Thursday, November 17, 2011

Patient Suicide: Part Four -- What's a life worth?

This is part of an ongoing story about a patient suicide. Click here for Patient Suicide Part One: The Phone Call, here for Patient Suicide Part Two: 30 Minutes to Think, here for Patient Suicide Part Three: Fully Present, here for Patient Suicide Part Four: What's a Life Worth, here for Patient Suicide Part Five: Treat People Like They Matter, here for Patient Suicide Part Six--Leftovers, here for Patient Suicide: Part Seven--Training Monkeys/Herding Cats, and here for Patient Suicide: Part Eight--On Scarves and Lessons Learned

I made several calls after I received the phone call telling me that a patient had killed herself. The one that stands out in my mind this evening was the call I had with my attorney. She's what one might called detail-oriented. She also has a laser sharp focus. I suppose these are two very useful qualities in an attorney. Despite having had prior conversations with her, I found myself taken aback by her sharp focus when I spoke to her the morning after my patient killed herself.

My attorney asked me a few pointed questions about my patient. I gave some clinical history and some information about her treatment.

"Look Jason, I'm going to say this directly to you," my attorney said. "This is likely going to be difficult for you to hear. We as psychologists (my attorney is a JD/Ph.D.) are trained to think we can do something about suicide. We are trained to think that we can predict it, we can prevent it, and we can save people. We help many people, but we can't help everyone. We cannot be ultimately responsible for the lives or deaths of our patients. We can only be responsible to not commit malpractice"

My attorney went on to quote some statistics. I felt like I should take notes. Mostly though, I was just numb.

"This is going to sound strange to you, and you might even think I am being cold."

I could have used  a better warning of what was about to be said. Really. You will be shocked.

"Attorneys look at the relative worth of a person when making a decision about whether to take on a malpractice case against a psychologist. Young children have value. Someone who is the primary earner in a family has value. Someone who is active in their community has value. Someone who has people who depend on them has value."

I wanted to make this conversation stop. I knew what was coming and I didn't want to hear it. I knew my attorney was doing what attorneys do: evaluating risk, evaluating the law, justice is blind and blah blah blah. My feelings had no place here.

"From this perspective, your client's life wasn't worth very much. She probably knew that too. That was probably part of her pain, part of the destruction left behind by her illness."

This phone call clearly needed to end. I heard what I needed to hear. I did what needed to be done. I sought out consultation. Consultation received. Stop talking. Go away now.

I needed to hang up so I didn't find a way to crawl through the phone and rage against my attorney. Misplaced anger, really. I wanted to rage against myself. I still do, sometimes. If I could have just found the right thing to say maybe she wouldn't have died. If I paid closer attention perhaps I would have detected some sort of warning sign. Maybe. Maybe. Maybe.

Many have told me that it is not my fault. It's a nice thing to say. Honestly. I know you all mean well. It's not really helpful. When you say that you really are just making yourself feel better. The same goes when I'm told that it's natural to feel rage and be angry at the client. Respectfully I say, screw off. I say it respectfully because I know that none of us are ever really taught how to be present with another person's pain. Really, I think that none of us are ever really taught how to be fully present at all.

This business about presence is important--so don't screw off just yet.

Mostly now I'm just plain sad. I miss her, too.

What haunts me most is when I think about the actual moment of her death. I'm sad she was alone. I'm sad to think how afraid she might have been. Sometimes I have a clear picture in my mind of the terror and panic in her eyes. Her desperation for deliverance from her pain mixed with the terror of her own impending demise. I know that look well as she would frequently find herself in that crucible of pain when sitting with me in my office.

Most of all, however, I'm sad thinking that she left this world thinking she didn't matter and that she was a failure in life. It wasn't my patient that failed life. She was already here. She already had life. That's the easy part. Life failed her. We all failed my patient. We've created a society where we don't value people for their presence here on this planet. We raise our children to think their value is in what they do or what they provide. We increasingly treat each other as serviceable others: we see others as objects to use for our satisfaction.

That's crazy. I think we all need to cut that out. Immediately.

We forget that the greatest mystery--the greatest gift--is the mere fact that we are present here in the universe for our few short moments of life. The important this is that we show up, we are present, and we exist.

My patient was once worth something. She was once alive. She was once present. Fully present. Now, of course, she is gone. In that empty hollowed out space she left behind in my heart I have learned this to be true: we matter because we are. That is the miracle  That is the mystery. The rest is just crap we create to make it difficult (if not impossible) to see the beauty in our presence.

