Monday, February 16, 2009

How to Save a Life


Caveat: This may make you feel bad. If you know someone who killed himself, or herself, and you feel badly about your part in it somehow, get therapy. Or talk to someone about it. You matter, too, and despite what you might think after reading what I write below, you probably couldn't have helped that person, probably could not have saved a life. It's one of those things, best to take yourself off the hook.

One night last week FD said to me, "We should make a shiva call tonight."

Someone who sits shiva has lost a parent, sibling, or child, a member of the  family of origin. From burial to "getting up" from shiva, friends have a week to stop by and sit together with the mourners, console. Or they can call on the phone, if the mourners are out of town. My parents call it a condolence call.

I felt badly for not being on board, but it had been a long day. I just didn't want to sit anymore, not with anyone. I wanted to eat some dinner, make a few calls, work on taxes, try walking a little on the treadmill, see if I could ride a bit on the stationary bike. I told FD I had a break the next day and intended to visit our friend then, maybe do some shopping afterward. Did he want to come along then, skip tonight?

Call me before you leave, he said.

So I did, and he went along. We visited someone who had lost his father, a dear man in his eighties. Our friend talked about his mother, alone now and missing her spouse, what that must be like, missing him for what will be the rest of her life. To her, this man in his eighties died prematurely.

Sad but a relatively easy shiva call, as shiva calls go. No one lives forever, children should outlive their parents. There's a certain order that makes life just a little easier to take, sometimes.

After the visit we grocery-shopped and had some lunch. I dropped FD off at his office and started back towards mine.

Then I heard the song. I'd heard this song maybe three or four times before, and each time would think, Catchy, but what's he's saying? Is the refrain really, how to save a life? Is this song about suicide? It sounds like the lead singer is blaming himself, this mournful, plaintive voice in the band, the one full of regret.

But honestly, all due respect, words run together for me and I don't want to think this. I'm on my way to work thinking, how to save a God knows what, flashing on that first patient and  wondering where am I going with this woman. Is my treatment plan on target? One false move. . . No room for mistakes.

I’m an aquarist and have had a bad fish week, lost three, one to an attempted homicide. The bat fish didn't make it through the mauling. A trigger mistook him for a leaf, perhaps. The clowns died of broken hearts, in sympathy, no idea. They just couldn't smile anymore.

But these are people.

I get to the office early and log onto YouTube, because there's really nothing to worry about with that first patient and I know this, truly the job is in hand, the work's been done. We're in middle phase, putting together a few pieces, not resuscitating anything, anyone.

And there it is, the music video, obviously a hit, a clear winner, it pops right up. Many others boast videos "with lyrics." So apparently I am not the only one who didn't get them on the radio. Once you know the words, like everything else, meanings are clear as rain.

Where have I been? Why haven't my kids told me about this? Don't they know I need this stuff? It's like oxygen for me, a song like this. I print out the lyrics, then watch the video maybe five times, mesmerized.

Fray, the band, won't let me embed it on my blog, so readers must find it themselves or follow a link.  With their permission, here are the lyrics.
How To Save A Life:
Step one you say we need to talk
He walks you say sit down it's just a talk
He smiles politely back at you
You stare politely right on through
Some sort of window to your right
As he goes left and you stay right
Between the lines of fear and blame
You begin to wonder why you came

CHORUS:
Where did I go wrong, I lost a friend
Somewhere along in the bitterness
And I would have stayed up with you all night
Had I known how to save a life

Let him know that you know best
Cause after all you do know best
Try to slip past his defense
Without granting innocence
Lay down a list of what is wrong
The things you've told him all along
And pray to God he hears you
And pray to God he hears you

CHORUS:
Where did I go wrong, I lost a friend
Somewhere along in the bitterness
And I would have stayed up with you all night
Had I known how to save a life

As he begins to raise his voice
You lower yours and grant him one last choice
Drive until you lose the road
Or break with the ones you've followed
He will do one of two things
He will admit to everything
Or he'll say he's just not the same
And you'll begin to wonder why you came

CHORUS:
Where did I go wrong, I lost a friend
Somewhere along in the bitterness
And I would have stayed up with you all night
Had I known how to save a life

CHORUS:
Where did I go wrong, I lost a friend
Somewhere along in the bitterness
And I would have stayed up with you all night
Had I known how to save a life
How to save a life
How to save a life

CHORUS:
Where did I go wrong, I lost a friend
Somewhere along in the bitterness
And I would have stayed up with you all night
Had I known how to save a life

CHORUS:
Where did I go wrong, I lost a friend
Somewhere along in the bitterness
And I would have stayed up with you all night
Had I known how to
Save a life

A critical thinker would watch the video and say, so emotionally manipulative. These are actors, hired to look sad, to draw attention to a problem affecting youth today, but there is no way that any of them would really want to die, would voluntarily take their lives.

But the truth could be otherwise. Although these are actors, they are representative. There is an ennui that affects young people, like old people, a psychic pain that affects the leaders of tomorrow, and I see them in my office and we talk and talk and talk, and there was a time, when I was young, that I would be on the phone all night with them. I knew so little back then.

