Tuesday, October 09, 2012

Dinah is Mad

A few days ago, I posted a link to what I thought was a nice article in the New York Times about a special team of NYC police officers who talk people out of jumping off bridges and buildings, and even jump into the waters to fish them out.  The responses to the post and to my comments left me a bit distraught.  It's been a while since Shrink Rap has been this contentious, and it left me feeling rather defensive.  I tried to put up a response in the comment section, but my comment was too long, so I'm posting it as it's own post.

First, Sarebear, thank you.  She wrote:

"The range of human behavior, motivations, reactions to illnesses is huge. Just because it's not YOUR experience, doesn't mean it isn't valid as someone else's. Just because your experience isn't THEIR experience, doesn't make yours invalid either."

Brilliant.  Thank you.

To the assortment of anons who felt inspired to write in with:

"Yet again, I wonder if this is how you interact with your patients. How do you maintain a practice? Or do you perhaps see only the very mildly mentally ill, the slightly neurotic."  and " It's also surprising that both of you claim enough knowledge of suicide to present at a conference."

I think you should find other another psychiatry blog.  This is far beyond the realm of what one would say to someone in their living room, and the readiness with which you insult us is as though we are not human beings with feelings!  I showed this to my husband whose response was "I don't know why you do this and why you would interact with people this way." 

My comment on the damage suicide leaves in it's wake is a statement of fact.  One friend told me that she started to feel just a little better five years after her son's suicide.
A reader responded that my comment was "demeaning and insulting." " Of course every suicidal person has considered carefully, long and hard, the effect his or her suicide will have on his loved ones. The implication that they have never thought such a thing is really offensive." 
To the anon who wrote:
"Dinah, it sounds like you've never treated suicidal people. If true, it is surprising.
"
I have never treated a patient who has successfully committed suicide.  I have treated two patients who have had serious attempts while under my care, and many who have had serious attempt before they were my patient.  In general, a serious suicide attempt is reason change doctors -- it is a sign that the treatment is not working, and it destroys trust.

And while I have not treated many seriously suicidal patients, most people with depression have suicidal thoughts and feelings, different from what it takes to complete the actual act. On the rare days when the thoughts seem like anything more than thoughts, I have no qualms about telling my distressed patient that I would be devastated if they committed suicide.   

I can't count the number of people I have treated who have had relatives commit suicide, but it's a lot.  Should we start with the woman whose husband waited until she was coming up the walk to shoot himself in front of her? That began her long and involved time as a psychiatric patient.

No, it's not always thought out enough to be "selfish," (I never used that word) sometimes it's from psychosis, sometimes it's a teenager who can think of no other way to deal with heartbreak, sometimes it's an escape, other times it is the by-product of overwhelming depression.  It's still leaves generations of pain.

  Over 38,354 died by suicide in 2010, despite the best efforts of psychiatry, the NYPD jumper team, and the lack of mental health euthanasia teams.  That number doesn't count the suicides done in ways that medical examiner might have deemed accidental.

Jane, we don't believe that people with intractable psychiatric problems should kill themselves, much less have an institution promoting euthanasia for the mentally ill (what's next?).  We believe they should change doctors, try different or unconventional therapies, seek other opinions from experts,  and we see psychiatric conditions as treatable.

Re: The suicide prevention conference: they invited us to present, we had never heard about the conference before.

I am sorry to be so defensive.  The comments from this post left me very angry. 

I will leave you with a quote from the comment section of the NYTimes article on their Special Teams:

  Casey from Denver wrote:
This work is profoundly important because many people thinking of suicide change their mind. A study by Dr. Richard Seiden of people prevented from jumping from the Golden Gate Bridge found that after an average of 26 years, 94% were still alive or died of natural causes. One of the rare jumpers who survived said later:
“The last thing I saw leave the bridge was my hands. It was at that time that I realized what a stupid thing I was doing . . . It was incredible how quickly I had decided that I wanted to live.” So keep up the good work, you brave men and women of the Emergency Service Unit!

47 comments:

Anonymous said...

Well written. I would probably find offense if someone was attacking who I was and what I did.

Reality is that we only get a tiny glimpse of what your actual private practice is like and who you really are as a person. It's like looking through that peep hole in the door - you get a limited view.

