You have opened your sealed envelope because suicide is now an option. Through no fault of your own, you were drawn here by your illness and circumstances. As your past rational, cogent and lucid self, I don’t know exactly what led you to this point. To fall this far, something has happened to all you have learned in therapy and by practicing various skills. Your confidence that you are strong enough to survive this is shaken, if not completely absent. Know this, Barry: you have survived the fearsome specter of suicide before. You cannot control the events that brought you here; with courage and support you can alter your responses to the events. You can choose to survive.
Many times you have stood alone on the banks of your black river called depression with its dead and gnarled trees along the banks with green meadows in the distance. You chose not to enter the river then. Something made this time different. Perhaps it is not beneficial to focus on the path taken but to focus on the path forward.
Where are you now? Are you ankle-deep in the slow-moving waters near the safety of the riverbank? Or, have you loaded your pockets with stones, turned your back on the safe haven of the bank and moved into the swiftly moving neck-deep water in the center? Have you been carried downstream by events and emotions, past the safety of the accessible riverbanks to where the river’s edge now meets the vertical canyon walls, making an exit seemingly impossible? Even so, it is not too late. You can choose. You can cast the stones from your pockets and float down to where the terrain is more amenable to an exit from your river. You cannot choose to be rich, handsome, or loved; however, you can choose to be alive.
I cannot dispute, that at this future moment, your feelings, emotions, pain and suffering are palpable with an almost physical presence with you. You may have concluded them to be beyond the hope of real or palliative relief. Several times in your life, you have been in the river at various depths with your back to the bank. At those times, you chose to come back to the safety of the bank. What makes this time different? Is it a matter of degree; is the trauma beyond your ken?
Before the monster can be tamed, its powers and effects must be known. In May 2016, a phrase in a psychology book struck a deep emotional chord with you: “Suicide is a death like no other.” That same day you wrote the following:
Suicide is a death like no other; I cannot let this statement simply stand alone, it begs and demands that I expound upon, define and make it my own.
Suicide denies the survivors the rationality of a loved one’s slow death by a terminal illness and time to say goodbye. It denies them the righteous anger of sudden death at the malicious hands of another. It denies them the “bad things happen to good people” comfort of an accidental death. The survivors are left with questions that can only be asked but never answered and an intractable guilt due to actions not taken or clues not seen.
The grief of surviving a suicide is only comparable to the loss of one’s child. Time does not heal these special wounds. They are festering scabs, persistently and forever reopened by memories, the empty chair and thoughts of what could have been. The survivors may even lose the solace of their religion; their loved one is now and forever a sinner.
The person completing the suicide harbored no viruses, germs or bacteria. Unbidden by the breath, not conveyed by innocent contact, nonetheless others will be infected and tainted by the act itself. Perversely, those most intensely affected by the suicide may well become the most severely infected. It may lay dormant for decades, but once having lost a loved one to suicide, the survivors are now more at risk of the same sad and lonely fate. The heirs are now doubly damned; they carry the potential genetic curse and have been infected by the act.
A terminally ill person. A mother whose car has skidded off an ice-covered road into a lake; the car is filling rapidly with frigid and numbing water; her seat belt is jammed. A father trapped in the upper floors of the World Trade Center on 9/11. The person contemplating suicide has a power these others do not possess although they desperately desire it: he can choose not to die.
The person contemplating suicide is alone in a manner which brings me to tears because I so ache and desire to express it but lack the poetry and emotive skills to do so; I have experienced that desperate isolation once. The person contemplating suicide is in so many ways more alone than the physical isolation of a shipwreck survivor far from shore or a compass-less solitary hiker lost in a blinding mountain snowstorm. He is so maddeningly mentally alone because his rational self has abandoned him or been driven away. The irrational self is left in an impenetrable dark solitude with a faint light over the only door; the door is labeled ‘suicide.’
The person contemplating suicide has knowledge no others possess about themselves, even the classically terminally ill (neglecting that depression is too often a terminal illness). He knows the moment, manner and method of his passing.
