Wednesday, March 5, 2014

Suicide Is Not a Choice

I peered over this very overpass on the Eisenhower Expressway.  Years ago, there was no the fence along the top, just a rail.  It was pie that brought me there.  Yes, pie.  It was Thanksgiving night, and the holiday was ending without pie.

Of course, it wasn't a reason to commit suicide.  Of course, suicide is a permanent solution to a temporary problem.  Don't treat me like an idiot with your clever lines.

No, pie brought me there, but that was not why I would jump.  Pie was a match, a tiny little three letter match.  My problem was a brain filled with gasoline.  And one tiny match, that I should have been able to snuff with my fingers, threatened to ignite it and send me over the edge.  The shame of being powerless over one tiny match poured on more gasoline.


My baby?  He was safe at his godparents'.  At thirteen months, he had just been weaned.  That covered, I didn't think more about him.

Can a mother forget her baby?  Or a woman the child within her womb? -- Isaiah 49:15.  He meant it rhetorically.

But yes, Isaiah.  Yes, she can.  This disease can suck from us capacity to reason, will to live, control over impulses and yes, thought for one's own child.

I have friends, mothers mostly, who say, I thought about suicide.  I was close.  But I would never do that to my children.  I am glad for them.  I am glad for what they do not know.

I am not glad for how even the nearly suicidal use shame to distance themselves from those who have been lost.

Live!

Suicide seems incomprehensible, and rightly so.  Built into our genes is the imperative to live.  It is reflexive.  Somebody comes at you with a lit match, you back away.  Try it.

So what do we make of those who overcome this most basic reflex?  Or rather, whose reflex fails.  Friends, family, doctors, New York Times Op Ed writers try to put themselves in that position, remembering times of deep despair, even the impulse to end it all.  They remember how they overcame that pain.  Why don't all of us?

Out of love, out of frustration, out of anger or pain, they give us their solutions.  If only we would adopt the same, we would be freed. Remember those who love you, who need you.  Stay.

Jennifer Michael Hecht wrote her book Stay to search for history's most persuasive arguments against the irretrievable act. The author lost two friends to suicide, and I am deeply sorry for her loss.

I hate suicide.  I hate what it does to those left behind.  I hate what it does to those whom it takes.

If we only needed arguments, we could defeat this horror.  We have arguments to spare.  Up to the end, we use them.  We hang on to any tether.  We really do.

We do not leave easily.

Another time, two decades, three therapists, four psychiatrists and eight antidepressants later, I would spend weeks in arguments. Without ceasing, I batted down the horror with one argument after the other.

But the horror would not release me.  When I finished all my arguments, it circled back on me and started again.

Until I was exhausted.  Until I begged it for mercy, this horror that had taken over my brain and erased the memory of my baby.  Just kill me.  I don't know if I can do it myself.  Take me over and do it for me.  And it prepared to do that.

Suicide Prevention

Edwin Schneidman, the father of suicide prevention, makes his own arguments, but is clear about their usefulness in suicide prevention, which is, not.

Schneidman cautions that attempts at persuasion do not  prevent suicide. Rather, The most effective way to reduce elevated lethality is by doing so indirectly; that is, by reducing the elevated perturbation.  Reduce the person's anguish, tension, and pain and his level of lethality will concomitantly come down, for it is the elevated perturbation that fuels the elevated lethality.

In other words, people don't commit suicide because they can't figure out it is a bad idea.  They don't do it because they have lost their religion.  They don't do it because they have some benighted libertarian idea about how they have the right. The right?

They do it because they are in pain.  Arguments separate the clever one from the other who is in pain.  Arguments may reduce the arguer's pain.  But they miss the point of prevention.  They miss it by a mile.

Is There Virtue in Living?

Twice, three times I have teetered on the edge of the abyss and I consider it miraculous that I did not tumble in.  Periodically, the thought of dying dogs my footsteps.  I hear the semi behind me, think about jumping, but I stay put. I pick up the knife, and lay it down.  It doesn't take pie (or, no pie) anymore.

After all these years it has a life of its own.  It is the reflex of a brain whose neurological pathways have been entrained by a remitting, recurring illness that is held at bay.  I hold it at bay.  When I am well, which I am now, every day I work to keep myself well, rested, modulated, in shape to resist this reflex that hits me even when I am well.  I will do this for as long as I live.

Sometimes, when I do all the right things, it returns full force anyway.

Am I brave for choosing to live like this?

Seriously?

Are you brave, when you flinch from the match?

So what is it that has kept me alive?

Flinching, mostly -- the basic human urge to survive.

What about those three times when I almost crossed over?

The night of the pie, when I forgot my baby, at the last minute I thought instead of the police officer who would answer the call.  It was Thanksgiving.  And if he spent it wiping me off the freeway or out of somebody's windshield, it would probably seal in his memory a link between my favorite holiday and his nightmare.  I wouldn't do that.  So I lived.  I got to see my baby grow to a fine young man.

Ah!  Does that relieve your mind, that I thought of the consequences of my actions and did not do harm?  My friends are not prepared to give up the notion that I am a good person, even if I did forget my baby.

Does it help to train a mind to move toward the thought of others?  I don't know.  I have lots of resources to help me survive this thing, and I was able to draw on that one that night.

