Medicine / Psychiatry

The Other Side

Written on August 11, 2015

My psychotherapy supervisor taught me a tip during residency — to pay close attention to the very first thing a patient says, and more importantly, the last topic they bring up towards the end of session (because it’s likely that the subject weighing most heavily on their mind is too uncomfortable to discuss at the very beginning).  I struggled to come up with a topic to discuss on my blog today.  At first, I uploaded chipper, smiley pictures taken from a recent spontaneous trip to the coast, but there was something about my grin and carefree expressions that didn’t seem quite appropriate to post today.  I try my best to ensure that my blogposts are reflective of my current state of mind, and my current mood is actually quite solemn.

I know that today marks the one-year death anniversary of Robin Williams, yet avoided news articles, tweets, and Instagram posts that paid tribute to the iconic, inspirational actor.  While sitting on the couch and staring blankly at the television screen, a short reel of Robin Williams popped up on entertainment news.  Not content with the mainstream, flowery piece which strung together brief clips of some of his finest, Oscar-winning work followed by a quick moment of silence in remembrance, I picked up my phone.  While scrolling through Instagram, I focused on a long, detailed post written by a young man in which he describes his own personal battle with depression and multiple, near fatal suicide attempts.  Robin Williams’ lost battle to mental illness motivated this man to share his story rather than isolate in shame and silence.  The words authentically describe the powerless experience of succumbing to the disease.  The depression takes exclusive command and overrides any attempt at rationalization.  And I know the story to be true because the writer is a dear friend of mine who miraculously survived.

Several of my patients have described similar experiences.  Several people living with mental illness whom I follow on social media share similar stories.  Every morning that I arrive in clinic, I log on to my electronic medical records and pray not to see a message from the coroner’s office.  As a psychiatrist, getting that dreaded phone call from the medical examiner is probably my equivalent to the oncologist receiving a call from a family member or hospice staff.  As a young teen, I vividly recall accompanying my family for routine, frequent visits to my grandparents’ apartment, where my grandfather passed away, rid of the suffering he endured from colon cancer.  A few years later, my grandmother peacefully died from multiple myeloma.  Her last words to me before she passed was that she wished for the opportunity to pay for my education and witness me become a doctor.  My other grandfather, as he approached the end stages of his battle with cancer, fulfilled his wish to fly back to the Philippines, where he comfortably spent his final days in his homeland with our large, extended family by his side.  When the medical examiner’s call ends, my immediate response is to shut the door and sit alone in silence.

Finally recognizing the mixture of emotions that I suppressed the entire day, I could no longer hold in my tears.  Rather than isolating (as clinicians tend to do when it comes to coping with patient loss), I attempted to share my thoughts and emotions on social media, with the goal to make others aware of the difficult emotions that we, as mental health practitioners, face when dealing with patient suicide.  The loss not only permanently impacts us professionally in our practice, but also as human beings.  I left the post on my feed for 20 seconds, then immediately deleted it.  Shame, embarrassment, and fear of judgment overrode my hope to break the norm of silence and connect with others too afraid to open up about their own experiences losing a patient to suicide.

As you can see, I waited a few days to publish this post after much contemplation.  The truth is that the fear of losing a patient to suicide weighs heavily on my mind almost every day.



16 thoughts on “The Other Side

    • He wrote about his feelings about the patient he lost to suicide.

      My psychiatrist also has lost patients to suicide and he almost quit when he lost his first patient.

      You are not alone in your feelings on losing patients.

      • I appreciate you sharing the post as it made me realize even more that i’m not alone and gives me courage to keep writing. i’ve heard similar stories of others, like your psychiatrist, who nearly quit as a result. i’ve come close as well, but i must keep going

  1. I lost a dear woman due to suicide about thirty years ago. I still can’t get used to the idea. Still, I ask myself if it is not selfish of us to put our own fear of death before the peace those people finally have found. I think I have been close to something you can call depression for a week or so, and it is HELL. Also, shouldn’t we respect their choices? You can go merilly through life hoping everyone is happy, but that is simply not the case!

