Recent shocking news has reported on the deaths of celebrities Kate Spade and Anthony Bourdain. Many have speculated about how such successful, beloved people can “kill themselves.” While the news is horrible, the story line misses critical points. First and tragically, Spade and Bourdain join a growing number of more than 100, mostly less famous, Americans having similar deaths “by suicide,” each and every day. More importantly, the notion that Spade, Bourdain, and the others, decided to end their own lives is, in a deep sense, not true. These individuals are the victims of the pernicious illness of the brain, Depression.
Depression is a horrific illness that affects as many as 10% of Americans at any one time. Depression is a brain disease that can cause confusion and distortions in thinking, as well as interference with basic physiologic functions, including: sleep, energy, appetite, motor function and more. It is neither self-inflicted nor a moral failure. Depression interferes with cognition (or thinking), making it impossible for the individual to perceive and accurately interpret the environment with a consequent inability to experience pleasure and anticipate the future. The brain’s failure to undertake accurate self-assessment of risks is intrinsic to Depression, with a disruption in sense of self and loss of the basic evolutionary drive for survival; this leads to dangerous behaviors and even death. Death during Depression is not a “self-inflicted” death (suicide) because the sense of self is gone; it is Death by Depression.
In the face of overwhelming evidence that Depression and other psychiatric disorders are serious illnesses that can disrupt brain function, including the will to survive, why do we still use the term “suicide?” “Suicide” is associated with the stigmatizing concept that those with psychiatric illness are intrinsically flawed or weak and want to die. Stigma and antiquated understandings about Depression and brain disease foster ignorance about the fact that Depression is just as life threatening an illness as are cancer and heart disease.
It important to accurately understand Depression and Death by Depression. Depression is a treatable brain disease and, Death by Depression is preventable. Depression is a medical emergency! It requires the immediate attention of medical professionals, friends, and family. The victim of Depression should not be left unattended any more than should someone bleeding profusely or having a heart attack – even if they insist that they are “OK.” Along with the immediate protection of the person with Depression, it is essential to rapidly apply evidence-based treatments. This will not only prevent death and debility but it will also help those with Depression save their lives so they can have much wanted, productive futures to share with friends and family.
Protection and prevention of complications (including injury and death) are the important first steps in treating Depression. But, this can’t be done if Depression is not identified early. Look for depression! When you find it, act promptly. If you are the victim of Depression, immediately tell someone (friend, family member, and / or professional) and let them help you get treatment. If you know someone with Depression, ask how you can help and make sure that they receive urgently needed professional care.
No one wants to die from Depression, or any other illness. To suggest otherwise is diminishing the value of life and the individual affected by Depression. Unfortunately, the concept of “suicide” interferes with our shared responsibility and opportunity to effectively prevent Death by Depression.
Bennett L. Leventhal, MD
BC2M Scientific Advisory Council + BC2M HS Research Co-Lead
Professor of Psychiatry, University of California San Francisco
Neal D. Ryan, MD
Professor of Psychiatry, University of Pittsburgh