More aggressive, I haven't done that in a long time. Not only are youth at risk, of course. Anyone who has lost everything, which is easy to do, is at risk—middle-aged men and women who have no savings, no jobs, fathers, mothers, grandfathers, grandmothers, the old and the young have angst, suicidal wishes. We know them.

Along comes one, distressed, withdrawn, glassy-eyed, a friend of any age, who has changed. And let's say you have this chance, somehow, to stay, to help this friend through one night in particular, one awful night. It is a horrible position, to have to do that, to make that choice. And with grown men, it's not as if anyone is asking you to stay and hold hands, not usually.

Maybe you know. He’s not going home to anyone. He’s isolated. In a book you are reading you learn that isolated people are at higher risk. It is sometimes easier if there are friends, family around. Living with someone is better than living alone; the support is built in, not that this always helps. People can be in the next room and not be there, not be very much help at all. They may even be a part of the problem.

Thus as a real friend, you have to stay to save a life, as Fray tells us. You may have to call someone else, explain why you'll be late, maybe why you'll be out all night. Mention that you might need some assistance, too.

But you have to stay, and you might have to stay up all night.

You never want to be in charge of someone's life, it's not a great position, it's not usually what we sign up for when we say, I'll be your friend. But sometimes, by staying, we make it a little easier for a friend in trouble to hold on. Stay just a little longer, until you have a chance to bring in bigger shoulders.

It can be hard hanging in there with someone who is seemingly smiling politely back at you. (Lyrics like these strike a familiar chord. We've seen this smile). You can't politely look right on through, go your own way. To be trite, you may not pass this way again.

Between the lines of fear and blame. You begin to wonder why you came.

Except you shouldn’t wonder, because your fear is nothing compared to his, and no one, really, is to blame. Depression happens and is obviously the domain of the therapists, the professionals—doctors. We have the tools. Sometimes all we need, however, is some unknown actor to play a quiet understudy role, to be a stand in for a few hours, keep our patient alive, watch him and don’t let him let that impulsive, senseless act happen. Get through the night and then find help, the bigger guns, to fight your friend's depression. Tell someone, a parent, a primary care doctor. A cop.

Anyone can sense a death wish, you know, feel that Spidey sense tingling. It is a scary feeling, sensing a death wish, because we have no control, none over the actions of others. Intimate information, insider knowledge direct from the mouths of our suicidal friends will haunt us if the act is consummated.

Like isolation, seeing self-destructive behavior is insider information. If a friend has been hurting himself, or has been hurting for a long time, drinking and drugging without any thoughts about tomorrow, then the direction of his mood won't spontaneously lift, the negativity won't fly away, not without medical intervention. That is when we have to seek help, can’t wait around for tomorrow. It is too dangerous a cocktail, negative thoughts mixed with accessibility, the accessibility of drugs, alcohol, bullets, ropes, blades. We can't walk away the truth of our violent world. We have what to fear, old Yiddish expression.

So scary, and we’re so powerless, You wonder why you came. So you go.

When we don’t, when we reach out, they punish us. This is how they make us feel, depressed people, like we're useless and powerless, like we can't help them. Why bother? This is how they feel, useless and powerless, failures, better off dead, not worth bothering about. It is called projection, and a sensitive friend feels what is in the heart of another, this feeling that there may be, truly, nothing that can be done.

Such a trap, and so wrong! Over-rated, powerlessness, hopelessness. Push help, find those friendly cost-effective social service people at the local mental health agency, the professionals. They’ll think of something. That is the rational way of seeing despair. The social scientists can't treat everything, not every time, but God knows, they can treat depression, and more often than not, win the battle.

Someone has to stay rational, unafraid, and above all, hopeful. You, the friend, perhaps the lover, sister, brother, parent, spouse, are elected. Maybe it won't work, maybe you will lose this person in the end, but you don't really know that, do you? So you can't run away, that's for sure, hoping that in the morning your friend will be okay.

You can't stay right if he turns left. This is the projected abandonment he is hoping for, you validating his worthlessness with your leave-taking. Don't fall for these words, I'm okay, go home. Be sure someone else is on call. Or stay.

This is not to say a person should be manipulated to stay by suicide threats designed to control the relationship. This is entirely different, a typically borderline personality modus operandi, and it is not an easy call to make. One in five with this disorder do kill themselves. But threats are threats, and as such need to be taken to a higher court. There is a fine line between dependency and despondency, but sensing you are walking that line, it is best to get out of the helper/rescue role.

It is too big for you. It is too big for most of us. That is why such people are so lonely.

Oh, so much to say. Why did I start?

Because so many people, after a suicide, say, I knew.

I tell people to talk openly about it, about this idea that most of us have had, at least once in our lives, that life is too tough, that we wouldn't mind finishing it. And they should discuss meaning, why choosing life is the better alternative, because there is meaning. It is our job to find it.

