Last week was a terrible one. Both the designer Kate Spade and chef-author Anthony Bourdain took their own lives. These are public figures but they had their own private demons and tragically, in both cases, the demons won.

I remember reading Bourdain’s book, Kitchen Confidential a while back. His writing style was so intimate that it was like hearing a good friend talk about their experiences. Through the years, every time I saw him on TV, his openness and honesty were such that it felt like I was catching up with my pal and hearing about his latest exploits. That’s why losing him was even more difficult for me, and I’m sure many others share my sentiments.

Kate Spade was a more private person, but she was universally admired for the stamp she put on women’s fashion. She’d been a breath of fresh air, bringing color and a great sense of humor to everything she designed. Both of these individuals were unique, with their own distinctive voice.

Suicide is a devastating experience for the survivors. Friends and family members ask themselves if they could have done something to prevent it; if they ought to have seen the signs. But often, there are no clear signs. Perhaps, in retrospect, one can look back and put the pieces of the puzzle together, but hindsight isn’t helpful in preventing anything.

I learned in my psychiatric training that it’s exceedingly difficult to predict if or when a patient is going to commit suicide. Unless they state clearly that this is their intention – a rare occurrence, in fact – so much of dealing with this issue comes down to guesswork. It’s not surprising that people everywhere were shocked over Spade and Bourdain’s decisions to take their own lives.

There’s no formula that suicidal individuals follow. In many cases, the person doesn’t even know that they’re going to do it until moments before the act. Suicide can be a long-planned decision or an impulsive one, but even the former can be kept secret from everyone, including the person’s doctors.

Some people hint at their intentions to their therapist, GP or loved ones but some are determined to carry out the act and don’t let anything slip. Their friends, family and physicians can have little clue as to the severity of their situation.

Suicidal people often look like any other depressed person.  And of course, most depressed people, even severely depressed ones, don’t take their own lives. It can come as a huge shock when someone chooses to end their life.

The only constant is that the suicidal individual is at the lowest point to which a human being can descend. They’re in despair, overwhelmed by their pain, and hopeless of finding a way out of it.

Some people commit suicide because they have a chronic, deteriorating medical illness, and these people are choosing to take control of the way that they suffer and die. Many, though, have no physical cause for their suffering. It’s a purely mental condition that drives them to the depths of misery.

Depression is a major cause of suicide, but people also choose to end their own lives if they’re suffering from a severe personality disorder or from Post Traumatic Stress Disorder and they can no longer tolerate their pain. Sometimes, a schizophrenic will act on it when the voices in their head are unrelenting in telling them to harm themselves.

As a psychiatrist, I tend to err on the side of caution with regard to suicide. I learned that it’s preferable to hospitalize someone who has suicidal plans rather than assume the best, send them home, and risk them following through with their threat. A few days in the psych ward can be unpleasant, but death is permanent and I’m not prepared to take that chance.

I can’t know the circumstances around Ms. Spade’s death, but from what I’ve been reading it appears that Mr. Bourdain did seek help but didn’t follow up with his doctor’s recommendations. It’s impossible to comment on this, except to say that it’s tragic that he didn’t receive the help he so desperately needed.

Psychiatry is as much an art as it is a science. There’s still so much to be learned about mental health and mental illness in order to provide society with the services it requires.

It seems that more and more high-profile people are coming out and acknowledging that they suffer from a mental illness, and growing numbers of young people are seeking mental health care but at the same time, funding is dreadfully low for a condition that affects at least 25% of the adult population.

When I entered psychiatry, it was considered the poor relation of the medical world. There are never enough psychiatry residency positions to meet the need of the community and anyway, medical students are discouraged by the low status and low pay, opting instead for higher-profile specialties.

People don’t like to talk about mental illness. Sadly, there’s still a lot of shame attached to it. It doesn’t help that psychiatrists are portrayed as odd-balls, incompetents or even monsters in the movies. Our pay is the lowest among specialists with equivalent education and like the old comedian Henny Youngman, we “don’t get no respect,” from our medical peers or from the community at large.

And yet, our work is so essential. Oftentimes, we’re able to help people get their lives back after they experience a mental illness. And sometimes, when the stars align, we’re able to snatch a suicidal individual from the jaws of death.

Bottom line, we need to open up the conversation about mental illness and mental health, and we need to fund more psychiatry residencies and start paying psychiatrists what they’re worth in order to ensure that the best people are entering the field.

We need to ask the question, “why are so many people these days suffering from mental illness?” and we need to invest in research and treatment, so as to prevent the types of tragedies that happened last week.

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