonably be expected to have reached some sort of self-knowledge. So many spectators of Bourdain’s and Spade’s lives saw in them reflections of the lives they would have liked to have lived.
Spade created what many women would consider the ideal way of living. Her world was filled with creativity, beauty, family and meaningful work. Having brought into being a fashion line alongside her husband, she sold it and was able to take years off to raise her daughter. She had a successful, creative, family-centric business that gave her time to be a parent. After she died, so many women spoke of how she made them feel seen; how her fun, quirky feminine handbags and style made them realize they were not alone.
Bourdain managed to be masculine without being swaggeringly macho. He was rugged and adventurous and knew how to use big knives, but he had his own literary imprint, Ecco books. Tall and handsome, he got to travel to exotic locales constantly and won awards, fame and wealth. And he ate so well. He was also seen as a rare male hero in the #MeToo movement, for championing Asia Argento’s claims against Harvey Weinstein and for siding with women over fellow chefs. What more could a person want?
And yet these two could not bear to live their lives any longer.
Apart from yearning again for more help for those who struggle with depression and mental illness (though we do not know the exact reason for Bourdain’s death), what can we do with the information that those whose lives we admire cannot bear to be alive? How can we process the fact that all that they had and all that they’d done were not bulwark enough against the darkness? What hope is there for the rest of us?
It’s not much of a solace, but perhaps one thing these deaths could remind us of is the uselessness of envy. As with many of the behaviors once considered vices — greed, sloth, lust — envy reflects a miscalculation in the relative worth of things. When we look at lives like Spade’s and Bourdain’s, it can make our own feel wanting. We haven’t started our own companies, or turned our work experience into a book. They’re happier and more fulfilled, because we are not as hardworking or talented as they are. Their lives look better than ours, therefore they must be better people than we are.
Our desire to turn Bourdain and Spade’s success into a judgment on our own stems from a flawed comparison due to incomplete data. Many lives are not as they appear. Happiness is not the end result of a sum of accomplishments. The person whose wealth/wardrobe/job/talent you wish you had has his or her own struggles, and they could at least equal our own. Bourdain seemed to hint at his, when during an episode shot in Sardinia, he asked in a voiceover, “What do you do after your dreams come true?“
And if our envy is misplaced, maybe there’s also a case to be made for having more compassion. If people’s lives aren’t as amazingly blissful as they appear, perhaps they’re not as evil or stupid as they appear, either. Especially on the Internet. Bourdain once flew Marilyn Hagerty, whose sweet review of her local Olive Garden had been mocked on the Internet, to New York City to dine at the restaurant of the moment, Per Se, and then published a book of her columns. Kate Spade donated boxes of clothing and bags to a foundation to help young women get started out of college so their lack of business attire didn’t obscure their talent.
It seems they both knew that outward impressions of people’s lives are often wildly off-base.
And please, if you or someone you know may be contemplating suicide, call the National Suicide Prevention Lifeline at 1-800-273-8255.
"We can't talk about bipolar pertaining to Kate Spade, because we don't have data to suggest that," Sit said. "But we need to encourage people to seek treatment and consider a different diagnosis. ... Bipolar is not recognized quickly enough in women," she said.
The medical community, as well as mental illness sufferers and their support networks need to consider whether a diagnosis of major depressive disorder (unipolar disorder) is correct versus bipolar disorder, because use of antidepressant drugs for bipolar disorder will not work and could make the situation worse, Sit said.
Kessler said misdiagnosis is definitely a piece of the puzzle, but it is hard to know how much it contributes to suicides. But he did say that misdiagnosing bipolar disorder for unipolar depression is dangerous, because even though bipolar is much less common, people who suffer from bipolar have higher suicide rates.
Sit that that ultimately mental illness is not a medical issues founded on gender. "It's not just women but men also with unrecognized illness," she said.
"Do we need some special treatment for women?" Kessler asked. Research shows very little gender difference when it comes to treatment options and the key is getting people into treatment and getting patients to stick with treatment after initial failures.
