March 28, 2008 1:46 AM | Posted by Lee B.: | Reply

This reminds me of what my mother once said: suicide is the single most selfish act a person can perpetrate.

March 28, 2008 2:53 AM | Posted by LSun: | Reply

Your life isn't your own? I find that creepy, but not as creepy as the analogy that a life is a publicly traded company. Worst of all is your repellent idea of a life being forced to improve other's lives. I know I wouldn't want someone with a 'responsibility' obliged to help improve my life. I'd run screaming. If caring doesn't arise spontaneously and freely, I hardly see the point.

I sincerely hope you aren't serious.

March 28, 2008 3:03 AM | Posted by Anonymous: | Reply

I agree that suicide is a choice. But it's mine. Not yours and not someone else's. Mine. Medication might amplify my already emotional state and that's of no help to me. And no, happiness is not secondary to my existence. They are two in the same. To live a meaningful life, I must be happy and fulfilled. If I'm neither, my existence is meaningless. And if it's purely my own fault then you should be out of a job because it's people like you that classify people like me, trying to come up with reasons why I do the things I do and what my thoughts and tendencies are, thereby prescribing said medications to make me feel worse. You may not be out to make money, but you are supposed to try and help. And putting the weight and responsibility of everyone else on my shoulders when I already have my own issues doesn't help. My life does not belong to anyone else, except maybe a deity of sorts. And if things are predetermined then I guess I already know who to thank once I pass. And if not, they He/She/It should've seen this coming a long time ago. I have no children therefore I have no responsibility to anyone else. Nor do I expect them to have responsibility over mean. It may not be your fault that I died, it's probably mostly mine. But whether I'm ove sound mind or not, someone will always be to blame.

March 28, 2008 3:05 AM | Posted, in reply to Lee B.'s comment, by Anonymous: | Reply

You can never say suicide is selfish unless you've lived and breathed the life of someone who is suicidal. You don't know what goes on in their head prior to death. I think it's pretty selfish to say it's selfish.

March 28, 2008 3:20 AM | Posted by Rose: | Reply

Thank you. I don't think I agree, but I respect your intellect and your experience (I DO read your blog), and will take this under advisement.

I do agree that we are all and each responsible to others in general, and to improve things as we can, where we can. I'm not sure that's my go-to discussion point for someone so unhappy immediate death seems a good option. And I'm positive I'm not going to bring out "how can you be so selfish."

Lucky me, though: I'm not a psychiatrist.

March 28, 2008 6:01 AM | Posted by Ronie: | Reply

The Doc is right. Everyone wants freedom to do what they like but they also want a safe society to do it in. Does one work that way. Can't have the cake and eat it too. Our lives are not our own, especially if we have kids. It is our responsibility to live our lives in a way that doesn't mess up other people too much.

However, I still feel that people with a painful terminal illness should have the right to choose.

March 28, 2008 7:55 AM | Posted, in reply to Ronie's comment, by Leon: | Reply

Is suicidal depression a painful terminal illness?

March 28, 2008 1:02 PM | Posted by Anonymous: | Reply

The good doctor has missed some major points here in his response:

1. In point 1, he states "the act itself is yours. Own up." but then the rest of the post later goes on to tell you that your life is NOT yours.

2. "If you kill yourself, it puts that option on the table for your kids..." this all assumes that this person HAS kids, has friends, has a caring family. Many don't. It's such a naive, Pollyanna viewpoint to assume that everyone out there has a bunch of people around them that care of them and would pine for them if they died. They don't. Get real doc.

3. Assuming that a suicide would always hurt the ones around them rather than help them is ridiculous. You think that people WANT to pay for the care of the infirmed that have no hope of a meaningful recovery forever? You think that there are not some people who everyone would agree are better off dead?

4. "You have a responsibility to improve the lives of those around you." Excuse me?! When did THAT become part of the constitution? NOBODY has the responsibility or even the capability to improve anyone else's life! Hell, you're a Doctor and you don't take responsibility for improving anyone's life!

Weak, weak response. I frankly expected better.

Alone's response: ok, that sounds like a challenge.

1. The act is yours, i.e. you do the act, not something makes you do it. This doesn't at all contradict my point that you should not do it.

2. Hmm. I guess it is possible that I didn't know that some people don't have kids, and I guess I may have missed the past three seasons of Six Feet Under where I would have learned that some people don't have people who love them.

Or, perhaps I was using that as one single example of a greater point.

I should also point out that I never said that the people around you had to like you, or you them. Again, that's incidental. It only matters that your suicide has a negative effect on them in every case. Even if they celebrate your suicide, that's a negative effect. Being around a suicide changes people; there's always collateral damage, always. Hell, on this blog alone we have debated whether or not copycat suicides exist. Even if they don't, the effect is always negative.

2b..You have no more right to inflict this collateral damage on others, than you do to go around punching random people in the face. _That_ I've actually done, and it is a negative experience for everyone.

3. You're slipping in euthanasia here, which isn't fair. First, it's not exactly suicide. Second, in a sense, you are asking other people to vote. But to be fair to the argument and to you, I will except the person with hopeless medical issues, not because I think euthanasia is ok, but because I'll accept that it is a different dynamic altogether.

4. Too bad, I stand by this. I'm not saying you have to go green, give to charity, work at a non-profit. I'm not even saying your job has to be for the betterment of man. I'm saying that your existence has to have some beneficial effects to those around you, otherwise it is all pointless. Not to go all existential on you. This is separate from suicide; I was linking them merely to show that since the maxim is to exist for the overall good, you have to at least minimize irreversible negative actions. Or something.

March 28, 2008 2:36 PM | Posted by barista: | Reply

He's right. Your life is not your own; it's like a credit card company, there are people invested in your outcome. Everyone has friends or relatives, a boss, a neighbor, hell even the friendly starbuck's barista. Dead? what answer do you give them, or exactly what message were you trying to convey? did you wonder how the people left behind would feel, and the possible ripple effect it could have, in a negative impact--say yes, for children if you have them. I visited a man in a psych unit who had a suicide plan. Pissed me off. Why? because he checked in the day he dropped bankruptcy papers at my door. The day after he took his high need psychotic daughter on a drive. It's not his ex's fault, it's not the credit card company suing him fault; it was his choice. Granted, yes, we all have the ultimate control and I believe in choice. I do think there is an added dimension when it appears a person is basically checking out of responsiblity. This is one of those cases. Of course now he blames it on a new word: disease. The inpatient doc gave him a concrete word he loves and has now used the word disease to tell me none of his lacking parental involvement or obligation to his family was his fault; it's the diseases fault. Nice psychiatrist. Now we will see how the blame shifts to Wellbutrin, the drug the disease monger doctor rx'd for a magic bullet. Any change in behavior? no. Avoidance of lawsuit continues until I handle it. Yeah that's life folks, and guess what, I take my responsibility seriously, I take suicidal talk seriously. I also am smart. I can see a bluff when I do, and this time was one of them. I know people who have shot their brains out, stood on train track and have killed themselves. I also know people who use excuses to get out of life. Get it? If a person does not want responsibility then don't have friends, family or others that you can jerk around with psychiatric bullshit. It is an insult to the people I DO know who killed themselves.

March 28, 2008 3:29 PM | Posted by Jim: | Reply

I suppose this comes down to a belief about what we owe people. I think one ought to make decisions because it benefits oneself, not because it benefits other people. Again, seeing other people in pain or pleasure might influence one’s decisions, but it ought to be because observing others’ happiness or sadness brings me happiness or sadness, not out of some duty to others. This is different in a contractual relationship, like a doctor-patient relationship; duty comes from a different source in these relationships.

I don’t want to defend suicide as rational or irrational because I think there are too many issues involved, some being the question of an afterlife, whether an individual can really know they will be in pain forever or if new drugs, etc. will be invented, or whether one can ever really know the pain their death will cause to others in the future. I guess, in a nutshell, I think individuals can believe they are making a rational choice to kill themselves, but it's predicated on some potentially false beliefs.

I’ve always believed an emotionally healthy, rational person makes decisions for themselves, not other people, and I’m curious why Alone thinks differently.

March 28, 2008 4:46 PM | Posted by Anonymous: | Reply

um.....anyone else think that "Barista" post made absolutely no sense?

March 28, 2008 5:15 PM | Posted by Annie: | Reply

Anonymous' bullet points are spot-on. There aren't any arguments, reason, or any semblance of logic in this post.

Taking my life is my choice, even though my existence is a publicly traded company in which a board of directors can veto the choice that is unequivocally mine? I didn't choose to be born, therefore I don't get to choose to die? There are people who chose to conceive me, you know, they even arranged the date and all that jazz, can they off me if they so pleased? I have a duty to others and my passing away by my own hands has negative consequences and can't possibly offer a different outcome? Is my free will dictated by the prejudices of other men?

