Abstract

We reply to the thoughtful commentary by Joiner and Robison (this issue) about the documentary Robin’s Wish. Joiner and Robison suggest that a major depressive episode may have been a proximal cause of Robin Williams’ suicide, but that stigma surrounding mental illness led the documentary to eschew a role for depression. We find this perspective compelling and important. Mental illness can be an important cause of suicide, and stigma can harm our ability to understand and treat mental illness and suicide risk. As a complementary perspective, we discuss research and theory suggesting that mental illness does not explain all deaths by suicide. We present research and theory suggesting that suicide is motivated by pain and hopelessness, and that pain and hopelessness can be caused not only by mental illness but by other factors such as overwhelming interpersonal struggles or loss, seemingly insurmountable financial problems, chronic medical conditions, and systematic discrimination and persecution. Finally, we reaffirm Joiner and Robison’s belief that understanding and preventing suicide requires the pursuit of accurate knowledge, unburdened by stigma that can harm progress and people.

摘要

回复Joiner和Robison（本期）对纪录片Robin's Wish的深思熟虑的评论. Joiner 和 Robison 认为严重的抑郁症发作可能是 Robin Williams 自杀的近因，但围绕精神疾病的污名化导致这部纪录片避开了抑郁症的角色。我们发现这种观点令人信服且重要。精神疾病可能是自杀的一个重要原因，而耻辱会损害我们理解和治疗精神疾病和自杀风险的能力。作为补充观点，我们讨论了表明精神疾病并不能解释所有自杀死亡的研究和理论。我们提出的研究和理论表明，自杀的动机是痛苦和绝望，而痛苦和绝望不仅可以由精神疾病引起，还可以由其他因素引起，例如压倒性的人际关系斗争或损失、看似无法克服的经济问题、慢性疾病、系统的歧视和迫害。最后，我们重申 Joiner 和 Robison 的信念，即理解和预防自杀需要追求准确的知识，摆脱可能损害进步和人们的耻辱感。