Having the discussion doesn’t make it your job to find meaning for your friend, the one who wants to die. It is the job of professionals. But you can play with it. It is a wonderful, rich, very intimate conversation we're talking about, and as such can be therapeutic. Therapists have no corner on these conversations. We do tell people that a suicide is permission to the generations to come that it is okay to throw their lives away. And if you do happen to help a friend find meaning, if together you find that elusive raison d’etre, within the throes of discussing depression, you are amazing, both of you are, and should consider this profession.

Oh, but we aren’t finished. In the process of this philosophical discussion, should your friend mention a suicide plan, then this is a heads up, don't take it lightly. There is real risk. Your friend is capable, armed, can exact a suicide. Now is the time to phone for help. More drama now, less later.

You can and should call parents, if there are any, and they are around. Real friends know how to find them, aren't afraid of these people, the ones who birthed a suicidal buddy, who brought a suicidal friend into the world. It is possible that these people hold the key to something very elemental to your friend's survival.

If there are no relatives nearby, then you may be the closest relative right now. You don’t want to lose him, but he can be such a burden, sometimes we give up. If it were our child with a fever, we wouldn’t give up. This is a child with a fever.

Where did I go wrong, I lost a friend. Somewhere along in the bitterness.

Whose bitterness? Suicide is an angry act, a vitriolic act. At some point there's energy, enough to make it so, that decision, the one that spells relief. It takes a lot of psychic energy. The decision to do it can be invigorating. So we watch people when they say they're feeling better, watch them more closely. We're thinking, the energy is available, the time is now. He's going to go left. There's so much energy in the bitterness and anger. Toxic stuff.

Let him know that you know best. Cause after all you do know best
All you know is there’s something really wrong here. Even we, the professionals, the ones who know, don't give advice. We listen. We teach from experience and we do it gently, if we do it at all. All we know is we find death repulsive. Our friend does not.

When your Spidey sense says, You're not getting through, this person is going to try it again, it is time to call for reinforcements. I've had kids never see me again because I forced a hospitalization.

Enough. It is a blogger’s prerogative to ramble on, but you get the idea. You know the symptoms to look out for, the loss of interest in the usual pleasurable activities, not caring about school or work, not caring about hygiene, expressing hopelessness and helplessness, giving away possessions, revealing a suicide plan.

You don't want to be an armchair therapist, here, not a self-appointed therapist, certainly don’t want to beat on someone's short-comings, not ever. Like Fray warns us in the song, we don't tell a person what he doesn't want to hear.

Our unconditional love and support? It might feel good, but it might not, won’t necessarily save anyone’s life and doesn't take the place of professional help. It is all we have to offer, however, when someone won’t get help. The real kicker is that people can fool the healthcare professionals. As soon as they’re released, they overdose or shoot a bullet through their heads.

When they have had help and given up, it is the worst. We have to reinforce that therapists are a dime a dozen. Try another.

Meanwhile, scheduling is impossible, and there are no appointments and your friend is taking his feelings into his own hands, dosing out his own medicine, not caring if it helps or not. And you're there and you can tell, he's too drugged up, or he's drinking too much, that this isn't good.

So you call 911.

And there, you've saved a life.

You don't have to wonder about any of it, you don't have to wonder why you came, why you stayed. The un-timeliness is what we're talking about, the premature death, the one we want to avoid, no different in its importance than the one we talked about earlier, the octogenarian who still died prematurely, at least according to his wife.

We want to save a life at any age. That's why we stay. We—you—are a part of it.

therapydoc

44 comments:

Lou said...

I understand this post on a gut level. Thank you very much.

Wendy said...

OMG THANK YOU - THANK YOU - THANK YOU.
You know that we lost our precious son to suicide. But after all these things you said, it would not have saved our son. He hid from us how he was feeling, he hid from his friends how he was feeling, he gave each one of us a small pieace of his pain - but it wasn't until after his death that we started to put the pieces together and saw the whole horrible picture.

If there is anyone out there who is suicidal - SEEK HELP NOW. The pain you carry now, will be blessed upon all those who love you a THOUSAND fold (and right now you think no one loves you?? You are so wrong). Visit Caleb - then call 911. Http://caleb-joseph-mcintosh.memory-of.com (leave a message - remind him/yourself that love is all around us!!!)

Therapydoc - it is never out of season to speak of suicide. Thank you from the bottom of my broken mother's heart.
Wendy

therapydoc said...

Yeah, I kind of worried about you when I wrote it. It's a relief to hear you say that. Thanks.

therapydoc said...

Yeah, I kind of worried about you when I wrote it. It's a relief to hear you say that. Thanks.

Jack said...

I know or should I say knew two people who committed suicide. One killed himself at 20 and the other was about 30.

Can't say that I was best friends or all that close with either one of them. But they were people that I had spent a lot of time with. I have often wondered what led them down that particular path.

So very sad.

jeanie said...

I remember when someone I once loved committed suicide, I talked to people who had seen him the evening of the incident.

They all said he had been acting "strange". When I asked why they hadn't called in help they had not wanted to because it would be too invasive.