A what if: 1) Meth addict, loner, no family, no friends. He kills himself. 2) Meth addict. Chooses the righteous path, rehabilitates himself, engages in sport, world champion. Both scenarios send a positive message to the "shareholders". 1) Don't do drugs or you'll end up in a position where you'll want to be dead, so do whatever you can to stay out of such a mess and makes sure your loved ones do, too and 2) The resilience and fortitude of the human spirit against all odds. Caution and inspiration. Humans need both.

And my life is my own, thank you very much.

March 28, 2008 5:40 PM | Posted by Alone: | Reply

I'm a little shocked at the negative response to this post. People seem to be insulted at the suggestion that their life isn't there's, or that there can be any interference with their choices or their free will.

Which is inconsistent with the equal vehemence that behavior isn't under complete volitional control, that there are limits to accountability, etc.

But yes, I believe in absolute freedom, and for the most part all behaviors are entirely your own. But you still have responsibilities, duties, which (unfortunately, I guess?) supersede your freedom. And if you have to ask me from where come these duties and responsibilities, may I suggest that this blog is not for you, and direct you back to the comforting, never demanding, always affirming arms of modern psychiatry.

March 28, 2008 5:41 PM | Posted, in reply to Annie's comment, by Rose: | Reply

My beloved nephew is an addict, just about to turn 22. Had a hard time with most members of his and our family, who have cast him out. He's intellectually lazy, no particular ambitions, just about to be released from jail. No friends. All the emotional resilience of 13-year-old.

Killing himself doesn't send anyone a positive message. He could easily think he's so up against the wall, his life is so screwed up and pointless, and no one loves him anyway, he should just die. Do the world a favor. Wouldn't it better if he just stopped committing crimes and started trying to help himself in whatever big and small ways he can manage? He's not done yet. His life has worth and meaning without ever becoming "a world-champion athlete" or anything at all but another struggling human being.

When he was nine years old, his favorite aunt attempted suicide and came within a hair of succeeding. I was 23. Maybe it had no effect at all on my precious boy, but somehow I doubt it --- just as his suicide, if he goes that way, will ripple out to the younger cousin who adores him, even though the kid's parents keep him away. We may be within our rights to do such things to each other, but that doesn't make it ok, or harmless, or negligible.

March 28, 2008 5:47 PM | Posted by Joseph Bergevin: | Reply

This all assumes that people have free will, which I see no evidence for. Why do OCD patients perform rituals or stroke victims confabulate? Like the administrative justifications preceding the war in Iraq, the decision is already made, and the conversation is merely a formal exercise. Thought is informative, but not authoritative.

Let's assume that there is free will, though. People choose their destiny based on their beliefs. Even in this light, if someone kills themselves, I don't think it's fair to say they did so anticipating the same outcome as someone who's not depressed. Where you forsee people being devestated by their act, they genuinely see people not caring. The incentives table is different.

March 28, 2008 6:21 PM | Posted, in reply to Rose's comment, by Annie: | Reply

There's a difference, though. You started off by saying "My beloved nephew". My example, though way too generalizing, isn't meant to scoff at addicts, but to counter what the blog entry insinuates. Believe it or not, there are people out there in the world we know nothing about, who nobody really cares for, and who we'll only get to know as a news item (maybe).

If your nephew commited suicide, the suicide in itself does not constitute a positive act. It will not bring well-being to your nephew, who would cease to exist, or to your family. By positive feedback, I mean that you and those around (including those that merely know about him) will reach the conclusion that is desirable of human emotions: you will feel grief, you will feel that maybe your nephew is now at peace, and people everywhere will (hopefully) feel, in some ways, the responsibility to prevent undesirable traits such as addiction and delinquency from happening again. Negative feedback, on the other hand, constitutes counterproductive emotions of coldness, neglect, and the encouragement of this sort of behavior onto others.

It is the age-old philosophical problem. For there to be a great deed, a greater good, tragedy must befell. The problem is "must". We don't know that it must, but we do know that it usually does. In some cases, tragedy can bring about (positive) change in times where change would not have happened had the tragedy not occurred in the first place. The doc rules out this possibility by sidestepping the issue that misery is, regrettably, one way of serving mankind.

March 28, 2008 8:04 PM | Posted by Stan Stamerson: | Reply

It seems a lot of people are obsessed with the illusion that they own themselves and they make their own choices for themselves. You wouldn't exist except other people chose to bring you here, whatever for. At the end of the day, even if you think your making your own choices, your still human, and your choices will have a decisive human ring to them regardless of how involved you feel you are in choosing them. The purpose of your life whether you accept it or not is either cultural or genetic impact, which might vary from person to person, but while you might choose some alternate internal reason to exist, good luck preventing the other two from occurring without non-existence.

March 28, 2008 10:57 PM | Posted by bean: | Reply

Alone is actually making two related points, not one.

Suicide hurts other people, even people you have no direct contact with.

1a. so I'm going to try to stop you killing yourself even if you're really miserable and think you have good reasons for killing yourself and even if I had no risk of getting sued.

1b. For the same reason, you should try to stop yourself (because it is wrong to hurt other people).

Good luck trying to convince anyone who is serious about suicide of point 1b. Suicidal people are usually extremely self-absorbed. I am avoiding the word selfish because what I mean is their own pain consumes their attention to the point where it is difficult to get them to care about anyone else's. But it's worth a try.

March 29, 2008 2:10 AM | Posted, in reply to Leon's comment, by Maya: | Reply

Yes.

March 29, 2008 3:45 AM | Posted by Doubting Thomas: | Reply

I've never been to s shrink, but I get the feeling that if I had a psychiatrist like this guy, I would most definitely be dead by now. "Who cares how you feel, you have a responsibility to the greater good, because if you die it might have some negative effect on someone somewhere like your mailman or the lady at your dentist office, and we just can't have anyone feeling the slightest bit of negativity just because you think you're in so much pain that you can't go on".

I, for one, have my doubts that the guy who is posting here as a doctor is really what he says he is. (What kind of doctor goes around randomly punching people in the face?) Not only that, but what doctor needs to support himself on donations that come in via Paypal? Just because you start a blog that says you are a doctor doesn't make it so. Sure, he claims to have a lot of knowledge that makes us think he is in the medical profession, but he could easily be a records clerk, a student, or just a very well read kook. Remember that anyone can be anything they say they are on the internet, and we should take these postings with a grain of salt.

March 29, 2008 12:57 PM | Posted by dodgerdodger: | Reply

Being part of "George Clooney's America" is irrelevant to whether one accepts your main point. Yes, you have a responsibility not to increase others' suffering. Yes, you have a responsibility to leave the world better than you found it. No, it is not negotiable. No, it is not an infringement of your 'liberty' or whatever other Enlightenment terminology you want to deploy to give your selfishness a more erudite cast.

I have to admit, Alone, that I've never really bought your point that narcissism is the main destabilizing force in our culture (mostly because your political asides left me with the impression that by 'narcissistic' you meant 'being a liberal').

Until now. The response to this post look's like a particularly sacrosanct and untouchable bit of narcissism this culture has instilled in us getting a jab. And what's been the response?

Rage.

March 29, 2008 12:59 PM | Posted by Anonymous: | Reply

What about those people out there who have no family, no children, no one who cares that they are alive? Responsible for no one, if they should commit suicide, are they still to be considered selfish? Is it not selfish of us not to respect the enormous pain that must at some point be behind a decision like this (even when it seems impulsive and/or a kind of revenge)?
We send messages overtly or covertly to many of those who are mentally ill, especially perhaps those presently dx Borderline PD, that basically tell them we think we would be better off if they were dead. If in their pain, they cross the line and do kill themselves, we accuse them of selfishness and irresponsibility and even "manipulation". Is this rational on the part of those who are supposed to be sane?
I had a friend who spent the last six years of his life immobile from the neck down. Hooked to a breathing apparatus to stay alive, he went from medical crisis to crisis. Needed care twenty four hours a day and his pension barely covered his basic needs, lacking funds, he never left the house except in an ambulance to the hospital and back again. He did buy an apparatus that let him use his head to type out one letter at a time on the computer. Enough to contact the outside world and get a stranger to administer the magic potion he needed to check out of this world.
No children, no wife, no parents, friends that cared about him but who didn't have the money to ease his situation:
Was his suicide responsible, was it selfish? I miss him but I can't judge - I think it would seem terribly selfish of me to do so.

March 29, 2008 1:15 PM | Posted by barista: | Reply

"But you still have responsibilities, duties, which (unfortunately, I guess?) supersede your freedom."

That was my point to the confused anon who questioned the sense in my comment. There are people who use suicide "talk" to remove themselves from personal responsibility and were never planning on killing themself. A form of escape from reality.I believe we all have freedom to do what we want and if a choice of death is it, then go for it; but don't use a threat of suicide to others who expect responsibility from you. My comment makes no sense to anyone but me; in this forum it does speak volumes regarding a parent who would be left caring for a high need child, bankrupt and let alone the child the parent left behind. Harshly speaking: people DO have a stake, a claim in your outcome, if you have people in your life. Right down to the clerk at the store who might have enjoyed your company. I also do not feel it is in any doctor's control as the outcome of their patient living or dying. One can only do so much for a person, and this in my opinion is called patient responsibility. My point I was making re: knowing people who HAVE killed themselves; is that someone crying wolf is like calling 911 because the toaster has crumbs in the tray that might catch fire.

