Docsplainin' -- it's what I do

Docsplainin'--it's what I do.
After all, I'm a doc, aren't I?

Saturday, April 18, 2009


'Cause suicide is painless,
It brings on many changes,
And I can take or leave it if I please
-The theme from M*A*S*H,
by Johnny Mandel & Mike Altman
I've never tried it myself, but I really doubt that suicide is painless. Yes, I know--it's just a song. But there are lots of songs out there that imply the same thing, and the sentiment corresponds with what more than a few of my suicidal clients have as much as said. The truth of course is somewhat different.

The time leading up to the decision is certainly emotionally painful, and of course sometimes the person is motivated by chronic physical pain to consider suicide in the first place. And finally, suicide is ugly, so that no matter how you do it, it is going to be traumatic for whoever finds you.

It's not at all romantic

Suicidal people are in a world of pain. They do not feel loved, or even lovable. Waldowski, the suicidal dentist in M*A*S*H, couldn't get a girlfriend, and that was his central motivation for wishing to die. But most suicidal people (I would except folks like Hitler in his bunker) are loved. If you are depressed enough to kill yourself, you can't feel the love, but it's there. Both fictional scenarios, M*A*S*H and Tom Sawyer, are accurate in that regard. People will go to great lengths to keep you alive if you give them the chance (witness the ritual the whole M*A*S*H unit puts on to help Waldowski get laid), and they will certainly grieve you if you don't.

People die because they have given up hope. It is one of life's greatest tragedies that a laughing baby, a beloved toddler in his new white Stride-Rites, a snaggle-toothed teeny-bopper with her braces and pigtails, and a grinning teenage boy can grow up to be so hopelessly miserable that they end up blowing their brains out under a tree in the park one night, swallowing pills and putting bags over their heads in lonely motel rooms, or swerving their cars into oncoming traffic. Or like my friend back in '85, stuffing towels under the garage door and sitting in her car with its engine running, her favorite music on the radio, and a Moosehead in her hand, waiting for the Reaper.
Seasons don't fear the reaper
Nor do the sun, the wind, or the rain
We can be like they are...

We'll be able to fly...
Redefine happiness...
We can be like they are
-Don't Fear the Reaper
Blue Oyster Cult
No, you can't: You can't be like the elements, you can't fly. (The last verse of the song makes suicide sound like the Darling children following Peter Pan out the nursery window.) You'll be dead. Suicide doesn't redefine happiness, or bring on many other changes, either, other than that you are now dead. I once heard a workshop presenter liken people's fantasies of suicide to the scene in which Huck and Tom watch from their hiding place as the townsfolk drag the Mississippi for their bodies, grieving the boys' presumed deaths and regretting every wrong or injury done them, however slight. I'm not sure suicidal people really understand that they will not be here somehow to see that their loved ones or the bosses or whoever "will be sorry." That relationship can't change after you are gone. The people you leave behind may well wish they could have a do-over, but will be too late for that. If you want things to be different, you have to be here for it.

Some folks, like teenagers, or persons with Borderline Personality Disorder, tend to give up hope when the problem situation is clearly (at least to the dispassionate outside observer) a temporary one. This was, of course, the case with Romeo thinking Juliet had really died. But they over-react, they believe that they way they feel now is forever, always has been, and always will be. They cannot remember that they actually have felt better recently, and most likely will again soon. They see no solution to their situations. Such folks are particularly prone to impulsive, lethal attempts. This is perhaps life's greatest tragedy, because such people do not have to die. Many, if not most, suicides don't, but these people really don't. Unfortunately this is a decision that, once made, cannot be un-made: As the old line goes, it's a permanent solution to a temporary situation.

I'm not sure what I'm trying to say with this rambling missive. Perhaps I just want you, if you are feeling this way, not to give up hope. I want you to believe that the love is out there, even if you can't feel it right now. I want you to believe that you can find happiness again, or maybe for the first time, but you can find it.


Lindsay said...

I'm not sure suicidal people really understand that they will not be here somehow to see that their loved ones or the bosses or whoever "will be sorry."Well, I can only speak for myself, but I *HAVE* been suicidal (I am no longer, woohoo) and I can tell you I understood this perfectly.