The weekend she killed herself she sent me an e-mail. Perhaps it was a day or two before her suicide, perhaps it was just a few moments before her final act. I will never really know.

I am not a bad or horrible person - I totally realize that. Just suffer a lifetime of mental illness that makes life difficult for me and those around me.

I'd like to think that in these last few moments of life, my now dead patient was finally able to show up and be alive. I'd like to think that she died alive, present, and in possession of the knowledge that she mattered because she was.

The unbearable tragedy is that if I am right, her life was but a moment. We can do better. We owe it to ourselves. Don't you think?


  1. Dear Jason,

    I am so touched by the honesty and courage with which you wrote and shared in this post.

    My heart goes out to you and to your patient (may she rest in peace).

    I don't know what words I can possibly offer to console you but what I can say is that I think you sharing just how badly you feel about your patient's suicide, how much she mattered by just being, how much everyone matters by just their essence vs. what they provide means a lot.

    In fact, your words, your heartfelt feelings may be enough to make a difference for another person who is feeling very depressed and wondering whether his/her therapist truly cares, whether he/she really essence helping someone whom you don't even know.

    Take care,

  2. I am so sory for your loss.
    and am touched by the way you are honoring your own experience, and your relationship through this writing.

    and you are not alone - and its good for the whole community for you to give voice to this.

    Thank you.

  3. "I know that none of us are ever really taught how to be present with another person's pain"

    This is a very interesting insight. I'm trying to unpack what that means exactly, what do we do when we are not present? We feel compelled to make a DIFFERENCE, we want to improve how others feel, progress, progress, feel better NOW. We are impatient. We want to be the agent of change, to try to displace or define whose "fault" it is, to locate agency, think rationally. We say - stop sulking, stop feeling pity for yourself, life goes on... move, change, grow, become normal, move on, progress,progress, move on...

    What would it mean to be present? Here is W.H. Auden's answer:

    Stop all the clocks, cut off the telephone,
    Prevent the dog from barking with a juicy bone,
    Silence the pianos and with muffled drum
    Bring out the coffin, let the mourners come.

    Let aeroplanes circle moaning overhead
    Scribbling on the sky the message He Is Dead,
    Put crepe bows round the white necks of the public doves,
    Let the traffic policemen wear black cotton gloves.

    He was my North, my South, my East and West,
    My working week and my Sunday rest,
    My noon, my midnight, my talk, my song;
    I thought that love would last for ever: I was wrong.

    The stars are not wanted now: put out every one;
    Pack up the moon and dismantle the sun;
    Pour away the ocean and sweep up the wood.
    For nothing now can ever come to any good.

  4. Thank you, Dorlee. What a wonderful thought: that my words here might find their way to someone thinking about suicide, and that these words might show someone another way to live.

  5. Thank you, Martha. Part of what has surprised me the most is how little many of my fellow colleagues are willing to talk about patient suicide. A few people have spoken privately with me and talked about the silence that has accompanied suicide--whether in private practice, hospitals, or community mental health centers.

  6. Thank you, Engelo. It's been great interacting with you on Twitter. Thanks for the poem, and for a great idea for a future blog post.

  7. Jason, thank you. So often the suicide of our clients really is shrouded in silence that comes from our own fears . . . that we could have done more, that we might be sued, that we have done something wrong, that we are not enough . . . .

    Your courage to move beyond your fears to share your experience is invaluable to those of us in mental health. You, too, have put words to the unspeakable . . . to the unthinkable . . . and in doing so you have taken away some of the power that looms over us as we struggle to speak about the suicide of clients.

    Like you, I work with clients who, on occassion, consider suicide. The work is humbling and exciting, scary and rewarding. I know that one day, it's likely that I, too, will get that phone call. Thank you for paving the way to have the conversations - with myself and my colleagues and my attorney and supervisees, too. They are the oh-so-necessary difficult conversations that come with the privilege of working in this field.

    Blessings to you, Jason, on your journey - for your courage and your commitment to do the right things even when the risks are high and the choices are hard.

  8. Tamara -- thank you so much. In particular, thank you so much for recognizing the importance of making this a dialogue that extends beyond this blog and into classrooms, consultation rooms, living rooms (okay, rooms of all types). I'm flabbergasted that in the thousands of hours of supervision I had, not a single hour was spent talking about patients dying. I'm even more shocked now as people come to me and share their own stories of loss couples with a punishing silence from colleagues.

