A Personal Remembrance of Robin Williams

It is fitting that a health care blog should take on the subject of Robin Williams’ suicide head on.  I was not aware, and I suspect most people were not aware until after his death, that Robin Williams suffered from depression of apparent long standing.  Depression is one of the last diseases that some people are still “ashamed” to have.  But clinical depression is just as organically based, that is, chemically and biologically based, as having an enlarged heart or an amputated right arm.  No one would think of keeping those conditions secret from friends and family.  But depression not only hurts. It is, needless to say, dangerous when untreated.  Maybe it’s time we understood the conduct of comics like Robin Williams and the behavior of many other people as the symptoms they may well have turned out to be – masking deep and fundamental emptiness.

I want to turn, though to a more positive personal remembrance of Robin Williams.  Many people shared their favorite Robin Williams movies.  My favorite movie of his was Awakenings, which came out in 1990.  Based on the book of the same name by one of my favorite authors, the neurologist Oliver Sacks (who later went on to write the bestseller The Man Who Mistook His Wife for a Hat) the movie was set in a Bronx hospital in 1969 where a group of patients were unable to make any voluntary movements at all.  They had been admitted as a result of the 1917-1928 encephalitis epidemic.  So there they sat, for decades, without effective treatment.  One such patient, who had apparently contracted encephalitis as a very young child, was played in the movie Robert De Niro. His mother faithfully visited her son every day.

Robin Williams played Dr. Malcom Sayer (Oliver Sacks) who realized that the absence of all voluntary movement was the result of Parkinson’s Disease – not the symptoms we’re used to seeing but Parkinson’s Disease so severe that it demonstrated that the encephalitis had likely destroyed all or a substantial portion of the neurons in the substantia nigra, the brain region where dopaminergic neurons are located. So he came up with the idea of treating his patients with L-Dopa, which had just been the subject of a 1969 article in the New England Journal of Medicine.  His patients “awoke” – thus the title of the movie.

Of course, all was not well forever.  In 1969 L-Dopa was not entirely understood. Because it is converted into dopamine not only in the central nervous system but within the peripheral nervous system it caused a host of adverse side effects (the movie featured dyskinesia) and dose resistance (what later became understood as dopamine dysregulation syndrome).

But as played by Robin Williams, Dr. Sayer was both humble in the face of victory over the hospital establishment that had initially doubted his patients could be treated, and deeply sympathetic to their individual spiritual needs when it became obvious that this treatment was not a cure after all.  They had their own unique physical and emotional needs when “awake”: to dance, to sing, to play an instrument (one of the patients was played by the famous jazz saxophonist Dexter Gordon), and to rebel and to educate in turn (De Niro’s character).  In the end, the rest of the hospital staff learn to treat the patients with equal compassion as they relapse.  Dr. Sayer continues to treat his patients who are all “frozen” and the mother of the patient played by De Niro (who never left his side) is there still, taking care of her boy.

Now, in the most tragic irony, we learn that Robin Williams had been diagnosed with Parkinson’s Disease himself and had kept it secret.  It may have been the catalyst for his suicide.  Maybe if Dr. Sayer had been at his side.

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