To Be Alive

Jill was 43 years old. “My life has been a fake”, she announced. Jill described herself as an imposter, filled with self-loathing.

She had no friends.

“Give me some meds, Doc, please.”

But, in my mind, psych meds simply were not warranted for Jill. Instead, I took out my script pad and wrote:

“Share three personal things with a peer that you trust.”

“Oh, no!”, she responded as she walked out of the office, “I could never do that.”

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We all crave connection. That is how we are wired. The problem is that to truly connect with others, we have to allow ourselves to be seen. And that can be scary as anything.

When we have the courage to be imperfect, when we allow ourselves to be authentic, then relationships reach new heights. To be vulnerable means you are alive.

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Jill never returned to my office. Perhaps I made the wrong approach, pushed her too hard, scared her…?

…One year later, I saw Jill sitting with a group of friends at a park, her demeanor quite different, laughing and totally enjoying herself.

As a psychiatrist, I customarily do not initiate conversations with patients that I run into in public. But imagine my delight as I turned away and Jill suddenly ran over to me and whispered, “thank you”.

To Lead Is To Serve

“Heads in beds, heads in beds.”

There are some ugly aspects to the workings of a psychiatric hospital. One of these is that medical care has become big business, run by corporations and, unfortunately, psychiatry is no exception.

“More heads in beds, that’s what we need!”, one might hear a CEO shout. “When we have lots and lots of patients, then lots of problems can get solved!”

Well, yes, one problem that gets solved is more money for the investors.

Certainly, psychiatric hospitals need to exist to care for those who are struggling severely. But the constant corporate pressure and appetite to keep beds as full as possible led one CEO, years ago, to proclaim that we should keep patients in the hospital for extra days “if it will help.” He then chuckled and added, “That means, if it helps the corporation.” Sickening.

Great leaders and great corporations do best when they are there to serve others and give a top-notch product. I have worked with many CEOs in my career. The best are those who take a genuine interest in patient care, who walk every day onto the psychiatric ward and connect with the staff. CEOs who take the time; CEOs who inspire. CEOs who don’t regard a suffering human soul as another “head”.

CEOs are supposed to be leaders. Leadership is not holding oneself above those who work in the trenches. No, to lead is to serve. This sounds counterintuitive - and it is. Leadership is not about power because power inevitably corrupts.

Great leaders have a humility about them. They are able to embolden others because, more than anything else, they see the value of every human being

Suicide

Suicide. The word itself is frightening and shocking and leaves so much pain in its wake. How tragic to reach the point where life is so insufferable that one simply doesn’t want to exist anymore.

Bob, who was 34 years old, married, and with two children, arrived at the psychiatric hospital and said he lost his will to live. He had put together a plan to hang himself. However, he first shared this plan with his wife. She then did not let him out of sight until he was delivered to the emergency room.

Bob showed a nice improvement in the hospital, seemingly. But there were concerning signs. Whenever I would ask him about his will to live, his eye contact would shift and be avoided. For Bob, there was also a family history of suicide. Studies have shown that there may well be a genetic predisposition, that among those who think suicide, some people are more likely to carry it out than others.

So I met with Bob together with his wife multiple times. We talked about life, his future, their future, their kids. I started him on antidepressant medication.

Bob would smile, but to me his smile was forced and filled with agony. When he finally denied feeling suicidal, the insurance company said they would no longer pay for his hospitalization. Next, the hospital administrators insisted that I discharge him right away, that his stay was now costing the hospital money.

I didn’t care what the insurance company or the administrators said. There was no way I was going to discharge him despite all his proclamations that he felt fine.

And so, after another week, which included daily meetings with his wife which went well, after more time on the antidepressant medication, after Bob was able to talk about his dreams for the future and his love for his family, and with a seemingly real smile on his face and more spontaneity, I discharged Bob from the hospital. The plan was for him to follow up with myself at my office the next week.

Humans are complex. We have so many things rattling deep inside us. Too often we hide our real emotions not only from others, but from ourselves.

Four days after Bob was discharged from the hospital, while his wife came to the hospital to pick up some belongings that had accidentally been left behind, Bob hanged himself at home.

Why?? I will never know for sure. There was no note, no last words. In retrospect, I believe that both before and during his hospitalization Bob had quietly, secretly, firmly made up his mind that he would take his life. He was at peace with it and that’s why, outwardly, he appeared to look better. But who knows??

From a professional point of view, I searched and searched for why, how, and what. What did I miss? What could I, should I, have done differently? These questions haunted me.

From a spiritual perspective, the sages say that suicide is never an option. That our body and soul are gifts from G-d and therefore it is not our choice to take our life. I actually shared these spiritual thoughts with Bob, but it seems they did not truly resonate with him.

As I grieved for Bob, I realized my failings, that somehow I had not communicated well enough.

But also there’s only so much one can do.