If you want things to be different, you have to be here for it.I did not want things to be different. I wanted them to end.

Anonymous said...

In light of this blog post on I though you might be interested to read this one. Not so much the main story itself, but the comment by Prokofy Neva a little more than halfway down makes for lively discusion. I will thow it into the mix for people to dwel on.
Prokofy Neva says: May 2, 2009 at 6:09 pm
“I have no sympathy for suicides or the suicidal, because time and again in RL [Real Life], I have seen that what they really suffer from is narcissism, passive-aggression, manipulation or outright psychosis, and the desire to use violence and coercion on other people to get their way. There is a conditionality in our society to the idea that you should pile on the sympathy, understanding, forgiveness, etc for some who is suicidal, but I’m not buying it. Many times I’ve seen classmates, relatives, etc. who commit suicide as either people suffering from a growing mental illness and sickness of the will that involves increasing efforts to try to get other people to bend to their will. It’s much more rare that you find some very obvious uncontrollable mental illness like a psychosis, and often you find this is genetic, that is generations of people with suicide in their family.
People who commit suicide commit an immoral act, a mortal sin, and a criminal act. They commit not only the murder of themselves, they harm everyone else around them. they sometimes bring years of distress and permanent damage to others and entire communities, as you’ve just described. Even though you were merely doing your volunteer job, this murderer was able to take away your life from you, even while you were trying to help him, by performing the ultimate toddler’s temper tantrum and pulling the trigger. I have ZERO sympathy for him, and I wish you had more rapidly consigned him to the immoral and criminal realm he belongs in, exonerating yourself, instead of assuming ANY blame or guilt for his crime.”
Prokofy is a very devicive figure and self proclaimed expert on everything. He has been banned from all the Second Life official forums and has his own blog here
Interesting that you should quote two songs I ofter sing. Suicide is Painless and Don’t fear the Reaper. I have never been suicidal myself but have someone very close to me who has contemplated it many times. I must say I do agree with some of Prokofy’s thoughts in that it is a cry for attention. Whether it’s a genuine cry for help or a manipulative ploy, may be more a matter of perspective, than anything. My heart does go out to Linday as I have been there with this person in my life and the comment "I did not want things to be different. I wanted them to end." ring true with my experience with someone in that hole.

Virginia S. Wood, PsyD said...

And this from someone who complains that my posts are too long!

I hesitated to post Anonymous's comment as the excerpt from Prokofy's site was so hate-filled. Ultimately I decided to because I think it is a good example of the kind of pain and anger that lingers among survivors after a suicide.

Anonymous said...

I work in an ICU of a large, busy, teaching hospital and have seen many people die as a result of suicide attempts that we could not reverse. Lithium and Tylenol, especially the latter, are consistently the most deadly. It is particularly sad because when people overdose on Tylenol, they think they are taking something "safe" and making a gesture. When they come in, before they have lost consciousness, they all express remorse. Unfortunately, we cannot just "pump the stomach" as seen on TV. Liver transplants are almost never (I would say never, but I have seen one exception) offered to people who try to commit suicide. It is a horrible, drawn out, sometimes gory death. And death is certain. I wish the general public understood just how dangerous Tylenol can be.

Having said that, I am considering ending my life via Tylenol OD. Don't tell me to get help because I have been in therapy with the best (of the best) psychologist for thirteen years. I also regularly see my psychiatrist and take my psych meds religiously. I just don't think I want to live anymore. I'm not depressed. There are demons from my past from which I can't escape. My husband and children don't love me (my main function is to bring home a paycheck from I job that I've come to hate). Nobody loves me or even likes me and that is the problem. I was born with it. There is something about me that is fundamentally unlovable. I know very well how to love others and how to give to others. My life is built around this. I don't believe in god so I don't care if others think it's a "sin." I'm tired. And I want a final solution. And I'm a little frightened by the fact that I KNOW how to do it right. If I do it, I WILL do it right. The last thing I want is attention. If I did, I'd just go to the hospital. The only reason I haven't done it yet is that I know how badly this will damage my children, 15 and 12. I keep telling myself that I can wait a few years until they are adults, but I am awfully tired. I'm going to die anyway (my natural death would almost certainly be something horrible like cancer or heart disease) so I think at least I should be able to call the shots. Just this once. And I know it's narcissistic. Self-loathing usually is. But do you know what? I really don't give a damn.