His own family had driven past a hospital the day before bringing him back from a psychotic episode, but had not taken him in because it would be too invasive.

Suicide is invasive - thank you for saying that it is okay to get help for others.

For many it is too late. But if this post makes someone think "I will call for help" for a friend, please I hope to goodness they do because being there, being supportive and calling out for those who can help is not an invasion.

Anonymous said...

Been in therapy FOREVER, with MANY different therapist, have tried probably every Rx ever compounded..been inpatient, outpatient..and all I have to show for it is an empty bank account. I feel like I "white knuckle" it through every single minute of every single day, in an attempt to NOT act on my desire to put myself out of my misery.

Sure, if someone's new to depression, having some random crisis etc..then by all means, haul out all the resouces available and things will probably improve. Eventually though, if nothing ever works, then there does come a point when enough is enough. I can't afford more help even if I thought it might work, but honestly, I feel like I've tried everything and have given up on others helping me. If anyone is going to save me, it's gonna have to be me.

Retriever said...

A beautiful and helpful post. Our family knows too much about such things, mercifully all averted so far, but we had a scare about one family member this Thanksgiving that just about destroyed us all. I had to keep telling the others that we had professional care for the hurting one, and that tho there were many things they could and should do to help them, that they couldn't find meaning and purpose and resolve to live for them. Iit takes a terrible toll on families, as well as the sufferer. One feels awful responsibility without much power.

In the past (worry over another relative) we found the NAMI 12 week course for relatives helpful, but a lot depends on the other people and the leaders, That was the only place a few of us ever felt understood enough by others going thru isimilar vigils to keep someone alive (not enough psych beds and insurance refusing to pay for long enough) that we could smile or even relax briefly.

Anonymous said...

What about people who are chronically suicidal?

I have a friend who is really struggling right now. She's had several serious suicide attempts in the past. She's had several long inpatient psychiatric stays. She has a psychiatrist who she sees several times a week. She's still not better. I can't stay over at her house every night or have her move in with me.

How do I help her? What can I do to nudge her, even a little, towards choosing to live another day?

Any suggestions, comments, would be really appreciated. I worry about her a lot.

therapydoc said...

I love NAMI, thanks Retriever, and Jack and Jeanie.

ANON, I think there's so much to this, the idea that if anyone's going to save a person, it has to be the person himself, herself. The only problem is that depression is the enemy and limits us, zaps our emotional zip, so to speak.

And yet. If a person can keep the words in her head going, keep up a positive dialog, and this is surely possible, our minds are infinite, capable of all kinds of good thoughts, then survival is surely possible. Our thoughts and energy are boosted by what we see, what we read and learn. So sure, a person can make life stimulating without treatment. It's surely possible.

I personally recommend some kind of therapy or even an eco-therapy, being out and about as a community person, damn the mood, if one can do it. I prefer this being out and about, knowing that dialog can help. And the problem with depression is that it makes us vulnerable to very self-defeating, negative thoughts and behavior, events that are on the hopeless side, that may very well be a consequence of the very limitations of depression, that tunnel-vision, or maybe we should call it, tunnel-thinking that leads to nowhere.

But if we're in some kind of meaningful dialog, be it with a therapist or a friend, a homeless person, the neighborhood grocery bagger, the mail carrier, the guy who cuts your hair, for all I care, we have more of a chance at connecting to some kind of reason for living.

Depression cuts us off from meaning, from touching others, being touched by others, from behaving in ways that might actually matter, to others, maybe to ourselves.

And unfortunately, it can be very vegetative. There goes the out and about. And this very nature of depression, so limiting, which is why beating it somehow, maybe by oneself, maybe with dialog, maybe medication, or a therapist, some kind of life line, might jump start hope for tomorrow. Beating depression, it always seems to me, is the prime directive.

If a person either has the big shoulders I'm talking about, can help himself, or knows people with fairly decent sized shoulders, the capacity to nod, lend a smile, an opinion, the day to day food, source of feel-good, then the therapy, surely is oneself and others. If you can do it, more power to you. I'm sure you can. Probably most people do it alone.

As a social worker, I'm all for it, helping yourself. Anyone taking the time to read stuff like this is on the way, is essentially in recovery. It was a long post, and I shortened it considerably, and the comment, apparently, is too. But the very nature of it, this process, even though I'm speaking hypothetically, not really to you, ANON, so much as about what you say, is social.

And March is National Social Work Month. So we're getting close, aren't we, to something.

Meansomething said...

Therapydoc, a long time ago I stumbled across and read a book called HOW I STAYED ALIVE WHEN MY BRAIN WAS TRYING TO KILL ME: One Person's Guide to Suicide Prevention, by Susan Rose Blauner. I wonder what you would think of this book. I thought it was smart, and touching, and authentic. Maybe Anonymous at 5:41 would check it out?

Cham said...

This post was so moving. Thanks therapydoc

blognut said...

Ouch - you DID warn me though, didn't you? I talked an employee off of the proverbial ledge early last fall and got her parents to check her into a good facility. She's doing well, but I never could have done that for her had it not been for the fact that I volunteer on a hotline and have taken these calls many times. It's SO different when you're talking to someone you know and you're questioning everything you "should have seen."

