SUICIDE

My favorite Robin Williams movie is Good Will Hunting, a close second is Dead Poet’s Society, and of course Mrs. Doubtfire is a close third.  None of us will ever see future movies of this great comic, as we were saddened to hear that he recently took his own life. 

Like almost everyone else, I’ve always found it difficult, even as a doctor, understanding how the human mind can reach a point where the “treatment of choice” for a problem is to end one’s life.  And while we certainly should never cast judgment on another to do so, discernment about why they did it is in order.

Over the years I’ve had less than a handful of patients, fortunately only a few, who’ve committed suicide, and with respect to most any death from any cause, and like many physicians, we reflect and soul-search wondering if something could’ve been said differently, or done differently, perhaps an earlier follow-up, or something, wondering if it would’ve made a difference in one’s thinking or reconsideration of their plan to end their life.

Before Prozac the drugs of choice for treating depression were tricyclics.  The main problem with them was that taking an overdose to commit suicide was easy, making the physician’s discernment rather acute.  When Prozac came out it was touted as very safe and effective (difficult to overdose with).  Two months after Prozac came on the market, I saw a young mother who, attended by her husband, in her early twenties, came in with severe postpartum depression, almost catatonic-like.  He did the talking.  I prescribed the then new and safe drug Prozac, writing for 30, one daily.  The following morning her frantic husband called to say she had taken the entire bottle.  To make a not so long story short she recovered in the ICU without any organ damage or injury.  Didn’t bat an eye.  Thirty tricyclic pills would’ve put her in the grave.  Through the years it was this particular case that sold me on the safety of Prozac.

Suicides continue to increase in this country and while there are all sorts of hypothecations about the reasons, depression is the foremost outward manifestation of them.  Some people are more outward with their depression, while others keep it inside.  It’s these quiet ones that after they end their life, evoke the community-wide lament that “we never knew” and “if only someone could’ve reached out to them.”   

The common denominator of depression is almost always present in suicides, but how and why one gets to the depression stage is another matter that runs deeper than the surface awareness of just “being depressed.”  Not everyone who is depressed commits suicide.  But almost everyone who commits suicide is depressed, to say the least.  Actually, shortly before they commit the act they’re in despair.  It would be more accurate to say that at the end of the long road of depression is despair, a radical solitude – a total hopelessness.  How do they get there?

Hope is what gets us to turn the page in our life, to get to the next day.  Without it, we are dead-in-life, frozen on our journey.  Dead-to-the-world.  For some, with a non-existent future, delusional as it may be, they simply close the book.  The emptiness at this point is nothing more than spiritual suicide – one that occurs before the existential one.  Those who suffer spiritual suicide, the death-in-life experience of despair, these are the prime candidates for “closing the book.” 

How does one get to this point?  Studies and surveys continue to show that people who practice some kind of spirituality do not have, in general, the medical, mental, or adverse health encounters that those without a practicing spirituality own.  This is especially true with respect to mental illnesses.  It’s not a particular faith or spirituality but instead the fact that one is engaging in it, practicing it, enveloped by it.  I often ask some patients going through emotional tough times if they have a spiritual element in their life.  Most of them say something like “I believe in God,” but are void of any lived-out experience of the sacred, or of prayer, worship, or devotion.  I usually refrain from reminding them that the devil too believes in God.

I’ve come to believe that, while it is by no means the cure-all preventive for suicide, that because of it, people of faith -- any faith, a practicing faith -- are not as vulnerable to slipping down the road of depression towards despair and hopelessness.  Because to them, as a group, life has a textured meaning that those without this element eventually lose or lack.  To the spiritually inclined there exists something other than what is here.  To them there is hope, a “future”.  Something beyond. 

If you, like me, believe in the Judeo-Christian doctrine that all human beings are made in the image of God, then we also agree we are children of God.  To the reader not sharing this truth the following will sound absurd.  As children of God, we are owned by him.  Our time is his, and yes, while we have a free-will to “continue reading” or “close the book,” each and every one of us is here for a reason, for a purpose, a direction, or so we believe.  And to short the journey is not for our choosing.  Again, this is bizarre and absurd-sounding to the secularist.

And it will seem absurd because they are, in general, steeped in a culturally-driven individualism.  An individualism, which undoubtedly is responsible for the remarkable gains in a political democracy, but is nevertheless an enemy to the comprehensive self, as well as to the family.  It is by its nature self-absorbing.  Couples who are strict individualists do not endure, in general, long relationships, which by the way may very well be contributing to the divorce rates, as well as the increasing suicides in this country.  When the “what’s in it for me” loses its invested value then the person who lacks participation in the Transcendent begins his march down the Depression Road.

To continue slogging it out, day after day, moved by hope of something better, if not only to be an example for others, and especially those who’ve thought about or attempted to “quit” but opted for life, these are the real heroes.  Robin Williams has said as much himself in his foreword to the book, Tell My Sons, “For those who refuse to let an incurable illness keep them from doing their duty, for those who keep fighting, for those who live life vigorously and joyfully to the very end, we have names for those people. We call them heroes.”

One of my favorite heroes is the actor, Michael J. Fox.  You know his story.  He’s the living epitome of what we all should strive to be, at least in spirit.  I would like to read his biography someday to learn what moves him.  I may be wrong but I would venture to say somewhere in the depths of his soul is something to do with a Higher Power.

Being authentic is integral to any enduring relationship as well as one with the community.  One’s authenticity – true identity – is found in the embrace of the comprehensive self, the union of the spiritual and material dimensions of ourselves, and especially the nurturing of it.  It’s not found in the embrace of egoism, or the autonomous self.  Turning away from the ego and towards God, as well as towards others, is the keel that keeps life’s boat steady and the sail that moves it along.  It’s what keeps us “reading.”  By removing God from reality, and all that comes with it, we become in essence creators, free to create as we see fit, free to “re-design” at will, and as a result also free to destroy ourselves.  But this of course is not our purpose, and it’s certainly not the point.

Human interactions, I’ve come to believe, are driven by two overarching paradigms – one that unifies and converges, and one that separates and divides.  To the extent the former prevails or replaces the latter we see Good.  To the extent it is accompanied by an understanding of the comprehensive self and engagement with the Divine, we also get meaning, as well as hope.  And with meaning and hope we are able to move forward.  And to this end we are able to focus on the future, focus on that Point in the distance for which we were all made.

For the point, you see, is to live.