Have you ever had a patient die by suicide?
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This is the 50th anniversary and I am still haunted by one patient, although the grief has continued to diminish. But triggers can remind me, especially when there is some connection to suicide, such as the upcoming Jewish High Holy Days of trying to be put into the “Book of Life” for the next year. I once wrote and wondered how those who are suicidal view this congregational desire. This week is also National Suicide Prevention Week, and the last day of that week, Saturday, is the first day of those 10 Jewish days of awe, Rosh Hashanah.
In fact, the first time I realized that I never grieved adequately was when I was to participate in a Yom Kippur study session on suicide after a teenage girl died by suicide and shook our community. This session was perhaps 15 or so years ago, but it harkens back earlier, to 1973.
In 1973, I was a second-year psychiatry resident at the University of Chicago. I was just beginning to see outpatients and was assigned an elderly white male, who came in with his wife. He seemed depressed but denied suicidal thoughts. I started the old tricyclic antidepressant Elavil. A week later, he seemed brighter, though I wondered why. We scheduled again in 2 weeks, but I got a call from his wife a few days later; he had walked into Lake Michigan and drowned himself.
I was both heart-stricken and frightened. I thought that perhaps I was not cut out to be a psychiatrist. However, the faculty said I probably should not have been assigned that patient in the first place so early in my career. That was a relief. Perhaps, it was discussed, he seemed better after 1 week because he had decided on suicide. That my supervisor approved the use of Elavil, which was a high risk for death with a suicidal overdose, was some confirmation that the suicide intent was hidden.
Burying that trauma was one factor in delayed grief. Another may have been the Jewish principle that to “save a life, you save the world!” I certainly did not save this life.
It was many years later that my grief overflowed at that Yom Kippur study session. I had decided to discuss my patient who died by suicide in order to try to convey empathy with the loved ones of the teenager who died by suicide. I started to talk, but soon started crying and could not stop until I heard a soft male voice nearby who said: “Slow down, take it easy.” And I did, and went on fine. Afterwards, I searched out whoever consoled me, and it turned out to be the girl’s father, whom I had never met! We went on to establish a new community program called RedGen to reduce suicide in teenagers. It is still running.
This is not the first time I have written or talked about my patient who died by suicide. Each time helps to further resolve the grief. Suicide of a patient is probably the most painful experience a psychiatrist can have. We do not encounter nearly as many deaths as many other medical specialties, which probably adds to its impact. Perhaps that helps explain the old somewhat ghoulish saying:
“You are not a real psychiatrist until you have a patient who commits suicide.”
My gratitude for today is that despite focusing my care on the highest risk patients, I never had another patient who committed suicide and received confirming awards for my clinical work.
Dr Moffic is an award-winning psychiatrist who has specialized in the cultural and ethical aspects of psychiatry. A prolific writer and speaker, he received the one-time designation of Hero of Public Psychiatry from the Assembly of the American Psychiatric Association in 2002. He is an advocate for mental health issues related to climate instability, burnout, Islamophobia, and anti-Semitism for a better world. He serves on the Editorial Board of Psychiatric Times.