Suicide

'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.

Wounded

Untitled: © Irina Sidorowicz - Visit NoHappy.com to see additional artwork and photography. The artist studies Graphic Design and Visual Communication in Buenos Aires.

This picture, posted as a writing prompt at Every Picture Tells a Story is powerfully evocative for me. My first reaction was that she is Palestinian, but she quickly became bigger than that. She is Afghan, too, married at ten or eleven to a man decades older than she. Then she became all wounded women.

Inside every battered woman, every woman who was sexually abused as a child, every rape survivor, lives a girl-woman like this. However bright and strong and confident she may look on the outside, and they do, this wounded girl-woman looks out from behind her eyes. I may see a flicker in the first session, or I may not catch a glimpse until she's been here a few times.

If I can earn her trust, sometimes she will come out.

How do psychologists work?

My Dad e-mailed me recently to say that
"it has always been my understanding that real world, the psychiatrist gets the patient to talk talk talk talk until he reveals his own feelings and finds himself.  ...

So the question:  How do shrinks in the real world get the patient to see why they work the way they do?"
That ought to be a relatively easy question to answer after nearly 30 years in the profession, so the difficulty of forming an adequate response surprised me.

Part of the problem is that "how" means more than one thing. If by "how" my Dad means "what are the actual motions we go through" then that's not so difficult. If his "how" is more at "why", as in, "what is the actual process by which change occurs?" then we are getting into the harder stuff.

One answer to the why-does-it-work? part of the question, and the part which I gave Dad, is "I'll be damned if I know. It just does." And that really is true. Why should talking to someone about your problems help? I have no idea. But I know that it does. I have experienced over the last three decades innumerable sessions in which I felt like I didn't do anything and yet the patient leaves feeling so much better. It never ceases to amaze me.

Then, when I thought about it, I got back to the old core of William James's interpersonal theory, which is, in modern lingo, that we are hardwired to live and to experience life in groups: mating pairs, family groups, tribes, and so on. In particular, the human species has the longest period of dependency on parents of any species on earth, and this period of dependency lasts long past sexual maturity--which is true of no other species on earth. So any way you look at it, we are definitely relational down to our very bones.

Looked at that way, it makes sense that what gets injured, or never developed properly, in a relational context might then heal, or grow, in a relational context. Add to that the importance of language in our cognitive and emotional lives, and it only makes sense that talk is the solution to any problem that is not strictly biological.

As to the mechanics of how it works, again, as I told Dad, there are reams and reams of writing on that subject. Not something one boils down into an e-mail or blog entry with any degree of ease. The core, however, I think is the ability of the therapist to create a safe space. I have had clients tell me that the only space that they do not feel alone in, or the only space that they do feel safe in (and sometimes both) is my office. This sense of safe, secure connectedness is the sine qua non of therapy. And everyone who comes to me for help, without exception, either has never had that secure attachment (e.g., with a parent) or has lost it in some way.

Talking it through of course involves much more than just talk. Talk, per se, accomplishes little. Sometimes the issue is that there are feelings that could not be expressed at the time (read Charlie Mike for the perfect explanation why)and so an important part of therapy is that the patient gets a chance to experience those emotions in a supportive environment. We call this a "corrective emotional experience." Especially in the case of childhood issues, a vital part of therapy is the cognitive restructuring that, ideally, follows the re-experiencing. Kids have limited ways to understand what's happening to them, and what gets tucked away in the brain in kidspeak has a tendency to remain conceptualized in child-like ways of thinking. Consequently, in adolescence and adulthood, there are vast pockets of experiencing of the self and of self-in-the-world that get thought about, felt, and acted out behaviorally in immature ways. So we have to re-understand ourselves from the vantage point of adult experience and ways of thinking. As a small example, a person may need to see that she wasn't sexually abused because she was "so sexy"* at age 5 or 6, but because her father was a sexual deviate. This will totally change her outlook on herself and on life, not just on men or sex.

So. To recap, this is how psychologists work:

1. We establish a safe space.
2. We encourage the patient to talk.
3. We listen.
4. We help reframe--if not the experience itself, then the patient's experience of it
   

How it works is:

1. The patient gets to bring up issues in a safe space that they may never have had the chance to talk, think, or feel about before
2. The therapist helps him reframe his experience, or at least his experience of his experience, in a more functional way
3. As a result, the experience loses its power to interfere with his day-to-day lived experience