Posts in Category: Minds

Who, What, Why? : The Questions of Suicide

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I’ve been asked to write about suicide. Can you write about something that makes us speechless?. The news of a suicide intrudes into our lives suddenly, like an iceberg looming in front of our small unsteady boat. What is true about suicide?  A few facts but none of them answer the questions that underlie essays about suicide prevention and statistics:  Why her? Why him?  Why not me?
What should I have done to help?
Copycat suicides do exist. The contagion effect does exist.  Asking for help does help. Depression can cause suicide. People who  feel a little better after depression often get a surge of energy to kill themselves. Sometimes there are clues. Statistically, the person most at risk for killing himself is a middle-aged man with no community, a history of mental illness and a completed suicide in his family. Patients discharged from the hospital who are chronically depressed or suicidal are most at risk within the first 48 hours of discharge.  And the ability to talk to others truly can help change our thinking.
Sometimes, however, there are no clues.  I have patients who live securely with a plan for suicide tucked into their back pocket. I have had many patients who kept knives or razorblades in their cabinets ; living with a Plan B felt safe. They were in control. My own father, a lanky oncologist, told me he had cyanide pills from WWII in his basement workshop. Although he joked “they probably wouldn’t work by now,” he wanted to be able kill himself if circumstances or his pride dictated. My mother told me in a rash confidence that she continued smoking so that she would die before my father. She died suddenly of a cerebral aneurysm-  leaving us dumbfounded.  She got her wish. My dad lingered for nine years in the stupefying air of Alzheimer’s Disease, listening to Schubert. 
Teenagers tell me stories of walking out onto the roofs of the tallest buildings in Boston “just to see.” To see what? Whether their dizzying fear of heights will overcome their desire not to feel? I have called the caretakers of hotels to tell them to raise their security access to roofdecks.
The desire to stop pain is not the same as wanting to die.
 I saw one patient  every week for nine years. One day after a New Year’s holiday, he tried to kill himself. I  thought I knew him well. My hubris.  After I  returned from a vacation, I waited for him in the office at a church where I worked. Snow piled up beautifully on the brick church while I waited.  When he did not show, I was mildly surprised and picked up the phone.  I began making calls to find out where he was but I was not worried.
In fact, he had taken an enormous overdose of his psychotropic medicine after living tortured by schizoaffective illness. He was saved by the odd fact that his blood thinners diffused the toxicity of his overdose. This man was lovely, tall and funny; he tried to overpower his aloneness and psychosis with joy. He wrote poems.  He chanted gregorian chants.  He longed for and feared intimate connection with equal force.  I’m not sure his life was any better for having survived. The morning I discovered his overdose, I cried and shook.  Foolishly I had believed that our connection,  only of therapist and patient, was enough. But it was a gold thread thrown across an abyss of darkness. 
Mostly, I wanted to rush to the hospital. Lawyers stopped me in case his family would blame me for the overdose and sue the clinic. It’s true. I would have been a terrible witness. I wanted to confess and be absolved. I sought help. I realized that my vow as a psychologist was ” to do no harm,” not to keep people alive.  For my career I had confounded these intentions and they had to be untwined.
 I reduce my understanding of suicide to one truth. We underestimate the “otherness” of other people. They are not thinking what we are thinking. They are not feeling what we feel. When their minds wander they do not go where ours might. A woman drops her childhood friend like a dress that is too tight. Partners turn on a dime. A child we thought wouldn’t make it, suddenly finds a passion and launches on their own. Someone we shared a life with, a team with, a class with, kills themselves. It happens again. And again.  We wonder.
 Do they see something that we don’t?
In my own family there has been one completed suicide. I was told it was a heart attack. My grandfather, embezzled out of his money in his own shop, stormed out of a family dinner on Riverside Drive and checked into a hotel. His body was found the next morning and my own father was called to identify it. Cause of death = heart attack. Actual cause = overdue of barbiturates.
Recently I heard three wildly divergent responses to a suicide. The first: “If she could do that could I?.” The second: “I can’t imagine this. I never could imagine. Can you?” And the third: “Who among us hasn’t imagined this before – or at least said it?” None of these responses were insensitive.  None were wrong. They all came from people reasonably attuned to the range of feelings in life.  Some people will never kill themselves.  Some will.  And some people can walk a middle line, wondering what would tip the balance.
But the assumption that we can truly know what it is like to be another person – that we walk along next to someone assuming they are  like us- that assumption is inevitable but wrong. In the car last week, I asked my daughter what she ( at twelve)  was thinking about. “Candy,” she replied. The next day I asked her the same question. “I just remembered I have a math test.” When I asked her if she was nervous she replied: “No, Not at all. Just don’t be late.”
I am always grateful for health. Both kinds. All kinds.

 

See Jane Read. See Jane Jump.

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I identified myself as a reader at the same time I understood I was a self. I was at day camp which seemed quite far away from my home in the city,  though of course it was not. Underneath a dense triangle of pine trees, I remember holding a book open before me as I walked the  path.  Suddenly the words made sense. I saw pictures where I had seen dark code. 