I am with your husband though, why you do this blog if it is such a huge source of frustration. Not attacking here, just curious.

Anonymous said...

"In general, a serious suicide attempt is reason change doctors -- it is a sign that the treatment is not working, and it destroys trust."

I would be interested in more info about this.

Jane said...

"what's next?"

The comment from the anonymous who decided to list forms of suicide that have been considered acceptable by others (such as suicide bombing)and use them as an example of different viewpoints on suicide was a mind bender.

I do not believe my comments will take us down a slippery slope towards legalizing sati or encouraging seppuku. There is no grey area where suicide bombing is concerned. I think we are all safe in the knowledge that the US government is not a fan and has no interest in making it a trend in the states.

Anonymous said...

Just because you disagree with it does not make it contentious.

Everyone is entitled to their opinions. I think (hope) you may not really mean what you often say. If I wrote a diatribe after each post you wrote that I felt offended by, you would delete it without qualms. That's because you're the blogger and I'm the reader. It's your right. But, like I said, just because you disagree or don't like or feel attacked by a response -- perhaps the responder felt exactly the same from your post. We may expect too much - that you behave like a psychiatrist since that is the persona you put out there - but perhaps that is a good point to remember. We are not in your office. Perhaps in your office you present and far as offensive and eager to step on toes and tongues. I hope so. And mos tof the time, we refrain from commnetiong...until that becomes intolerable because we perceive that you are presenting something irrational/unfair/wrong.

George Dawson, MD, DFAPA said...

Your comment about what the surviving jumper said is critical to an understanding of suicidal behavior. I have seen it presented at both of the seminars on suicide from the Golden Gate Bridge that I have attended and that is the impulsive nature of suicide. I have been discussing this dimension with the suicidal people who I see ever since. That is why helping people in potentially lethal situations and erecting barriers is important.

Anonymous said...

Jane,

Are they not different viewpoints on suicide or murder? No, your comments will not take anyone down the slippery slope to legalizing sati or encouraging seppuku. What was once legal and accepted and encouraged is not now. That does not detract from the reality that these events took place and were not considered abnormal. Did someone actually imply that the US government was a fan of suicide bombings or was interested in making it a trend? I do not see that in any of the comments.
At times, it has been considered the noble thing to do to commit suicide. This is not specific to suicide bombing and of course, some people who have been coerced did not consider it noble. Stepping back to consider the meaning that self murder and other murder has in different cultures and time periods is not an indictment of those cultures. It is not an incitement to commit any of these acts. We do know about the baby girls in China who have been left out to die by parents who went on to have and nurture a boy. We do know that governments turned a blind eye. We do know about a lot of things that we consider abhorrent. In North America, we would probably not allow any parent who left an in infant out to die to raise another child. Of course, we have tended to turn a blind eye to child abuse of all sorts.
I am attaching a link about female Sri Lankan suicide bombers. http://kobreguide.com/content/My_Daughter_the_Terrorist
Your point about coercion among of young or impressionable persons wrt suicide bombings is taken. At the same time, someone is responsible for encouraging the suicide/murder and therefore it can be said that some people do have very different views on the meaning of life and the value placed on it.

Jane said...

@anon: I was referring to Dinah's "what's next" comment that was directed at me...if we extended euthanasia services to the mentally ill then this would take us down a slippery slope that would spin out of control. And I don't think that would actually happen. No one is going to come forward and say now that euthanasia is legal for the mentally ill then that means someone else has the right to sati or some other form of suicide. I heard a similar argument about gay marriage. If we allow gay marriage then people who want to marry their dog will suddenly be allowed to marry dogs because marriage will no longer be defined as between a man and a woman.

Euthanasia is not a slippery slope for allowing people to commit suicide on a whim or however they choose. There would still be emergency services to prevent someone from doing something rash. The argument for gay marriage is also not a gateway towards marriage between people and animals. There would still be a contract between two human beings and it would not extend to animals that are unable to consent to marriage.

I was responding to her comment that I was taking us down a slippery slope and my ideas would lead to all kinds of unimaginable consequences.


Jane said...

