Thursday, August 7, 2008

Poetic Suicide

There is an interesting suicide poem, "Trouble" by Matthew Dickman, in the current The New Yorker. When one steps back and considers enough suicides, by different means in varying circumstances, it starts to seem dangerously anthropological in a way, as if suicide is just a behavior that self-conscious entities exhibit on occasion. People speculate about elephants and whales sometimes yielding voluntarily to death, but few things separate human beings from the rest of the animal world more starkly than suicide. Consciousness (or at least some neurological proclivity of which consciousness is an epiphenomenon) must have had major survival advantages over evolutionary time in order to outweigh suicide.

One alarming fact about psychiatry in the modern era (the past fifty years, when psychotropic medications have been more widely available) is the minimal impact on the suicide rate, which has hovered around 30,000 annually in the United Status for quite some time. Clearly there is much that we do not understand about suicide. Suicide has a grip on the social and historical imagination that far outweighs its actually impact on mortality; obviously one is much more likely to die of heart disease, cancer, or even an accident than from "self murder." In psychiatric practice it is striking to see the wide continuum of suicidal thinking and behavior. Of course, it is a truism that virtually all "normal" people occasionally have the thought of suicide cross their minds, particularly on a really bad day, but one useful boundarly marker of the grim realm of depression is a qualitatively different attitude toward suicide, which takes the form of a wan indifference to the attachments and rewards of life. Before one can pursue death one must first abandon life. As the conclusion of this poem suggests, this temptation must be resisted. Why? As every parent tells their children, "Just because."

10 comments:

Anonymous said...

Some of us are in such endless pain that there is no other choice.

"Suicide is not chosen,; it happens when pain exceeds resources for coping with pain".

Novalis said...

Yes, I understand. But in most cases suicide is undertaken impulsively and without recourse to (imperfect, granted) help that is available.

May you be well.

Anonymous said...

Have you ever lost a pt. to suicide? What's the protocol? Do you call the family to console them? Take a day or two off to regroup? Or do you take it as failure career-wise, and not think of it as a loss of a life of worth?

Novalis said...

Yes, I have had this tragedy happen a couple of times over the years, and obviously as a loss it far transcends professional disappointment. In addition to a kind of grief, there is the endless self-questioning.

In one case I did call the spouse, whom I had met. In another case I had never met any family and it would have been inappropriate for me to initiate contact (I never did hear from them). I think anyone associated with a suicide feels not only a loss, but also "at a loss." There is always the feeling that more could or should have been done (although sometimes that isn't really the case).

Anonymous said...

Do you think it possible that the family members and those who cared for the person who killed themselves could possibly ever get past their grief when they realized that the one who died is no longer is agonizing pain?

Novalis said...

Actually, in my opinion suicide is so often a preventable tragedy that the social stigma against suicide is useful and appropriate. Families never recover from suicide. Suicide may be understood, that is, explained, but it should not be condoned, because it is a short step from there to encouragement.

Suicide is never an "answer," but rather is a refusal to answer the "question," if one insists on viewing life that way. If life is so dispensable, then why bother even TRYING to treat depression, or cancer, or whatever, when people can just opt out? It can never be that easy. Many people suffer, but the great majority do not opt out.

A psychiatrist should understand suffering, but if he validates suicidal ideation as a response to suffering, he is only doing harm.

Anonymous said...

Just curious--have you ever suffered from severe, mind wrenching depression that dictated your every move?

Novalis said...

Well, that's an interesting question, isn't it? Perhaps I flatter myself, but I think that when I combine extrapolation from personal experiences I have had with years of working with people who do in fact suffer very severe depression, I at least have an inkling of what you speak of.

Can I know EXACTLY what any other person is going through? No, but we can all say that; no one walks precisely in another's shoes. We have to trust imagination and respectful curiosity to bridge some of the gap.

Consider this though. A murderer could say, "Have you ever had overwhelming homicidal impulses? No? Then how dare you judge my deed?"

Anonymous said...

I am just about to give up if it doesn't get better in a week. However, I am willing to try a shrink. How do you find one when you don't like the reputation of the one recommended by your PCP? And, how do you get in without having to wait a month?

Novalis said...

I don't know of any magical way to find the best "shrink" in your area (wherever that is). If you are at all close to any city that has a university with a medical school, then the outpatient psychiatry department affiliated with that school is usually a reasonably safe bet. Unless the matter is sufficiently urgent for a trip to an emergency room (and if it is, then that is the thing to do), there may be no avoiding waiting a couple of weeks or more.