Only atheists complete a suicide. Even the most devout and pious person completing a suicide, in his final moments becomes an atheist. How can he not be when his God has forsaken him?
You are now in a better position having explicitly defined suicide as a death like no other. You know what suicide is and what it does; it is no longer some ephemeral construct as it once was. You know the impact on the survivors. You retain at least the vestiges of your coping skills. Moreover, you know that suicide is a permanent solution to a temporary, albeit devastating, problem. You survived August 2015. You can choose to alter your deadly path; with help and hope you can alter your potentially lethal response to events.
At 7:30 p.m. on August 22, 2015, you made a noose from your belt in a period of utter hopelessness and loneliness. You may very well be as scared now as you were then and rightly so. As you knew then and know now it would have been/will be no tepid halfhearted attempt; you would have/will die. Know this, Barry: in that indescribable fear and loneliness, staring at your improvised noose, you still retained enough wits to call your therapist and the suicide hotline. You have progressed so far since then; you have more options, skills and support. You can make a rational choice.
Note that tragic events may precede a suicide but do not cause it. Your response to the events is what will put your head into the noose. There is no ironclad and formal if/then logical construct that binds you to death by your own hand. True, something horrible has happened, perhaps you cannot even express it. Know this, Barry: there is a vast range of choices, pathways and actions between a traumatic event and suicide; it is by no means foregone. Do not go down the single path that immediately and forever excludes life. You can do some of the things in this letter but more powerfully you can decide to survive.
A helpful phrase stays with you: “Just because you are struggling doesn’t mean you are failing.” A physical battle would be so much easier! Instead you are fighting a two front psychic war. You are trying to deal with, cope and understand the trauma that caused you to open this sealed envelope. The fact that a “death like no other” is being considered means that a potentially fatal internal battle is being waged between your rational and irrational self. Do not judge yourself too harshly as failing, driving yourself farther from the safe haven of the riverbanks. You have an illness, no failing on your part brings you here. You can choose to alter your emotional response.
When you were well, you clearly understood the distinction between pain and suffering. In fact, you were proud of yourself that you were able to grasp the distinction. Recall that pain is inevitable but suffering has some element of choice. It may seem hard to grasp right now but pain and suffering are different. If you are truly suffering right now, can I ask you to back up a step? Did you somehow choose to suffer as you sometimes do to punish yourself or simply to feel some kind, any kind, of emotion? If the former, you have had success with holding those thoughts at bay. With courage and knowledge of past successes, you can alter your suffering. The pain will still exist but the suffering can be minimized by your choice and actions. If the latter, and you are reading this, you have simply gone too far.
Read the “Suicide, a death like no other” section again, particularly the survivor impacts. You are not a mean or vindictive person. Is it possible for such a caring person to possess such suffering as to damn your progeny with your final act? What pain do you feel right now? You are considering ending that pain; indeed you might only have one hour left of the pain. When will it end for those you leave behind; after decades, when they follow you in the same desperate act? Although not the most self-caring act, you must survive with the pain, to prevent hurting others. With help, you can come to understand and deal with the pain and the associated suffering to improve your lot.
When you were young, you watched the TV show MASH every week. You were also drawn to the seemingly innocent melody of the theme song. A few years later you found out its title: “Suicide is painless.” This was a troubling and conflicting discovery for a teen like you.
Know this, Barry: For the person completing the suicide, it is not painless. The body’s violent and wracking attempts to expel a poison. The crushing pressure of a hanging. The terror of the onrushing ground. The brief but intense panic of self-suffocation or drowning. Can even a bullet outrun the synapses of pain? In addition to the physical pain, there is also emotional trauma; recall that you have been near death three times. When you were 8 you almost drowned; you know it is true that your life flashes, backwards, before your eyes. You will never know how you survived your almost-fatal accidental asphyxiation when you were 20; you regained consciousness, alone, in fresh air with no idea how you got there. Although these are no doubt traumatic, they are almost mundane when compared to 2005.
