{"id":65048,"date":"2016-05-01T08:00:23","date_gmt":"2016-05-01T12:00:23","guid":{"rendered":"http:\/\/1boringoldman.com\/?p=65048"},"modified":"2016-05-01T10:48:54","modified_gmt":"2016-05-01T14:48:54","slug":"some-voices-in-the-clouds","status":"publish","type":"post","link":"https:\/\/1boringoldman.com\/index.php\/2016\/05\/01\/some-voices-in-the-clouds\/","title":{"rendered":"some voices in the clouds&#8230;"},"content":{"rendered":"<div align=\"justify\" class=\"small\">All this talk of the recent suicide statistics and what they might mean isn&#8217;t my native land. I&#8217;m more used to thinking about suicide and meaning[s] one case at a time. I recalled something from my earliest days as a resident. One of the first lectures we had was about the standard suicide statistics. You probably heard one too &#8211; women attempts [9:1], men successful suicides [9:1]; social isolation, alcohol\/drugs, older, plan &#8211; all ominous signs; etc. etc.<\/div>\n<ul>\n<div align=\"justify\"><sup><em><font color=\"#332201\">One late night on-call, I was interviewing a man brought to the hospital because he was contemplating suicide. I no longer recall the specifics, but I do remember what occurred to me while I was talking to him. I realized that when I saw a suicidal patient, I got anxious and didn&#8217;t think quite right. I became focused on things like &quot;is he really going to do it?&quot; &quot;does he have a plan?&quot; With suicidal patients, the stakes were  suddenly raised by the threatened action, and I started worrying that I  was going to do the wrong thing, &quot;blow it.&quot; Without really knowing it was happening, I was abandoning the patient as a suffering person and becoming focused on risk management and suicide prevention. Not that there&#8217;s anything wrong with that &#8211; in fact it&#8217;s the right thing to do [evaluating risk], but not the only thing. It certainly didn&#8217;t mean that I should forget that I was talking to someone in a lot of pain and confusion &#8211; a unique person, not a category. And if ever there were a group of people who deserve our fullest individual attention, they&#8217;re among this group&#8230;<br \/>  <\/font><\/em><\/sup><\/div>\n<\/ul>\n<div align=\"justify\" class=\"small\">I don&#8217;t think much of population statistics or Tom Insel when I&#8217;m seeing patients. Let me introduce some of the people that do live in the clouds when I think of suicidality and suicide in clinical work:  <\/div>\n<p align=\"justify\" class=\"small\"><img decoding=\"async\" border=\"0\" align=\"right\" hspace=\"4\" height=\"150\" title=\"William Shakespeare\" alt=\"William Shakespeare\" src=\"http:\/\/1boringoldman.com\/images\/suicide-13.gif\" \/>My sister, an academic, wrote a paper long ago analyzing Shakespeare&#8217;s <em><font color=\"#200020\">Hamlet<\/font><\/em> using double-bind theory. I think I would&#8217;ve thought it brilliant even if we didn&#8217;t share a name and a history. She showed how Hamlet&#8217;s soliloquy on suicide applied to all of the characters, each of whom was in a double bind, and how madness and suicide were tempting solutions to the impossible situations each of them faced. I can&#8217;t count the number of suicidal patients I&#8217;ve seen where parsing the double binds they were experiencing was the key to finding their way out of a suicidal dilemma. I owe both Shakespeare and my kid sister for that insight.  <\/p>\n<p align=\"justify\" class=\"small\"><img decoding=\"async\" border=\"0\" align=\"left\" vspace=\"2\" hspace=\"4\" height=\"150\" title=\"William Styron\" alt=\"William Styron\" src=\"http:\/\/1boringoldman.com\/images\/suicide-10.gif\" \/>Another great writer who made a major contribution was William Styron, the author of <em><font color=\"#200020\">Sophie&#8217;s Choice<\/font><\/em>, another variation on the theme of double binds, impossible situations. It&#8217;s a must-read book and a must-see movie if you are someone who sees suicidal patients. One will never find two better teachers than William Styron and Meryl Streep. And Styron gave us something else. His <em><font color=\"#200020\">Darkness Visible<\/font><\/em> is a first hand account of the pain of Melancholia that makes the why of the suicidal risk in the afflicted patients unforgettable. Another must-read.  <\/p>\n<p align=\"justify\" class=\"small\"><img decoding=\"async\" border=\"0\" align=\"right\" hspace=\"4\" height=\"150\" title=\"Virginia Woolf\" alt=\"Virginia Woolf\" src=\"http:\/\/1boringoldman.com\/images\/suicide-11.gif\" \/>And speaking of the great writers, <em><font color=\"#200020\">Virginia Woolf<\/font><\/em> and her <em><font color=\"#200020\">Mrs. Dallaway<\/font><\/em> are in close contention with the next paragraph&#8217;s featured author as the best piece of fiction ever written. The book is, in part, about her character, Septimus, a man with a War Neurosis who kills himself to avoid being committed. Some 16 years after writing the book, Woolf herself committed suicide as an episode of her periodic psychotic illness was coming on &#8211; likely for the same reason. I have three books on my shelf, each explaining her illness convincingly, each with a different diagnosis [Schizophrenia, Bipolar Disorder, and PTSD]. I can&#8217;t summarize her themes &#8211; but they&#8217;re all there.<\/p>\n<p align=\"justify\" class=\"small\"><img decoding=\"async\" border=\"0\" align=\"left\" vspace=\"2\" hspace=\"4\" height=\"150\" title=\"William Faulkner\" alt=\"William Faulkner\" src=\"http:\/\/1boringoldman.com\/images\/suicide-12.gif\" \/><em><font color=\"#200020\">William Faulkner<\/font><\/em> is the other contender for the greatest piece of fiction ever written [personal opinion]. It&#8217;s two books: <em><font color=\"#200020\">Absolom, Absolom<\/font><\/em> and <em><font color=\"#200020\">The Sound and the Fury<\/font><\/em>. The books explore the interplay of culture, history, myth, and personal biography as they lead his character Quentin to suicide. I expect that my own history as a Southerner has something to do with my reverence for these two books. But even with that COI declaration, their complex messages have frequently come to mind with suicidal patients and opened up fruitful avenues for exploration.  <\/p>\n<p align=\"justify\" class=\"small\"><img decoding=\"async\" border=\"0\" align=\"right\" vspace=\"2\" hspace=\"4\" height=\"150\" src=\"http:\/\/1boringoldman.com\/images\/suicide-5.gif\" alt=\"\u00c9mile Durkheim\" title=\"\u00c9mile Durkheim\" \/>While countless academics and graduate students have had their way with <em><font color=\"#200020\">\u00c9mile Durkheim&#8217;s <\/font><\/em>1897&nbsp; Treatise,<em><font color=\"#200020\"> Suicide<\/font><\/em>, his insights have weathered the century. His study compared suicides among Catholics and Protestants using a scientific method. &quot;<em><font color=\"#200020\">Overall, Durkheim treated suicide as a social fact,  explaining variations in its rate on a macro level, considering  society-scale phenomena such as lack of connections between people [group attachment] and lack of regulations of behavior, rather than  individuals&#8217; feelings and motivations.<\/font><\/em>&quot; <a target=\"_blank\" href=\"https:\/\/en.wikipedia.org\/wiki\/%C3%89mile_Durkheim#Suicide\">Wikipedia<\/a>. It&#8217;s a piece of Sociology important to consider at the individual level with suicidal patients..  <\/p>\n<p align=\"justify\" class=\"small\"><img decoding=\"async\" border=\"0\" align=\"left\" vspace=\"2\" hspace=\"4\" height=\"150\" src=\"http:\/\/1boringoldman.com\/images\/suicide-6.gif\" alt=\"Karl Meninger\" title=\"Karl Meninger\" \/>We all likely know about Karl Abraham&#8217;s and Sigmund Freud&#8217;s thoughts about the relationship of anger to depression and suicide. But <em><font color=\"#200020\">Karl Meninger<\/font><\/em>&#8216;s 1938 contributions in <em><font color=\"#200020\">Man Against Himself<\/font><\/em> are what actually come to mind with every suicidal person I&#8217;ve ever seen. Paraphrased, suicidal people want to die [escape], to be dead [relief], and to kill [rage] &#8211; and I try to find the personal version of each one of them in every interview. This is a timeless book that isn&#8217;t often mentioned these days, but it should be. I had to occasion to reread it a few years ago along with a student, and it was as fresh and useful as it was the first time I read it.  <\/p>\n<p align=\"justify\" class=\"small\"><img decoding=\"async\" border=\"0\" align=\"right\" vspace=\"2\" hspace=\"4\" height=\"150\" src=\"http:\/\/1boringoldman.com\/images\/suicide-14.gif\" alt=\"Albert Camus\" title=\"Albert Camus\" \/><em><font color=\"#200020\">Albert Camus&#8217; Myth of Sisyphus<\/font><\/em> is a classic on many fronts. While the philosophical point is that Hamlet&#8217;s existential dilemma has to be resolved to truly live authentically, to <em><font color=\"#200020\">choose<\/font><\/em> to live, I found it helpful with any number of patients. Concretely, I had cases who had a lethal cache of medications as a beloved possession, a talisman, a way of holding out, a way of not fully stepping into life until life proved itself. And there were a significant number who kept their cache secret until they decided to throw them away and step into life after all. That&#8217;s a whole psychotherapy topic of its own, but for the moment, suffice it to say that Camus is definitely a required read.<\/p>\n<p align=\"center\"><img decoding=\"async\" border=\"0\" src=\"http:\/\/1boringoldman.com\/images\/suicide-a.gif\" \/>  <\/p>\n<div align=\"justify\" class=\"small\">So where did this post come from? I&#8217;ve spent a couple of days thinking about those suicide statistics, and their meaning&nbsp;<span class=\"st\"> vis&ndash;&agrave;&ndash;vis<\/span> the NIMH and Insel&#8217;s leaving [<a href=\"http:\/\/1boringoldman.com\/index.php\/2016\/04\/25\/whats-missing-2\/\" target=\"_blank\">what&rsquo;s missing&hellip;<\/a>, <a href=\"http:\/\/1boringoldman.com\/index.php\/2016\/04\/27\/off-of-my-plate\/\" target=\"_blank\">off of my plate&hellip;<\/a>, <a href=\"http:\/\/1boringoldman.com\/index.php\/2016\/04\/28\/all-aboard-2\/\" target=\"_blank\">all aboard!&hellip;<\/a>, and <a href=\"http:\/\/1boringoldman.com\/index.php\/2016\/04\/30\/the-chemistry-of-paint\/\" target=\"_blank\">the chemistry of paint&hellip;<\/a>]. But what those numbers really brought up in my mind were cases I&#8217;ve seen over the years. What I was writing seemed so disconnected from those real people, sterile, and I wanted to populate the posts. But I can&#8217;t write about the cases in my mind so I started writing about some of the people in the clouds with them that I could talk about. V<span class=\"st\">oil&agrave;<\/span>&#8230; <\/div>\n","protected":false},"excerpt":{"rendered":"<p>All this talk of the recent suicide statistics and what they might mean isn&#8217;t my native land. I&#8217;m more used to thinking about suicide and meaning[s] one case at a time. I recalled something from my earliest days as a resident. One of the first lectures we had was about the standard suicide statistics. You [&hellip;]<\/p>\n","protected":false},"author":2,"featured_media":0,"comment_status":"open","ping_status":"closed","sticky":false,"template":"","format":"standard","meta":{"_bbp_topic_count":0,"_bbp_reply_count":0,"_bbp_total_topic_count":0,"_bbp_total_reply_count":0,"_bbp_voice_count":0,"_bbp_anonymous_reply_count":0,"_bbp_forum_subforum_count":0,"footnotes":""},"categories":[5],"tags":[],"class_list":["post-65048","post","type-post","status-publish","format-standard","hentry","category-opinion"],"_links":{"self":[{"href":"https:\/\/1boringoldman.com\/index.php\/wp-json\/wp\/v2\/posts\/65048","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/1boringoldman.com\/index.php\/wp-json\/wp\/v2\/posts"}],"about":[{"href":"https:\/\/1boringoldman.com\/index.php\/wp-json\/wp\/v2\/types\/post"}],"author":[{"embeddable":true,"href":"https:\/\/1boringoldman.com\/index.php\/wp-json\/wp\/v2\/users\/2"}],"replies":[{"embeddable":true,"href":"https:\/\/1boringoldman.com\/index.php\/wp-json\/wp\/v2\/comments?post=65048"}],"version-history":[{"count":52,"href":"https:\/\/1boringoldman.com\/index.php\/wp-json\/wp\/v2\/posts\/65048\/revisions"}],"predecessor-version":[{"id":65100,"href":"https:\/\/1boringoldman.com\/index.php\/wp-json\/wp\/v2\/posts\/65048\/revisions\/65100"}],"wp:attachment":[{"href":"https:\/\/1boringoldman.com\/index.php\/wp-json\/wp\/v2\/media?parent=65048"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"https:\/\/1boringoldman.com\/index.php\/wp-json\/wp\/v2\/categories?post=65048"},{"taxonomy":"post_tag","embeddable":true,"href":"https:\/\/1boringoldman.com\/index.php\/wp-json\/wp\/v2\/tags?post=65048"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}