Patients who are at risk need to be assessed, monitored, and seen often. Their grief needs to be acknowledged, whether or not the object of grief was known to them.
PORTRAIT OF A PSYCHIATRIST
– Series Editor, H. Steven Moffic, MD
Dr Seeman is Professor Emerita, Department of Psychiatry, Institute of Medical Science, Toronto, Canada. She reports no conflicts of interest concerning the subject matter of this article.
On August 5, 1962, Marilyn Monroe was found dead of an overdose of barbiturates. I was a second-year psychiatry resident in New York City at the time, and I remember exactly where I was when I heard of her death. The sad news shook the staff and dazed the patients in our all-women’s hospital ward. The ripple effect of Marilyn Monroe’s death can still be felt today simply by counting the number of books and films dedicated to the stories of Marilyn’s deprived childhood, her astonishing Hollywood career, and the fame and glamour of the men in her orbit, not to mention the psychiatric theories about her mental ill health and the many conspiracy theories that continue to surround her suicide.
The women patients for whom I was responsible were particularly devastated by the news of her death because they identified with her in so many ways. Many had experienced similar childhoods in foster care, had aspired to be film stars, and had suffered through difficult relationships. Like Marilyn, they often had suicidal impulses.
As it was summertime when this happened, the head of our ward was on vacation in Europe. This left me temporarily in psychiatric charge.
Once I realized how deeply Marilyn Monroe’s death had affected my patients, I knew that some form of intervention was urgently needed. I immediately invited whoever wanted to do so to join a support group that I would lead. I had led groups before, as these were fairly routine on our ward. I knew how to be emotionally supportive and how to listen. I was confident that I was good at bringing people out. I had all the brash self-assurance of the very naïve.
Our group of eight got off to a good start. We cried and shared our feelings. The women talked about their suicidal urges. “Her life was so great compared to mine,” one woman said. Everyone agreed, as she added: “She was rich; she was beautiful; she was talented. Look at all the men who loved her!”
“This group is a catharsis,” I proudly pronounced to my fellow residents.
But this is what happened next. Three of the women in the group attempted suicide, one very seriously. Fortunately, all three survived. The head nurse, frightened by what had happened, contacted the head of our ward in Europe. He immediately cut his vacation short and returned to New York. The first thing he did was to stop the group. Then, he gave me the worst dressing down of my life. I thought it was the end of my residency, but he allowed me to stay. What came to an end was my early confidence in myself as a therapist. Since then, there has always been a seed of doubt when I see a patient. I now ask myself, “By stirring the pot, am I perhaps doing more harm than good?”
It was not as if I hadn’t read up on suicide. I had read Émile Durkheim’s work in my first year. In the French sociologist’s 1887 study on anomie, he had in fact underplayed the effect of imitation as a critical factor in suicide.1 Durkheim believed it was useless, for instance, to prohibit newspapers from publishing suicide stories. But he was wrong. Human beings are very easily influenced. What my Marilyn Monroe group had done was to bring together eight vulnerable women who, with the complicity of their group leader, had laid fertile ground for intense behavioral contagion.2 I had unknowingly created a suicide cluster.3,4 Out of a mix of would-be Marilyn Monroes, raw emotions, media prodding, and myself as a greenhorn therapist, the belief had emerged that suicide was the answer to distress.
The Werther effect >
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