Hiding from the Pain: Robin Williams's Autopsy

Robin Williams’s death on August 11 2014 generated a lot of interest because there were so many cues. Or cues that we strongly believe we need in order to be able to explain his suicide as “rational”. We are now learning that depression, anxiety, and Parkinson’s disease weren’t the only issues plaguing Robin Williams in the months before his death. According to a new autopsy and toxicology report his brain also showed signs of dementia. We have now “explained” the suicide as a biological fate accompli. Biological determinism. Dementia and Parkinson’s at the same time. What better reason to commit suicide.

But this is rubbish.

What neurologists think as the disease in the brain—the neuropathology—which in Alzheimer’s are the plaques and tangles—has never been validated. We see a lot of plaques and tangles in the brains of dementia or Alzheimer’s patients after they die. But there is not one study that shows that the plaques and the tangles CAUSE the disease. The same as a scab over a wound. The scab is an indication of a trauma, but it is not the trauma itself.

If we did an autopsy of you today it is very likely that you have some of the signs of dementia. In fact most older adults have these plaques and tangles. So much so that just under one in three of  older adults have as much disease as those with dementia but without expressing the disease. And it is not just older adults who have these neuronal damage. A study on young victims between the ages of 26 and 30 reported that more than one in five already had early stages of the disease.

What is stranger still is the observation that there are people with dementia who do not have the disease in their brain. There is a famous long-term study conducted by David Snowdon looking at nuns. Snowdon was one of the first to report such cases. There are inconsistencies in how we are trying—but failing—to define the cause of Alzheimer’s disease and dementia in general.

Diseases of the brain are not all that distinct. Although we have given names to specific diseases these are not as distinct in real life as neurologist would like them to be. We talk about Lewy Bodies dementia as though it is distinct from Alzheimer’s, but in fact they are on a sliding scale…more likely to look like Alzheimer’s or Lewy Bodies. There is also the vogue to call all types of dementia “Alzheimer’s”. Even Alois Alzheimer himself, more than 100 years ago, was confused by the distinction. And we remain confused today. Most of brain diseases share similar neurological deficits. Whether these are the cause or an expression of an underlying disease has not been determined.

With Robin Williams’s death we have to stop looking for simple answers. There is no greater answer to be found in biology. Our biological body is a balance—it is not a digital machine. As with cancer—and we all have cancer—it is how the body manages to keep it in balance. It is not whether there is a disease, but how we control and keep it in check. Evidence of dementia is no evidence. It is after-the-fact excuses to rationalize an individual’s pain and suffering as legitimate without understanding the pain and suffering.

© USA Copyrighted 2014 Mario D. Garrett