That said, my nephew tried to hurt himself just last night. He lives far away, and I totally saw it coming, warned my sister, begged and pleaded for her to get him help. She felt limited in what she could do for him because he's 22 and she can't tell him what to do. True enough, I suppose, but you have to try. I guess this is sometimes what it takes to get people to get the help they need, because he's getting it now.

Rachelz said...

I had heard that song, but had NO clue what it was about.
This was a beautiful and helpful post, thank you.
I live in fear of losing a client, or someone in my life.
Connection is the most important thing I guess.

Samurai Scientist said...

The song is a great one and certainly one of the most popular songs of the last few years. I always took it as talking about relationships, about losing friends (or loved ones) over stupid stuff.

There's a lot of wisdom in rock and roll.

therapydoc said...

Right SAMURAI. If I ever ran out of material, which isn't possible, I could search the rock and roll lyrics and go to town. It's crossed my mind, too.

therapydoc said...

Or talk opera. But not so many readers like it as much, I feel.

rosysunset said...

What a touching post, TD. I love all of them, but maybe this one is best?

I came close to the precipice this fall. Did some stupid things. Was lucky to wake up in the morning.

Ever since then, it is like suicide has this rosy glow, this aura for me. I used to be ambivalent, even negative about it. Now it has this attraction for me.

I was feeding my baby awhile ago and was just looking at him thinking "am I going to die by suicide? A lifetime is a long time to NEVER make that decision."

All this even now that my mood is stable (with the help of meds).

I wonder how to gain back my former perspective on the whole thing.

Anonymous said...

TD,

This is one of the best posts I have read from you, even if a tad bit emotionally manipulative. ;P

Anyway, it applies deeply in my life atm.

ps... my capatcha was reper.

Syd said...

Thanks for the post. This is really good advice. I would hope that I could see the signs. I think that many people don't think that someone will actually kill themselves. It's foreign to our nature. But it does happen and it is real. Great post.

Anonymous said...

Beautiful post. My Daddy committed suicide when I was 14. We did not have the hindsight that so many have. It hit us out of no where. His depression was shortlived , but severedecieving ..and fatal.

I recently put distance between a friend who frequently yells suicide. Till I reailzed the docs aren't admitting her ... when she supposedly calls 911 they 'do nothing' (then she's not calling 911!) and that it was being used to manipulate me ... and to keep me close ...

porcini66 said...

I used to think that suicide was so incredibly "selfish". That anyone that committed suicide was just out to hurt those that were left behind. Thankfully, I have grown older and a bit wiser, a bit kinder. And, I've gone through a lot of pain (more than others, not as much as most). I see now that it is all about pain. Their pain. Their feeling that they cannot possibly resolve that pain. I have seen people through more than one night since my young "they should get over themselves" years. And I am always glad that my shoulders "seem" strong, even when I am quivering inside and sure that I am gonna screw this up...

At the end of the day, though, it's not about me, is it? It isn't about whether I am strong enough to be there for them. It is about their need to have another human being care enough about them to just BE with them. It is about being there for another person, always, through the darkest moments. Steadfast. Loyal. Sure. Unafraid. Be that for them, until they can learn to be (want to be) that for themselves.

Or, like you say, call 911. Either way, you save a life. Please, let me always be able to help my friends in pain. It is the least I can do as I have been given such a gift. I have suffered (again, more than others, not as much as some) and I have come through the other side to know that it ALWAYS passes. It ALWAYS changes - for good or for ill. It is never dire enough for suicide, no matter what - because we can start every day over again at ANY point.

Sorry to ramble on - but wow...that post hit home. Thanks, as always, for writing.

Anonymous said...

hey therapy doc--I saved a life the other day when i was talking to one of my tutoree's mom and she was telling me how manic/depressed she was so I gave her the number of my doctor and she is going tomarrow to be helped---is that exciting! She is going in the morning and i in the afternoon.

therapydoc said...

I have the best readers on the internet. Hands down.

nashbabe said...

My therapist said "you know, it won't always be this difficult." I knew she was right. Hope deferred makes the heart sick, as the good book says. Perspective helps a lot. Good post.

caroline said...

this post has had a powerful impact on me - i have come back to this post over and over again. and the song by The Fray has played constantly in my head. i come from a large family that has strong history of mental illness and attempted suicides. i have struggled most of my adult life with depression, but through work in therapy i have been able to find a good place for myself in my early 30s. i have broken the cycle of addiction and denial of mental illness. i am successful in my job and have an advanced degree. but no matter the amount of therapy, or the work i put in, or the success i achieve, i have a belief that some day i will take will own life, that is my legacy. i know that i have control over that action and that it is irrational, but it is a belief that i have not yet been able to change.

thank you for this post and for all your other posts.

therapydoc said...

You see? That's exactly why we have to stop people from doing this, taking their own lives.

There's a self-fulfilling prophesy, this ridiculous notion that because others in the family did it, you have to or you will, too.