There are certain treatments that work better for women, he said, pointed to interpersonal therapy. Meanwhile, men respond better to cognitive behavioral therapy. I layman's terms, that's the difference between talking things out and pills. And even though it sounds like a stereotype, Kessler said research backs it up. "The basic idea is that men don't really want to talk about emotions, they just want rules to follow, a pill. Women want to talk about it. And that works better. .. It's a noticeable difference, but not dramatic."
Other variables such as socioeconomics, individual personality and genetics are much more predictive of mental illness than sex, he said.
"What we need to do is improve treatment of depression and get more people into treatment. Rather than saying we need to do something for women, we need to do something for people," Kessler said. "Depression is an enormous problem. ... We still have massive undertreatment. Half the people depressed in America in a year never get treatment and of those who get treatment, a high proportion drop out."
Kessler said in most cases if a patient tries a variety of drugs, even after a first option fails, 80 percent to 85 percent of patients can recover from a mental illness. In a week that has seen two high-profile suicides, Kate Spade and Anthony Bourdain, Kessler said he is "far more hopeful that we will find proper treatment" and that the number of suicides resulting from depression will ultimately be insignificant statistically.
He expects precision medicine to hone drug treatments for individuals in the future, and with those developments on the way, "it's matter of getting them into care. The key factor is making sure people get into care and engage in treatment, and providing resources for communities."
— Additional reporting by CNBC's Eric Rosenbaum
The list of warning factors for suicide reads, in part, like a catalog of everyday modern ills: lagging self-esteem, depression, loss of relationships or economic security, insomnia.
“When you look at those lists,” says Eric Beeson, core faculty member at Northwestern University’s Counseling@Northwestern, “it almost seems like who’s not a candidate for suicide?” And yet, in the wake of highly publicized deaths by suicide like that of fashion designer Kate Spade and, according to initial reports, television personality Anthony Bourdain (few details were public early Friday morning), our scrutiny of the act centers on a need to quickly settle on a cause and, on some level, to distance ourselves from it.
Spade’s longtime friend Elyce Arons told The New York Times this week that when the subject of celebrity suicides came up in their discussions about Spade’s depression, her friend assured her, “‘I would never do that. I would never do that. I would never do that.’ And I believed her.”
“At some point in everyone’s life,” says Beeson, “they have said they would never do that. But I believe we are all just a few life events away from considering it. So for me, we’re all on that continuum.”
National Institute of Mental Health data show that, in 2016, 1 million U.S. adults made plans for death and attempted suicide. Yet most of us lack even the most basic understanding of what leads to these deaths, beyond those well-known risk-factor lists. The picture is much more complicated, says Beeson, and it might be time to take a more nuanced view.
Suicide risk is not as simple as a list of risk factors. “We talk about suicide as this one thing,” says Beeson, “but suicide is really this spectrum of behaviors. You always ask, ‘Are they suicidal?’ and for me that’s really a limiting question.” In assessing whether people might kill themselves, Beeson looks at “key variables that seem to be more related to death.” Those are:
Perceived burdensomeness, “this idea that my death is more valuable than my life.”
Thwarted belongingness, “meaning I try to make meaningful connections, and they just don’t work out.”
Hopelessness, “OK, I have this, and it’s never going to get better.”
Acquired capability, the ability to set aside normal psychological and physical constraints and perform an act that may be painful or horrifying.
With the first two factors, Beeson says, people begin to have ideas about suicide. Adding hopelessness can bring on planning of a suicide. But the final factor is the hardest to discern.
Clinicians like Beeson look for clues that the person might have become more inured to pain, shame or guilt. Past histories of abuse, substance abuse disorders, assaults or even professions such as medicine that make contact with death part of the everyday can constitute a slow wearing away of the mental and physical barriers to self-harm.
“People work along that continuum until they start to overcome the pain, the shame and the guilt,” he says, “and then the value of suicide starts to outweigh the pain, shame and guilt.”
Suicide is not typically an impulsive act. “People talk about it being selfish; people talk about it being irrational,” says Beeson, “but actually I think a lot of suicides are very well-thought out, very well-contemplated. And generally not impulsive.