But you see, I have been sicker since.

Once I believed I had to get my Effexor-poisoned blood out of my body. I called somebody I trusted with my life for advice about how to proceed.  Before she heard me out, she put me off.  She hung up.  The light went out.  I barely walked, I barely talked for a week.  So I didn't do Plan A, the emergency room.  I didn't do Plan B, the DIY job.  I didn't do anything.  I didn't have strength to lift the knife.

The crisis passed, and I recovered, until several months later, when my arguments failed me and I lost that inner battle.  I finished my last project.  I set a date.  I gathered my method.  I said three of my four good-byes.

Pretending to my wife and my therapist that I was still trying, I took an over-the-counter antidepressant.  It flipped me into hypomania.  And my life was saved.  Maybe it was the med.  Maybe it was God.  I don't know about that one.  But it wasn't me.  I did not choose to live.  I just lived.

And if I had not lived, I would not have chosen death either, any more than somebody with cancer chooses to die, while her loved ones waste precious last moments urging her not to leave them.

Being Brave

It does not take bravery to live.  It takes air and bones and blood, each in its appropriate place.

I have been brave about other things, mostly about telling people things they do not want to hear.  About living, I have been lucky.

Hope for Those in Suicidal Pain

David Conroy, a psychologist who has been there himself, did the math.  There are alive today on the planet 50,000,000 people who will struggle with suicidal pain.  45,000,000 will survive.

The other 5,000,000 would like to have been among them.  They are not selfish and they are not stupid.  They will die because they are in pain and they do not find release in time.

Some struggle for a long time.  Some are impulsive.  Some don't much mean it, but they are unlucky enough to have a gun in the house.  Some are drunk.  Some are not mentally ill, but are suddenly overcome.  They are in pain, and they do not have the resources to cope with the pain, and nothing postponed the deed before it could be averted, and the method was lethal enough.

If you want to help, do one of two things.  Help reduce the pain or be a resource.  Okay, a third -- get rid of the damn gun.

Is Suicide Immoral?

Last week I wrote about Ronald Pies and a firestorm he began on Pyschiatrictimes.com with an article, Is Suicide Immoral?  The firestorm has calmed down, now that the people who know what I am talking about have been deleted from the conversation.  What remains is disembodied discussion with one exception, posted by someone with posting privileges -- an impassioned letter to a man who died by suicide, written by his daughter.

The letter is eloquent evidence of the pain that suicide leaves behind, a pain that raises moral implications for Pies.  The daughter accuses her father of choosing to cause her that pain.  I have never told the boys what you did because I want them to remember their grandfather with affection and not the horrible final act YOU CHOSE.

But again, the mitigating evidence, the testimony of those who know the father's pain, who know that treatments fail, who know that other people's solutions meet their own need to provide solutions, has been deleted.  The dead man has no defense.

Our silence, whether enforced from without, by people who would not hear, or from within, when we cannot bear the consequences of speaking our truth, continues to bedevil this conversation.  What you know about suicide, what it means, how to prevent it, comes almost entirely from people who project their ignorance, however kindly intended, onto our experience.

What Kind of Hope for the Suicidal?

Dr. Pies writes There is always hope for remission or recovery, in my view -- no matter how refractory or resistant the condition.  This is not an argument for declaring suicide "absolutely immoral".  It is an argument for refusing to abandon hope, even for the most severely afflicted psychiatrically ill patients.

Well, it is good to have a doctor who has hope, who will keep trying to help, because most of us, 90% of those who face serious suicidal pain, will survive.  Even among those who do take action to end their pain -- if they survive the attempt, 93% will not die of a later attempt.  A full 70% will never attempt again.

It is my life's goal that at my funeral, somebody will say, We won this one.  Willa died -- of natural causes.

Mine is a progressive illness.  Each of the times I described has been worse than the one before.  And I can't imagine the strength to survive another.

Yet -- the odds are in my favor.  If you suffer from suicidal pain such that you don't know how you can survive, the odds are in your favor, as well.

That said, I do not share Dr. Pies' hope, not his kind of hope.  For some of us, those hanging out the window of a burning building, Dr. Pies calls up, There is a fire station just down the road.  But the ladder is not tall enough.  Yes, we know they are building a taller ladder.  But the funds for ladders have been diverted to tax cuts, and a new ladder is not coming soon.  The person inside the building has become Isaiah's forgotten child.


It is worth hanging on as long as possible.  Anything might yet happen. But nobody on the ground has any business calling up to the one inside that the flames are not unbearable -- they are only almost unbearable, not even those who think they have been there before.

Many oncologists have learned a different hope.  Would that psychiatrists and our families learn the same.  For that forgotten child who can hang on no longer, for me if I need it, I return to Isaiah 49 for my hope --

Yet even if these forget, even if all these condemn, God will never forget his own.




photo of Oak Park Station by Paul Goyette, used under creative commons license
book jackets from Amazon.com
flair from FAcebook.com
photo of burning match by Sebastian Ritter, used under creative commons license
photo of burning building by Bo Yaser, used under creative commons license
image of Tree of Life by Tiffany, in public domain

1 comment:

  1. Willa, yet again I am humbled by your words, your elegant eloquence and most of all by the pain within which you live. Please stay.

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