A Primer on Depression and Bipolar Disorder

II. MOOD DISORDERS AS PHYSICAL ILLNESSES

D. Suicide (cont.)

There are other complicating factors. Physical illness: sometimes suicide is the response to a terminal illness or a chronic condition that is very painful. I have lost a couple of good friends this way. From those limited data, I can't help but believe that depression is implicated too, and that if the depression these individuals experienced because of their illness had been treated, they would have been able to go on, at least for a while longer.

A particularly tragic case touched our self-help group in 1992. One of our members was afflicted with both epilepsy and severe depression. The medication for his depression made the epilepsy worse; the medication for the epilepsy made his depression worse. He was caught, and the doctors weren't helping; worse, he couldn't afford to see a doctor anyway. He lived alone on Social Security, and had no family or friends.

One evening, he described his situation and, in essence, gave positive answers to the questions listed above. If we had known then the significance of what he was telling us, we would have gotten him to a hospital. But we didn't. He killed himself the following week. We all felt bad, guilty, and responsible for a while. Then we resolved that we would inform ourselves so that the same tragedy would not occur again. We are ready.

Old age: Age is a definite factor in suicide resulting from depression. A young or middle-aged person may be willing to tough it out even untreated because they figure the odds of recovery are on their side, and that they will have plenty of life after recovery (they always assume that the depression will go away completely). But an older person, again untreated, may feel that it's all over, that there's nothing worth living for at that point. Or he/she may have been through the depression mill one or more times earlier in their life, and can't face the prospect of going through it again (this was the case with the brilliant author, Virginia Woolf).

Young people: The suicide rate is also high during the late teens and early twenties. Many studies have been made to determine why the rate is so high in this group, and many books have been written on this subject. One fact that emerges is that the victims very frequently are caught up in crises resulting from adjustment problems related to romance, sex, pregnancy, conflicts with parents, and so on. However, there may well be a serious underlying biological depression as well, which, while not as obvious as the emotional conflicts, is nevertheless quite capable of being deadly. Thus for young people, both biological and psychological causative agents may be present, and both require expert care. In many cases, this treatment can be very effective.

People considering suicide often examine their life in agonizingly minute detail. In doing so, they will recall many sides of their life long forgotten. Unfortunately, because they are in a very negative frame of mind because of acute depression, they will almost invariably discount what is "good," and attach special importance to what is "bad".

Skilled psychiatric intervention can often play a beneficial role in by helping the victim to gain a more balanced, favorable, picture, and reminding him/her constantly of the bias induced by the biochemical imbalance in the brain. But sometimes, none of this works, and the victim moves on a smaller-and-smaller orbit around the black hole called suicide. At some point, he/she may become defensive about the desire to die, well before it reaches an actual decision to die.

There may result a "Mexican standoff" with the victim resisting efforts to help him/her. A very succinct indication of the situation is provided when he/she asks (directly or implicitly) "whose life is it, anyway?!" The implication is that it is "my" life to dispose of, so "I" can/will "dispose of" it as I please.

This is by any standard a deep question. It can be debated on many levels using many disciplines. At one point, I engaged in this internal debate myself; fortunately I found a convincing answer to the question. The story I will tell below is true, but obviously it is only my answer to this very hard question.

As described in the Introduction, in early January, 1986 I went home one afternoon to pull the trigger. But my wife had already removed the gun from the house, so my plan was thwarted. Being incapacitated to the point I could not immediately come up with another plan, I was stuck, and I simply stumbled forward. Somewhere in the end of January or early February, my wife and I had lunch near campus, and in walking back to our offices, we parted company on Springfield Avenue.

It was snowing moderately. I went along for a few steps, and on impulse turned around to look at her going away. As she moved further along her path, I watched her slowly disappear into the falling snow: first her white knit cap, then her parka, then ... gone! In an instant I felt a tremendous pang of loneliness, a tremendous sense of loss and emptiness as I found myself asking "What would happen if she suddenly disappeared? How could I stand it? How would I survive?" Then almost immediately, I understood that same those terrible questions would be hers if I were to kill myself. I felt like I had been hit with both barrels of a shotgun, and I had to stand there a while figuring it out.

What I finally came up with is that my life isn't really "mine". It belongs to me, sure, but in the context of all the other lives it touches. And that when all the chips are down on the table, I don't have the moral/ethical right to destroy my life because of the impact that would have on all the people who know and love me.

Killing myself implies killing part of them. I could understand very clearly that I did not want any of the people I love killing themselves. By reciprocity, I realized that they would say the same of me. And, at that moment, I decided I had to hang on as long as I absolutely could. Today, needless to say, I am very glad I made that decision.

This is a story. It is not meant for the logician or the philosopher. It is meant for the heart more than the mind. I know it is not the only conclusion that could one could reach, and that many other things might be said. Nevertheless, it has had a very strong influence on how I have run my affairs ever since.

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