The only other thing I could think is that she quite literally meant, "what's next?" Like once your dead there is no more hope for treatment and nothing is left. But something tells me she didn't mean it like that...

Anonymous said...

I have a friend who has been suicidal. She has repeatedly said to me that she considers suicide a very selfish act.

Anonymous said...

I've been a little behind on Shrink Rap posts, so in reading the original post that has caused such concern, I have to say that Sarebear is such a rockstar. She consistently offers such value to posts and I wish that I was so articulate about my experience.

It seems to me that there is a pattern of Dinah posting about topics that people have strong reactions to (some attacking) and then a second post where Dinah will say "Hey this upset me". And I have to say I love that. It's honest. It shows that Dinah is invested in the conversation.

The first time I tried to kill myself was when I was 10 (I'm 37 now) and it was an impulsive action that was the culmination of a lot of pain. The second time was when I was 21 and it was something that I carefully considered. I remember one time in a hospital that a nurse told me that suicide is a permanent solution to a temporary problem, and I have to say I got REALLY angry (people came to remove me from the room).

I'm in a stable place right now, but if there comes a time when I'm not and I take my own life, I'm sorry but people can't say that I didn't do everything to try and manage my crazy and I have a right to that choice.

Plain Anon

Ann said...

Dinah, I am sorry that you have felt so attacked. For people like me who have had suicidal feelings off and on since my teens (I am in my 50s), your response is very important. As in my earlier comment, I would have probably succeeded in killing myself if I didn't have people around telling me my life has value. Suffering is part of human existence and people like you, who dedicate their lives to healing and never give up on their patients, are heros on my book. Everyone's life has value! Thank you for your blog.

Dinah said...

Please note, the commenter Casey is wrong, the study was on people who DID jump and lived. These were not people who had been prevented from jumping.

Anon 1: The blog is an intermittent source of frustration, mostly I love it and I love having somewhere to write and having feedback. Thank you for your support.

Anon 2: It's hard to have trust with a patient who has tried to kill themselves, especially if they OD on meds I provided, especially if they did not try to reach me first. It's just a difficult thing for everyone, the patient included.

Jane --oh gosh, but I was thinking that if we should assist the mentally ill to commit suicide (Isn't that a horrible thought?) then what about the mentally retarded? Or drug addicts and alcoholics are pretty miserable, what about helping them off themselves? The chronically ill? And fat people, they are often really down on themselves, we could knock them off too. And who wants to be ugly, let's help them commit suicide and end their misery. Oh wait: Is anyone left???

Anon 3: it's not the disagreement I am troubled by, it's the "how can you keep patients" -- "you must not treat suicidal people" etc..it's the personal stuff. I don't really understand how you can not see some of the comments as personally insulting to me or something I should just be taking. Some people rub each other the wrong way and I clearly push your buttons. Another blog? And when you say "we" who is "we"? Shouldn't you just speak for yourself?

Plain anon: thank you for weighing in. I hope that if you feel awful again, you will remember this time of being stable and wait out the awful time. Thank you for commenting, you clearly have something to contribute and I hope you stick around.

Ann: Thank you for your support and encouragement!

Alison Cummins said...

Dinah,

Some of the comments may not be fair, but consider this:

A venerable method of enduring life today is to tell oneself that if it gets too bad, one can always commit suicide tomorrow. Many of us have used this technique to get from one day to the next. Many of your readers are relying on it right now. I’m sure that you must talk about this with your patients, if not every day then every week.

When you refer to ways of taking this last comfort from us, it’s not surprising that some of the most desperate among us will feel threatened. Paradoxically, when you casually point to a nice article about nice people who make their livings trying to take away the last bit of hope we cling to — that we can end it if we need to — some of us are going to feel as if you have just threatened our lives.

It’s common for living creatures to react badly when our lives and autonomy are threatened. You may not have intended to threaten the lives of your blog readers — or even to make an existing threat more salient — but it is a predictable effect of your post.

Now, having said something that you could have predicted would make some of your readers frightened and angry, you are expressing that your feelings are hurt because some of your blog readers have expressed their fear and anger.

You would like the blog to be a safe space for you. Well, so would your blog readers. It doesn’t always work out that way for you, and it doesn’t always work out that way for us either.