I'd like to have more comments from Alone frankly, to pick this apart further.

March 29, 2008 2:37 PM | Posted by Sfon: | Reply

Seeing the responces to this is sad, but not surpising. The points here seem to me to be:
1. You are responcible for you own actions.
2. You have a duty to others.
3. Suicide hurts others, thus to do so is to neglect your duty to others.

Are the points here, true or not, really so unreasonable? Is it really so off-the-wall to say suicide hurts others in a way you are responcible for, and thus you should not do it? When you murder someone, you hurt many people, not just the one you kill. Suicide is no different in that regard, it is highly selfish and in many ways morally the same as murder.

I've been suicidal often in my life, so don't give me any "you don't understand" nonesense. I can barely hold my life together even with antidepressents because my depression is so severe, but no matter what role my environment has played in all that I am still responcible for my own actions.

As for those saying there are exceptions, that should go without saying. We can all hopefully agree here that throwing oneself on a grenade to absorb the explosion and save others is not relivant to the point he was trying to make about killing oneself. Just because there are some situations where what he said may not apply 100% does not mean nothing he said has merit.

March 29, 2008 2:50 PM | Posted by anonymous: | Reply

no, if it indeed is suicidal depression, then it is not a terminal illness, but rather an illness with a large chance of being treated effectively.

March 29, 2008 6:40 PM | Posted by Dilbert28: | Reply

For some reason, Sfon forgets the fourth, very important point:

1. You are responcible for you own actions.
2. You have a duty to others.
3. Suicide hurts others, thus to do so is to neglect your duty to others.
4. Choosing life hurts others too, if you are dependent on them

Now we truly have all parts of the equation.
You can hurt others in many way by choosing life. For example,
if you are disabled or ill and depend on your familiy, the longer you live, the more money it costs them. So basically you may be stealing good education of their kids. Or ruin them financially.

I do not say it's always the case; but if you say your suicide *may* hurt people, you should say that the opposite can be true too, just to be fair with yourself. Otherwise it's self-deception.

I recommend everyone to watch a brilliant Oscar-winning movie "The Sea Inside". The movie talks about this exact issue and is probably the best movie ever about suicidal people.

March 30, 2008 12:14 AM | Posted by Annie: | Reply

Let's see if I get it: Suicide is selfish because it may hurt others, it doesn't take into account other people's feelings. Ok, let's follow that logic backwards. A suicidal individual is hurting and miserable, but does not hurt others by not committing suicide. Aren't the "others" who are keeping him alive and miserable selfish themselves and not taking his feelings into consideration? Like I said: no matter how you spin it, you're basing this thing off prejudice. Does not compute.

March 30, 2008 9:08 PM | Posted, in reply to Annie's comment, by $hrinks suck: | Reply

I agree with Annie - when a person is suicidal, the last thing this $hrink is going to do is say, "well, then let's round up all the people who have wronged you and explain to them that they have to play nice because they have a responsibility to the greater good". No, he's going to tell them that it's their own fault and that they can't blame anyone around them for their own "disease". There is just no logic in this point of view, period. If other people have hurt you and made you miserable, than it's your fault. But if you decide you are in pain and can't take it anymore, that's not fair to others because it might hurt them in some way? Sounds like this response is greatly prejudicial against those who consider taking their own lives. I don't find anything about this $hrink to be the slightest bit compassionate for his patients. Another bottom-feeder just in it for the almighty dollar.

March 31, 2008 10:01 AM | Posted by Anonymous: | Reply

A person who is suicidal and perhaps eventually completes is ill. He's sick. Terribly so. The debate over disease models and such is irrelevant. As a physician it it my responsibility to help help this person, make him healthy, or as healthy as is possible. This talk of the patient's "responsibility" or "selfishness" is rubbish. It comes from people who have never been on a psychiatric ward and seen people in the throes of acute psychotic mania or a mixed state, or severe depression. They are not thinking of responsibility or selfishness because they simply _can't_.

The talk here may be more relevant when that patient has recovered to the point where talk therapy and perhaps group discussion can be, finally, of use again. To help him or her gain better insight into their illness. But until then, forget the high mindedness and, especially, the sense of superiority that oozes from this particular forum topic.

March 31, 2008 12:11 PM | Posted by AK: | Reply

When young and trying to define our identities, its probably normal in American culture to think that 'my life belongs to me.'

But as we get older, we are in a position to find out we are not lone atoms, but are interconnected in all kinds of way.

If in a long line at a cafe, the decision to opt for fast, simple cup of coffee, rather than a labor intensive mocha, just to speed the line up for the people standing behind you, can in its tiny way, improve the quality of life.

Not all of us get recognized as being heroes and saints, but we are all agents and can do a multitude of tiny things that can invisibly make life easier and sweeter for those around us.
If anyone wants to learn the extent to which your life is not your own, attend the funeral for someone who has committed suicide.

I attended the funeral of someone who had been bipolar (she was Dx'd a very long time ago, and it wasnt a modern borderline-masquerading-as-bipolor diagnosis).

Over the years, X made 3 suicide attempts that I know of. One attempt at suffociation. Two jumps. First time she jumped she broke most of the bones in her body, but avoided head and spinal cord injury. But, despite all that, she refused to ponder the implications of her life long dislike for medication and authority figures.

Her second jump was what killed her.

Her life had been productive. The room was packed with her friends. We all missed her.

Her life had not been her own because it touched ours and because we cared about her.

I dont think euthanasia should ever be an easy decision, which is why I dont want to see it 'made legal'. In the American mind set, legalizing something implies that it is broadly permissible and could create a social context in which persons who are dying might find themselves pressured to 'make things easier' for caregivers by allowing their deaths to be hastened, to 'get it over with'.

March 31, 2008 3:58 PM | Posted, in reply to Anonymous's comment, by 404 Error: | Reply

"Sick" with WHAT, doc? I love these blanket generalizations that assumes that everyone that would not want to participate in this WONDERFUL fantastic life must be "sick". People in the throes of some type of mania in a psych ward are but a small portion of those who consider suicide. Helping them gain better insight into "their illness" is just more patronization and minimalization of that person and their feelings. The truth is, under a given set of extreme enough circumstances, every human alive would at one point consider ending their lives if pushed far enough to the limits of what a human can stand. This is not a "sickness". There are plenty of people who haven't been diagnosed with a thing who consider suicide. If the single factor in diagnosing someone with an "illness" is that they have, then what is the disease? "Thinking about suicide-osis?" LOL If this were something that could be cured with pills, then why do so many people who take the pills still kill themselves? Get a grip on reality before you hurt somebody!

March 31, 2008 5:33 PM | Posted by as if: | Reply

""Zoloft doesn't make you suicidal. Period. It may help, it may make you more emotional, but the act itself is yours. Own up.""

All other issues aside, since I personaly believe there is no reason to argue over the "rationality of suicide" because it is such a complex phenomena, and there are so many reasons for or against that choice that can come into play in any one persons circumstance, you'd have to talk about each individual case, it's just too complicated to get a black and white picture of....
...What I quoted above though, that one I have to say something about.

I've dealt with suicidal depression since I was about 9 years old, and I have never acted out on them (other than minor self harm to "get thru it) or tried to commit suicide EXCEPT for when I was ON AN ANTIDEPRESSANT. The first time it was zoloft, the second time it was zoloft and then Elavil being thrown in the mix. (Yes I know, stupid doctor for rxing the zoloft a second time - though standard practice I guess- and I WAS a stupid patient. I've learned my lession since and have done a great deal to educated myself so as to avoid listening to bad advice from bad doctors)

In anycase, if you truely are a doctor YOU need to "own up" about the fact that yes, certain medications can make certain people "flip". If for no other reason than to be able to admit to yourself the fact that any certain class of medications may be seriously dangerous for any certain patient who's had a suicidal or other adverse psychiatric reaction to that class of mediations, you need to come to terms with the fact that sometimes medications can cause a person to "flip out" and lead to such "complex" behaviors as suicide. That way you'll be less likely to lead your patients down the road to self destruction simply because you blame them for a suicidal reaction to a medication instead of blaming the medication, which in the case of ADs has been proven to cause these problems.

It's sad that not a one of you actually believes a patient when they say "those sorts of medications have never done anything but make me worse off". It does a lot of harm to patients when the reality that these DRUGS put into a persons system can cause toxic psychosis, trigger mania or worsen depression just as any street drug can, well when doctors are in denial that their precious medications could actually cause the very problems they are meant to treat.

