When the Patient Commits Suicide
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When the Patient Commits Suicide

There’s an article in the January 20th issue of The Atlantic called “How Patient Suicide Affects Psychiatrists.” The author uses the term “psychiatrists” loosely, referring to any mental health clinician.

As I read it, the first situation described by the author sounded familiar. As I continued, the words attributed to a “Dr. Brown” sounded even more familiar. My thoughts went from, “This is interesting. Dr. Brown thinks the same way I do. I’d like to meet Dr. Brown” to, “Wait, those are my words!”

Then I remembered being interviewed last fall by a Sulome Anderson, who was writing an article for The Atlantic, and I realized “Dr. Brown” was me. She was quoting me directly from our interview, but changed my name to “Dr. Brown,” apparently to protect my anonymity.

On September 12, 2013, a client of mine, a mother and wife, stepped in front of an oncoming train. She had a doting husband and several exceptional children. I had seen her the day before (which was my birthday) and I thought she was doing well. The next day her husband called to give me the news.
Shortly thereafter, my son Dan took his life.

One of my strategies for managing grief is to find something constructive that might come from this tragedy. I hoped my interview might contribute something to others in a similar situation. One thing I discussed with Ms. Anderson, which she mentioned in her article but attributed to others, was my uncertainty about whether the clinician is or isn’t responsible for the client’s choice of suicide. My uncertainty about the role of a parent was only implied.
The question of responsibility is an agonizing one for the clinician. If I take responsibility for my client’s choices it may be my grandiosity. If I take no responsibility it may be my denial.

I was surprised that Anderson’s article didn’t say more about the effects of suicide on the clinician. Of all the effects that suicide can have, and does have on us, she focused mostly on one: the tendency of clinicians to refuse services to suicidal clients.

The son of the client who committed suicide had been seeing me for several months before asking me if I would work with his mother. During this time his primary focus was on her depression, and on her multiple suicide attempts before he came to me. I knew the risks were high.

I swallowed hard but agreed to see his mother partly because of my relationship with him and partly because I believed I could help. Maybe it was naive. Maybe it was hubris. Maybe no one would have done better. Maybe someone could have and would have. We will never know. These questions form a part of my struggle to resolve the matter of responsibility.

Knowing the risk was high, I consulted with her psychiatrist. I held meetings with her children. The meetings were energetic and lively. They made sure the younger ones got a chance to speak. They asked me questions about how to act around her, how to ensure her safety, what to look for as signs of increased risk. They took notes. The sessions seemed a good thing to do.

There has been no word of a lawsuit and I would be surprised if there were. My suggestion to any clinician in a similar situation would be to stay in touch with the family. You will ensure that you are more than just a professional. You will be a human with a name. You will learn things you wouldn’t learn otherwise. You will gain perspective on your client. I view such involvement to be the perfect convergence of good risk management and good therapy.

I was standing by the graveside after the service when my client’s husband came up to me and threw his arms around me. He said, “I want you to know I don’t blame you.” I appreciated his gesture, but with mixed feelings. I knew his words meant he’d been thinking about who was, in fact, responsible. As a therapist I had to wonder, was he saying, “I’m tempted to blame you but I don’t want to.” Or, “I blame myself but I’m trying not to.”

After my son’s funeral, almost reflexively, I said to his girlfriend, “I hope you’re not blaming yourself!” I was instantly reminded of the scene at my client’s graveside. Was this my way of saying, “I blame you but I don’t want to” or, “I blame myself but I’m trying not to”?

I appreciate the way Ms. Anderson interviewed me. She seemed concerned, and not just for her story. She was respectful and compassionate. In the end, I think she handled the question of responsibility in the best way possible; she let the reader decide.

There are times when the questions we ask are more important than the answers we seek. This seems true of our most important questions: “For whom and for what am I responsible?”, “What can I and can’t I control?”, “Am I doing too much or too little for someone I love?”, “What is the meaning of it all?”
I am wary of certainty and closure. If I keep the questions open, I keep my mind open and I remain receptive to a continually changing reality.

I am also wary of anonymity. As a therapist, I lament the stigmas that are ascribed to people with mental health problems. To insist on anonymity for myself makes me complicit with the process that stigmatizes. In anonymity I indulge the illusion of my superiority to the people I serve while, at the heart of it, I am as much like them as they are.

Posted by Jim Roberts, MSW

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