Anonymous said...

Also, fwiw, most of the comments I've seen here over the years are directed towards you, Dinah. I don't see them directed towards Clink or Roy. Possibly because Click and Roy state their views less offensively, or more respectfully. Maybe reconsider some of the defensiveness and try and look a little more openly. What would you think if a patient presented with as much defensiveness as you do?

Jane said...

This is probably one of the more bizarre episodes of Shrink Rap history. On some level I sympathize with Dinah. She created a psychiatry blog with psychiatrists in mind and got their patients instead. And so of course she ends up getting views that take her aback. Even for me the whole thing has gotten goofy and kind of farcical.

I wonder if it had been a bunch of psychiatrists on here arguing for or against suicide...Armageddon?

I think I will stop commenting now on this whole topic. And I will leave it for doctors to discuss how they want to deal with their suicidal patients.

Anonymous said...

Dinah,

I thought it was a good article and I was glad you posted it, otherwise I would not have seen it. I am really surprised that there is any controversy about this.

I think people should realize that Dinah, like any other psychiatrist or any other practitioner, is a good fit for some patients and not such a good fit for others. We are all individuals and need to seek out those professionals that fit with our own personality and needs. If you disagree with Dinah, that is okay, just don't make an appointment with her. You can still read her blog, if you choose, without needing to agree with everything she says. If you don't like what you read, you are free to find a blog that you do like and that does not cause you distress. Above all, everyone please be respectful. You don't have to like every opinion someone has or like everything they say in order to be respectful.

Karen

Anonymous said...

Alison Cummings: "Paradoxically, when you casually point to a nice article about nice people who make their livings trying to take away the last bit of hope we cling to — that we can end it if we need to — some of us are going to feel as if you have just threatened our lives. "

Alison, just as you pointed out, Dinah just casually pointed to an article, an article that some of us found interesting and others did not like. It's just an article, and she just linked to it. That's all. Did anyone get upset with the NY Times for printing it in the first place? Does anyone feel the need to attack these people on the Emergency Services Unit? I think there is a lot of projection onto Dinah going on here. Again, she only pointed to an article that she thought some people might be interested in. Period.

Karen

Anonymous said...

I think can be hard to understand that how a therapist is outside the room doesn't always tell you a lot about what they are like inside the room, for example one can be good at couples therapy but bad at being married. I am a prickly person, outside the therapy room I get my knickers in a twist fairly easily. I don't know how much my clients know that about me, and for whatever reason (and I won't take the space here to speculate why) I rarely feel prickly when I'm in the therapist chair, but I do use my soft spots as a way to connect with my client: to be sensitive to shame, to be able to normalise difficult feelings, and to help them think of ways they might act differently all the while empathising with how hard that is to do.

I don't know if I read Dinah as defensive, but then again why wouldn't she be, would you want a therapist who was so defended s/he couldn't be hurt? Dinah's position on this blog is as A psychiatrist/therapist, not as OUR psychiatrist/therapist. While you can (its a free Internet) make assumptions about what Dinah is like as a therapist, I'd like to suggest you'd probably be wrong.

- Eliza

Anonymous said...

I wanted to add that I was touched by what Alison said about thoughts of suicide as a way to stay alive. Sometimes people worry that they aren't getting better because they still have suicidal thoughts, but that's often, in my experience, the last thing to go - if it does at all, sometimes it is just the meaning of those thoughts that changes. It is possible that one can both have periodic thoughts of killing themselves and still experience beauty, love, and happiness over our lifetimes. I think the most beautiful response I've ever read about this was Chris Gethard: http://tmblr.co/Zi-9ExTCM38d

- Eliza

Anonymous said...

I'm sort of new to this blog posting thing, and one thing I can't get used to is not being able to edit my posts the way I could edit myself in face-to-face conversation!

Anyway, I'd like to amend the last line of my penultimate post - "While we can (its a free Internet) make assumptions about what Dinah or anyone we know publicly is like as a therapist, I'd like to suggest we can't know" - because, a) I want to include myself as someone who makes assumptions, and b) allow that some of us may make positive assumptions and we could also be right!