Well I went off topic, I don't care. Hopefuly if you actually are a Pdoc (you sound arrogant enough to be one) you'll think twice about your know it all attitude about meds not being able to cause complex behaviors such as suicide, and think twice about what it MEANS when a patient tells you that they believe that any certain class(es) of medications have caused them to become more ill, even suicidal or violent. Sometimes the patient does know some things about themselves.
I mean if a person came into your office and said "every time I have smoked meth I have gone psychotic and hurt somone" Would you still prescribe them Adderall if thier main complaint was ADHD? No of course not, because you can ADMIT that a street drug, meth, can cause these problems (and addiction issues obviously, but that's not the point)... but had the patient come in and said "every time I have taken Adderall for my ADHD I have gone psychotic and hurt someone"... well you would give them a diagnosis of something like Bipolar probably right? because when it's an rx'd med causing this sort of reaction, it's a manic reaction *and a sign of an underlying illness*. Yet if it were a street drug, with almost the exact same effects upon the brain, you would attribute the bad behavior and reaction to the "bad drug".
You know I am right about that, at least right that this is generaly the way doctors think. Maybe you don't do it, but you've been trained to do it: A bad reaction to street drugs ='s toxic psychosis. A bad reaction to a psych med ='s an underlying mental illness issue.
The truth is that drugs are drugs no matter how educated the dealer is, and if you doctors keep on saying that your drugs could never do anything bad to a persons psyche, despite obvious evidence to the contrary, you're no better than a dealer on the corner selling his herion and telling his clients diddly squat about what psycho dope fiends they have become.

Anyways, as far as suicide goes, and antidepressants having some effect on a person making that choice, here's my experience:

For me the "choice" to kill myself was made in a state of mind that I have only experienced whilst being on antidepressant medications. It was an impulsive act, the thoughts behind it were completely irrational, but for some reason, when I have been on antidepressants and suicidal, it has become impossible to do the same thing I have done soooo many times to talk myself out of it, which is to be able to say to myself: "it will get better eventually, you're sick, you're not thinking correctly, find another way to get rid of the pain".
You just CAN'T think of any other way to escape the pain but suicide when you're having one of these reactions to an antidepressant. When I have had suicidal depressions whilst NOT being on and AD, there is still a little tiney dot of light and intellect that I can turn to to keep me pushing forward no matter how dark thinsg are. When on antidepressants, after a certain amount of time SUDDENLY it's not there anymore and it is replaced by rage. You become not only depressed but pissed off that you are depressed, desperate for relief and enraged at yourself and the world, all in a few minutes time, and then you "flip"....then you decide to kill yourself, just like that, like it's nothing, and there is nothing there to make you think twice or to want to stop. Unlike the hundreds of times befor when you've seriously been wanting to kill yourself to end the pain, this time YOU are not there to stop yourself. Seriously, your just acting on impulse all ability to reason is gone.
When you wake up out of your coma, you are left wondering "how the fuck did that happen?"... and you really can't find a reason except that you were in a state of mind that you had never expereinced befor, complete loss of control, complete forward thrust into self anihilation... And when it happens to you a second time, again when you're taking the same drug, well THEN you realize that all those stupid statistics and the black box warnings, that they actually mean something and you should have paid attention to them.
Course good luck getting a doctor to agree that this might be a sign that you need to stay away from that drug though... I guess it's insane to live in a world where you think 2+2=4.

I dunno. I just think it's dangerous medicine when a doctor doesn't believe what even the slack ass, big phrma ass kissing FDA has been swayed to believe, that ADs can cause suicidal behavior. But hey, who cares, you're only treating the mentaly deranged anyways, so how can you be held accountable for what happens to them? It's always the patients fault, and underlying disease process, never the drugs...well unless they're "actual" drugs, you know the type you can't prescribe.

I really hope you're not an idiot, I really do for the sake of your patients. And if you are an idiot, I hope you're just pretending to be a psych doc. There are just too many idiot MDs in the psych field. Not that I am a genius, but it doesn't take a genius to spot an idiot, and hearing a doctor say that despite all the evidence to show that antidepressants can cause suicidal and violent behaviors/reactions, that he doesn't believe it... oh it definately makes you sound like an idiot. ;) just so you know, so maybe you can keep that opinion to yourself in the future when you're around people who actually believe mind altering drugs can cause mind altered behaviors - like actual doctors and stuff-. It just makes you sound like you don't know WTF you're talking about... like someone saying that a person who takes acid and jumps off the roof should be held responsible for thier belief that they could fly. yeah, HUH? that's right it doesn't make sense. Sure the person should be held responsible for the choice to take the acid in the first place... but what comes after the drug takes effect in thier mind, how can they be responsible for that?
Blaming people who have suicidal reactions to ADs for having those reactions is like blaming a stroke victim for not being able to talk anymore. It's STUPID. It's an IGNORANT point of view. I mean have YOU ever taken an antidepressant? Do you actually know what it feels like when suddenly your mind snaps under the effects of a drug and you LOOSE YOURSELF to the mindaltering effects of the drug?
Obviously you've never tripped or taken drugs/psychotroopic meds, nor had any episode of mental illness, or you would know sometimes, when certain shit happens, your mind is no longer yours, and sometimes even the safest of drugs can make a person go balistic.

Face the facts, if you prescibe and antidepressant to someone, and they try to off themselves and tell you they think it was the drug that lead to that moment of stupidity, YOU NEED TO LISTEN TO THIER OPINION, and realize you probably don't know what was going on inside thier heads quite as well as they do. This belief that they made some sort of choice, that the AD had nothing to do with it, it may be correct in some cases but it is not in all. If there is anything I can compare those moments of "flippin out" due to the effects of an antidepressant to, it is to flipping out due to the effects of a hallucinogen. And You should know, if you are the doctor you claim to be, that most hallucinogenic drugs work on the serotonin system... and since a lot of ADs indescrimatly raise serotonin all over the brain and for all subtypes of serotonin recptors to "benefit" from... then isn't it just maybe a possibility that for some people this leads to a "bad trip". That really is what it felt like, a bad trip, cept it had been creeping up on me for weeks instead of over the course of a few hours.

In anycase, maybe you should try a hallucinogen (salvia divirnium is legal ya know), or a good month long course of Effexor and see what it does to your ability to be in control. It'd probably make you a much more compassionate care giver if you actually knew what it is like to have your mind hijacked by a psychotropic substance, even just a little bit, even for 15 or 20 minutes from smoking some salvia. Then you'd actually know WTF a person is up against when it come to dealing with a MI and/or a bad reaction to a drug or medication.
BTW - don't actually smoke the salvia at my behest, I don't want to be responsible for any stupid shit like that. But think about it on your own time, it's probably the closest you can get to experiencing psychosis (cause you actually believe what's happening in a salvia trip is real) without having to endure it for a long enough period that it'd cause you any problems. what's 15 to 20 minutes of insanity? nothing really, least not if you're not a pussy. And hey, I've never heard of anyone trying to off themselves because they consumed salvia, so you'd have a leg up on all of your patients on ADs in that respect.

You know all your psychologist rivals have done it, damn hippies right? But maybe they're onto something... or maybe they should just get the right to prescribe meds like psych docs can, that way I can deal with someone who doesn't piss me off in order to get my meds refilled.

March 31, 2008 5:34 PM | Posted by mo: | Reply

This is hilarious. This is narcissism gone wild.
Can anyone hear themselves here?
Read it all again...if you commit suicide or are actively suicidal you affect other people and oh good gracious we can't have that can we?
Because in the end it's all about us right? It's all about how WE feel or will feel.
And that bad suicidal bastard might make me feel something, anything, bad or good and only I have the right to choose feelings and how I control them...oh, right...we can only feel what we CHOOSE to feel people.
People can kill themselves if they want. I wish they wouldn't and I would hope a support system could spring up in their defense and change their mind but not for the sake of MY feelings. How about we all take a break from gazing lovingly in the mirror and consider someone else's feelings. Note how I said someone else's feelings..not how we feel about what they are feeling and oh goodness I am going to feel bad/good/indifferent considering someone else's feelings and well, hello there mirror once again.

Everyones reaction to suicide is narcissistic and judgmental . Some of us don't like that,( the rest of us LOVE IT) it makes us feel bad that all we are thinking about is how angry/sad whatever we are feeling and how other people are feeling about us and then we realize we stopped wondering how the person who killed themselves was feeling and then we feel guilty and that makes us feel like bad people.
We cannot stop obsessing about our own feelings.

Let's be truthful here..no one really cares about the feelings of the dead guy(he's dead), we care about ourselves so we do everything we can to make suicide a dirty, filthy criminal thing.
We announce you will burn,burn, burn in a lake of fire or something equally supportive and caring like that or we tell you it's a crime and you will go to prison to be gang raped by the Aryan brotherhood.Or let us go even farther..if you kill yourself you are going to ruin your children's lives.
And to those of you moaning that suicide is the ultimate selfish act? Of course it is, that's not exactly riveting insight..but your ultimately incredibly selfish, judgmental response to the act gets you accolades? It is all of you that make these damning, vicious moral judgments that damage society and children. If you stopped your pronouncements that suicide is evil why would the children need to feel anything but sadness? But all of you would prefer they carry guilt and humiliation too.

