Suicide – But Not Death By Your Own Hand – Dr. Suzanne Black

Suicide post by Suzanne BlackSuicide: from the Latin “sui” – “of one s self,” “-cidium” – “a killing” – “suicidium.”

“I cannot stand feeling this way anymore. Please let IT end.”  Let the pain end.  We embody the pain, therefore as the source of pain, we feel compelled to end ourselves in the desperate moments. But is it not the pain we want to end and not ourselves?

Should it not be then “Morsuscidium?” The Latin for pain is “morsus” which translates into “biting.” Stopping the biting (pain), the sting, the acuity of the feeling of pain.  Is that not what we want to stop then is the pain?  Killing off of the pain?

When I was a postdoctoral fellow at UCLA Medical Center in Los Angeles, California.  I took a course with the eminent Professor of Thanatology (the study of death) and Suicidology , Edwin Schneidman, MD .  He was quite elderly, and he has long since left us.  His course was one of the most moving experiences I’ve had in all of my clinical training.

Dr. Schneidman, in my understanding, said that none of us are responsible for another committing suicide, but we are responsible as empathic beings for extending our hand to the one who is despairing and not letting go. We are compelled to speak from the heart and remind the person that they are in life and are alive, and that there are possibilities beyond what they can see in that given moment.  True that.

You lend your own will to live to that person and you let them know that their presence in this world makes a difference in countless ways to so many people and situations – that they matter – we all matter. You do whatever you can to remind that person that they have a responsibility to learn how to live and to live well , and that you are there to facilitate that happening . They are not alone .”No man [person] is an island” unto himself [herself].

When I was working in the Psychiatric Emergency Room at UCLA, I recall being assigned a patient who was brought in after a major suicide attempt. He had a terminal illness.  He was quite angry with me, insisting that he had a right to die by his own hand, if he should so choose.  He asked, what right did I have to “play God”, and tell him he MUST live when he did not want to suffer a painful, protracted process of death.

I reflected. I felt humbled by his indirect assertion of his choosing to take on the “role of God,” so to speak, rather than I, as the doctor, taking on that role of a semblance of God,  to make sure he stays alive as long as his natural life will permit him .  The Hippocratic Oath – yet I am not a medical doctor.

I am a psychologist.

I told this patient: “You are right. I, in fact, have no right to tell you that you cannot do as you wish.  I do have the right to try to save you from yourself in your extremely distressed state. The paramedics have brought you to my domain, and I have the ethical obligation and even more so the personally compelling desire to help you to come out of the depression, so that you can see much more clearly with greater perspective.  Make an informed decision, if you will.”  Suicide is not an option. Not yet. Not at all.

This is how it goes.  Giving yourself a respite from the agonizingly painful, predictably unpredictable cycling of moods, and the Concorde flights to hell that seem like they last forever, physically painful, emotionally and mentally torturous.  We always know we will come out of it, but when we’re going through it, we don t recall that. We don t think of that. We simply think of wishing desperately for the pain to stop. “Morsuscidium,” please!  Now!

As a clinical psychologist who has trained and worked in various clinical settings, emergency rooms, inpatient psychiatric units at inner city, private and teaching hospitals, we were told repeatedly -if not outright warned-  to remember that we may encounter, one day, the suicide of a patient of ours. If so, that suicide would not be our fault. However, we would feel moments of despair in the sense of helplessness to have not been able to save that devastated soul. Perhaps it would be that same helplessness that the person felt moments before they took their life .

To my knowledge I have never had any of my patients suicide, though there are those who have made serious, albeit unsuccessful, suicide attempts. There have been many a call sometimes in the wee hours of the morning expressing acute despair and asking for help, yet feeling hopeless about receiving any relief from their abyss of pain. Therefore their relief comes from choosing to end their suffering through annihilation of their existence .

Just die. Just do it. No, don’t!

What I have been known to say to my patients in these dreaded moments is that feelings are transient states and not necessarily accurate indicators of current reality. Our emotions color our perceptions of our internal and external realities, and when our moods shift, most likely so will our perceptions. It makes logical sense, of course. However, when one is so pained and desperate in their desire to alleviate their suffering, one acts from a place of feeling and not cognition. All that matters is having mercy on their seemingly relentless emotional choke hold.  Stop the pain as soon as possible.

Just die. Just do it. No! Don’t!

Many people who contemplate suicide have thought it through for some time. There is the relief that occurs when one has finally made a decision to end their life.  This is why in emergency rooms we re taught to be aware of those patients who suddenly seem to get better and are now stating they are resolved to live life. This suddenly euthymic affect is only a mask for their decision to make another suicide attempt.

I remember the article written on the survivors of suicide attempts off the Golden Gate Bridge in San Francisco. Every single one of them stated they wished they had not jumped at the precise moment they started to free fall off the bridge, instead wanting to live .  The adrenaline rush, perhaps, of such a bold, dramatic physical act, awakened the senses .  I don t know.  I don t know how a study could be done on such a phenomenon – but the chemistry is always implicated .

Suicide is also something that is not always necessarily thought through.  It could come on abruptly without forewarning.  Welcome the unwelcomed – the predictably unpredictable mood shifts of BAD – an acronym for bipolar affective disorder.  Indeed, this is bad.

Suicidal ideation has been linked to a drop in the serotonin levels in the brain.  Some women, when they are premenstrual, will have a sudden down shift in mood and may have suicidal ideation seemingly out of nowhere.  They are high functioning and overall happy.  Then there is a drop in the estrogen level premenstrually. Estrogen is a neurotransmitter mediator, so neurotransmitters responsible for our feeling of well-being suddenly start to go awry and run amok.  Suddenly, we don’t feel like our usual selves.

This is not to say that our neurochemistry is the sole determinant of the act of committing suicide.  Many, many factors are implicated in suicidal ideation and attempts, but neurochemistry certainly is a major player . An incident may trigger a terrible drop in mood, and then neurochemistry takes the helm.  But we have higher cognitive functions.  No matter how bad we feel, can we not override the compelling beckonings of the tortured mind, soul, heart and simply not succumb to what feels out of our control??

The only constant in life is change. Whatever we are feeling in any given moment will ultimately change – and in the end, we all leave this life, so why choose to die by our own hand? Why hasten the inevitable?

My Mother was a Nazi Victim Survivor . She passed away earlier this year, unexpectedly, and with her, most of the memories of experiences she dared not utter until just before her Suzanne Black Photopassing.  My Mother said that no matter how horrible life can be, we have an obligation to live because we are alive. ‘Live boldly’, she said. ‘Live with fervor and conviction, and enjoy when there is life to enjoy, and acknowledge misery when it comes – it is simply passing through, and we will survive it. If we don t, it should never be stopped by our own hand’. Amen.

Thank you for your thoughtful reading of this essay .  Much more to say on this topic …. look forward to upcoming posts .


Suzanne Black, PsyD