    • i appreciate your comment. grief is so so hard, and among the most difficult things we experience as human beings…even after 30 yrs of losing your dear friend. that’s a good question and i can see your point. however, i truly believe that suicide is preventable, not just because it’s my goal as a psychiatrist, but because depression is a true, neurologic disease where hopelessness, suicidal thoughts, and impairment in the ability to make rational decisions are manifestations of it. Also having known suicide survivors turn their lives around makes me believe even more that there is hope.

  2. I think you’re very good at free associational writing and this is more proof of that. Your emotions come out slowly, so the reader can feel with you. And as your mentor predicted, you’ve saved the most difficult for last. What’s good for the therapist is good for the writer, too.

    • hi Tom, it’s always a huge compliment to receive a compliment from u regarding my writing style. i questioned my writing format in this piece, but i believe it was more about my insecurities of writing about such a difficult topic. i also know of someone who is very good at free associational writing — and perhaps we can expect more?

      • While browsing some old posts, I came across another quote from Thoreau: “What you get by achieving your goals is not as important as what you become by achieving your goals.”
        I think Thoreau would support your continuing your free associational writing. Your insecurities will still be there, but that’s OK.

        • Another great quote that I will likely use in a future post. Until then, I will use it as a motivator to continue writing…insecurities and all. Thank u Tom for always inspiring me to keep blogging 🙂

  3. You bewail Robin Williams’ “lost battle to mental illness” without the slightest hint of awareness that there can ever be a motivation, other than simple insanity, for suicide. Williams, who had had Parkinson’s disease for years, was becoming demented and undoubtedly knew it; his autopsy confirmed that he had Lewy body dementia. Had he “won” the “battle” and gone on to live decades longer, this once-brilliant man would have spent many of those years as a near-vegetable in a nursing home. My own father, once a certifiable genius, is now dying of late-stage Alzheimer’s. Based on my own carefully considered values, which owe more to Stoic philosophy than to such modern fashions as Freudianism or behaviorism, I don’t have any hesitation in saying that if I should develop this condition in future, I’ll choose to die rather than end up in the state he is now in. Hopefully, if that should come to pass, my death won’t be followed by total strangers blatting on the Internet about how I “lost my battle with mental illness.”

    • Hi Jane, I appreciate your comment and respect your opinion. Nobody except u can fully understand the gravity of what u are experiencing with your father dying of late-stage alzheimers. Just like nobody can fully empathize nor understand what people diagnosed with mental illness go through the moments leading up to a suicide attempt, unless they’ve experienced and have been in that same state themselves. My intention of using the words “lost battle to mental illness” is to convey that depression is a true neurologic illness, just like lewy body dementia. Similarly as people die of cancer, people battling depression may die of suicide. Though I respect that u disagree and have your own beliefs, I ask that u not minimize the experience of many who continue to fight their mental illness on a daily basis, nor invalidate the experiences of people like myself who have lost people to suicide.

      • Agreed, I certainly didn’t mean to imply that all or even most suicides were justifiable, or that they aren’t painful to those left behind. A childhood friend of mine killed herself after years of depression that were not relieved by any drug she could bear the effects of. Since she had had an apparently ideal life and a family, her death seemed utterly tragic to me – however, I cannot know what her life was like from the inside. I would wholeheartedly agree that someone who is suffering terribly from a potentially treatable condition, whether mental or physical, should certainly seek treatment (and perhaps, if relief is not thereby obtained, try a range of alternative as well as conventional approaches) before taking such an irreversible step. Dementia, if it is not caused by a pharma drug that one quits, is never curable and it never stabilizes; it keeps getting worse and worse until you lose not only the right to say “no” to aggressive life-prolonging efforts, but the ability to do so. Thus, though I respect my father’s effective choice to endure to the end whatever became of him, I also respect Mr. Williams’ at least equally voluntary choice not to.

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