When Psychiatry Does Listen: Talking About Suicide

Patient Expert

This piece has to do with why we are the real experts when it comes to suicide. It is a continuation of a piece I posted the other day, titled When Psychiatry Won’t Listen.

That particular piece had its origins in one of my readers, Willa, who alerted me to a commentary posted by an enlightened psychiatrist, Ronald Pies, in Psychiatric Times. Only in this case, Dr Pies proved remarkably adept in saying all the wrong things.

This tends to happen when isolated people in power positions talk amongst themselves with no input from the people they happen to be talking about. In this case, Dr Pies had no appreciation for the fact that suicide is not a choice. It is nonvolitional. We don’t commit the act. The act commits us.

As one of my readers observed in a thoughtful comment:

The fact is, no matter which choice I make it is not a moral one because it is not made by a mind capable (at that moment) of rational judgment.

My reader’s comment motivated me to dig out the late William Styron’s classic Darkness Visible. This was a short book that came out in 1992. Mr Styron is a celebrated author who is no stranger to depression and suicidal thinking. In the mid-80s, he experienced a particularly severe episode that resulted in his hospitalization.

The original (and shorter) version of his work first appeared as an article in Vanity Fair in 1989. You can access it for free online. The first few pages are pure gold, and speak to the exact point I raised in my earlier piece.

What motivated Mr Styron to write Darkness Visible was the unexpected suicide in 1987 of Primo Levi, scientist and humanitarian and survivor of Auschwitz. In his article, Mr Styron recounts being appalled by comments in the New York Times, ones that suggested that his suicide pointed to some kind of character defect.

This motivated him to write an op-ed piece for the New York Times. As he put it in his Vanity Fair article:

The argument I put forth was fairly straightforward: the pain of severe depression is quite unimaginable to those who have not suffered it, and it kills in many instances because its anguish can no longer be bourne.

Later in the piece, he described his own descent into the abyss:

I had now reached that phase of the disorder where all sense of hope had vanished, along with the idea of a futurity; my brain, in thrall to its outlaw hormones, had become less an organ of thought than an instrument registering, minute by minute, varying degrees of its own suffering.

Just when he could take it no longer, a piece of music from a video he was watching “pierced my heart like a dagger.” This jolted him out of his suicidal thinking. The next day, he was admitted to a hospital.

Of all things, the hospital environment proved to be his salvation:

_ … a transfer out of the too familiar surroundings of home, where all is anxiety and discord, into an orderly and benign detention where one’s only duty is to try to get well. For me the real healers were seclusion and time._

Mr Styron's account underscores my point that psychiatrists need to listen and learn from the true experts. Actually, a certain head of the Department of Psychiatry at Johns Hopkins did just that.

When Raymond de Paulo read Mr Styron’s op-ed piece in the New York Times, he urged him to come down to Johns Hopkins and give a talk. The talk led to the Vanity Fair piece, which led to the book.

Thirteen or fourteen years ago, I was interviewing Dr de Paulo on the phone about a different matter. He happened to mention a one-day conference that his department was hosting in a few weeks. Would I like to come down?

Of course I would. There, one of the sessions featured Dr de Paulo interviewing Mr Styron.

In my previous piece, I discussed when psychiatry doesn’t listen. Here, I witnessed the very opposite. When psychiatry does listen, when the profession actively seeks us out and acknowledges our true expertise, then everyone benefits.

Further reading ...

When Psychiatry Won't Listen