Another soul to cling to - The Lancet

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Aug 3, 2016 - sessions, taking medications as prescribed, exercising, and working. But through my all efforts I could not stop my unabating wish to die.
Insight

Another soul to cling to

Sheila Terry/Science Photo Library

I had been battling an episode of despondent depression for over a year without relief; as my exhaustion increased, so did the effort required to keep my demons at bay. I was drawing on all my knowledge as a mental health researcher, and various skills I had learned from years of psychotherapy, attending twice-weekly sessions, taking medications as prescribed, exercising, and working. But through my all efforts I could not stop my unabating wish to die. Suicidal thoughts were not new to me, but this time their intensity did not wax and wane. Relentless and unending, as months passed, the feelings remained. But I have a life worth living—a loving husband, a meaningful job, a few dear friends; I have a life I want to live. My childhood was riddled with trauma, and I had many years of therapy under my belt. I had been working with my latest therapist for over a year. I shared my feelings with her, working diligently to understand them, but relief was nowhere to be found. As my wish to die remained steadfast, my sense of self was eroding. The longer I withstood this erosion, the less I believed recovery was possible. I feared I had lost my personhood; nothing would be left to recover. We were doing everything we could, yet I remained tormented by the wish to die. I felt ashamed knowing that my death by suicide would profoundly hurt people whom I love and care for deeply. I also knew that it would not make sense to those closest to me. I did not want to leave people behind to wonder helplessly what had gone wrong, but it seemed impossible to communicate

the depth of my suffering. Suicide is highly stigmatising, making it difficult to share with others. People often respond with guilt-inducing remarks: “What an incredibly selfish thing to do!” or resort to platitudes: “What doesn’t kill you makes you stronger.” Unfortunately, sometimes, what doesn’t kill you leaves you weakened, and these well-intentioned but ill-thought-out responses left me feeling even more alone. Overcome with desperate tears, I said to my therapist: “I want to die so badly.” I had said this many times, but this time she leaned forward, rested her forearms on her thighs, looked me in the eyes and with sadness in her voice said: “I know.” Her two words, followed by silence matched by body language communicating her continued engagement, managed to contain my overwhelming feelings. But more than that, she provided me with genuine human connection. She did not encourage me to use skills or default to any other “intervention”. She simply tolerated the intensity of my despair, acknowledging its consuming presence in my life, and sat with me in my darkness. It didn’t take away the pain, or ameliorate my symptoms, but it shifted something. For the first time in a long time, I experienced a healing witness to my suffering. People die by suicide for many reasons. For me, though, suicide seems simply the ultimate act of aloneness. After this encounter I remained chronically suicidal for months, but I thought of her words, “I know” and remembered I was not completely alone in my anguish. Clinicians have an awesome responsibility—caring for another’s life. Skillful practice and responsible action are critical. People and situations are complex and we all need different things at different times. It will always be a tragedy when someone dies by suicide. But the more I reflect, the clearer it becomes to me that the conduit for my healing has been the small, often-overlooked encounters that saw past constellations of symptoms and interventions to transcend loneliness and despair. It is easy to overlook the person who is suicidal and focus solely on symptoms—the stakes are high, the work is daunting—but this error of omission risks further compounding an already unbearable loneliness. Clinicians face forces that distract from connection and in the world of managed care, checklist manifestos and rigid adherence to protocols, the healing power of presence is often seen as unimportant. But as I experienced my therapist as fully present with me in my darkness, I received a healing gift: acceptance and genuine human connection, which birthed a tiny grain of hope.

Ashley Clayton

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www.thelancet.com/psychiatry Vol 3 August 2016