This is more I am not responsible for anything bs, I only react to all the people around me and they are totally responsible for my feelings so they better behave dammit because it's their job to keep me happy. You have responsibilities to ME ME ME! You dare to make me unhappy and I will go medieval on your ass and curse your children.

I am not responsible for how much enjoyment/lack of you receive from life. That is your job.
I am responsible for my own enjoyment or how much I hate every second of it.
It's about responsibility.

If someone feels that they no longer want the responsibility of life it is their choice, their feelings. . I do not bear responsibility or obligation to feel anything except what I want to. I have no obligation to guilt or public shaming. If this person was a kind friend I get to feel sad that my friend is no longer with me..that is all.

For the rest of the drama queens who can't wait to roll around in a fit of narcissistic orgasm then it's you that have made that choice and value judgement.Your masturbatory joy in judgment is what creates the pain for families. Your prying why? Why? is what creates guilt and recrimination.

All the guy did was die..just like we all are going to do.

The only reason the discussion even takes place is because someones God and a bunch of academics declared it's a naughty act and damn don't we all just love to join in with the mob and condemn.Why feel sad when we can feel mean?

If the Bible and the government said suicide was ok would anyone really get all this shitstarty about it?
Wouldn't we all just try our best to dissuade and if failing that feel grief for a death like any death?

April 1, 2008 4:16 AM | Posted by bwago: | Reply

So if you're a loner who no one cares about its ok to do yourself in right? Or can you not because you'll contribute to statistics that might make someone feel bad eventually?

I agree we have responsibilities to our loved ones not to do things that will hurt them, but it isn't that hard to imagine circumstances in which their sadness isn't quite as important as your suffering.

April 1, 2008 6:07 AM | Posted by Ha, ha: | Reply

You seem to understand economics, TLP. Here's a bit for you:

"... it is concluded that the net economic cost of the 30,906 completed suicides in 1990 entailed an economic gain for the society of roughly $5.07 billion in year--2005 dollars. This calculation does not include estimated costs due to the psychological pain and suffering of the survivors. Suicide should be prevented based on humane considerations, not on the economic cost involved."

April 1, 2008 6:26 AM | Posted by Ha, ha: | Reply

Furthermore, here's a moral argument, from "A Kantian Moral Duty for the Soon-to-be Demented to Commit Suicide" by Dennis R. Cooley.

April 1, 2008 2:21 PM | Posted by John: | Reply

I was suicidal so I starting taking Prozac. I was instantly overwhelmed by random fits of karaoke singing (not divulged by my psychiatrist) which did wonders for my comorbid social anxiety disorder, leading to improved self-esteem, and rapid recovery of my depression til I was no longer suicidal... then I read most of the comments posted. Any recommendations for a mood stabilizer?

April 1, 2008 8:36 PM | Posted by Ha, ha: | Reply

Hypocrisy at its best.

April 1, 2008 9:56 PM | Posted, in reply to 404 Error's comment, by Anonymous: | Reply

"Sick" with WHAT, doc?

A psychiatric illness.

People in the throes of some type of mania in a psych ward are but a small portion of those who consider suicide.

Approximately 95% of people who _complete_
suicide have a diagnosed psychiatric illness
commensurate with the act. That is, schizophrenia,
bipolar disorder, severe, perhaps psychotic
depression.

_Everyone_ "considers" it at some point in their live, by far the majority fleetingly. The ones who actually follow through are from a completely different population. And they are suffering from a diagnosed psychiatric illness at the time of their death.

I can get the reference if you like.

April 4, 2008 5:39 AM | Posted by Dilbert28: | Reply

Approximately 95% of people who _complete_ suicide have a diagnosed psychiatric illness commensurate with the act.
Right. But correlation does not imply causation (cum hoc ergo propter hoc).

Let's take CHF, a treatable physical illness with limited impact on quality of life. This article says that 24%-42% (!) of CHF patients suffer from major depression. Reduction in quality of life that CHF patients experience can and does cause secondary major depression.

Now, people who commit suicide quite often face some kind of unbearable situation in their life. Isn't it just logical to assume, similar to CHF sufferers, that this situation is the root cause of their depression, and not vice versa ?

Depression is a normal reaction to unbearable circumstances and NOT a root cause of suicide, by any means.

April 5, 2008 4:17 PM | Posted by InControl-for-now: | Reply

If cum hoc ergo propter hoc, then why do I bother even seeing a psychiatrist when I am suicidal to begin with? Alone seems to believe I just need to take responsibility for my actions, and Dilbert28 doesn't even believe that my wanting to suicide is even an illness. Maybe its just my bad luck that I believe that these thoughts in my brain telling me to off myself are real. Not an illness. Just bad luck, or maybe just lack of personal responsibility on my part to control the thoughts. I, like everyone else, must be in absolute control of my mind at all times. Even when I am addicted to drugs, on antidepressants, or depressed or schizophrenic and on anti-psychotics. Even when I am washing my hands constantly, afraid to ride bus or leave the house or when I am spending the evening trying to remember the names of my 5 children while I look up ways to commit mass murder as I shout expletives constantly into the empty room. No, there is no such thing as mental illness, because I am in control at all times. I don't need drugs to treat my suicidal thoughts or therapy to cure this or any other condition because these thoughts and actions are not medical conditions. Any time I have a thought or an impulse in my brain that is destructive, it is all my fault, my lack of control. Mental illness just doesn't exist on this blog, and TLP is probably L.Ron Hubbard back from the dead.
Or so it would seem.

April 5, 2008 11:22 PM | Posted by Anonymous: | Reply

Glad to see this. I feel the same:

troublewaits.

April 6, 2008 12:49 AM | Posted by Sarah: | Reply

I am majorly depressed and would kill myself if I hadn't seen the ripples of loss, disharmony and harm that emanated from my dad's suicide. When you're that depressed, you have a really hard time believing people won't be better off without you. The answer almost all of the time is that they won't. Suicide is such a violent act that it affects many beyond just the suicide's immediate family. The people who had to clean up my dad's dead body - what about them? The people he interacted with day to day who didn't realize he was so bereft? They are left with a permanent guilt load.

And I am left wanting to kill myself but stripped of the illusion that anyone would be better off. Damn it.

April 6, 2008 3:34 PM | Posted by hopeless: | Reply

Every attempt must be made to give people alternatives to suicide -- I wholeheartedly agree with that. At the same time, we must accept a very difficult truth: There are a few people, such as myself, who truly are so wounded, so tormented, so sick of life and failure that -- as tragic as it is, as selfish as we must be -- the only way out for us is death.

I have already tried many things. Do you really think I would give up that easily before trying every possible way to make it better? I've tried both meds and therapy, among other things. About 7 different antidepressants/mood stabilizers and 3 different antipsychotics. Various types of therapy too; cognitive, even biofeedback therapy. As the years passed, I went through several treatment programs for my bipolar disorder, but the bipolar disorder grew more intense. Doctors prescribed me mountains of medications, none of which alleviated the pain which grew daily inside me.Nothing is helping; my condition is just getting worse over the past two years. I have fought till I cannot fight anymore. I really have nothing left. I really have nothing in my life of any worth. The dreams, hopes that I had are shattered. I don’t have any reason to continue to needlessly, forced to live through a lingering and painful life. Happiness and quality of life are distant memories. All that remains for me is the reality of an indefinite or hopeless future.

There are some things for which we are responsible or play a part in creating...other things just happen. Some of the latter can be unbearable for people to live with or take away all meaning and joy from their existence, leave them too burdened, unable to cope...whatever. There are people who suffered so much damage, have been hurt so much, that they will never recover to be able to live life without pain.

Personally I believe that resorting to suicide should always be a last resort, that one owes it to oneself to explore all possible alternatives first. However as a thumb rule there are some sort of cases in which I really do believe things can be changed and improved, while there are many irreversible cases such as prolonged suffering from a rough mental disorder after exhausting all options. I don't think that always living is preferred to dying. Not at all.

I can think of nothing more designed to turn love into hate, to make love a burden, than the presumption that one person is obliged to live a painful life for the sake of another.

Mourn the life that leads one to end it, not the death that follows...

April 7, 2008 12:00 AM | Posted by flawedplan: | Reply

I really have nothing in my life of any worth. The dreams, hopes that I had are shattered. I don’t have any reason to continue to needlessly, forced to live through a lingering and painful life. Happiness and quality of life are distant memories. All that remains for me is the reality of an indefinite or hopeless future.

Right, hopeless, that's life, our common condition and nothing special about it. We are all hopeless. What is special is your gift for expressing and communicating these taboo feelings. Your post touched my heart and I'm glad you're still here to share what most of us are afraid to look at and acknowledge. My advice to you is to legitimize and normalize your feelings, they don't make you strange and alien, to me you sound enlightened. Be proud of your ability to dig deep and perceive and find community that nourishes what it means to be human. And if you haven't yet, read Irving Yalom, a brilliant writer and definite comfort.

