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Suicide and Survivor Guilt

January 4, 2015

“There`s nothing selfish about suicide” writes Katie Hurley, a Child and Adolescent Psychotherapist in the current edition of the Huffington Post, in describing her internal struggle following her father`s suicide.

The “what ifs” kept me up at night, causing me to float through each day in a state of perpetual exhaustion. What if I had answered the phone that night? Would the sound of my voice have changed his mind? Would he have done it at a later date, anyway? Survivor’s guilt.

The ensuing discussion describes the descent into the  private hell of severe depression experienced by a group of patients who end up taking their lives.

No-one could dispute or blame that unfortunate group of patients so consumed by gloom and despair that they become disconnected from friends, family and any sense of personal relief or comfort.

According to Jewish Law, such patients do not lose their share of the “World to Come”. The Bible brings King Saul as an example in the Book of Kings, when the prophet Samuel consoles him. (King Saul suffered from a cyclical mood-disorder and during his depressive relapses suffered from paranoid delusions and pathological jealousy that led him to commit atrocities from which he was exonerated after death).

Today we know that most depressions are cyclical, leading to a treatment-philosophy of getting the patient through the depressive crises. Only after the patient has responded to treatment and established a safe distance between his current perspective and that which darkened his perceptions during his depressive relapse can he begin to reflect on his distortions.

I remember raising the question with one of my mentors when I was a Psychiatric Research Fellow on a dialysis unit. One of my patients with End-Stage-Kidney-Disease had given-up, and was refusing dialysis. This was a case of “rational suicide” I proposed to my mentor.  His response reminded me that I still had what to learn: “Lets hear how he sounds after we’ve treated his depression !”.

This speaks to the point that the majority of depressions do respond to some form of treatment intervention. Sometimes that requires the therapist work through their own counter-transference despair. At times we just need to get the victim to weather the storm. They often do emerge on the other side to find that the landscape can change.

One of my patients would always fall-back on a one-sentence C.B.T. technique: “Don`t use a permanent solution for a temporary problem”.

Another situation is more common than one would imagine: Youngsters during that awkward stage of “finding themselves” (described by Eric Ericson as the stage of “Identity Formation”), find themselves in transitional states. The term doesn`t have to be limited to a change in physical location, but one between jobs and relationships where they just lack the emotional self-soothing resources to weather the storm of personal alienation, mood-loss, and a sense of helplessness.

When those situations end tragically, we should ask ourselves “could those five minutes have made a difference ?”. If enough people reflected on whether giving five or ten minutes of interest, a smile, hug, or cracking a joke could have made the difference……

The answer is “yes, but we`ll never know”. My apologies to those who always prefer to hear that they did the right thing.

Just a note on the definition of a “wilderness” experience.

There are therapists who take groups to a remote setting, leaving the familiarity of their urban environments and deliberately switch the predictable to one of “newness” for its the potential benefits of personal transformation.

These expeditions are typically holistic experiences creating group-intimacy between strangers while disconnected from their “real lives” at home.

These expeditions are used to re-shape traditional boundaries, roles, and restraints while removing one`s usual supports.

For educational purposes, creating such as a wilderness gives us a window into the vulnerability of some individuals ill-equipped to handle transitions.

How do we identify the ones at risk ?

Counselors, life-coaches, educators, and even lay friends and acquaintances who have learned and applied empathy-skills will testify that just by showing they care has saved lives.

Paying attention and caring is sometimes all that’s needed to rescue the most vulnerable among us from acting-out temporary despair in a very permanent way.


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