“You are sick, very sick. I do not know why I do not commit you to a hospital today,” stated the psychiatrist as she set down her pad and pen, and stared into my eyes.
The therapist I had been seeing for a few months had encouraged me to make an appointment with a psychiatrist for an evaluation. She suspected I was depressed and needed anti-depressants. To humor my therapist I made the appointment. I went into the appointment certain the psychiatrist would tell me to stop playing games with my therapist, I was fine, and get back to work. Instead she told me I had a serious depression and implied I was suicidal. On my way out her door she picked up the phone to consult with my therapist. I left her office shocked, a box of anti-depressants in one hand and an appointment card to return soon in the other.
A few months earlier I had started seeing a therapist because I felt stuck. I had stopped working out at the gym, did not feel motivated to do much. I felt needy in relationships at work. And what I did not share with my therapist at the time, I occasionally had images of shooting my brains out. These were just brief visual flashes, less than a second in time of my brains being blasted from my skull. As the relationship with the therapist progressed and my trust in her grew, I began to share the growing number of suicidal images I experienced. At the point I was able to share thoughts of suicide she stopped suggesting and insisted I see a psychiatrist.
If you looked at my life from the outside I was doing very well: in a loving relationship for over two decades, many close friends, a healthy happy social life, as well as being very successful and respected in my career. My partner and I had just bought a house, a fixer-upper in a relaxing vacation spot. There were absolutely no problems or stresses in my life that would explain why I wanted to commit suicide. And, in fact, I did not WANT to commit suicide. The idea of suicide did not make sense to me. But inside I had an internal dialogue, a chatter of voices that told me my loved ones would be better off without me. I did not deserve to live. I was utterly worthless. Yet my psychiatrist and therapist could not convince me that this was a serious condition. I had no intention of killing myself. These were just words in my head, not psychotic voices, nothing dangerous or serious. How could this be depression if I was not sad? I really was not sad. Just chatter in my head, a feeling of being stuck and only thoughts of suicide, no real intention.
My reaction to the anti-depressants was slow. My reluctance to accept the diagnosis was slower. But six weeks after the first consultation with the psychiatrist my internal chatter, suicidal thoughts and images were so constant I finally agreed to my psychiatrist’s advice and admitted myself to a hospital. The final straw was the day I was driving with my partner and had the idea; “I could drive us off this cliff to simplify things for both of us.” For me the notion of ending someone else’s life along with mine crossed a line. I went to the hospital.
Time in the hospital was sobering. Everyone in the ward was dealing with depression. Most had attempted suicide. This experience woke me to the reality of my illness, the seriousness of my depression. As I listened to the numerous stories of other patients I began to see the similarities I shared with them. Not all of the patients intended to commit suicide. Not all of them had hopeless and tragic circumstances in their lives. There were some just like me who had everything going for them except an internal dialogue of self-contempt. We had loving people calling and visiting us at the hospital, reassuring us of their love and need for us. Yet these internal strangers in our brains continually whispered to us that REALLY we did not matter, REALLY everyone would get over us and be better off without us. REALLY, you are worthless. With little deliberation just impulse, many had acted on these insistent thoughts.
The impulsiveness of suicide began to scare me. I realized I was one impulse away from an attempt. And in all my previous images and thoughts I had already decided if I ever took this out of the hypothetical, there would be no mere attempt, only success. I had several ways planned to kill myself, one plan so elaborate that my body would never be found. I would just “disappear.” Other ways that would look accidental. Even though I had no intention to kill myself, the time and energy I devoted to scheming about suicide scared me. I stopped fighting my treaters at this point and opened up to what they could teach me.
Two weeks of inpatient and partial hospitalization care which then stretched to months of outpatient therapy; peeling away at my resistance to being “ill;” tweaking drug treatments; getting rest, I finally had to agree to give up on the idea of returning to work “soon;” allowing others to take care of me and support me; it has turned into a long year. My therapist still has to encourage me that a year is not that long for what I have been through. It has been a much longer haul than I ever imagined. And it still goes on.
A year later I still have the occasional suicidal image or thought. The internal dialogue of self-hate is still there. Pressure and exhaustion quickly rouse the negative voices but my goal is to have no relapse. Through lots of psychodynamic talk therapy, a medicine cabinet of drugs, and cognitive behavior therapy techniques I am able to tap into other, more positive self-talk. It may be years before I successfully root out all the voices of the death wish or even hope to understand why they are there at all. I do not feel “cured” yet but I do not plan, do research, or consider suicide an option any longer. The irony is I had to start getting better before I could see how unhealthy I had been. I could not see how serious I was at my worst. It scares me now how very close I was to ending it all.
When I encounter the pain people experience suffering over why their loved one committed suicide I feel a shudder. I wonder why it was not I. Had I not had an established relationship with a therapist who recognized a serious need before I did and dragged me in for help; would that be my friends grieving, questioning why, and angry at me for killing myself?
There are as many unique reasons for suicide as there are victims. I have only one small perspective, no answers. Had I acted and left a note to explain why to my loved ones, all I could say is the chatter in my head is too loud to live with any longer. It is nothing to do with you or anything you can do or say. I cannot hear you over the voices; believe in your love over my worthlessness and self-hate. You are not responsible for my actions. I just need the internal voices of recrimination to stop.
I feel fortunate I did not have to write this note. I feel for those who have. And particularly, for their bewildered loved ones.