My own daughter struggles when she reads. She is not the first with her hand up in class, eager to share her thoughts about the characters or images inside her. After years of waiting for her quick mind to catch fire, I realize that reading is “not her thing.” Not that she can’t, or won’t read. But not at any moment, any pause. The sheer delight of dipping into a a book does not beckon her. The libraries that were my home away from home do not call her. Annabelle generously commands the playground, the snowball fight and the dance studio where she shepherds younger girls with subtle grace. They flock around her asking for their hair to be brushed into buns, smooth as glass.

I watch the laborious unnatural training of her mind to read and it strikes me as surprising. She observes my inability to get a package back in its wrapping and laughs at me. I find myself rethinking my lifelong companion, my addiction, the pure peaceful pleasure of reading.

My daughter does not always want me to read to her though I want to open the world of my childhood. I want to introduce her to the families I knew. The words unfurl as I read to her, stored in the place age has not decayed. I cannot remember most of this morning but I can remember what comes next in the Rush’s first Saturday or how the All of A Kind Family slept in chocolate cracker crumbs traded in the dark.  The Brown family that harbored Paddington and his marmalade sandwich wait to entertain her.

The hunger to read has been, for me, like other people describe the hunger to practice medicine or be in nature. Only in the books of childhood was I free from the romance tale. Girls are thinking and talking and feeling; they are using all their senses to become known in the world and explore history, cities, fields, mysteries. Books have the power to stop the passage of time,

Before ‘happily ever after’ arrived, before the princess and prince eclipsed my stories, I ran free. Childrens’ books remind me of a time when my deepest being was absorbed in an enterprise of pure imagination. As I read I was an orphan in India,  sister with a rare phoenix bird, a British child entering a wardrobe with rustling furs that led to Narnia.

When I wait online at her school, Annabelle bursts out of the line with excitement. When I ask her about her day, she shakes with excitement. I wonder how long it will be before she peppers her definite needs with the word  ‘like’, before she asks friends if she looks ‘fat’ in her clothes, before she finds her anger terrifying?  Books which guide girls quickly turn into a romance plot- each one ending with love like The Holy Grail.

If there were one thing I wish she could grasp- It is that she is already complete. Everything which comes next is misunderstanding. Books may deepen and enrich us.  They can mirror and extend our understanding of ourselves. But books also distort glaze over our goals and change our sense of an ending. Curiously, like my own mother, Annabelle favors detective stories: the mastery of right over wrong. The sense of justice, The role of the detective.  She reads in an investigative manner, methodically and for purpose. Perhaps her body and dextrous hands will give her more pleasure than my imaginings did.

Perhaps she will be freer than I was. I could not imagine having a book and choosing to ride a bike or play outside instead. Her own extroverted nature may force her away from the distortions of introspection. She has so many friends she does not hide behind a book. Perhaps her joy in investigating will serve her well as she pushes off from the land of childhood, waving.  This week she was still confident she could be a french teacher, a orthopedic surgeon or choreograph the dance of a shooting star .

Caring For The Caregivers: The State of Mental Illness

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This is a reprint from an earlier blog. I thought with Thanksgiving and other holidays so near, it would be the perfect time to highlight the work of so many that goes unnoticed so often. —Katy

As the nation held its breath, waiting for news about health care, violence has occurred to caregivers of mental health and from them. The psychiatrist in Fort Hood who shot military men and women was pre-ceded by a more intimate tragedy. At Mass General Hospital a bi-polar man, in an outpatient appointment, attacked his psychiatrist, a female doctor and was killed by a security guard who happened on the scene. The following day I sat in my office and wondered, not for the first time, if I might get killed by a patient or have a death on my hands. And I thought, how amazing it is that these events do not happen daily.

Mental illness shows no prejudice: It is invisible and slippery. Progress is difficult to measure and the care is given by people who are tired, severely underpaid, suffer compassion fatigue, and vicarious traumatization. We live in two worlds—often at the boundary of madness. Then we walk back onto the bright well-lighted rooms of our homes or children’s school and try to forget what we know. 

But at such an important moment of change, as we contemplate our American “system,” we need to review the state of mental illness. Thirteen years ago I began treating young women who were dying from eating disorders. I was tremendously optimistic, then, about change in my field. Taboos were lifted and therapy became widely acceptable as did new and effective psychotropic medication.

Yet, in fact, the opposite has happened. I see more and younger women, succumb to eating disorders. We know what treatment is but there are fewer places for this treatment. I also see the power of our culture, as it speeds up its demands and feeds us less.