April 7, 2008 7:57 AM | Posted by deedee: | Reply

I find the condemnatory tone of those who attempt suicide while suffering from a mental illness here disturbing.

I speak as someone who suffers from a chronic bipolar illness that is, most of the time, well-controlled with medication.

I have had a number of severe depressive episodes in the past, each requiring weeks in hospital while meds were adjusted.

I have attempted suicide once (took an OD of lothium), and subsequent to that learned to recognise the signs of descent into, well, maddness/irrationality/total out of touchness with the real world, and have brought myself to the doctor when I felt it "coming on" and so have not made an attempt since.

I do not, in fact, want to kill myself. I am perfectly well now and it would never cross my mind to do so when well. But when my depressive episode gets "lower" than a certain point, I get continual, obsessive thoughts surrounding suicide and continual impulses to act on it, which overwhelm me and I _know_ I need to get to a doctor, fast, or I will end up acting on them. My husband knows that I am ok with him, if, at some future time, he needs to section me, to stop it happening. We've discussed what needs to happen should I fall into that again.

But to say it's my "choice" at that point and that this makes me "selfish" is avoiding the fact that I am, at that point, well, severely mentally ill. I remember at one point that for an hour after exercising, the suicidal thoughts and impulses would just vanish. So I know there is a chemical component.

April 7, 2008 2:19 PM | Posted by BoriS: | Reply

what i miss in some comments here is a little differentiation. if you have a mental illness, and meds or therapy can help/ have helped you, i'm really glad for you - honestly.
but deriving that it can/ will help everyone else because it helped you does not follow.

but my main problem is this:
"Sick" with WHAT, doc?
-A psychiatric illness.

could it be more vague? this seems to indicate that considering suicide would be enough for a diagnosis of a "psychiatric illness".

honestly, this attitude scares me. it seems to be much more about power and control than about actually helping in individual cases.

"Insanity is relative. It depends on who has who locked in what cage."
-Ray Bradbury

April 8, 2008 1:37 PM | Posted by Anonymous: | Reply

""honestly, this attitude scares me. it seems to be much more about power and control than about actually helping in individual cases.""

That's been my experience with all psychiatrists, and that is truely sickening. It seems they are more concerned with "winning the arguement" than they are with making intelligent and medicaly valid choices for thier patients. But then we should all know by now, any of us crazies who actually dare to educate ourselves about the field that was designed to treat us, that many many so called "doctors" are nothing but sleazy drug dealers offering up and PUSHING upon us whatever medications are getting them the biggest kickbacks or the best access to and views of T&A... no matter wether or not the drug of the month is something that is medicaly appropriate at all.

I've never in my life met a psychiatrist who could engage in a civil conversation without threatenng or demeaning undertones, when I have dared to ask intelligent questions. They feel threatened I guess because their "science" and "medicine" is so unstable itself. Or maybe psychiatry just attracts people who have serious pesonality disorder issues themselves.
All I know for sure is that psychiatry is the only specialty in medicine where I have run into doctors who have treated me like a complete piece of shit because I asked questions or shared info about any medication or treatment I though was important to my progress in recovery -HOW IS THAT SUPPOSSED TO HELP A SUICIDAL PATIENT? Yes just try to make me feel stupid and try to demean me, very helpful doc.
Every other specialty, even if they find it annoying that in the age of google people/patients wind up with "too much info" and are always sharing things with them that they knew, or didn't know.. well at least the other specialists I have been to are kind despite the fact I might share with them some things that I already know -they don't cop an attitude, just continue to treat me like a human being and this is despite knowing my Bipolar Diagnosis - Its strange but it seems the doctors who are specialized in treating MI are the ones who have biggest "problems" with MI patients.
With Pdocs, when you try to be involved in your own care, when you bother to take an interest in how medication work, what the treatment algorythms are etc etc, it is like "how dare you educate yourself, don't you know you're crazy?!, Don't you know that everything you know should come from me?! How dare you think you could educate yourself.".... or at least that is the message I have taken away from many interactions.

It is a power play with psychiatrists and why shouldn't it be? They have "authority over the mind", and the mind is what makes you YOU, so they have authority over you... or at least they behave in a way that makes it seem they must believe this is true.
And remember these are the same people who are medicating six month old infants for Bipolar Disorder and little kids, like 3, 4, 5, 6 and7 year old for things like schizophrenia AT ALARMING RATES, with medications that have UNKNOWN LONG TERM EFFECTS IN CHILDREN.
It's not that I don't think a VERY SMALL minority of children might have a mental disorder that is so sever that it warrents using such strong medications, BUT NOT AT THESE RATES. And most definately not six months olds. There is a sickness that effects the field of psychiatry and it is called GREED, NARCASSISM and APATHY. Maybe the new DSM will have a catagory Pdocs can use to diagnose themselves and thier own practicing behavior, and some special therapy to help these know it all high horse sadistic assholes come back down to earth and realize they need to treat people with MI like human beings, that we are human being and that we should have a say in our own treatment (baring being completely off the wall bonkers AT THE MOMENT) just like any other pateint with any other disease.
Also think about the fact that the #'s/$ info that has come out in states that have passed laws requiring all physicians to disclose any money they get from the pharmacuetical industry have shown that Psychiatrists get the most money of ANY specialty. They are nothing but drug dealing scum in my book so long as they continue to behave the way they do, take the money and if they don't take the money it's just as dispicable that they allow it to continue going on in thier profession.

If only I could find a GOOD, HONEST, HUMBLE psychiatrist, I would make so much progress in my treatment. But since all I have come across are a bunch of megalomanics who insist on making me feel like shit for daring to ever have an opinion about my own treatment, well I haven't gotten too far.

So how am I suppossed to be helped when I am suicidal if my insurance only covers psychiatrists and not the actual truely helpful field of psychology? I can't be helped because psych docs are themselves sick, maybe not all but a great number of them are and the sick ones are much easier to find than the kind and caring ones, and they would rather play power games and FUCK with thier pateints heads than offer real help.

If it's not bad enough that the medications for MI suck, that some of them DO induce suicidal behavior, and that they can actually make you more crazy should you end up on the wrong med for you... it is HORRIBLE that so many psychiatrists are just as unbearable as the side effects of the medications they prescribe. No wonder people are still killing themselves off at a good clip because psychiatry offers them no real hope, just more demeaning BS and BLAME.

DOCTOR:

The same doctors who claim that thier field, thier specialty is VALID because mental illness is a BIOLOGICAL disease, treat thier patients as if they are the ones to blame - So which one is it doc? You can't keep riding the fence and expect people to remain ignorant of the scam you are pulling. You make a choice: either mental illness is the fault of the patient, and you refer them to a psychologist, don't give them medications and admit defeat and close up shop -OR- you ACCEPT mental illness is at least in part a biological illness and you start humbling yourself and STOP placing blame on the people who are coming to you for help. To not make the choice, to continue to lure people in with the promise that thier emotional and mental turmoil is a medical condition that needs medical treatment and that you can help them by giving them meds... but to then turn on them once you've got them in yor office and HOOKED on a medication or a cocktail and THEN start placing blame on them, telling them in your oh so subtle ways how stupid and pathetic they are as human beings - Well it is just sadistic and cruel behavior. If you can't see that, if you can't see the dilema here, that you say one thing to validate the existance of your profession yet ACT another way which completely invalidates the need for your profession, then once again, you are an idiot. Either that or you are a sadistic son of a bitch that gets off on giving people false hope, whilst knowing it is false, milking them for thier money for treatments you know are bunk, whilst not refering them to the type of treatment that would lead them to TAKE RESPONSIBILTY for thier illnesses even though you think that it is most important for them to take responsibility, and then once something goes wrong you go ahead and blame the patient and get a little kick out of knowing you've just thrown the stool out from under them, and you get watch them strangle in the noose of lies you have worked so ellegantly to knott around thier necks...So which one are you? a highly educated idiot or a sadistic psycho?

April 13, 2008 11:07 PM | Posted, in reply to Anonymous's comment, by Anonymous: | Reply

I must say that I agree with just about everything that the previous poster said with one caveat - this seems to be the case specifically with American pdocs. I have dealt with pdocs from other countries who are exceptional and even go so far as to NOT push any pills with patients who don't truly need them. While these docs are trying to wean people off the dangerous meds and help them learn to live a life without dependence on drugs, the vast majority of their colleagues are putting everyone and their dog on a big cocktail of pills after their first few minutes of meeting. This perhaps speaks to the Big Pharma culture in the US and the difference in compensation structures. Imagine what it would be like if it were illegal for Pharma to court the doctors the way they do? We would see a whole different ballgame in American psychiatric medicine.

