The Last Psychiatrist: "But I Wanna Kill Myself!" ~ We Must Not Think Too Much

Thursday, April 3, 2008

The Last Psychiatrist: "But I Wanna Kill Myself!"

7:27 AM

Ovidia

on The Last Psychiatrist:

An Open Letter to The Last Psychiatrist, from a guy who hasn't actually read my blog, because if he had, he'd realize I agree with him.

Almost.

He writes:

...Just for kicks and giggles, try this out for a second: imagine you live in a world where there are no lawsuits. I know this is hard for you, as your profession is almost entirely shaped by the fact that there are.

Is it even remotely possible, then, in this world with no lawsuits, that there are people who don't have a "disease" and aren't delusional or out of touch with reality who have thought through all their options and decided, clearly and rationally, that they no longer want to live in this world? Is it possible that some people would be better off ending their lives then continuing on in endless pain?...

...Even in a world with no lawsuits, would you still insist he be kept alive? If so, why? So he would continue to pay your fees? In which case, who are you really helping?

In a world with lawsuits, does it help the patient any to continue to stay alive just so you can collect money and not get sued?

Knowing the answer, is it any wonder that so many people in "treatment" continue to kill themselves anyway?

Suicide is always a choice. Whether it is rational or not is a case by case question. It isn't always irrational (what's euthanasia?) and it isn't always well thought out (obviously.)

1. The answer to your question, "would you keep him alive even if there were no lawsuits" is, yes, almost always. I say "almost always" because there is always the chance that some situation may arise, but I can't imagine it, and it hasn't happened. Lawsuits hardly ever drive my practice, lawyers are rarely on my mind. (see #4.)

What I take issue is that people attribute suicidal thoughts to externalities which are at best mitigating. Zoloft doesn't make you suicidal. Period. It may help, it may make you more emotional, but the act itself is yours. Own up.

2. Can a person have perfectly rational reasons for killing himself? Sure. Does that matter? No.

Here's the reason. No one in George Clooney's America will agree with me, I'm sure, but I am certain they are wrong. "Under perfectly rational conditions, why can't a guy consent to kill himself?" Because your own happiness or misery is a secondary issue, secondary to your existence. Why? Because your life is not yours. It's mostly yours, but to the extent that it affects other people in any way, you have a responsibility to them. Maybe to help them, but at least not to harm them. Your life is a publicly traded company. You may have majority ownership, but you still are subject to a Board and to your shareholders. If you want to kill yourself, everyone you have touched in any way gets to vote. Good luck.

In these posts I am trying to make a very subtle distinction. It is the duty of the psychiatrist to try to do whatever necessary to keep you alive; but it is not his fault (short of gross negligence) if you succeed. Neither is it Zoloft's fault, mania's fault, alcohol's fault, capitalism's fault, your ex's fault...

"You know, if you kill yourself, it puts that option on the table for your kids when they hit your age." Get it?

Let's all hear this at least once: you did not get to choose to be born, neither will you choose to die. If you care nothing about your own life, so be it. But you have a responsibility to improve the lives of those around you-- I don't mean good samaritan style, I don't mean person by person, I mean that your life has a net positive effect on the people in your life, in general. Some people need to get punched in the face, I get that, it's not a nice thing to do, but I'm sympathetic. But overall, miserable or not, you have to leave the world better off than you came into it, to the best of your ability. Miserable or not, painful or not, like Prometheus you will bring fire to man and take from man the expectancy of death, and you will stay chained to the rock.

Mistake me not; I would not, if I might,
Change my misfortunes for thy vassalage.

Lo, I am rockfast, and thy words are wave
That weary me in vain. Let not the thought
Enter thy mind, that I in awe of Zeus
Shall change my nature for a girl's, or beg
The Loathed beyond all loathing-with my hands
Spread out in woman's fashion-to cast loose
These bonds; from that I am utterly removed.

