I recently read the very disturbing news of a third teenage suicide in my hometown of Newton, MA.
As a specialist in suicide, whenever I hear such news, I try again to understand what is going on in someone's mind at the moment they take their life. Each time I am prompted to do that, I come up with some new understanding.
It's a lifelong work in progress, because I'm not sure I will ever entirely grasp it.
However, reading about the most recent suicide, this time of junior, Roee Grutman, at my high school, Newton South High School, caused me to recall an incident when I firsthand experienced the "sanity" of killing oneself over thirty years ago when I temporarily went into the mind of someone set on killing herself.
I had been moonlighting (covering call for 48 hours alternating with another young psychiatrist) at Metropolitan State Hospital in Norwalk, California. As a result I was very sleep deprived when I met with Nancy (name changed) on Monday. Nancy was a highly suicidal woman in her late twenties who had made three prior suicide attempts (two of which should have killed her) and been hospitalized 3-4 months every year for the previous four years.
I didn't think I was helping her and yet here she was in my office eight months after her last hospitalization following her last suicide attempt (having jumped off an third floor balcony that shattered her pelvis). That was the longest she had been out of a psychiatric hospital or gone without a suicide attempt in four years.
Nancy rarely looked directly at me, but instead stared thirty degrees to my left or right. On this occasion as I was seated with her, the room suddenly went from color to black and white. And in a few seconds the black and white turned into a horrific wavy grey. I thought I was having a stroke or seizure. Since Nancy wasn't looking at me and I therefore didn't think it would be rude, I did a neurological examination on myself. I tapped on my knees, then my elbows, then stared at my right index finger as I pointed in up and down and left and right.
Everything worked, so I concluded I wasn't having a stroke or seizure. I then had this crazy idea that I was somehow emotionally seeing the world through Nancy's eyes. And it was awful.
I leaned into it and it became even more horrific. In retrospect I think I was seeing into something that others have referred to as "the dark night of the soul."
At one point, Nancy's suicidality made all the sense in the world to me. Being sleep deprived I blurted out, "Nancy, I can't help you kill yourself, but if you do, I will still think well of you, I will miss you and maybe I'll understand why you had to."
I then asked myself, "Did I think that or did I say that?" Realizing I had indeed said it, I thought to myself, "Dammit, I just gave her permission to do it."
Nancy looked me directly in the eye and when I stared back into hers I realized I had seen her world correctly. Thinking I had just blown it I asked her, "Nancy, what are you thinking?"
Nancy looked at me with a slight smile and what looked a little like "life" in her usually lifeless eyes and said, "If you can really understand why I might have to kill myself, maybe I won't need to."
And then the color in the room came back and so did Nancy. She went on to get a Ph.D. and get married and have children.
But what I have been left with is how at a moment when someone is experiencing what I call the six lesses of suicidal thinking—helpless, hopeless, worthless, useless, pointless, meaningless—suicide can seem like a rational way out of their pain.
It's as if your mind has hit the opposite of a jackpot on a slot machine where all the tumbling wheels have lined up to spell "des-pair" and where you feel unpaired with help, hope, worth, use, a point, or meaning and where pairing with death as a solution makes sense.
And in that moment not realizing that suicide is a permanent solution to a temporary problem, you don't live long enough to give the this slot machine one more pull.
In my studies on neuroscience I think what may be happening is that our three brains (referred to as the Triune Brain by Paul MacLean)—rational/upper/human on top of the emotional/middle/mammalian on top of the fight or flight/actional/lower/reptile—in a suicidal mind are not able to line up with their world as they are experiencing it.
That is why terms such as "unglued," "out of sorts," and "wigged out" seem so apropos to a brain that has lost its mind's connection to the world. When the three brains are really out of alignment and out of sync with anything in their life the feeling of free floating anxiety and panic can become unendurable.
It's at that point when the feeling, "I can't bear this another moment," connects to the thought, "I can stop it all if I kill myself" becomes the impulse, "Just do it!" Ironically, in many cases the moment just before committing suicide can be a very calm one as everything in your mind aligns with a solution to the inescapable pain you are feeling.
I think what might have happened in my meeting with Nancy is that being sleep deprived, connecting with, understanding and even feeling the sanity of her having to kill herself, helped her feel less alone, feel less "without" and more "with." And that seemed to be enough to bring her back.
And the takeaway?
If you're dealing with a suicidal mind that might be feeling without help, hope, worth, use, a point or meaning do what you can to feel it with them as opposed to giving them a solution that they may nod in agreement with from the neck up, but have other more lethal plans from the neck down.
To help you with that check out: What your teenager wants you to know, but won't tell you and if you have a teenager or know anyone it might speak to, share it with them and have them tell you what's going with them. And then don't try to solve or fix it, "Just Listen."
Pain is pain, suffering is feeling utterly alone in pain. If you can find a way to help people feel less alone in pain, suffering they can't live with becomes pain they can.