April 22, 2008 8:25 AM | Posted, in reply to Anonymous's comment, by Anonymous: | Reply

I agree

April 24, 2008 12:42 PM | Posted by jessa: | Reply

I have been in a lot of therapy and I have noticed that the only time I am told, as a patient, to think about the feelings of other people is when the issue is suicide. How is that not another way of having your cake and eating it too? Yes, I think I should be allowed to make the choice to commit suicide, but that isn't my point here. My point is that mental health care is inconsistent when it comes to thinking about others. For most things, I'm told I can't change other people, so I should focus on changing myself. That I can't be a "caretaker" worrying more about taking care of others than myself, because I will suffer. But suddenly, when suicide is the (not imminent) issue, I should be thinking about how it will affect others?

Maybe the Last Psychiatrist is consistent. Maybe he always encourages people to take others into account. But I don't find his words here untypical of psychiatrists and those psychiatrists from whom I have heard this before aren't consistent about this.

Again, I have my beliefs, but my point here isn't about whether we "should" take others into account or not, but rather, that we should at least be consistent about which we decide on.

April 24, 2008 2:29 PM | Posted by angry happy person: | Reply

I hate narcissists who harsh my buzz by getting all sad and killing themselves. They're so selfish they can't think of anyone's feelings or needs but their own. It sucks enough being around selfish sad people, but killing themselves? That could really put a crimp in my day.

Depressed people have a responsibility to other people, like me, and they should be glad that I tolerate their sadness at all. Assholes.

April 24, 2008 10:32 PM | Posted by Marissa Miller: | Reply

Wow. K, then.

How do you continue a discussion from here now? I see both points. To die or not to die--that is the question. On each side of the coin, narcissism is present: the suicidal person and those who are "loved ones" of the suicidal person. All involved are selfish; all desire an outcome they deem favorable.

April 27, 2008 5:57 AM | Posted by Hopeless: | Reply

Angry Happy Person,

This probably doesn't deserve a reply but why not? You are probably correct about some people. What percentage I couldn't say. However your words do not apply to everyone. There are those with mental illness, physical illness, and other circumstances of life that are entirely foreign to you. If you are not helping then you are hurting. Your tone is deplorable and it raises questions about your own life if you feel the need to degrade random people on the internet.

Your vocabulary is diverse enough (for a rant) to assume you have a few years of English under your belt but you do not understand proper comma usage, let alone the semi-colon. Your sentences lack flow, rhythm, and direction. It is all just painfully immature, both what you say and how you say it. I hope you have youth as an excuse.

Congratulations for making one of the most idiotic posts ever to be made to an Internet forum.

April 27, 2008 6:16 AM | Posted by Dreamer: | Reply

There are some things for which we are responsible or play a part in creating...other things just happen. Some of the latter can be unbearable for people to live with or take away all meaning and joy from their existence, leave them too burdened, unable to cope...whatever. To ascribe unexpected tragedies and loss to being caused by how someone thinks is just absurd.

April 27, 2008 7:48 AM | Posted by aaron: | Reply

Angry Happy Person:

Please. Until you're in the same state of mind as those who are suicidal you'll never understand. And I second Hopeless' comment above; grow up. That is all.

April 28, 2008 12:17 PM | Posted, in reply to Hopeless's comment, by meatling: | Reply

Hopeless:

Actually, angry happy person contributed a gem here, mercilessly ridiculing the egocentric shallowness with which "normal" people demand to not be inconvenienced by the misery of others.

I can only suspect that you're so immersed in your own misery that you totally failed to appreciate the satire. Either that, or you're a humorless twat with the IQ of a pancake. The real tragedy is that it's often impossible to tell the difference, so you might get judged harsher than you probably deserve.

April 28, 2008 6:59 PM | Posted by angry happy person: | Reply

Yes, I was satirizing our host's claim that suicidal people are "selfish," that they need to stop thinking their feelings matter against the superior weight of everyone else out there in "normal" culture. He dresses it up in just enough faux-humanist claptrap that some are fooled into thinking he's giving them encouragement, a reason to live. He's not. He's taking the side of culture against the distressed person whose resources have dropped to zero. And the culture is American culture. American culure makes the display of happiness a requirement, requires that you be a winner, not a loser, and withdraws sympathy if you're not--in fact, withdraws sympathy if you simply fail to make other people feel good at every moment with your smile. Any depressive will tell you about the immense social punishment they receive for not being sufficiently happy in public at every moment. Americans feel the demand for other people's happiness as an entitlement: don't harsh my buzz, you goddamn sad people. And about half the people who have answered in this thread have leapt enthusiastically to agree. I think that was the secret intent of Lastie's polemic. I think he's working out a lot of his own issues on his patients.

Clinically speaking, it would be criminally inept to address a patient's suicidal depression with harumphing, accusatory Victorian lectures about their social duty. "You've been abused and abandoned, but you need to take the feelings of your abusers and abandoners a little more seriously, you narcissist." But that's not the argument to pursue, really, because Lastie simply doesn't take the distress seriously in the first place. Look at the title of the post: ooooo, I wanna kill myself! He makes fun of it, as if suicidal ideation is always just childish, histrionic preening. Before you've read a word of the post, he's already slyly framed depressives as unserious fakers, immature whiners, manipulators, so you'll be encouraged to direct contempt toward them and feel that it's somehow justice. Even if someone making this argument actually meant well, that slide toward contempt is already going to happen because of what I said about American culture: start talking about the "selfishness of depressives" and you're going to tap into that sense of entitlement about not having buzzes harshed. People are going to start unloading a lot of hostility on vulnerable people. But Lastie pushes harder, and successfully! Look at the very first comment--that's the reaction he wanted to generate. He gets his readers to take up the attack; that gives him a bit of plausible deniability, even makes him look compassionate by comparison. And so many of the objections are hesitant and polite and ineffectual; they assume this is a rational discussion, and not a emotional game intended to delegitimize empathy toward some group. They may win the battle, but they lose the war. That's the game pundits play. Just as they write bullshit "contrarian" posts which upset and trigger people, and then sit back to enjoy the fireworks and the uptick in traffic, offering no clarifications or apologies sixty comments later.

I'm sorry my satire was misunderstood by some. Good for you for getting mad about it, though.

May 2, 2008 7:40 PM | Posted by Alice J: | Reply

Has anyone read "The Book on the Taboo Against Knowing Who You Are" by Alan Watts?

Gives some good perspective on a subject like this for people who have grown up in very individualistic societies like those in Western countries.

No one should kill themselves before reading it, as a truly informed choice is impossible without first understanding one's own life in the context of a holistic view of the world. Watts is very easy to read and is designed basically to explain some Eastern philosophy to Westerners.

May 27, 2008 10:42 AM | Posted by juniper: | Reply

Perhaps we should just stop generalizing.

In the years when I desperately needed therapy I had a great psychiatrist/psychotherapist who did not "coddle" me, but who was sensitive, empathic and who did indeed help me to turn my life around. I'm sure he had some of his own issues, but he knew himself well enough to keep them out of the consulting room. One could argue that a totally "normal" person as a psy would know nothing of anguish and human suffering, which doesn't strike me as preferable.

I also had a very close friend who died by suicide and he certainly had his reasons. He was a great guy, he keep his demons to himself and was always there for a friend in need all his life.

It's bewildering to me how angry people get when someone kills himself. I could understand sad, guilty, etc. but this deep rage that even a Mother can show towards her teenage son's "selfishness" - never mind a psy towards their patient? It seems to me we are not so far away from the Middle Ages when the body of a suicide was hanged in the public square as just punishment for his crime.

Sometimes I guess it's just too painful to put yourself in someone else's shoes.

