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!