Generally, this is a long process for an individual that started with a faint idea that gradually took hold as those risk factors mounted and as the capability came into their purview.” Leaving behind a note, as Kate Spade reportedly did, can be interpreted as evidence of the contemplation suicide often entails — it may be an attempt to remove the last psychological barriers to death.
“Some people might say that it’s a last way to cope with some of the guilt,” says Beeson. “The guilt can be a protective factor in a certain way, so some people might say that’s a way to reduce that. There’s something about this that the person is still not OK with, so they are trying to address that.”
The philosophical debate on suicide is more present than ever. In ancient societies, suicide was sometimes interpreted as an available and even noble choice. Today, in countries like Switzerland, where there are euthanasia clinics, assisted suicide is accepted. And five U.S. states and the District of Columbia have “Death With Dignity” laws that allow assisted suicide in cases of terminal illness.
“That gets us into the discussion of whether it is ever OK and under what circumstances,” Beeson says. “Some people would argue that if I have a chronic mental health condition that interferes with my quality of life, is that any different than a fatal medical condition? And that’s a really really hard discussion to have.”
To shift your perspective on suicide, think back to the events of 9/11 and how you felt about the people who chose to jump from the Twin Towers before the burning buildings collapsed. “That analogy is not too different from someone who has a depressive disorder,” says Beeson. “It’s not true flames, but it’s the flames of something.
It’s easier for us to look at the 9/11 example and say, ‘Yeah, I’m not going to judge that person,’ but what if it’s flipped around and these are not real flames, but it’s something that’s very real to that person?” Given any of these circumstances — the burning building, the terminal cancer or the extreme, persistent mood disorder — Beeson points out, none of us really know what we would choose to do.
Condemning suicide might hinder prevention. “I think we run the risk of looking at it as a black and white thing,” says Beeson, “and that’s just not the way it is. I really do view suicide as a continuum and frankly we are all on it in some way. Some of us are just much farther from it than others.”
There is a movement aimed at destigmatizing suicide, including changing the ways in which we talk about it — “committed suicide” conjures an image of committing a crime, while more straightforward language — “died by suicide” or “killed himself” avoid those punishing overtones. Willingness to view suicide as a part of human behavior, without judgment, may be difficult. But, Beeson says, it can be the key to helping someone who is considering killing herself.
“If we view ourselves as too separate from people and we think that we’ll never be there, then it’s really hard to connect with people in a meaningful way.” Before talking to someone who might be contemplating suicide, he suggests, think about where you’re coming from.
“Have the hard dialogue with yourself: ‘Am I so far removed from this?’ and if I am, I’m probably going to be perceived as coming from a judgmental place. That’s going to make it harder to connect with someone and catch it sooner, if you will.
It’s always interesting, and sometimes infuriating, to see the conversations that take place following a suicide. There’s a confusion, an unwillingness to believe that someone would end their own life, that permeates the discussion.
Anthony Bourdain, a hugely successful chef and author, has died and it appears that he committed suicide. While many people are completely stunned today, a familiar dialogue has already begun on social media.
“I just saw a video of him laughing two days ago. Surely, something must have happened. He seemed too happy to kill himself.” “Why would he commit suicide? He was rich and famous!”
Similar sentiments were expressed when news broke earlier this week that designer, Kate Spade, had taken her own life. “But she’s got a 13-year-old daughter. Why would she just leave her child behind? This doesn’t make sense.”
Only it does.
It makes complete sense to anyone who has ever descended into the dark abyss of depression and anxiety. They’ve seen the disbelief, incomprehension and judgement from people around them first hand. They’ve lived through the inexplicable moments when their world has been filled with both joy and despair, simultaneously.
The living, those who continue to battle these emotional demons, have spoken the words, described the pain and bravely reached out for help — but, too often, there is a lack of understanding or compassion. This has to end.
A Growing Issue
In fewer than two decades, the rate of suicide has increased by more than 30 percent in half of America’s states. Additionally, the National Institute of Mental Health has shared that, in 2016, suicide was the 10th leading cause of death in this country.
According to the Anxiety and Depression Association of America, more than 18.6 percent of Americans suffer from anxiety and 6.7 percent live with depression. Considering the stigma that surrounds mental illness, it’s reasonable to assume that these numbers are actually higher.