Also I was thinking that another thing about this context not being like a face-to-face interaction, our relationship to the written word is different to spoken conversation, we're missing all the analogic aspects of communication. So please, I hope that people will "hear" my comments as well meaning and I will try to do the same for others!

- Eliza

Anonymous said...

i think Alison made an important observation. People who are seriously suicidal don't want to be reminded of the very things that tether them to this world, because it makes the choice less easy. i used to have a lot of problems with deep, dark depression. I had the plan lined out, the back up plan in case that didn't work, etc. But, i agonized over teh fact that if did it i would hurt people i love and who love me, very badly. i didn't want to think about that, because i wanted to escape. i didn't want the guilt or the added pain of knowing I would cause immeasurable grief to other people. That hurt too much.

I used to get angry at my therapist for gently reminding me of the people who loved me. I got angry, because i didn't want to have to think about that part, not because i didn't care, but because i did care.

A turning point for me, was when my parents found out after the fact that i was hospitalized (not by choice). My mom came to see me, and i cannot tell you in words the grief i saw on her face. She told me, "If you end your life, I will never recover." Let me tell you about guilt. I still feel it. I didn't want to hurt people I loved, but i finally had to face the fact that intent or not, that my actions would devastate the people who love me and who i love. I needed to be reminded of that, because that's the only thing that kept me here.

So, i think Dinah's reminder that this hurts people, is a kind thing, not a mean thing.

i will say that for me, once suicide no longer became an option, the urgency of this desire lessened significantly.

To all who are struggling, you are not alone in this. There are people who care about you.

AbbeyNormal

Anonymous said...

That was really lovely AbbeyNormal. Thank you.

Still Dreaming said...

I liked the article.
I like your blog.
Don't let the trolls stop you.
There will always be people who disagree. But to them, I say, if you don't like it, don't read it. There's plenty of other stuff out there to read.

Anonymous said...

When Dinah says that she is mad I assume she means to say that she is angry. If she were truly mad she might have to medicated or hospitalized against her will, for her own good, of course.

Sarebear said...

You're welcome, Dinah; glad I could say something helpful!

Thanks Dinah, and Plain Anon, for seeing something in what I try to convey.

It really lifted my spirits to feel like I was useful, and to find out that Plain Anon had such really kind things to say about me. (Dinah's compliments were also really cheering, too!)

I was too agitated the week of the suicide questions post, or I'd have put in my 2 cents.

Sunny CA said...

I am sorry that you have felt attacked. I have not been following closely enough to have read the offensive comments.

When I felt suicidal what kept me alive and kept me going, was knowing that my psychiatrist cares.

Dinah said...

Thank you, all.
I don't feel "attacked" because I don't think these comments are made with malicious intent. I think the anons (why are they always anons? can't you anons sign with first names, or even numbers...or pick an animal or color... to differentiate yourselves?) don't have a concept of how rude it is to say "how can you maintain a practice?"
I've come to understand that when I post a link to something, it may be very upsetting or provocative for someone, or that when I say something that feels to me benign or a statement of fact -- like suicide leaves the survivors feeling damaged -- that this is upsetting and provocative for some people, it pushes buttons, and so to them I deserve such comments as "how do you maintain a practice?"...so I don't see at as an attack. But I do think it is an unreasonable expectation that I not post such links on my blog and that I not say things like 'it's unfortunate that suicide leaves a trail of pain,' because this upsets someone. It's our blog, if we upset you, don't read us. I just won't stop posting links to articles that I found interesting or relevant to psychiatry. I had no concept that when I posted that link, with minimal commentary, that I would upset anyone, though the anon I upset felt this was obvious, and it is still not obvious to me. An entire country tolerated reading the article in the NYTimes. And had I known, I would have still posted it because I liked the article and readers can't expect me to take into consideration the feelings of each of 5,000 people who visit our blog each week as though they are each my individual patients. Buttons are going to be pushed. If you can't remain polite, don't come.

By the way, I LOVE that patients came, it's been 6.5 years and we are still blogging. Where else can you have a reader in Massachusetts engaging with a reader in Canada with reader in Hong Kong all about psychiatry and all on a level playing field? I Like The controversy, just keep it polite. If that's too much to ask, tune elsewhere.