This Crisis' Self-Help Shelf

When Things Fall Apart: Heart Advice for Difficult Times
Pema Chodron

Pema Chodron has written the Tibetan Buddhist equivalent of Harold Kushner's famous book, When Bad Things Happen to Good People. Consequently, Chodron's book is filled with useful advice about how Buddhism helps readers to cope with the grim realities of modern life, including fear, despair, rage and the feeling that we are not in control of our lives. Through reflections on the central Buddhist teaching of right mindfulness, Chodron orients readers and gives them language with which to shape their thinking about the ordinary and extraordinary traumas of modern life. But most importantly, Chodron demonstrates how effective the Buddhist point of view can be in bringing order into disordered lives.Copyright 2002 Reed Business Information, Inc

Faith: Trusting Your Own Deepest Experience
Sharon Salzburg

Buddhist teacher Salzberg (Lovingkindness) offers a deeply personal and luminously honest work that makes faith relevant to us all. Unyoking faith from its usual association of adherence to systems of belief (and even the belief that we have no faith), she allows it to be a verb, an act of offering and affirmation that can heal and enlarge our lives. True faith, according to Salzberg, is the action of the heart opening to admit life in all its unknown potential. It does not need to constrict around a particular belief or view, because it flows from an inner sense of reality, "a homing instinct for freedom." Salzberg shows that, in its essence, faith is a love of life that breaks out as it is exposed to real forces. Truth feeds faith. This is a work of great truth and great heart. It will help everyone who reads it.Copyright 2002 Cahners Business Information, Inc

The Year of Magical Thinking
Joan Didion

The Year of Magical Thinking is a searing portrayal of personal grief, a vividly documented case study in mourning rather than the kind of modern exercise in self-therapy that, however well-intentioned, is laced with narcissism. As a writer Didion has often demonstrated a keen eye for the loose threads that, when tugged, unravel human lives and institutions. Critics were deeply moved as Didion turns her lens inward to examine her own emotional disintegration, free of clichés and tidy, little life lessons. It is the book’s raw honesty and Didion’s meticulous reporting and research that allow her memoir to transcend the merely personal and become a universal road map of loss. Copyright © 2004 Phillips & Nelson Media, Inc.

Life After Loss
Bob Deits

Loss can be overwhelming, and recovery sometimes seems terribly daunting, if not impossible. But Bob Deits demonstrates that the only way past grief is through it. In this newly revised edition of Life after Loss, Deits offers sound guidance for navigating the uncertain terrain of grief. With practical and compassionate advice, personal stories, and helpful exercises, Life after Loss is not just about understanding grief-it's about doing something about it. Wise and universal, Life after Loss is a classic in the field of grief recovery, and with newly revised chapters on grief shared as a nation as well as on what Deits calls "quiet losses," it is a must-read for coping with any type of loss.

Healing After Loss: Daily Meditations for Working Through Grief
Martha Whitmore Hickman

Unattended Sorrow: Recovering from Loss and Reviving the Heart
Stephen Levine

According to Levine, "unattended sorrow," even years after a loss, casts a shadow over one's entire life, leading to fear, doubt, shame and, more concretely, eating disorders, troubled sleep and sexual dysfunction. These sorrows, he writes, involve not only death but "the ungrieved losses of love betrayed, of trusts broken, and of the repeated bruises left by unkindness" that, unheeded, "sink well below the level of our awareness." In this valuable addition to the literature on mourning and bereavement, Levine writes in a soothing voice informed by many of the principles of Buddhism, but also encompassing all the major spiritual traditions. Levine points out that a new loss may be intensified by earlier, unresolved griefs about the death or divorce of parents, the loss of a sibling or other psychological traumas. Levine identifies three stages on the path to easing the anguish of loss: softening the pain, cultivating mercy and making peace with the pain. He recommends a number of techniques, including a breathing exercise to loosen a stomach constricted by fear and denial and periods of silent time spent meditating or walking. All of his easy-to-follow suggestions involve extending kindness and forgiveness to the self, which, Levine says, will lead to the practice of dealing with others in the spirit of mercy and love. Although, as Levine acknowledges, the healing process is slow, opening the pain-filled heart can lead to the unfolding of a new life. Copyright © Reed Business Information, a division of Reed Elsevier Inc. All rights reserved.

Dark Nights of the Soul
Thomas Moore

There's an old saying that a devil is appealing at first but leaves you in despair, while an angel appears terrifying at first but leaves you refreshed and hopeful. This eighth book since Moore's extraordinarily successful Care of the Soul considers loss, pain, conflict, confusion, anger, excess, deviance and other disturbing feelings and behaviors not as devils to be exorcised but as angelic opportunities for deepening and altering the self. Derived from a chapter of the first book titled "The Gifts of Depression," the idea is not that suffering per se is good for the soul, but that to regard such visitations merely as suffering is to miss their point and meaning. He adopts F. Scott Fitzgerald's phrase "the real dark night of the soul" to refer to anything from a short episode to an entire marriage and sees it as an invitation to spiritual cultivation, work that can be intellectual, creative or even physical, but which the monastically trained Moore tends to depict as quiet, solitary reflection. Short on detail, long on evocation, this book coveys the important if familiar message that spiritual growth entails darkness as well as light.
Copyright © Reed Business Information, a division of Reed Elsevier Inc. All rights reserved