Further, a recent study looked at the lives of more than 20,000 American adults. The results were heartbreaking. Among other revelations, it found that 46 percent of respondents felt alone either sometimes or always and that 43 percent felt that their relationships were meaningless. Even more devastating — 27% rarely or never felt as though there are people who really understand them.
Behavioral scientist Deborah Stone, explains, “Suicide in this country really is a problem that is impacted by so many factors. It's not just a mental health concern. There are many different circumstances and factors that contribute to suicide. And so that's one of the things that this study really shows us. It points to the need for a comprehensive approach to prevention."
Reflect on Your Role
If you’re watching all of this unfold around you and are feeling helpless, you’re not alone. Many can relate. As this continues to become more common, don’t allow yourself to become complacent. In this age when we are overloaded with information on our phones all day every day, it’s easy to move on to the next story — but we have to do more.
Reflect on your own attitude about suicide and mental illness. In my role as a social sciences and psychology professor, I regularly encounter students who are shocked by the disparity between real facts and their own preconceived ideas about depression and anxiety. So often, they realize that their unintentional actions and unconscious beliefs contribute to a culture that minimizes the suffering of others. When we confront our own biases, we can help create change.
Think about how you respond to people in emotional crisis. Are you listening to understand? Are you putting yourself in their shoes? Are your opinions about their situation clouding your ability to provide support? When I worked answering phones for a suicide prevention hotline, almost every caller described feeling unheard and misunderstood. Many said they felt like a burden or an annoyance to those around them. As a collective, we need to do better.
We Can Fight This Together
No one should ever feel alone. We have to unite as allies to fight this darkness together. We can change the narrative by creating a culture of compassion. We don’t have to understand the specifics of someone’s journey to show empathy and love.
Here’s how you can become the warrior we need in this battle right now:
Get the Facts - No matter what you think you know, you can always learn more. Read current articles and dig through websites such as the National Alliance on Mental Illness . Keep up with new research and current initiatives. We need you! Know the Warning Signs - Maybe you’ve got a friend who has been withdrawn lately or a sister who always seems nervous. Instead of brushing it off as moodiness or a quirk, get familiar with the warning signs associated with mental illness. They may not even be aware of their own behavior. By being informed and sharing what you know, you could save someone’s life! Active Listening - If someone is in distress and says they are feeling overwhelmed, depressed or suicidal, take them seriously. Put down your phone, look them in the eye and let them know you are paying attention. Allow them to speak without interrupting, nod and offer reassurance. Treat them as you’d want to be treated. Enlist Help - Someone who is suffering may be unable to get help for themselves. A person who is drowning may be so far underwater that they can’t call out to anyone. In those situations, the responsibility falls on you. Take them to a hospital, call a hotline or reach out to a loved one. Just don’t leave them alone in distress. Volunteer - Crisis centers across the country are understaffed and struggling to meet the demand of a growing number of people living with mental illness. Many people cannot even afford to seek the help they need. Volunteering not only helps support the agencies that provide free mental healthcare but you will also gain valuable skills, insight and perspective. Raise Awareness - We have to shine a light on this life-threatening issue. In order to do this, we have to create a dialogue and have the tough conversations. We have to educate ourselves and others about the facts and myths surrounding mental illness. Invite a speaker to come to your workplace or school, participate in community events and donate to organizations committed to raising awareness. Do your part.
The mantle of mental illness is heavy but, if we all work together to carry it, we can lighten the load. In order to be truly supportive, we have to challenge our own biases and beliefs, but it is absolutely worth the effort.
Our friends, family, coworkers and members of our community are dying. They are not weak — they are in need. We cannot stand by and let this continue. We cannot scroll past another tragic story and then move on with our day like nothing has happened.
Anthony Bourdain’s life mattered. Kate Spade’s life mattered. My neighbor’s life mattered. My friend’s brother-in-law mattered. My life matters — and so does yours. Will you stand up with me? Can we work together to save lives?
The National Suicide Prevention Lifeline can be reached all day, every day at 1-800-273-TALK (8255).