Mental illness, the invisible dark cloak of depression, the shaking hands of the anxious, the rude voices of schizophrenia are one of America’s untouched frontiers. We believe that people with cancer are due every bit of bone marrow they can find. Yet we leave our ill to sit in squalor with demons in their heads and no one visits or calls. Loneliness is the chief complaint of most of my patients. Something in us still dares not name mental illness when we see it. Others of us trust everyday that the relationship we have formed with our patients—the web of connection thrown over an abyss, will hold. The anxiety, depression, and psychosis caregivers metabolize is staggering. We do it because we are curious, compassionate, and believe there we are not doing hospice work. I remain deeply troubled as to why this profession goes undervalued when it is lifesaving and life-affirming. Our country is still adolescent, We believe death will not happen to us. We believe that unattractive aging is optional. We believe there is an ‘us’ and a ‘them.’ Until that prejudice is dropped and we understand that mental illness is often a cruel accident of birth, we will never provide adequately for mental illness in those we care for or those who give care. The valedictorian of the class, the doctor’s wife who seems a bit ‘off,’ the college roommate who kills himself writing and in love … all of these are just the a few cracks in the pavement away from us. There is nothing especially ‘other’ about mental illness. Perhaps that is why it scares us so.

5 Books Every Mother Should Read

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Quizzes abound: What Disney princess are you? Which Downton Abbey character are you? These questionnaires are found everywhere. This new fad of quizzes tells me that we yearn for rules and definition the more we feel unclear. Books on mothering and motherhood are everywhere. As an academic (lapsed) and a haunter of libraries, there’s no better way to master a situation, I thought, than research. So, when I realized I was going to be a mother, I started reading.

I started out with What to Expect When You’re Expecting. In about 10 weeks, that book was obsolete. I was on bed rest and nothing went as “expected.” My reading also went far off the beaten path. I roamed about in fiction, poetry and mass market self-help. I have emerged 11 years now, with 5 books that are my guides. I turn to them and recommend them to others with the eagerness of a zealot or a convert:

1. Perfect Madness, by Judith Warner

2. I Don’t know How She Does It, by Allison Pearson

3. Operating Instructions, by Anne Lamott

4. The Bitch In The House, by Cathi Hanauer

5. Mothers Who Think, by Camille Peri

None of them, in fact, are self-help books. These are decidedly anti-selfhelp books. I prefer books which repeat passionately that predictable rules just won’t help in this sort of situation. These authors are the women who “get it,” get me, get the whole “wow I’ve really got this thing down … whoops, I have no idea what I’m doing” feeling, and shore me up. Thank goodness that women who write and reflect are as baffled as I was by the strange careerist role of being a mother in this time.

Darkness Visible

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“Hi how are you. Good? “ The answer comes right after the question.  I don’t need to speak.  That’s how many of my days begin when I drop my daughter off at school.  Parents cluster in pools of light, nursing coffees and trading gossip about vacations, teacher choices and new policies on parking.

I love that light- but I don’t live in it for long.  Like New England spring- happiness is elusive and luxurious. I move in and out of those pools of sun with friends and family.  But I don’t live entirely in light or even in sanity. My real life happens elsewhere, at work shuttered behind the city streets.

Last week I saw a man running with a long steel leg. He loped through his morning run in the suburbs like a mysterious creature. Half man and half steel. Miraculous and brave. The centaurs have come back.

A woman cycled past me on Brattle Street this summer while I waited for the camp bus. Crouched low on her bike, half an arm tattooed to the stump. My daughter observed ”she must have lost it in the marathon bombing. Otherwise the tattoos would have continued down her hand.”

Survivors are among us in all forms.  Some with wounds, some amputees.  Some with wounds that are invisible and harder to tend.

As a result of the terrorist attacks last year, the claims made to the Boston Strong fund are for PTSD, depression, or anxiety.

I treat invisible wounds. Scars on the soul largely go unseen.  Who stops a passerby and says “You look sad.  How was your day?” Who sits down with the person alone on the bench?

How can we tend the strangers among us?  Cutting and burning, even tattooing, show me how much we all want to be seen.  Internal pain must be transformed into something recognizable, demanding immediate care and attention.

No wonder that so many patients beg for a scar- a broken limb- the psychic equivalent of a scarlet letter on their forehead. No wonder they talk loudly to themselves.

How else is darkness, as William Styron, said to be “made visible?”

My father, an oncologist, taught me early on “The most serious wounds don’t look bad.  They grow inside you until you die from them.”  Doing psychotherapy is like doing neurosurgery in the dark.  We feel our way along, making connections. 

I try to decode the dusty Braille on the inside of a wrist.  The one word that flies up like a gleaming fish out of a sentence and sinks down.  The pearl inside the oyster’s slime.

Yesterday in the middle of a few things I stopped on-line for a coffee. From behind I felt a hand like a shaking butterfly, descend on my arm.  

“I don’t know if you are aware, but your purse is open?” It was an older woman, speaking with care.  A few years ago I would have brushed her off politely.

But now I thought- perhaps this is her one conversation, her only touch for the day.  I turned and talked about the wait and the line.

EM Forster said,” Only connect.” 

Do you talk to someone unsolicited?  Can you listen? Can you hold that thin thread of connection and ask them next week: : “How are you now?”

Ask them to step inside your circle of sun?