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When nothing works.

September 19, 2013

In my life I have known people who struggled with tremendous mental health problems, including myself.  I have known three people who ultimately took their own lives.  I can’t even begin to describe how painful it is to see someone suffering so much and be unable to help.  According to the National Institutes of Health, suicide is the tenth most common cause of death in the United States.  I find this statistic surprising and alarming.

There is significant controversy around suicide, even in the case of people who are terminally ill.  The Judeo-Christian religions generally consider suicide an offense against God and the sanctity of life.  Indeed, as a medical professional I have sometimes encountered quite sanctimonious reactions to patients who have attempted suicide, not just amongst the public, but some of my own colleagues.  What is often missing from the argument is compassion for the real pain and suffering of the individuals involved.  This is not a criminal act, nor a sin against God.  This is an attempt to stop the pain which has become intolerable.

In most cases this suffering can be alleviated.  In terminally ill patients, aggressive pain symptom management can make a big difference.  In people suffering from depression or other mental illness, there are medication and psychotherapeutic treatments that can be quite effective for some.  Social support from friends and family helps.  There are still people, however, who are not helped.  This may be because of a lack of resources to obtain medical treatment.  Psychiatric services for those with low income or lacking insurance are generally stretched quite thin and sometimes of poor quality.  Some people have access to care but refuse it.  Self-isolation is common in those who are very depressed.

A special case is the Department of Veterans’ Affairs (VA), which bears the responsibility for treating the medical and psychiatric problems of many of our country’s veterans, devotes scant resources to psychiatric care.  They advertise their anti-suicide efforts widely, but when a veteran seeks out services, those received are often of poor quality and just forget about getting psychotherapy.  My husband struggled with trying to get help from the VA for serious psychiatric problems off and on for 20 years.  It wasn’t until he had private insurance and was treated at a private psychiatric hospital that he even was put on the right type of medication for his condition.  The only psychotherapy offered was a 6 week anger management course.  Then they act surprised when studies some out showing continued increase in suicide amongst veterans.  According to the Center for Public Integrity, nearly one in five suicides nationally is a veteran, adding up to 49,000 between 2005 and 2011.  You mean the squeezy balls with the suicide hotline number distributed at the VA clinic didn’t help?

Unfortunately, some people suffering from depression never get better.  Sometimes even the best of care can’t take away the pain.  Of the friends I have lost, two had access to good care and made sincere efforts to take advantage of it.  One withdrew from everyone and refused care, even though he had successfully overcome depression and alcoholism in the past.  All three slipped away and I don’t think there was anything anyone could have done to stop it.  I couldn’t have stopped it.  All I can do is pray that they are now at peace,that the suffering has finally been relieved.

If you have arrived at this page because you are contemplating suicide, please know that there are probably many more people than you know who care about you.  You can go to to find the numbers for national and local hotlines where you can talk to crisis counselors right now.  And even though I have been knocking the VA’s efforts to help veterans with psychiatric problems, do try the VA’s crisis line.  They can at least help in this moment and they understand what soldiers have been through.  Whoever you are, there are people who understand your pain.

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