Alison Cummins said...

Dinah,

Everything you say in your comment is fair and makes sense to me exceept...

If you didn't feel "attacked," then why did you feel "mad" and "defensive" (your words)? Do you commonly feel mad and defensive when you feel safe and loved?

EastCoaster said...

I know someone who plans to shoot himself if he ever gets a dementia diagnosis. I think he'll probably succeed, and although, I'm quite sure that I'm against suicide in the young and otherwise healthy, I don't know how I feel about what is called "death with dignity" for those with obviously terminal diseases (dementia not being one.)

This same friend recently consulted a psychiatrist, because he was struggling with a prolonged grief reaction. The psychiatrist had known him a long time from his work as a biophysicist.

The psychiatrist said, "You and I both know that some day you'll get diagnosed with a disease and kill yourself. In the meantime, let's see what we can do to make you feel better."

My friend appreciated the lack of bullshit.

Anonymous said...

Dinah: if you don't like the comments, turn them off. Don't invite comments and then get mad and defensive (and later retract that and say that you aren't) when you get them. You have the right to your opinion; I have the right to mine. I wouldn't be able to stand a psychiatrist who says some of what you do; perhaps you wouldn't be able to stand me as a patient. The one doesn't negate the other. This has been going on for months if not years - every once in a while you stir it up again. If the comments bug you so much, shut them off.

Anonymous said...

It is very difficult to take seriously anyone who responds "anonymously". Dinah has her name out there so she doesn't hide behind a facade. It is easy to attack someone else's opinion when you hide behind "anonymous". Maybe Dinah should omit comments where people don't at least use a first name and don't take the extra time to create a name.

Ann said...

My computer is kind of wonky. My name is Ann

Anonymous said...

Also: how egotistical. "A serious suicide attempt is a reason to change doctors." Not simply that the doctor is human and the suicide attempt a culmination of years, perhaps decades of unrelenting severe depression?

Perhaps that's a sign for the therapist to give up. But name it like it is, and don't blame the act as destroying trust. YOU feel untrusted or let down or angry or whatever. The patient may still trust you more then anyone else, given that he wasn't planning on being around to find out. Good to know you would walk out on a patient at that point.

Dinah said...

Anon--
I said "doctor" (not therapist) and you distorted this. I stand by my statement: If you have years of unrelenting severe depression you should see another psychiatrist -- especially if your psychiatrist/medication provider is leaving you on a set cocktail of medications without exploring other medication and treatment options. Maybe someone else can help.
It's not about my ego, it's about a patient's right to get better. Please find another blog!

I have no idea if there is one single anon who has such issues with my posts or 2-4 anons. I hate to turn off commenting or moderate or delete rude comments because of a single person's rudeness.

Jane said...

I told myself I wouldn't comment anymore, but I just think it is such a fatal flaw with Blogger that there is no "Block" option like on Facebook. If you think someone is being inappropriate on your FB page, then you can block that person and he or she is banned from ever commenting again (unless you lift it). Your profile will become invisible to that person. You don't have to prevent everyone from commenting. Unfortunately, while I do not know the rules of Blogger, it seems that the Rappers are unable to "block" people and render their blog invisible to undesirables.

Perhaps this is something for the inventors of Blogger to consider...

AnonisWashinghishands said...

Far from a distortion, though it may serve you well to think of it as such. My psychiatrist does psychotherapy as well as I refer to her interchangably as doctor and therapist. She also refers to herself as both. Usually I just stick with "shrink." You yourself have stated that you are a psychiatrist who also provides psychotherapy.

And for what it's worth, I've posted a couple of the anon posts, in a back and forth, but certainly not all. Far from it.

Sarebear said...

To the anon who wants Dinah to just turn comments off if personal comments about her practice, her competency to practice, and things like that offend her, well, it sounds like you expect that commenters should be able to say anything they like, no matter how uncivil, to put it politely.

You may have a problem with their request/requirement that it be at least a minimally civil dialogue, but these are their requests, their "rules" and if you can't abide by them, you may leave. They may resort to comment moderation again, or perhaps eventually consider not allowing anonymous comments, which cuts off alot of people who don't want to register with Blogger . . .