The Way of Transition: Embracing Life’s Most Difficult Moments
William Bridges

When author Bill Bridges's wife died from breast cancer, he began to question all his previous groundbreaking work on transitions. Because Bridges weaves his personal story into the narrative he comes off as a wizened sage rather than a cocky aficionado. "Change can come at any time, but transition comes along when one chapter of your life is over and another is waiting in the wings to make its entrance," he begins. "Needless to say it is impossible to imagine a new chapter is starting when your wife's death has just closed down what feels like your whole life. You simply cannot imagine a new chapter...." Overall, this is a book that offers an abundance of insights without faltering into self-help clichés or specific how-to advice. Instead, Bridges examines the events that bring about transition (marriage, death, change of vocation, tragedy, and crisis) and why it's so important to fully experience these transitions and how they offer opportunities for closure as well as launch pads for enormous personal growth. --Gail Hudson

Traveling Mercies: Some Thoughts on Faith
Anne Lamott

For most writers, the greatest challenge of spiritual writing is to keep it grounded in concrete language. The temptation is to wander off into the clouds of ethereal epiphanies, only to lose readers with woo-woo thinking and sacred-laced clichés. Thankfully, Anne Lamott knows better. In this collection of essays, Lamott offers her trademark wit and irreverence in describing her reluctant journey into faith. Every epiphany is framed in plainspoken (and, yes, occasionally crassly spoken) real-life, honest-to-God experiences. Whether she's writing about airplane turbulence, bulimia, her "feta cheese thighs," or consulting God over how to parent her son, Lamott keeps her spirituality firmly planted in solid scenes and believable metaphors. As a result, this is a richly satisfying armchair-travel experience, highlighting the tender mercies of Lamott's life that nudged her into Christian faith. --Gail Hudson

Plan B: Further Thoughts on Faith
Anne Lamott

Five years after her bestselling Traveling Mercies, Lamott sends us 24 fresh dispatches from the frontier of her life and her Christian faith. To hear her tell it, neither the state of the country nor the state of her nerves has improved, to say the least. "On my forty-ninth birthday, I decided that all of life is hopeless, and I would eat myself to death. These are dessert days." These pieces cover subjects as disparate as the Bush administration; the death of Lamott's dog, her mother and a friend; life with a teenager and with her 50-year-old thighs--yet each shows how our hearts and lives can go "from parched to overflow in the blink of an eye." What is the secret? Lamott makes us laugh at the impossibility of it all; then she assures us that the most profound act we can accomplish on Earth is coming out of the isolation of our minds and giving to one another. Faith is not about how we feel, she shows; it is about how we live. This is that rare kind of book that is like a having a smart, dear, crazy (in the best sense) friend walk next to us in sunlight and in the dark night of the soul. Copyright © Reed Business Information, a division of Reed Elsevier Inc. All rights reserved.

Grace (Eventually): Thoughts on Faith
Anne Lamott

With gentle wisdom refining her signature humor, Lamott explores helpfulness, decency, love and especially forgiveness. She explains the change: "Sometimes I act just as juvenile as I ever did, but as I get older, I do it for shorter periods of time. I find my way back to the path sooner, where there is always one last resort: get a glass of water and call a friend."
Copyright © Reed Business Information, a division of Reed Elsevier Inc. All rights reserved.

The Hell With Love: Poems to Mend A Broken Heart
Mary D. Esselman, Elizabeth Ash Velez

Those looking to poetry to ease a recent breakup won't have to thumb through painfully irrelevant odes to joy any longer. The pocket-sized The Hell with Love: Poems to Mend a Broken Heart organizes its contents according to the stages of heartbreak ("anger," "sadness," etc.). Most are by well-known 20th-century U.S. poets: William Carlos Williams, Louise Gleck, Sharon Olds, though Donne, Shakespeare and Larkin also make appearances. Predictable selections (Margaret Atwood's "You Fit Into Me") are balanced out by a few eccentric, perhaps witty curatorial decisions, such as the inclusion of Auden's "Musee Des Beaux Arts" in the section called "Moving On."
Copyright 2001 Cahners Business Information, Inc.

