May we all see many more.

Welcome to September.

In case you weren't aware (as I wasn't, until recently), September is National Suicide Prevention Awareness Month.

I've talked on here several times about suicide, and the devastating effects it has on families, friends, and society at large. Because it really does. No matter how inconsequential you think you are, someone is going to know that you're gone. Someone is going to miss you. Someone is going to wish with all their heart that you hadn't taken your own life.

Suicide is an everyday thing in my job. Now, actual completed suicides are fairly rare, as the statistics go, but every last one of us knows a patient who's died by their own hand. And it touches us all. I wish people could see how the sadness ripples through our department when this happens. But every single day, we deal with people (usually multiple people) who express some wish to take their own life.

On my inpatient service right now is probably the single most suicidal patient I've ever worked with who hasn't actually killed themselves. And what we're holding on to right now is that ambivalence she has, that there is a part of her that desperately wants to live. I've really learned so much from her. We were talking one day about how she views her life and herself, and I sat back, and made this interpretation: I said to her, it seems to me that you're coming to the table with all of these messages that you're useless and worthless and horrible, gathered from childhood experiences and projections of other people's pathology. And then, now, you're in this situation you desperately don't want to be in, but you don't see a way to change it. It's like you're standing in a corner and see no other way to go. She nodded, suddenly awash with tears. I thought about this for a minute and said, "I can see why you want to kill yourself."

This caught her a little off guard. Which, honestly, it shouldn't, because how many times had we made lists of ways to cope with a situation, and I always told her "Well, cutting or killing yourself is a way to deal with it, we'll put it on the list. And then let's come up with some better ways." But that always catches her a little off guard, too, it seems. So I say this, and she looks up at me, and I shrugged. I said, I get it. You genuinely feel like there is just nowhere to go from here. The only thing you can control in this churning sea of misery is whether you live or die. So why wouldn't you cling to that like a life preserver?

The thing is, I told her, that there are other ways to go that you just can't see, because you're facing that corner. My goal for you is to get you to turn around, see the rest of the room. Look at what's here, because you have a lot to work with. She argued that last statement with me, because she, of course, thinks she brings nothing to the table. But I'm awfully stubborn, and kept insisting she's got a lot of potential.

I actually discharged her a bit ago. I knew she wasn't safe, I felt it in every cell of my body. But she insisted that she felt safe, and wasn't thinking those thoughts anymore. She made it 36 hours, and then downed a bottle of sleeping pills. I saw her in the ER afterwards. I walked into her room, and she looks at me and started to cry and said, "I lied." And all I could say was, "I know." Later I hugged her and told her I was so grateful she'd come back in, that she was safe again. It totally broke my heart that she'd fallen so hard when she left, but I slept better after that, honestly.

I have another patient who comes in to my clinic and constantly insists that he has the right to take his own life. We've gone back and forth about this, and on a logical level, honestly? I can't argue. His claim is that he is in so much emotional pain it's unbearable, and that he's tried meds, and more meds, and ECT, and none of it has relieved this pain. So, he says, it's his right to end that suffering. I don't argue that point with him. What I argue is that he has not, in fact, failed everything.

And I find it interesting that the one thing he refuses to try is therapy.

Recovery is a program of brutal honesty. To yourself, to those who are helping you, to the people around you. If you are really honest with yourself, you will always find hope. And if you can't find hope, borrow some from someone else.

If you're thinking that ending your life is the only option, tell someone. Talk about it. Hold it up to the light of day. Seek help. I promise you, suicide is only one option, and it's the most destructive one of all.