And everything you have to offer others, everything you have to teach, to give, poof.

I don't see it this way. I'm not giving you personal advice, Caroline, you know I can't, but people develop all kinds of new skills, new aptitudes, new trajectories in life.

As Dr. Seuss used to say,

Oh, the Places You'll Go.

Or Woody Allen would say, All the Movies You'll See!

Or as therapydoc is forever saying, A permanent solution to a temporary problem? Feh!

catatonickid said...

Wow, Doc. Serious clarity and impact right there.

Having been there and done that, so to speak, several times I really get this one. But it sure feels good to hear someone who knows a thing or two say that yes, that is a good path to take...

Because when you're faced with someone struggling like that you sure do wonder.

Be present 'eh. I like it :) I wonder if there's much more we can give each other when we confront death so closely?

therapydoc said...

Please understand that I'm not trying to minimize psychopathology. People who survive suicide attempts will tell you that they are in a hole that they cannot see getting out of, ever. They really aren't in a place you can cajole, joke, encourage, advise, or coax out of. The mood is unshakable.

That's why I tell people, don't bother with advice, don't bother with criticism, don't bother with talk, really. Be there as a policeman, basically, making sure nothing bad happens, because sure as rain, it will.

and you don't want it on your head, not that you would be to blame, but you would do it anyways, blame yourself.

Therefore, 911.

catatonickid said...

Oh, no, I didn't think you were.

I agree. I mean, it seems hopeless because it *is* hopeless... once someone makes that decision they don't just snap out of it.

I think maybe part of the difficulty for an observer is letting someone be that hopeless if they have to be. That's not so easy to sit with 'eh. Sure I don't have to tell you that. LOL

But yes, yes, yes! Call help. Watch 'em like a hawk. Remove/hide sharp things and meds if you can.

Lisa Marie said...

I can see this in two perspectives. I found my sister on the bathroom floor after swallowing a bottle of pills. Did not understand why she did it and why we had no idea about her having a hard time.

I wanted to kill myself in November after the prospect of healing was just too much. I didn't tell anyone because I was worried about what would happen. I finally understood.

This post is so wonderfully delivered. Thank you for your wisdom.

twodogsblogging said...

Wonderful post and thanks. I have watched so many of my friends go back to using and die. Some commit suicide directly; others do it on the installment plan. I love the song, BTW. It's on my I-pod.

JJ said...

I know you have no shortage of songs to blog about, but I heard a new one today by Tim McGraw called Nothin' to Die For... made me think of this post.

Here are some of the lyrics:

Stopped to have a few at five now you’re crossing that center line for the third time
Second time like this this week had a friend ask you for your keys
You said ‘no I’m fine’
You sure do act like you don’t got a thing to lose
But every car you pass might be the one’s you take with you

{Chorus}
You’d give your last breath to your wife
Take a bullet for your kids
Lay your life down for your country for your Jesus for your friends
There’s a whole lot of things you say you’re living for
You’ve got to fight it somehow, stop and turn around
‘Cause this ain’t nothin’ to die for

So what’s the harm in a little fun
‘Cause you’re off to work before the sun everyday
And the inbox outbox locks you in and the money you make ain’t worth the time you spend to make your pay
The doctor says ‘man your numbers they don’t lie’
The graveyard’s full of folks that didn’t have time to die

therapydoc said...

Oh, I have to blow that one up and post it in my office! Thanks.

Beloved Parrot said...

I am so glad to hear someone talk about this song. It's an excellent post.

I heard it on the radio on the way to work this morning, and thought again about your post and your blog.

My 40th high school reunion was this past weekend. There was a boy in my class who, unbidden, did two incredibly special and sweet things for me in high school, and I've looked for him for years to tell him how much they meant to me.
This weekend someone told me he'd committed suicide when he was 25 or 26.

The waste of it, the waste of such a valuable life, staggers me now.

Even after all these decades I find myself wondering if there was something I should have recognized, something I should have done or said -- even though we barely knew one another.

But that was before Prozac and being socially allowed to talk about depression. Things are so much better now for people who suffer with mental illness. Even rock songs demand we talk about it now. ;-)

therapydoc said...

I'm still always surprised when I hear a story like this, the nice guy, wanted to thank him, gone.

Mental Health Specialist said...

Wow, this is a truly inspiring post. In fact, I am very familiar with The Fray and my perception of that song has forever been changed. Great article on calling for therapy and "how to save a life".

Anonymous said...

Thank you for this. Written from your gut and heart.

I know what it is to lose almost everything in late middle age--including my health and the ability to work--and to live with the Sword of Damocles hanging by a hair over what little is left--the result of wrongdoing on the part of a once deeply trusted professional.

To face catastrophe alone, with no family. Friends having turned away--because they don't know what to say. Or go into 'blame the victim' mode, judgement, minimization, comparative suffering--in order feel comfortable. The Just World Fallacy. And the worst, gossiping....

I am still here because of two deeply loved animals--a horse and a dog. I will hold them close to me as long as I possibly can.