It isn't for commenters to set the terms by which people interact here; it is THEIRS. I feel they actually allow a lower level of civility than most other blogs would.

Saying they should just turn off comments if they don't like something that's said, or are offended by something, is expecting them to tailor their blog to how you feel it should be run.

Part of the point of blogging (from MY perspective of having blogged) it seemns to ME, is saying what you want to say, and seeing what other people have to say about that. They don't seem to me to have any objections to civil disagreement; there are blogs out there who would censor even this.

Perhaps others besides you feel that comments should be turned off if the blogger(s) have problems with rudeness, but as Dinah has said, the interaction here between such a wide array of people from such a wide array of places, is one of the things she, at least, enjoys about the blog. (I do as well, but I don't expect them to run their blog to suit ME.)

This blog is an expression of their desire to communicate and interact with others in a manner that they feel is best. There are blogs out there who seem to feel that moderately to highly censored commenting is what is "best" for them. I am grateful that the Shrink Rappers have such a light and minimal (in my opinion) ruleset for commenting behavior.

I've probably beat the poor horse to death now. It's probably because feeling like someone is trying to control or dictate someone else's behavior is a sore spot for me. (Then again, I recognize I am telling you to leave if you don't like how they run things; you can do it or not, though, I don't figure people HAVE to do as I want, and perhaps you don't expect that people have to do what you want, either, though it SOUNDED that way to me . . .)

Anonymous said...

Very well said, Sarebear!

Karen

jesse said...

What an interesting series of posts. I just reread the last several blogs and all of the responses and just don't see what it was in Dinah's comments that got to a few of the anonymous bloggers. She sounded reasonable and moderate. As did the great majority of the posts, some of which struck me as very thoughtful.

One point: please do not minimize the effect suicide has on a family. I have treated depressed and suicidal patients for a long time, and know of numbers of people who have suicided. In every case the family was literally destroyed by it. The effects lasted generations and no one was spared. In a number of instances other family members later also suicided.

So, yes, the suicidal person often sees suicide as something welcoming or a relief. There is frequently a powerful pull towards it. But this is an effect of the depression. I have heard that the great majority of those who have jumped from the Golden Gate Bridge do so from the side facing the city. Whether that is true or not, it expresses the yearning for connection.

So, please, do not romanticize suicide, intellectualize it, or talk about other cultures, Ancient Romans, Samurai, or bring in intractable pain, free will, rights, or dementia. The exceptions and qualifications only pull us away from the horror of it.

Suicide and incest are the worst things that can be done to a family. There are no good outcomes.

Ann said...

Bravo, Jesse

Alison Cummins said...

My great-grandfandfather killed himself. He was an industrialist in the north of England and when his business failed (1928? earlier?) he killed himself. The family story was that it was an "accident." My great-grandmother died of alcoholism more than twenty or years later, but they had both been heavy partiers. It's not clear that his suicide caused her alcoholism though I imagine it did make it worse.

The family's finances were diminished but the family was not destroyed. Relations remained close and supportive - still are, between my grandmother and her little sister. My grandmother is clearly a resilient person by temperament, but her upbringing (boarding school, which she loved) and her close relationships with grandparents on both sides meant that she had other relationships and structures to support her when her parents became unavailable to her.

She married a Canadian and left England, which was not uncommon in 1940s England even among women whose fathers had not killed themselves.

I am not aware of any ill-effects my mother suffered as a result of her grandfather's suicide.

Jesse, you do love to catastrophise. Universally. *Everyone* who ever had a sexual relationship with their therapist had their lives ruined by it. (Especially if there was Oral Sex involved! How perverted, devastating, and unsalvageably life-ruining!) (Unless of course they got married, in that case it didn't count as an inappropriate relationship after all and everything was fine.) And now, *every* family where a suicide has occurred is destroyed and no member can be spared.

I have no doubt that if I had committed suicide when I wanted to, that it would have been devastating for my family, some individual members more than others. One thing that kept me hanging on was the thought of one particularly vulnerable family member who I thought had been through enough and did not deserve my abandonment in this way. One way I knew that my life was in serious danger was that I stopped caring about what the effects of my suicide on this family member would be.

