New York, NY – Not long ago I encountered the exceptionally talented comedian and actor Robin Williams in a New York City Greek restaurant. In his typical high-energy seemingly casual way, he said to me, “Oh, Dr. Judy, I need a psychologist.”

“Call me anytime,” I quipped back in a matching tone.

Half of me thought he was just jokingly relating to me by what I do, but the other half thought he was being truthful, given what I knew about his history of emotional issues.

I didn’t hear from him, and now, after news of his tragic suicide, I’m painfully aware of how serious his remark was.

All too often a cry for help is masked, or unheeded. 

On comedian Joe Piscopo’s radio show after news of Williams’ suicide, the host of AM 970 “The Answer” told me how well Robin was able to present his happy side to others. Williams guest-hosted “Saturday Night Live” in 1984 when Piscopo and Eddie Murphy were SNL stars.

According to his publicist, Williams was recently “battling severe depression.”

Williams’ wife confirmed her husband’s depression, and added “anxiety” and early stages of Parkinson’s Disease. Though she insisted he was now sober, Williams had a long history of addiction, from which the addict is always in recovery.

The trio of problems – addiction, depression and a physical disease — could certainly add up to desperation leading to drastic action like suicide, even if research does not prove that patients with Parkinson’s are any more suicidal than those without the disorder.

Yet, a performer like Williams who banked on his fluid speech and movements might be pushed to be fatalistic when facing such a diagnosis, even though actor Michael J. Fox has famously prevailed with the disease. 

The mode chosen for committing suicide is always significant. 

While use of pharmacological agents is the most common method of attempting suicide, hanging is actually the most successful. 

From a psychoanalytic point of view, Williams choice to hang himself and cut off his breath with his belt can be interpreted as cutting off his speech as symbolic of the very source of his talent; thus, committing an ultimate act of self-destruction, literally and figuratively, by silencing his voice.

This is consistent with what Williams said in a 2009 People magazine article that in his childhood “The ideal child was seen, not heard.”  

Even the most publicly successful performer can still carry a hurt little child inside. For Williams, as for so many other people, painful experiences growing up “short, shy, chubby and lonely” (his self-description) can always lie just beneath the surface and erupt when fears and failures pile up.   

Clearly Williams was not getting enough help, given a likely all-too-brief stay in the Hazelden Addiction Treatment Center this past summer and reports that he was receiving treatment lately.

Along with the world, I’m gravely sad over his death. His unique humor and creativity inspired millions.

Two images of Williams’ brilliance stand out in my mind and have influenced my work.

One is of Williams in a television interview on “Inside the Actors Studio” with host James Lipton, jumping up from his chair to face the audience, twisting a pink pashmina scarf in many positions — over his shoulders, around his head, straddling his hips – using the one prop to transform into a multiple of characters and situations.

The second is from the film “Dead Poets Society,” when Williams’ English teacher character entreats his young students to stand on their desks to free themselves and see the world from a new perspective. 

Both images inspired techniques that I use in my classes at Columbia University Teachers College and in many workshops I conduct around the world.  I ask participants to stand on a chair and then to kneel down close to the floor, to see things — like lights above or others’ shoes below — that they otherwise don’t notice when looking straight ahead. Also, I show participants an item like a glass, then turn it upside down and ask, “What can it be used for now?” and then turn it on its side and ask “What is it now?”

The lesson: be creative and keep coming up with new perspectives and new ideas.

Many lessons emerge – sadly – from Williams’ tragic choice to end his life.

One lesson: No one knows the private demons a sufferer faces.  We may see success, but he or she faces life every day that can be filled with private disappointments.

Other lessons are to notice and heed signs of others’ distress – in work and love. 

Another lesson is to cherish life.  And reach out in moments of despair. There is always hope and there are always new moments to value. Admittedly, the truly depressed person has a hard time seeing or believing this.

Despite marveling at Williams’ lightning-paced ad-libbing, the psychologist side of me always worried that his over-the-top energy belied a darker side and a serious underlying condition.

Williams’ stream of consciousness and free association were intrinsic to his comic genius. But such over-the-top talk is also symptomatic of cocaine use, to which Williams admitted in the 1980s.

In the psychology profession, there is another possibility, where symptoms of “pressured speech” and “word salad” indicate a manic state.  When combined with reported depressive bouts, the condition is called bipolar.

The term “bipolar” — which in recent years replaced the diagnostic term “manic depression” — is characterized by severe highs and lows and disabling seesaw swings of moods, energy and activity.

People in a manic phase have so much fun and are so entertaining, they don’t want to “dull” that with medication that would even out their mood and moderate their behavior.

Yet, the thrill of great highs extracts a high price when the opposite painful pole of depression hits.

Suicide is always a danger.

In my view, in Williams’ case, warning signs were evident even eight years ago in an ABC News interview with Diane Sawyer when Williams referred to standing on a precipice and hearing a quiet little voice say “Jump.”

Warning signs typically show up in troubles in work and love. Some people have asked me, “Why were he and his wife sleeping in different bedrooms? Isn’t that a sign of trouble in a marriage?” And people have also wondered about whether he had financial woes.

The question I’m always asked: Why would anyone who seemed to have so much to live for want to end their life?

The answer is several-fold.  For one, no one knows the private pain another person suffers, even if they seem to “have it all.” A failure at work, rejection in love, and fears about disabilities can trigger deep desolation that leads to the desire to escape it all and end the pain.  

Making matters worse, impulses can be totally out of one’s control when ruled by chemical imbalances in the brain – that occur with drug and alcohol abuse or certain mental and physical conditions.

Another problem is that the person suffering may hide their true self.

Sid Caesar was a comic genius of the1950s who late in life admitted deep-seated insecurities and pressures to perform, which led to a roller coaster of ups and downs, addictions and rages — endemic to the condition of manic depression. He wrote about it in his autobiography, Where Have I Been? An Autobiography.

Psychological studies show that comedians often use humor to cover underlying despair. One survey of 532 comedians found they have a much lower ability than ordinary people to focus and control their moods and a much higher rate of impulsivity and unusual experiences. British researchers attributed these results to creative talent, but also associated them with personality conditions.

Celebrities, such as Britney Spears, have notoriously been suspected to suffer from bipolar disorder. Others have admitted their condition, like Carrie Fisher, the famed Princess Leia of “Star Wars” and Catherine Zeta-Jones, well known for her role in “The Mask of Zorro” and being Michael Douglas’ wife.

Actress Patty Duke, who famously portrayed Helen Keller in the film “The Miracle Worker,” was the first celebrity to go public with her diagnosis of bipolar disorder in 1987, when she wrote her autobiography, “Call Me Anna” about her struggle with drinking, drugging, manic depression and attempting suicide in her youth. Her second book, A Brilliant Madness: Living with Manic Depression Illness was published in 1992.

More than 5 million “real” people are estimated to similarly suffer from bipolar disorder.

Vigilance about treatment is crucial. So is more attention to prevention, early diagnosis, and more funding for research and programs.  Patty Duke lobbies Congress on behalf of people with mental illness.

In playing a psychiatrist in the film “Good Will Hunting,” Williams advises Matt Damon’s troubled character to taste love, happiness and life instead of using defense mechanisms.

He calls the Will Hunting character a “genius,” empathizes that “no one could possibly understand the depths of you,” and advises him to talk about himself and who he really is.

The celluloid Williams could have been talking about himself. If the real life, had Williams taken this wisdom to heart, he might be still alive with us today.

Judy Kuriansky is a New York clinical psychologist on the faculty at Columbia University Teachers College and Chair of the Psychology Coalition of NGOs at the United Nations.