I practice mindfulness meditation daily. I write. I practice self compassion and dropping into and openeing my heart. I visualize grounding and centering, owning my force field. And when I am lost, I try very hard to find my way back.

I have a connection with a teacher of mediation who empathizes and genuinely cares. Sometimes, having just one person....

I walk away from toxic people. I set boundaries. I am learning the difference between being 'nice' and being 'kind'. I have become fierce.

And I get out and engage in superficial social banter with waiters in cafes and clerks in shops.
Dog lovers stop me on the street to meet my lovely pooch. People who know nothing about my trauma--it's better that way. But I do establish transient connections with others.

What has not helped--traditional talk therapy. Therapists who do not understand or have experience with trauma. Anti-depressant medication--I am very sensitive to drugs and the side effects are
worse than grieving so much loss. Being threatened with hospitalization--that will only make worse my dire economic situation, which is the source of my despair.

I very clearly have PTSD related to what happened, on top of an abusive childhood. Complex PTSD, I think they call it. Nightmares, panic attacks, crippling anxiety, avoidance, intrusive thoughts, hyper-arousal, increased startle, the sense of a fore-shortened future, sensitivity to triggers.

What keeps me "stuck"--my inability to work, due to my health, having no financial safety net if/when the other shoe falls, losing my home, the very real fear of losing my beloved pets who keep me here.

The truth is there is no "fix". I am a determined, smart, resourceful person who has tried everything possible to resolve this catastrophe.

When the other shoe drops, I will fall through the cracks, and into disaster. I pray for miracles that never come. I even stood up for myself in court, but the wrong-doer lied his way out of responsibility, putting me on trial instead, much as is done to the victim of rape A total travesty of justice.

Which pushed my PTSD symptoms over the top.

It is a very hard thing to live without hope. But I am still here. I want very much to live. I search every day for rays of hope in small things. Some days are spent in denial, when I convince myself all will turn out somehow. And then reality intrudes, denial falls away, and I realize my 'good day' was created out of delusion.

I totally understand why someone under extreme circumstances would act to end excruciating and endless pain, and save their dignity.

In the award winning German film, The Lives of Others, a character ends his life. His note said, "Suicide is the end of all hope". He was an artist, a writer--the totalitarian state had taken everything that held meaning from him. They banned his art, destroying his identity, his purpose.

I believe that an abusive, evil person or institution can drive a vulnerable person over the edge. When does suicide become homicide?

I sorta wrote a lot as well. Stuff I do not generally say. But spoken from my gut and heart as well.

Anonymous said...

It's not a fun call to make. I had a friend who said she was going to kill herself. I tried to convince her to call the helpline (we were college students, and our campus has a hotline any time the counseling service is closed). She wouldn't. She refused to talk to anyone. So, while her sister stayed with her, I walked around the corner and made the call. She was FURIOUS. She ran out of the building (leaving her shoes and purse behind). Her sister chased her, and I lost both of them. I stayed on the phone with the helpline until I found them, with the University police. (I called back later to say everything was OK, as the volunteer asked me to). The police took her to the hospital, got statements from everyone involved. The girl was extremely bright, though, and knew how to manipulate the busy residents in the emergency room. She said everything she was supposed to, said she was fine. They let her go. I think she signed a no-suicide contract, but I can't remember at this point (about 18 months later--I still remember the day, what I was doing, what I was wearing...) She was released from the ER just a few hours later, back to her sister. At that point, there was nothing I could do except hope and be there for support. All night, someone was up, watching her, but the next day we got separated during classes and the like, which was very scary. Her sister and I had lunch, talking about how afraid we were. The girl got back into counseling through the university (she had terminated a few weeks before this incident). She saw a psychiatrist, as well. Not too long after, she terminated therapy again. However, she is OK. She lived through that night, and the nerve-wracking days after it. I nearly failed an exam the next morning (I can't believe I passed at all!), but earned an A in the class anyway (barely--and my own counselor had supported my plan to explain the situation to the professor if I did not end up earning the A, but was close). I still remember the fear, the tension, the anxiety. The walk to the police car to make a statement, the panicked texts to her sister throughout the evening. But she made it. We did what we could, and had help from others, and she pulled through. I'm very glad I made the phone call (logically, she would have run anyway at some point, since we were trying to talk her out of committing suicide anyway), but it was DEFINITELY not an easy call to make. Nothing that night was easy, but if I could go back in time, I'd do it all again.

therapydoc said...

Rambling is a good thing, no? As long as you don't lose the message in the pop-up. Thanks for the comment(s). They're fantastic.

Medkid said...

Thanks so much for your post! I'm totally going to print it out and put it in my binder of important stuff for my future practice. I'm months away from getting my MD, but it's not actually for my patients I would print this as a reminder for (though patients do walk into family practices suicidal all the time, but for that I have been trained) but it's for my colleagues and myself as the malignant side of the culture of medicine attempts to eat us alive.