Similarly, when he was at his most depressed a friend of mine thought his eight year old daughter would be fine if he killed himself, but mostly didn't think about her much at all. He was clearly wrong.

So while I agree with you Jesse that a depressed person's evaluation of the impact of their suicide is likely to be unreliable and an underestimate, and that they should remember that in their darker moments, I wish you'd show a little more respect for the resilience of at least some survivors. The ones who end up in your office need the kind of help you offer, yes. Not everyone does, however.

Eliza said...

"why are they always anons? can't you anons sign with first names, or even numbers...or pick an animal or color... to differentiate yourselves?"

Or it could be, like me, that they are just unfamiliar with Blogger and didn't realise that you could use a name without it being connected to an URL! (I started "signing" my posts after being frustrated with the confusions of anons, but I didn't figure out the identity options until today). Which, I think, goes to the argument that one cannot be certain about the meaning of a behaviour without putting into context, yet we all act as if we can!

non anon said...

Jesse said:
Suicide and incest are the worst things that can be done to family.

Jesse,

Incest takes place within a family. It consists of acts perpetrated upon an individual or individuals who tend to be the child/ren of that family.. The silent partner does as much damage. The end result is often someone with a lifelong obsession with suicide.
I am sure you have dealt with suicide and with incest. In terms of incest, all a person wants is to escape but that has never happened for me. It is always there. I do not know if the same is true for the man and woman who were respectively involved and not involved. I don't think so. They live on believing I am a mental case and I take drugs to suggest that is the case. That is the irony of incest.
Suicide? Well that would have a terrible impact. I am certain that you are correct. Chicken and egg. Some people survive by intellectualizing. They do not mean go and commit suicide. They live in their heads. I hope you can understand that not all responses make sense to you since you do not know the commenters even if they go by non anon.

jesse said...

@Alison Cummins: You are bringing up a number of thoughtful points, yet you misunderstood one thing I wrote: I did not say that every family, always, is destroyed by suicide, but wrote that “I... know of numbers of people who have suicided. In every case the family was literally destroyed by it.” That is true. I was not speaking of all people all of the time, but of those I have known. Certainly there are people who, for multiple reasons, are affected less than others, and certainly numbers show resilience, fortitude, and strength in overcoming what they have experienced. While the people who come into my office are a subset, I have neighbors and friends who have had suicide in their families.

In using the word “destroyed” I was trying to convey the emotional turmoil and distress that those families felt. I am sorry to the extent it led you to think I was diminishing the resilience and strength of the survivors.

You noted that “I have no doubt that if I had committed suicide when I wanted to, that it would have been devastating for my family, some individual members more than others. One thing that kept me hanging on was the thought of one particularly vulnerable family member who I thought had been through enough and did not deserve my abandonment in this way.” Thank you for expressing that so well. We psychiatrists want people who are depressed to be aware that their suicides will hurt those they love, as they frequently imagine the opposite.

I do think it is a very, very bad thing for a psychiatrist to have a sexual relationship with a patient, whether or not they get married eventually. For many good reasons it is considered to seriously harm the patient, to be unethical, and to be malpractice, whether or not the patient had consented to it (and there is the question of whether a patient can give free consent to it). A very great number of my colleagues agree with this (and my own opinions are even stronger). It is the position of every psychiatric society and Board of Medicine. But this is not the subject of this blog - it would be a good topic for another one.

@non anon: Thank you.

Alison Cummins said...

Thanks, Jesse.

Wrt sexual relationships between therapist and patient, it has been the topic of another discussion. :)
http://psychiatrist-blog.blogspot.ca/2012/02/dangerous-method.html

What I objected to was not the notion that it’s a bad idea or unethical or bad for patients (it clearly is) but that you had such hard time with the possibility that a patient could demonstrate resilience in the face of it.

Russell Hyland said...

Is it possible to disable anonymous commenting? Angry people feel safe being rude if they know there is no penalty. if you require a valid email to comment, then you can disable comments for rude or disruptive commenters.

Anonymous said...

I agree that some comments are rude. But others, Dinah takes offense to opinions that differ from hers. And still others are not any less sarcastic then Dinah's own. Granted it's her blog so it's up to her. But I think it's quite relevant.