Kiss Off: Poems to Set You Free
Mary D. Esselman, Elizabeth Ash Velez

The editors of The Hell With Love are back, applying their irreverent view of life and love to help melt the hardest heart of all-your own. For anyone who's been let down by life and love, these poems reveal that the most important person you can fall in love with is yourself. The collection travels through various stages of self-discovery, self-doubt, and, ultimately, self-realization and acceptance-from first kiss to kiss off. Renowned poets, including John Keats, Margaret Atwood, James Wright, Lucille Clifton, and Marie Ponsot explore the universal issues of trust and betrayal, awakening and curiosity, freedom, and self-confidence. This collection will show anyone looking for love how to find it within.

Your Life Is Not Yours

"'Under perfectly rational conditions, why can't a guy consent to kill himself?' Because your own happiness or misery is a secondary issue, secondary to your existence. Why? Because your life is not yours. It's mostly yours, but to the extent that it affects other people in any way, you have a responsibility to them. Maybe to help them, but at least not to harm them. Your life is a publicly traded company. You may have majority ownership, but you still are subject to a Board and to your shareholders. If you want to kill yourself, everyone you have touched in any way gets to vote. Good luck."

~ The Last Psychiatrist

Coping Skills ...

(The line from this movie, has stuck with me for YEARS. It's amazing how often my life situation brings it to mind ...)

One day, Babe was depressed. Cornered by circumstances and choices, she stood on a wooden chair, tied a thick rope around her neck, knotted it to the overhead chandelier, and knocked the chair out from under her. As her weight crashed to the end of the rope, the chandelier flew out of the ceiling, and Babe, rope, chandelier, yards and yards of electric line, and huge chunks of plaster fell past the 2nd floor, past the stairwell, and into the front hall. Not to be daunted by this unforeseen glitch, Babe got to her feet, and dragged the chandelier (still attached to her neck), bumping and scraping across the floor, down the hall, and into the kitchen. She went straight to the stove, flung all the burners on, threw open the oven door, and hurled her body in, headfirst, with the sound of gas hissing menacingly in the background. Enter Meg, running. Meg yanks Babe out of the oven, throws her into a chair, turns off all the burners, flies back across the kitchen floor, and kneels at her feet.
"Why'd you do it, Babe?" she asks of her panting, gasping sister, while she frantically saws at the rope with a dull blade from a pair scissors that had been lying on the table (the first weapon of Babe's botched suicide attempts).
"I've had a really bad day," Babe replies.
You would think that would be the punchline, wouldn't you? But it only gets better.
"Babe, you have just got to find some other way to deal with those bad days."
Crimes of the Heart
play and screenplay by Beth Henley

(thanks to Louise Yeiser for this!)

Realistic and enthusiastic ...

We were all getting ready for the day the other morning (at 4am) and I mentioned to Nora that I had had an awful, gory dream about puppy mills the night before.

Nora, knowing what usually causes my nightmares, snaps: "Are you taking your medication?!"

"Yes," I hastily assured her.

"Oh," says she. "Then you'd better tell Scott (my therapist) about that."

As I dropped her off at day care a couple of days later, I mentioned that I might be late to pick her up because I was seeing Scott that day.

"Make sure you tell him about your dream," she instructed me. "Say how it made you feel. And be ... be ..."

Here she stopped and struggled for the right words for a moment. Then she beamed.

"Be realistic and enthusiastic!" she pronounced.

There you have it.

What We're Writing Down on Scraps of Paper ...

"Mental illness, then, was a distillate of pain, pain without physical pretense. Just as heroin produced a euphoria unconnected to -- and therefore better than -- reality, psychiatric disorders created agony without referent or peer." Jesse Kellerman, "Trouble"
"How do you go on when in your heart, you begin to understand there is no going back? There are some things that time cannot mend, some hurts that go too deep, that have taken hold." JRR Tolkien
"Everything shifted in that instant. One reality became another. In life, that's how it happens. Terrible and wonderful change reaches us at the end of its long journey out of an unimaginable distance. We realize in a single moment that a new state of affairs has been building itself around us, rising like a new house over our heads. Suddenly, the walls connect to the roof and you are there: the sky has vanished." John Marks, "Fangland"
"Be not the slave of your own past -- plunge into the sublime seas, dive deep, and swim far, so you shall come back with self-respect, with new power, with an advanced experience, that shall explain and overlook the old." Ralph Waldo Emerson
"At what point do bad decisions cease to be an interruption of life and become life itself?" Jesse Kellerman, "Trouble"
"And as I became more and more tense -- I couldn't help but wonder: can you get to a future if your past is present?" Carrie Bradshaw, "Sex In The City"

We Must Not Think Too Much

Thursday, April 3, 2008