My psychiatry attending always tells the story of a 3rd year medical student a few years back at my school who chose tricyclic antidepressants to end her life. His face goes grave as he says "and you know, it is so hard because we know she was serious. She knew what a TCA overdose would do." And we'd all shift uncomfortably on the cushy leather sectional sofa in his office (seriously the man had a stereotypical freudian sofa, it was awesome!) or in the lecture hall thinking about ourselves and our friends as he hits close to home. That was his objective I think. A not so subtle warning to watch ourselves and our friends.

My mentor tells another story. He only does surgery locum tenums these days and devotes most of his time to helping hospitals and physicians communicate with each other among other things. He recently gave a talk to about 60+ physicians. He opened his lecture by asking "how many of you know of or have had a physician colleague commit suicide." Every single hand in the room went up.

So I watch out carefully for warning signs of depression in myself and my colleagues. Because there were enough nights in the last 3.5 years when friends called me from across campus in a panic telling me they had to take another colleague to the behavioral health ER and they just didn't want to feel so alone doing it, or my roommate instructing me we had to now lock our interior door because another classmate was homicidal and suicidal, enough conversations when stress was reaching its peak being met with blunted affects and withdrawn behaviors. There are enough days when I get emails from other colleagues asking me for referrals to therapist (I have had a therapist for 2 years in med school and a small network within my class knows I'll refer other classmates when needed...). Enough papers have shown the depression and suicide attempts among med students to be higher than the average person of the same age. I'm glad they reach out. Even though most of my classmates are afraid to go to the school psychiatrist for help, I'm glad they are coming somewhere to get hooked in with a therapist. But my greatest fear is not for those classmates who reach out or who have friends who will reach out for them, but for those who don't.

We are trained in an old school, old boys network attitude of "physician heal thyself". Depression, self harm, suicidal ideation, hidden addictions are seen as major weaknesses and flaws of character and competence. It is enough that every day we feel incompetent as we train towards being a doctor, but depression adds insult to injury. This attitude is part of the reason why physicians have the highest suicide rate of people with equal training (seen here: http://www.psychologytoday.com/blog/the-narcissus-in-all-us/200908/the-occupation-the-highest-suicide-rate).

Medkid said...

So what do we do? I for one am working on changing the culture of my med school bit by bit. It's like turning the titanic around, but the first "coup" has been staged with many more to come. Even though it may not make any difference, I have to try, because it breaks my heart that those who devote their lives to helping other people are not met with the same compassion and empathy from their colleagues that they show their patients. Sometimes it feels like a drop in the bucket.

One afternoon I was sent to my PCPs office by another clinician because of complications from a medication I was taking. After revealing to my PCP why I was there and the story behind my taking an antidepressant (years of genetically loaded depression) she said to me: "and you came to medical school knowing this about yourself? That you had these problems?" Yes, yes I did. I applied and arrived fully aware I have a chronic illness and pro-actively signed myself up for a psychiatrist to manage medication with me and (I'll admit, once forced by my psychiatrist...sometimes I'm a little slow on the uptake and have had some not so good experiences with under-trained therapists :P ) a competent therapist to manage life and to learn new skills from and I will be a better, more empathic, healthier doctor because of what I have faced in my life. Nothing builds empathy like a little suffering. :) As a result I am likely healthier than a lot of my classmates.

But that moment changed my own feelings about my disease in the context of my new profession. If I had any question before (which I really didn't, I had lived in shame of my depression for years already) I now knew for sure that I had to keep it a secret because I will be judged harshly and fellow physicians may question my competence. At least while I am a baby physician who has yet to prove herself. I had always kept my diagnosis a secret from everyone but the ones very closest to me (for whom I am un-endingly grateful), but now a more panicked fear infiltrated my secrets. Suddenly I became scared someone would find out, and when I had my own run in with suicidal ideation a year later I was terrified to tell the school psychiatrist lest he tell my school and they suspend me from the very thing that gives so much meaning and joy to my life. Turns out confidentiality is a good thing, and having a therapist I trust who is aggressive and awesome is also a very good thing. Because of her and some hard work healing is happening.

A year later I found a new PCP and up front told her that if she couldn't handle the fact that I had a very well controlled chronic illness that I am managing appropriately while being in medical school then I will go elsewhere. Luckily I haven't had to. Turns out not all physicians turn on each other in judgement (thank goodness!).

So thanks again for your post. When I'm alone late one night and a friend or colleague calls for help, I hope to remember your words and remember how to save their life.

(sorry it's so long! I don't often have a place to share about this stuff...)

therapydoc said...

Don't be sorry, these are amazing comments. I think you're going to appreciate my next post. Not only are you more resilient, but it's also likely (and this is going to be super important as a family physician) that you'll be even BETTER in a crisis than your "normal" colleagues. Thanks so much for sharing this experience. That first doc just didn't get it. When people don't know how to help, it's not unusual that they blame the victim. Another, Wish I could'a said. . .

Samual Minor said...

After reading your sorrowful post,I feel so sorry for you. I realized so many things like how I deal with people. I should be the source of positive energy, not negativity. I should encourage them more, not discourage.