I have not written directly about the most serious of psychiatric diseases. Schizophrenia is…
The Invisible Deaths: Suicides
Sadly, again we have to deal with suicides, this time in prominent people. Society took a double hit this last two weeks with the suicide deaths of Kate Spade and Anthony Bourdain. “Forensic” history of backgrounds of their psychiatric issues and lives are now partially known.
Something that is surprising to me, as well as in Robin Williams’s case, was the method of the suicide. In an ideal world this would not be revealed by the press or law enforcement lest, for example, copycat suicides follow.
It is also sad and remarkable to me that in the 21st century suicide is kept hush, hush by families and considered taboo and even a sin. A suicide that occurred in 1966 without my knowledge in college changed the course of my life and I did not know what happened until twenty-four years. Later. More about that later.
I have had three further thoughts about suicide recently. First, suicide is not a selfish act. If anyone has suffered a major depression episode they know what I am talking about. Without reaching out for help suicide seems the only way out. People without mental disease do not understand the agony/anguish of major depression episode or the myth of selfishness would not be out there.
Second, the families and extended friends of Kate and Anthony must not feel guilt. They will but if rational thought can sneak in they will realize that whatever the prior distant or recent interactions or interventions, even if well utilized by seeing a psychiatrist and taking medications, the ultimate decision was entirely by the mind of the afflicted.
Third, suicides that seem to be purely situational are not. It is known that most suicides are impulsive and committed by folks with affective disorders, usually major depression or bipolar depression. If there is no history of same in a particular case, suicide in response to a situational event, such as after loss of a job, the individual either had undiagnosed mental disease or was genetically primed to develop it had they lived.
I call those who take this route the Disappeared. Why? Major depression, bipolar disease and to an extent, schizophrenia, are invisible diseases. I am not going to quote facts/statistics as they are getting better known. By comparison, though, there were 37,000 motor vehicle deaths, 15,000 homicides and over 66,000 opiate overdoses in 2016.
An article in the New England Journal of Medicine, Miller, 2008, states that 80% of all suicide attempts are conceived/decided within one hour, 35% within thirty minutes and 24% within five minutes. An article in Psychiatric Times, August 31, 2015 concluded that those with only suicidal ideation and suicide attempters had the same impulsivity.
Besides having bipolar disease for over forty years and being myself a survivor of a serious suicide attempt, a hushed up suicide illustrates just one of the consequences. I was a freshman at then all male Yale University and my girlfriend was at all female Smith College. We had come to know each other growing up in Arlington, Virginia albeit in rival high schools. We applied to schools that likely would both be in the northeast. As freshmen in November of 1966 one of the grandest weekend occasions was the Yale-Princeton football game. I was looking forward to a wonderful time. As was routine for Ivy League weekends, she arrived on Friday evening. However, she went quiet on me the whole weekend. She would hardly talk or engage in activities. My questions as to why went unanswered or vague. Subsequent letters and phone calls went unanswered.
I have now spent the last forty years of my life in northern California. I met my wife in San Francisco and we have two children now grown, out of the house and three grandchildren.
In 1990, my younger partner at Gould Medical Group, who happened to have graduated from her high school in Arlington, went back for his twentieth reunion. I had asked him to find out about C.S. who would have been in the class five years before him. Yes, it is a small world!
He returned with the following news. One of his classmates knew C.S.’s younger brother. My partner only found out that C.S.’s younger brother had committed suicide in the fall of 1966. My life’s direction was totally changed by her fear of telling me!
How many tragedies have had trickle down, sideways and up effects upon survivor’s lives? This is the same in 2018! How awful is that? We have made progress in racism, had an African-American president, gay and lesbian folks are in the work space, married and starting families. We have gone to the moon, developed commercial jets that can transport 300 people around the world now non-stop from London to Bombay. Cell phones and computers are ubiquitous. Yet, merely having a brain disease that can be explained chemically and seen on special MRI scans has to be secret for friendships, career, family dynamics and gainful employment and suicides
I want to close with what I call the visibly mentally ill. As discussed in Insane Consequences: How the Mental Health Industry Fails the Mentally Ill, by D. J. Jaffe, and E. Fuller Torrey MD, April, 2017, the seriously mentally ill (SMI) with untreated schizophrenia will never find treatment, gainful employment or even housing other than jails. They are very visible on the streets as they walk alone mumbling gibberish and make up a third of the homeless population. Marginalized by Federal, State and local monies they will die by exposure to the elements, catastrophic events in prisons, drugs, murder and passive or active suicide.
“During the next few days I shall either put a bullet through my head or commit something more shattering to myself than death…but I refuse to be cheated out of my death-bed scene.”
“I am not resigned to the shutting away of loving
Hearts in the hard ground.
So it is, and so it will be, for so it has been, time
Out of mind:
Into the darkness they go, the wise and the lovely
With lilies and with laurel they go; but t I am not resigned.”
Dirge without Music.
Edna St. Vincent Millay
Paul Golden, MD
An Insider’s View of Bipolar Disease 9/2015, Dudley Court Press
My Life as a Physician with Bipolar Disorder 10/2016, Dudley Court Press
Loving Madness: How to Help a Loved One
With Bipolar Disease 4/2018, Create Space, Amazon