Suicide: A Survivor's Perspective
(Part 1 in a series)
On April 12, 2011, I tried to kill myself.
I have bipolar II disorder, diagnosed after my suicide attempt. On that day, I had been in a mixed hypomanic/depressed state, forced to face the fact that I’d been doing something that was wrong and seen as bad by others. Sex is a common theme in mania and hypomania, and I saw nothing wrong with writing erotic fiction instead of working during the day, and then sharing it with my coworkers. I kept rewriting the stories, making them more and more explicit, in a vain attempt to match the hypomanic eroticism in my mind. As a result, people complained, and I was placed on administrative leave the moment I came to work that morning.
I remember sitting with the executive director of the hospital where I worked when he told me I was being placed on administrative leave, and that the human resources department would not allow him to tell me why. He said they would contact me to let me know, and all I needed to know was that I was to leave the premises immediately and stay away until further notice. I had a sneaking suspicion as to what the problem was, and I left as asked. I stopped to get a small pad of paper, went to a Starbucks, and while I sipped my tea, I wrote a suicide note which I left in the car for my wife to find after I was gone.
I was absolutely certain my professional life was over. And if that was the case, so was my personal life. I felt I had disappointed and ruined family, friends, and acquaintances, who would forever see me as useless and a disappointment. The shame and humiliation were unbearable. Telling people what had happened, what I had done, was a horrifying thought. I felt there was no other option left for me other than to hide forever. Death was the one thing that made sense, as if I’d been up for three days straight and all I wanted to do was to sleep, forever. I wanted to be securely in the grave beyond blame, beyond recrimination, beyond shame, beyond family, beyond friends or hope. It seemed there was truly nothing left.
Rereading these words doesn’t express a tiny fraction of how awful I felt. It seems that in that moment, I switched from hypomania to depression. I went to the medicine cabinet and took all of my medications at once. I laid down and waited for death to overtake me.
When I woke and realized I had failed, an even more profound sense of hopelessness overwhelmed me, and I laid in bed for 3 or 4 days, getting up only to have a drink of water now and then. My wife kept asking me what the problem was, but I had no energy or interest in responding. Eventually she more or less dragged me to the doctor to whom I admitted my suicide attempt. He arranged for immediate hospitalization and my life started to turn around.
A Survivor’s Perspective
I plan to write a series of blog posts about suicide from the perspective of a survivor. Being a mental health clinician, I have spent the time since my attempt trying to understand myself from many different perspectives and hope to share these hard-won insights with you. Let me start with some background.
I’ve been more often depressed than hypomanic. My hypomania comes about most commonly in relation to having been administered testosterone since my levels are low, and low testosterone can be used to treat depression. Unfortunately for me, the testosterone switched me from depression to hypomania 3 times that it was tried, the above being the last.
I am now 63 and first had depression at the age of 21, after the loss of my first serious relationship. There were episodes of depression throughout my life, which responded to SSRIs. There is also a strong history of depression in my family; both of my sisters have been depressed, my father had problems with depression later in life, and my mother had panic disorder. Family members beyond first-degree relatives have had difficulties with anxiety and depression as well.
For those of us who’ve experienced depression, it’s been a psychosocial stressor that has tilted us into the pit of despair: one sister with a postpartum depression, another with problems with her children, and me with a sense of loss of personal and professional identity.
In my case, the sense of loss of such identity was ineluctably intertwined with a sense of isolation and hopelessness. The certainty of ghastly loneliness and being misunderstood, even willfully so by others (which is how I felt) both led to the final common pathway of self-destruction as the only way out of the morass.
This introductory blog is here to explain why I have the views that I do about suicide, from a clinician-survivor. The coming blog posts will review what I’ve learned about myself and other suicidal patients, and how that can help your work with them. I hope the hard-earned skills I’ve developed can be of use to you and beneficial to your patients.
Douglas A. Landy, MD, graduated Hahnemann University School of Medicine (now part of Drexel University) in 1983. He is a board-certified psychiatrist, and practices primarily in an inpatient setting with additional work in the Emergency Room and nursing home consultations. He has had experience in sleep medicine and forensic psychiatry, and has an interest in traumatic brain injury. He lives in Rochester, New York.