Virginia S. Wood, PsyD said...

I just spent a good 20 minutes writing a heartfelt and detailed reply to your Comment, and damned if Blogger didn't eat it. Whatever else happens, I don't want to you thinking I'm ignoring you. So I'm posting this comment in the hopes that you've subscribed to Comments, and then I'll get about re-writing my response.

Virginia S. Wood, PsyD said...

"I'm not depressed. There are demons from my past from which I can't escape. My husband and children don't love me (my main function is to bring home a paycheck from I job that I've come to hate). Nobody loves me or even likes me and that is the problem. I was born with it. There is something about me that is fundamentally unlovable."If this paragraph were a picture, it would be next to the dictionary definition of depression, right along with your prediction of your death from cancer. No baby is born unlovable, and none of us knows how we are going to die (assuming we aren't doing it ourselves).

Furthermore, at least two of these problems are changeable: To wit, you can quit the job and leave the husband.

Your therapist and psychiatrist need to know immediately how you are feeling. That you are afraid you will do it right tells me you are still at least partially on the fence. Give yourself a chance here and talk to them. Even inescapable demons can be forced into peace talks. And your meds may need adjusting. Give your shrinks a chance to do those two things for you.

And finally, please don't fool yourself that waiting will make it easier for your kids. Suicide is never easy on the survivors, no matter how old they are. I grieved my girlfriend for longer than we'd been friends. I can't imagine what it would be like for your children.

This is me, giving a damn.


Anonymous said...

Thank you for your concern. I appreciate it. I really do. I will see my psychologist on Monday and will decide on the spot if I should tell her. She has a way of finding alternatives and I'm not so sure I want any more alternatives. I will never quit my job: The death, pain, suffering, trauma and grief that I see day after day, well, some part of me needs to go through that over and over again. Ironically, I will probably die in my own ICU. And I will never leave my husband. He tolerates me. And for that I am eternally grateful. In any case, don't worry. I am still on the fence and one way or another, it will all work out in the end. Thank you again for your concern.

Jared said...

ICU- You shouldn't stay in a relationship just because someone "tolerates" you. Go to some couple's counseling, both of you, and work on your issues, fix them or decide to part as friends. Yes, you don't have to stay in a loveless relationship and I encourage you to move on if that’s what you decide. The other person is probably as unhappy as you are. I was in an unhappy relationship for 10 years and have found new love now.
Most kids from split home turn out fine. I think divorce is healthier than fighting, contention, strain etc. Speaking of your kids, yes if nothing else, continue on for them. Your taking your own life would cause them more harm than any natural death, divorce or just about anything else you can think of. Take some steps to change yourself and make yourself the mother they need. At the age of 38, I still am grateful to have my parents to go to for advice. How long did you have your parents around for?
Second thing, what is it you do in the ICU? Are you Nurse, medical assistant? Are you making a difference in these people last moments? How about the injured people who come in and get better because of your help? I myself have always thought about nursing and not only am I concerned about you but also have a personal interest.
Oh yes, and I give a damn too.

Anonymous said...

Jared, thank you for giving a damn. I need that. I'm feeling much better after an important insight gleaned during therapy today. Yes, I am a nurse, which is both extremely difficult and extremely rewarding. If you have any interest in nursing as a profession, I highly recommend that you pursue it.

Severian said...

As someone who has struggled with suicidal thoughts at different points in life - the teen years, post-divorce, and then again in middle age, I'm usually dumbfounded by some people's misunderstanding of the psyche of suicidal people. Granted, there are all kinds of them, each one having varying reasons.
For myself, like some of the commenters here, it was only about wanting to bring a miserable life to an end. When you are in that dark place, you certainly don't give a damn about anyone else's suffering as a result of your death. How can you, when you can't even think clearly about your own predicament.
It's not selfishness. It's being trapped in a place where you only hear the recordings of all the negative things in your world.
I've made it through this far. At times on the radio when a Boston song comes on, I'll listen to Brad Delp's incredible voice sing in joyful harmonies about wonderful things, "Don't look back - a new day's breaking. It's been so long since I've felt this way." Brad's suicide is a reminder how insidious depression can be.