From Both Sides of the Couch

A therapist reflects on her time with patients, and her time as a patient.

Contemplating Suicide: No Way to Understand Unless You've Been There

Suicide: whether successful or not casts a lifelong shadow.

I’ve written about suicide before but with the tragic death of Tony Scott a week ago, it seems necessary to write about it again.  Mr. Scott, a well-known film director, jumped from the Vincent Thomas Bridge in San Pedro, California last Sunday.

 A friend of mine posted a blog that appeared on Salon.com titled, “Suicide isn’t painless.”  In it he writes, “Those who have never felt those moments of hopelessness can’t understand what they are like.”

 To read the post in its entirety, go to this link:

                 http://www.salon.com/2012/08/24/suicide_isnt_painless/

I highly recommend it.

 As I read Mr. Brown’s piece, I felt a shotgun-like blast of cold air hit me. I recalled the three separate times I attempted to kill myself in the years from when I was 25 years old to 32.  The injuries ranged from superficial to requiring emergency medical intervention. At that time when the awareness settled in my brain that I was going to live, trickling like the first drizzle of raindrops before the storm, I felt sad and confused.  When the full realization broke though the mist, my insides churned and twisted with anger.  Outwardly, because I was among people I managed to remain calm.

When my mother was diagnosed with pancreatic cancer in December of 2001, she was given three to six months to live.  In the same systematic way that she had gone about her life, she went about finalizing the business of death.  She purchased a plot in a Jewish cemetery near where my brother and I lived.  Casually, she told me that she bought the plot next to her for me.  I was puzzled but didn’t say anything.

After her death I found out from a close friend of hers the reason for this unexplained acquisition. We were having coffee at her kitchen table one winter afternoon.  “Gerri,” Nadia said gently.  “Your mother never stopped believing that you would eventually commit suicide. She lived in constant terror.”

A clear advantage that having continually fantasized about, and attempted suicide multiple times is that when my patients allow me access into their wounded psyche, telling me through their tears and trembling bodies that they feel hopeless and helpless and don’t know if they can go on, I understand.  I know the powerful call tempting them to yield to oblivion, the feeling that the hands on the clock have reversed direction; time is going backwards, because living every minute is full of painful anguish.

Suicide can be seductive.  Being crushed by depression, killing oneself can seem like the only escape from unrelenting physical and psychic pain. Convincing one to stay in this world — that seems to consist only of an unrelenting darkness — is a difficult task.

 I can’t tell my patients about my history.  Self-disclosure at this juncture isn’t appropriate.  But I do tell my patient that she is not alone; I emphasize that we – she and I - are in this together and that the thoughts and the depression will pass. If she has a plan or if she can’t commit to safety until our next appointment, then I will hospitalize her.

Often I will surprise my patients by seeming to read their minds; what I am actually doing is verbalizing some of the thoughts and feelings that many suicidal patients tend to experience.  I have firsthand knowledge of these because I felt them as well when I was suicidal. “I’m a burden to my family.  They’d be better off without me.” Stunned, they ask through their tears “How do you know that?”  And I reiterate that they are not as alone as they believe. 

Talking openly about suicide with my patients does not increase the likelihood that they will follow through.  Studies suggest the opposite. I encourage them to talk freely.  I may ask a few questions. But mostly I listen. Intently.

When I was finally able to share my fantasies and thoughts about suicide in the therapeutic office which I had come to know as a safe place with a non-judgmental person, I felt incredibly relieved.  Bringing a taboo subject out into the open decreased the intensity of my urge to go through with the plan I had so carefully crafted.

Today, nineteen years after my last suicide attempt, killing myself is no longer an option.  The thoughts and my old plan may creep into my brain during minutes or hours of distress and sadness, but I no longer want to die.  During my recent anorexic relapse, I would often experience chest pains and other symptoms that mimicked a heart attack.  I was so terrified of dying in my sleep that I would take myself to the emergency room to prevent that from happening.

Richard Brown (the author of the post Suicide isn’t painless — the link is above) refers to William Styron’s memoir “Darkness Visible” in his opening paragraph.  When my patients’ depressive symptoms are alleviated to the point where they are able to read, I recommend this slim volume. Mr. Styron is an eloquent writer and he captures the elusive essence of  an intractable depression and its fundamental nature as no one else has been able to do. 

It’s ironic that my favorite passage in the book contains a sentence that Mr. Styron credits to another writer.  Mr. Styron is walking through the woods and spots a spectacular flock of geese flying high above the foliage.  This specific line of Baudelaire’s that comes to his mind, pushes through his hazy consciousness.  “I have felt the wind of the wing of madness.”

Gerri Luce is a licensed clinical social worker who publishes under a pseudonym.

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