June 4, 2008 11:07 AM | Posted by sandi: | Reply

so, let's see my father commits suicide when he is 60, no note which is more typical than not, and I am 19, I spend my 20's on a decade long mission to prevent another tragedy in my family. Spent so much time in therapy and running to my family for anything that sounded like a crisis, wake up one day in my 30s, with another boyfriend who is about to leave me because they always felt like they came last, because I felt I had to prevent another tragedy - so I finally realized my dad's death had stopped me from living my own life, so I get married, have a daughter who is now 18 months and then my nephew, who was two when my father decided to hang himself with a dog leash and use the baby's cup to drink the booze to down the Valium and Inderol in the room right next to where the baby is sleeping, well, he was 21, seemed to have everything, talent, mentors, friends, photos published in a book when he was 12 and photos on the cover of many magazines, a very loving family - well, he was fighting to keep his uncle alive from stage 4 Esophageal Cancer and was at the Cancer Hospital's apartment, had a fight with his 19 year old girlfriend, and then decided to hang himself in the closet with her belt. So, what about the uncle's fight with Cancer who is now too wracked with guilt and grief to even keep up the fight or eat, what about his new niece that he claimed to love, what about his future that the whole family had tried to ensure would be great? Flushed down the toilet in a spur of the moment decision because his 19 year old girlfriend was unfaithful, maybe...but then again, he didn't leave a note either. he never expressed one suicidal thought and was instant messaging a friend for 2 hours that night making plans for a trip in the Fall. But, maybe he was afraid to let us know he was depressed because he thought we were too fragile, maybe in a weak moment he remembered his grandfather's way out, maybe he thought life was futile because he was watching his uncle die...maybe this, maybe that --- we spend all of our time theorizing...So, suicide is a personal decision but it is devastating on the survivors and if someone is going to do it - take just 60 seconds to leave a note - because the why's and what if's are what ruin people's lives, in addition to the guilt, grief and fear that you may too succumb to suicide because maybe it is in the genes...To the person posting about the hate who never lost a son, hatred somedays is the only thing that keeps people strong enough to go about their daily lives, as the cop who broke down at the scene of my nephew's hanging, advised me - when he heard about my nephew's talent, award presentation 5 days before, loving family and charisma --- and it brought back memories of his brother's suicide. The hatred only lasts a few hours though before you break down in pain imagining their pain --- and then you think hey, wow, my pain is even worse than his, I don't even have the talent or half the friends...hmmm, why do i keep struggling...? Anyhow, I'm a big believer in therapy and I am heading back to it now, it's helped keep me alive for the last 20 years --- as well as knowing how much my suicide would destroy my family, friends, coworkers --- and yes, even my barista at Cosi's --- who has my order ready when I walk through the doors in the am. Suicide is evil and it spreads like a virus, it gets in your head and waits until your darkest moments to pounce.

June 4, 2008 11:32 AM | Posted by sandi: | Reply

Oh, my father did say to my older sister the night before, that it was her responsibility to take care of her mother and that he was depending on her to do that for him. so, he knew he had certain obligations to others, even at the end.

I read through the comments above and I see that the overwhelming thought is that it is selfish to make someone live if they want to die and that you do not need to stick around for others --- but my mantra in life has always been that no matter how great my personal pain is, I can always find a way to help, even if by showing strength despite all adversity. I still think that most people want to survive, it's just that they are trying to escape the pain and if someone else can find a way to lift that pain, then they will go on living for another day at least. Anyhow, that is just my way of coping. If all of you would like to celebrate suicide since that person was only expressing their personal freedom, then by all means don't let my pollyanna approach to life get in the way. But, in my darkest moments, I sincerely hope that I have a friend more like me, not you.

June 5, 2008 12:23 AM | Posted by Rudd-O: | Reply

You are wrong, because you argue from the first principle that a life must have a purpose. It doesn't -- a life just *is*, and no one is obliged morally to give (negative or positive)purpose to it, even though the majority of us is naturally or socially driven to it. The rest is obviously and automatically void drivel.

However, I do agree with much else you say on your blog, especially with the narcissism topics.

June 5, 2008 3:58 AM | Posted by fenixmagic: | Reply

When I was going through a bad breakup that devastated me for a long time, each day I would make a point to look into the news and find someone who was worse off than me. It sounds self-aggrandizing, but empathizing about the victims of repeated bombings in the Middle East, the exodus from Tibet, and Darfur genocide allowed me to realize that many, many people have a worse situation than I was in, and yet they were not committing suicide. Simple-minded, maybe, but it did the job of keeping me alive and out of "I can't stand it" fallacy of suicidal thinking.

There is a lot of anger on this board at the "right" to take yourself out of your own misery. Of course you have that right; use a method other than suicide to do it.

June 5, 2008 7:03 AM | Posted, in reply to LSun's comment, by Anonymous: | Reply

Congratulations on two things.

1. Completely missing the mark.
2. Exposing yourself as a narcissist.

Have fun in your pointless trivial little life.

June 6, 2008 2:32 AM | Posted by Jack: | Reply

As someone who has been suicidal for much of the past two years, all I can say is "fuck off, doc. You don't know shit."

First of all, what is so precious about human life? There are 6+ billion of us on a planet that really should max out at 2 billion of us, if that. There may be a few hundred that are actually irreplacable, true prodigies who really do make the world better in some unique way. The rest might be good for a few laughs now and then; but really, death is going on all the time and people manage to move with family and friends dying off throughout their lives. Almost no one will make a contribution that is unique or essential or won't be provided by another nearby human.

So if life seems to be dedicated to kicking you in the crotch over and over again, if you can't climb out of your personal hell, if every sliver of hope turns out to be another feint to get you to drop your guard to get wounded again, then who the hell is the rest of the human race to demand you continue to suffer? What could possibly be worth this? Am I really going to contribute more than I consume?

No, probably not at this point. The world has plainly indicated it does not value my contributions and capabilities. My friends aren't going to feed and house me. They aren't going to enable to do the things I consider important. I have a responsibility to not be a burden to those around me as well, to not drag down their lives with my considerable failings. My insurance policy is worth dozens of times what the world actually seems to value me for each year, would that money be more worthwhile to improving the lives of those close to me than a few more laughs?

I mean, sure, if I go out of my way to make my suicide clearly a statement of how much I hate my life it could make people feel bad and wonder if they couldn't have done something. But what if I just put my car into an underpass wall at 90 mph? That's not burdening anyone with the guilt of my death, its just another car accident. Its damaging public property, but its just going to give some people some work cleaning up and repairing the damage.

So on the plus side:
1) I stop suffering
2) I stop bitching to other people about my suffering and bringing them down
3) Some people close to me get a bunch of cash
4) I am no longer a burden on a planet with too many fucking humans

On the negative side
1) Some people are sad for a little while, and then move on.

And even if some of them later commit suicide from the silly domino theory of suicide, do that really make a difference? There are still plenty of extra people out there.

July 18, 2008 12:19 PM | Posted by thestranger: | Reply

Wow, there are some emotional comments here. I have a picked up a severe case of Anhedonia, and I don't live my life feeling sad, but I do have serious problems enjoying or finding any pleasure in life. I'm not suicidal, but I think about it. My life feels empty and without purpose, and I don't really see a point in waking up and dragging myself out of bed. I see nothing bad bad things in the past, and only see bad things for the future. There's a part of me that can't wait to grow old and die, because I see life as boring and a waste of time and emotions. I'm also have schizoid tendencies, so I see my life as my own. I've lived my life in a way in which I'm solitary and I've removed all those people in my life who would care or be affected when I'm gone. nobody is going to notice.

But despite how I feel, I recognize it might be because I've been damaged in some way... be it genetics of the childhood I endured. I keep going on because I believe I can't see the forest through the trees, and that if I fight and work hard enough eventually I will see things a different way. I think there's a way out even though I can't see it yet. I owe it to myself to love myself enough to take care of me. Despite how living feels, and I'm still fighting for something better... but with little success.

July 23, 2008 8:02 PM | Posted by 생활지혜: | Reply

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July 29, 2008 2:52 PM | Posted by Wendy: | Reply

How many of you that left your comments here, have lost a child, father, mother, husband, wife, brother, sister or other close relative to suicide????
I lost my son. Caleb was 20 years old, had just been accepted to Marshall university, had a new car, new job, girlfriend that loved him, never did drugs or alcohol - and he shot himself between the eyes with a 12 gauge shotgun.
Was his life his own??? Hell NO!!! The pain that he carried, he unloaded on his family and friends - times a thousand. The pain of never understanding why he decided to tell us and life "F*** you" is heart breaking. WE will never recover.
Visit Caleb: http://caleb-joseph-mcintosh.memory-of.com
And then tell me again what you think of suicide...

August 8, 2008 1:13 AM | Posted by Anonymous: | Reply

Your life is not your own!? Board Members? Company. You compare something as complex and beautiful as life to something so tainted and simple minded as a business!? You are a sick man. Forgive me if I didn't bring usual kindheartedness and manners with me while typing this, but I have no love for psychiatrists and mental predators. "Mental Health"? What a joke! What the hell is "healthy thinking"? I'll tell you what isn't; the need to play around with the way one thinks, to use drugs (dirty and foul mind altering drugs) to manipulate people. You have a fetish of dominance doctor. You masterbate to the idea of controlling someone's stream of thought. You are the only ones with a sick thought process. Get help, rapist.

Suicide is the final frontier of human rights. It is the ultimate choice of oneself, and with the god given right to make that decision; to take or leave it; only then are we free. I'll admit, it is selfish, it is a tragedy, but it's our choice. I have a great life (because I took control of my life from the hands of white collared scum bag drug dealers like you and your drugs), I have a sharp mind, a sexy body of 21 years old, a loving family, great friends, and a bright future. I have no intention of leaving it behind, I would be crazy to. But you know what, it truly makes me feel fully alive and in control knowing that I have the right to leave it all behind if and whenever I please.

If you think suicide is selfish, then what about the ones that throw them into a mental hospital against their will. Are they so weak and ill equiped with words that they cannot persuade them without the use of force? There are two sides to each coin.

If I ever did fall again, I would rise again on my own without the "help" of the likes of you. I would sooner die than to put my life in the hands of people like you.

Go die, you Psychophiliac