There is a stark terror associated with impending death. In 2005, you had a medication reaction; headaches beyond what you had ever experienced. The ER staff dismissed it as a mere migraine. Although you had no history of migraines, they sent you back to the waiting room. As you waited, each heartbeat caused wracking spasms of pain which continually added to the overall pain, seemingly bringing death closer. Soon, you were on your hands and knees in the ER bathroom vomiting due to the pain; the passage of time slowing greatly. In this time-dilated space, as one particular heartbeat ended, you somehow knew that the next would end your life. In that prolonged time between heartbeats, you huddled in your pain, knowing you would die within seconds.
Some have dismissed your suffering because the next heartbeat did not kill you. No one can understand that you knew you were going to die and the trauma it caused. The physical pain was intense, the terror of impending death indescribable. Eleven years later, I choke up as I write about the terror. The hopelessness you felt last August and the knowledge of impending death in 2005 are of decidedly different natures but are comparable in intensity. Are you ready to face it again, perhaps within the hour?
There is no romanticism associated with the physical pain and emotional impact of suicide. The distorted reality for the person abruptly ending his life leads him to believe he is making a decision. He thinks that he has made a rational weighing of the short-term pain of the act against the interminable future psychic suffering. However, his suffering has cruelly deprived him of the keystone of the argument: hope. He sees only ‘pain now, no pain later.’ With hope, interminable future psychic suffering need not occur. With hope, there are alternate, healthy paths. With hope, an alternate future exists. Hope means things can be different. Can you now acknowledge the possibility of hope? Also, the act of suicide does not eliminate future suffering, it is simply transferred, albeit in a different manifestation, to the survivors.
Decisions and choices, Barry; that is what it comes down to. Right now, a purist would say that you are “cognitively impaired.” I wrote this while I was well because I don’t want to die; I want to cuddle and coddle my grandchildren’s grandchildren. I am trying to connect with whatever rational part remains; suicide is a permanent solution to a temporary problem. You can get better, you have before. You just need to be alive to do so.
At a high level, suicide becomes an option when suffering exceeds the ability to cope. The trite answer is to decrease suffering or increase coping. At this point, I’m not sure these abstract concepts will serve you. Focus on what can you do this instant to increase your survival odds. In no particular order:
- Contact your therapist; text first, immediately followed by voice mail. Don’t use soft words like you did before (“am in crisis, please call”). Be disturbingly clear and share your fear with her: “suicidal, alone, scared beyond words; I have a noose.” Truthfully, what you want is kind, palliative words; a verbal hug if you will; but her kind and caring words will not stay your hand. She cares about you and is concerned for your welfare but her effective options are limited. More than likely she will insist on the emergency room. If you simply dump on her that you are suicidal but are unwilling to do anything, she will, to ensure your safety, call the police for a welfare check.
- If alone, get with people. This may be as simple as watching TV with your wife or getting out of the house to the bookstore or coffee shop. Note that this is a safety tip, not a coping one; you may very well come back to the house in a state of mind not much better than when you left.
- Hold a puppy or a baby to refocus on life.
- Get a hug from someone who loves you.
- Tell your wife. I cannot imagine any circumstances where you would say “I am suicidal, please help me.” She loves you and is perceptive. Something as simple as “I feel like I did in August 2015” should do the trick.
- Do not drink alcohol. Through no fault of your own, your thinking is impaired by the severe state of your illness. You might not survive the loosening of inhibitions that alcohol provides.
- Do not even start a suicide note. Although you did not consider writing one in August 2015, completing one could be seen as accomplishing an expected task on the path to suicide.
- Do journal but be careful. Journaling in an impaired state can be risky; the words may give shape, substance and motive to the ugly thing. Stick to facts and descriptions of emotions for now, leave out judgments.
- Call the national suicide hotline at 1-800-273-8255. Expect care and concern and direction to the ER.
- Get to the emergency room.
Barry, it is vital to know that at this moment you are impaired by your illness. Life or death decisions made now are a sham. You must and can choose alternate responses. If not immediately for yourself, then to prevent harm to those you love and who return your love.
Lastly, I love you.