  9. Dear Jason,
    I agree with Dorlee, and hope that your reflections help those who are struggling with suicide. Along with such hugs as may be accepted, I'd like to suggest these resources for clinicians who are themselves survivors of the suicide of clients ("survivor" in this context meaning those who were in the suicidal person's life). The American Assn of Suicidology has this page: and their Clinician Survivor Task Force page is here:

  10. Thank you, Thomas. The American Association of Suicidology does, indeed, have an occasional active community for clinician-survivors. Many of the readers of this blog have found there way to these postings via that list serve. :-)

    Hugs are always acceptable. As is ice cream.

  11. Here I am at 4:30am googling suicide, trying desperately to convince myself that I matter. I am consumed with thoughts of killing myself all day everyday. It's an effort to get through a day faking that I am fine but I get through with work and my responsibilities then escape the real world and allow my thoughts to take over . I accepted long ago that I don't matter,am worth nothing, and one day not too far away will kill myself. I am okay with that. I can honestly say that me surving my suicide attempt in college is my greatest failure.
    I write this, not to alarm you, or because I want someone to save me; I write this to tell you thank you. At least for tonight I am choosing to believe your words. My life will be evaluated as having no value and in all likelihood your attorney's formula will show my suicide as a positive for the world. However, your words made me cry and for the first time in a long time I believe that someone wouldn't view me as a failure.
    I am not looking for a response, this is not a cry for help. I just wanted you to know that you made me feel connected and lessened the pressure I was feeling to kill myself. I am sorry for what you are going through, but I promise you brought her comfort and helped her more than you can comprehend. She didn't kill herself because you failed her in some way. I'm sure she saw you as one of her only blessings in life and she didn't in any way want to cause you grief; there was just too much that came before you weighing her down.

  12. Kerri --

    I'm so happy you decided to leave a comment. It means a great deal to me to know that what I write touches someone else--even if for but a moment.

    You and I—and in fact all of us—are united in the struggle of finding meaning in life. I'm sorry it's a struggle and that you are in a place where you feel your life has no value. Know this: reaching out as you did and expressing empathy for me and my experience of losing a client to suicide—that act in and of itself is valuable. It shows that you have great value here on this world. The ability for empathy. To feel for another, regardless of how horrible you feel, speaks volumes about the depth of your character and the expansiveness of your humanity.

    I hope you find some ways to put down some of the weight you carry. Maybe in time you'll discover that there are some ways that weight can be transformed into something totally unexpected and delightful.

    Thank you for stopping by. I hope you come again.

  13. Like Kerri above, I found this entry whilst googling suicide and trying to find reasons to keep living. I suffer from Complex PTSD, and after years of being told that I am worthless - and then years of watching my peers live fulfilling lives while I struggle with meds and exposure and hospitalization - it's easy to feel as though my life is insignificant and forgettable. As I described to a psychiatrist last year, I feel as though "I won't leave a very big hole in the world, when I leave".

    However, your words here are really touching, and this entire series on the death of your patient has affected me deeply. I have never really considered the perspective that a person is worthwhile simply for being alive and human, but juxtaposed here with your attorney's cynical attitude...what you're saying just seems to make so much more sense than what she is saying. I also have an intense admiration for your courage in revealing your feelings and experiences about this tragedy with such openness and honesty. It has certainly shaken me and made me more seriously and realistically consider what the effect on my own therapist would be, if he were to get "the phonecall" about me, one day; I would never want to put him through that. I think the great evil of mental illness is that it warps their perception and makes them think that nobody would care if they were gone, that everyone would be better off without them - and, it makes them too afraid and ashamed to seek out evidence that such is not the case. It's been helpful to come across your site and find some of that evidence, without having to ask for it.

    I am so sorry about your patient, and I hope that you are recovering okay. Thank you for a moving and incredibly helpful piece of writing.

  14. Jason, I just want to thank you for writing this post and being support for so many people through just this one post; those who are leaving comments and those who aren't.

    My heart goes out to you and your late client.

    I am not a therapist myself (but aspiring!). I speak with people thinking about suicide daily, I hear them talk about not being worth it. Thank you for talking about that here.

    1. Thank you so much for stopping by, reading my blog, and commenting. I'm enormously humbled at how many people have written me--privately and publicly--about this experience. I hope in whatever small or big way, we all are challenging to be a little bit more than we think we can be.