I asked Jack Gorman to consider writing a post after I noticed a comment he left a few weeks ago identifying himself as a former psychiatrist who had treated many suicidal patients. “One of the many things I learned is that I never knew what it was like to be suicidal until it happened to me,” he wrote. “No clinician can possibly know exactly what that depth of hopelessness is like.”
Gorman came across this site while doing volunteer work with a suicide prevention organization in New York, where he lives. “I decided to share my story because my recovery involves trying to make amends for the many errors I made, and this includes being open to telling what I did, if it can be helpful to another person,” he wrote in an e-mail. “It is not, of course, easy for me and I am wary of the consequences of being public, but I think it is the right thing to do.”
When I was a psychiatrist, I was terrified that a patient might commit suicide. Of course I cared about my patients and, like any feeling person, wanted them to be happy and enjoy life. But for a psychiatrist, a patient’s suicide is seen as a monumental and sometimes career-deflating disaster. I always remembered the boast of a famous professor of psychiatry who taught us during residency: “No patient of mine has ever committed suicide.” We were led to believe that if a patient committed suicide, the psychiatrist was entirely to blame; suicides happened only to incompetent psychiatrists.
Of course, most people who commit suicide suffer from severe depression, and depression is widely recognized as a potentially fatal illness. Cardiologists and oncologists treat very sick people and expect that many of them will die of their illnesses. The death of a patient from a heart attack or cancer does not automatically mean that the doctor messed up. Psychiatrists, however, generally do not see things that way.
I thought I understood what a patient with suicidal thoughts was feeling. I now understand that my ideas were clouded by professional fear and anger. I was afraid the patient might really go through with it and ruin my career, angry at myself for not being a better psychiatrist and angry at the patient for putting me through the ordeal of trying to stop him or her from making an attempt.
And then, after a lifetime of severe depression and alcoholism, I got the idea that it would be best if I committed suicide. I didn’t have a psychiatrist of my own at the time. No one, in fact, knew how miserably unhappy and hopeless I had become. The only thing that gave me a glimmer of relief from the incessant, crushing feelings of despair, worthlessness, self-hatred and guilt was the idea that I had it in my power to put an end to all of it. Furthermore, I convinced myself that doing so would be a blessing for my wife, my children and everyone else who had the misfortune, as I saw it, of knowing me. I did not think my problem was depression or drinking too much alcohol. I firmly believed my problem was that I was a terrible, useless human being. I was certain beyond any doubt that killing myself was the absolutely right thing to do. I used all of my expert knowledge about psychopharmacology to design what should have been a lethal overdose. It was not a “cry for help” or a “gesture.” What I did was designed to be fatal.
By a series of coincidences and detective work on the part of my wife and some friends, I was found, intubated and rushed to the hospital in an unconscious state. The doctors in the intensive care unit told my wife it was likely I would not survive. My electrocardiogram looked like random squiggles, and I had multiple seizures. The hospital asked to see my advance directives and living will.
But miraculously, I woke up after almost a week. I was furious at first. I felt like a failure — how is it that I screwed up killing myself, I thought. It was not a welcome message to my family, friends, doctors or nurses who had just spent a week slaving and worrying over my body, attempting and praying to save my life.
My recovery was very slow, and I was not always a cooperative patient. But it was clear to me that, in fact, killing myself was not doing my wife or daughters a favor. They would have been devastated. So I made three promises to them: not try to kill myself again, see a psychiatrist and take steps to stop drinking. Today, seven years later, I am happier than I have ever been. I have had no episodes of serious depression, despite having thoroughly destroyed my career. I have a terrific psychiatrist, and I am a grateful recovering alcoholic.
But I also now realize that I never really understood what it means to want to die. In making this statement, I fully recognize that I can only say that I truly understand how it felt for me to want to die. But to the extent that my own experience was consistent with that of other suicide survivors, I now have several insights into that awful state of mind.
First, it was absolute. There was no sense that I might have been even 10 percent wrong in my assessment of myself. Second, it was accompanied by a fierce moral fervor. As bad as I knew I was at that moment, I was convinced that from any possible ethical standpoint committing suicide was the proper thing to do. I happen to be a conventionally religious person, and suicide is not permitted by my religion. Yet I believed without the slightest doubt right before my suicide attempt that killing myself was even what God wanted me to do. Finally, my thoughts were well organized, unrelenting and clear. I did not feel confused about my self-assessment or about the solution — everything seemed perfectly logical and sensible.
I believe these observations are important because they contradict in some ways what I thought was the case when I was treating people who I thought might be suicidal. I cringe now at some of the formulaic things I said to try to dissuade them. I believed in my psychiatrist role that my perspective, my logic, was superior to the patient’s, and therefore my job was to convince him or her that I was right, that suicide was a mistake. I was certain that a suicidal person must feel frightened and confused and that kindness, logic and perfect interpretations would clear up his or thinking and change his or her mind.
Perhaps if I had known what I was truly up against in dealing with a suicidal person, I would have been even more frightened.
I am not at all sure what the practical implications of my story might be for training psychiatrists to deal with suicidal patients. As I said earlier, I am very happy now that I was unsuccessful and have been helped enormously by a kind and skillful psychiatrist. So I absolutely do not want psychiatrists to accept suicide as another expected medical outcome or to stop trying to prevent it.
Indeed, I am writing this because I hope that somehow being public about my own experiences may someday help one other person get through the blackness of contemplating suicide and decide to struggle with being alive.