Unhappy endings: where even innovation cannot make a difference

This week’s sad news of the death of comedian/film star Robin Williams and his ongoing battles with addiction and depression are the center of this thoughtful article by EIC Veronica Combs in MedCityNews. Even with access to the best care and innovations such as virtual visits, Mr Williams committed suicide. The larger point made is that access and healthcare innovation don’t mean automatic adoption or a positive outcome. Some of those with chronic physical or mental illnesses choose not to change their behaviors, comply with a regimen or even to seek help, much less seek out technology or be a QSer. And some are simply beaten down and depressed by the perpetual Battle of Stalingrad that is chronic disease–ask any diabetic [TTA 5 Apr 2013]. Her conclusion is that though innovation may not help everyone, it doesn’t mean we should not pursue it. And, this Editor would add, for developers to realize that they must make technologies simple and affordable enough–‘tear down that wall’–so that those who won’t access help become fewer. (And, yes, there is a spiritual aspect of care that must be addressed–see VOX Telehealth’s work with HealthCare Chaplaincy Network TTA 25 July.)

Update:  Other factors may have tipped Mr Williams’ depression flare-up. The first is heart disease; he had open heart surgery to correct several conditions in 2009. Cardiologists and internists tend to be dismissive of the short- and long-term effects of surviving a heart attack or having cardiac surgery–between the physical effects (emboli in the brain, post-anesthesia) and emotional aftermath it is likely, not rare. Hat tip to reader/guest contributor ‘HeartSister’ Carolyn Thomas; her Jan blog post. And the psychiatrists know–NY Daily News has an excellent interview with Dr Jeffrey Lieberman, chief of psychiatry at New York-Presbyterian Hospital Columbia. Another factor is a career fail reminder. While his TV series canceled some months ago after only one season, the start of the fall TV season with the seasonal media hype surround would only serve to remind Mr Williams of it. Though he lived away from Los Angeles, this could only have added to his feelings of being on the downslope of his career.

As I learned back in my airline days reading about incidents and crashes (a morbid pursuit that almost everyone who loves flying does), every airplane crash is a concatenation of events–subtract one or two factors and you may not have one.

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  1. Thanks, Donna, for this useful perspective and also for including a link to my Heart Sisters post, “When Will Cardiologists Start Talking About Depression?” It’s important to note here that depression is not just associated with cardiac surgery alone: it’s also common post-Atrial Fibrillation, post-heart attack, post-cardiac arrest (which is not the same as heart attack), and post-just-about-every-other-cardiac diagnosis – whether or not surgery is required.

    Although it’s impossible to know what went on behind the scenes leading to the tragic death of Robin Williams, the link between depression and a cardiac event is well known (although still tragically under-recognized by many health care professionals – as Mayo Clinic cardiologist Dr. Sharonne Hayes believes: “Cardiologists may not be comfortable with ‘touchy-feely’ stuff. They want to treat lipids and chest pain. And most are not trained to cope with mental health issues.”)

    This lack of awareness and training is both shocking and unacceptable given the amount of current research on mental health issues in heart patients. Some studies suggest that up to 65% of heart patients show significant symptoms of depression, yet fewer than 10% of these patients are appropriately identified. Cardiologist Dr. Deepak Bhatt, a Harvard Medical School professor, explains:

    “Everyone knows that a heart attack is a serious medical condition. What might not be as obvious is the psychological trauma that can result from having a major heart attack — especially the fear that it might occur again and cannot be predicted.”

    I suspect it’s that ongoing sense of relentless hypervigilance – especially if combined with a sense of abandonment during crisis (an identified risk factor for PTSD among heart patients) – that makes depression so alarmingly common among heart patients.

    Thanks for helping to raise awareness of this serious issue.

    • Donna Cusano

      Carolyn, thank you for the expansion of the ‘heart factor’ and it’s something everyone associated with healthcare should know. On a personal note, I mentioned this to my brother, a psychiatrist in private and clinic practice for over three decades. His reaction was interesting because it was so ‘night follows day’ — it was to him a commonplace. Another example of the disconnect between the parts of medicine. When he heard that Mr Williams had recently been diagnosed with early-stage Parkinson’s, his words were ‘no wonder’–the depression had yet another physical cause. Overall, any person would be absolutely crushed, which returns us yet again to Veronica Combs’ point–that despite access to the best care and certainly with funds not a major concern, Robin Williams could not stop himself–after a valiant fight over years *and* admitting himself to a healthcare setting (a last stay in rehab).