My Best Friend's Suicide

Right up front, I'll be clear that names and other details have most definitely been changed. Suicide is about pain, the kind that never goes away, for those left behind. The last thing I want to do here is inflict more pain by exposing personal details that could reveal identities.

Several years ago, my best friend of twenty years killed herself. We had done our psychology internships together. Although we came at the practice of psychology from different perspectives (she was strongly behavioral and I was much more psychodynamic at the time), we had many stimulating discussions about our work. She and her husband also became an integral part of our family and became "Aunt Sheryl" and "Uncle Gary" to my two young children.

Gary was a physician in a fast-paced high-pressure trauma center. Years in that setting eventually wore on him, and he took a job with a small practice in northern California. Sheryl moved out there after handling the sale of their home on the east coast. She had practiced psychology only intermittently after internship, and hadn't completed the requirements for licensure, so still had to be supervised by others in her work. She spent the rest of her time in community and charitable work.

The move to California was hard on Sheryl. She was thousands of miles away from family, had no friends there, and no professional identity. While she had had some vague physical ailments over the years, her health took a definite turn for the worse after the move. Gary spent much of his free time researching possible diagnoses, but to no avail. To say that he became frustrated is to put it mildly. Sheryl, on the other hand, became quietly despondent and withdrawn.

The details of the night I got the call is forever seared into my brain. As soon as I heard Gary's voice, I knew Sheryl was dead, but I instantly assumed it was an auto accident. As he went through the details of coming home from work and finding her body, I was enveloped by a whirlwind of emotions--indescribable pain, anger, loss, bewilderment. I also knew that my life was forever changed by her act.

As Gary and I talked by phone during the next few days, more details came to light--the manner of death, how Sheryl had staged her death scene, the amount of planning she put into her suicide, and that Gary was even briefly considered a suspect in her death. To make matters worse, her family back East also accused him of somehow being responsible for her death, that perhaps he had neglected her after the move or hadn't done enough to ease the transition for her.

I was ready to get on the next plane and head to California to be with Gary and help him with whatever arrangements needed to be made. He asked me to wait a couple of months until he felt ready to face the task of going through her possessions. Of course, I honored that and actually shared a very special time with Gary when I finally did visit. He turned over the task of sorting her belongings to me. We sat around and talked and laughed and cried. Gary and I remain good friends. He has remarried, a very special lady who has introduced him to an entirely different way of life.

The thing about suicide is that, so often, you never get what it was really about. Sheryl left a very lengthy, cryptic letter to both Gary and me. I read that letter over and over on my way home to my family. I concluded it actually raised more questions than it answered, and I even wondered if that was Sheryl's intent in writing it. Certainly Gary and I kept second-guessing ourselves. What had we missed that might have saved her life? I read and reread her emails to me over the last few years of her life to see what was between the lines that I didn't pick up on. And I found nothing. I don't know whether that was a blessing or not. To think that I might have been able to do something, but failed to do it, would have flooded me with a sense of lifelong guilt. On the other hand, to find no clues as to her state of mind, what the tipping point between life and death was for her, has left me with a sense of helplessness that I'll carry forever.

The Intimate Hour (Part II)

What is a patient looking for when he or she comes to therapy? My experience is that, in general, he has tried everything he knows to do in dealing with an issue. He has exhausted his own personal resources. But making that initial call can be fraught with anxiety. The patient has delayed it and delayed it, while he struggles along with the situation. Admitting that you're unable to resolve a life problem on your own, that you'll have to address it with a stranger, can be a daunting prospect.

A patient is seeking first and foremost understanding. Whether in therapy or not, each of us ultimately wants our life narrative to be heard. Whether it's someone wanting to share her rage at her husband's infidelity; a person isolated and in the throes of hopelessness who writes a suicide note; or a serial killer who eventually feels compelled to describe his horrific crimes; we all desire for at least one other fellow human being to hear our story and understand our motivations.

A patient is seeking acceptance. The slightest whiff of judgment will taint a therapeutic relationship. The therapist must have a very high tolerance for dealing with attitudes, behaviors, even lifestyles that he does not personally endorse. If he struggles with this, it behooves him--and is in his patient's best interest--to either do some work in therapy himself regarding his discomfort, or to make a referral to another therapist.

Most patients are seeking some specific means for effecting change in their lives. For all but a few, gone are the days when an individual can spend an hour a day, four to five days a week, on a therapist's couch. The vast majority of today's patients come in with a specific problem or problems. Pursuing self-actualization in therapy is a luxury that few can afford. To that end, as a new patient and I wrap up our intake session, I help them formulate and prioritize their goals for therapy. The question might be something like, "What would you like to be different in your life as a result of coming here?"

Finally, patients frequently need what I call a "takeaway". This can be something as specific as an "assignment" to journal, to chart behavior (e.g., eating, exercise), to take turns planning special events with a spouse, to read certain portions of a book or listen to a podcast, to contact an estranged family member, to think about their goals at work. You get the point. A small task or bit of information at the end of a session can reinforce the work done in the session and enhance the patient's sense that she has gained something positive and concrete from her work in therapy.

The Intimate Hour (Part I)

The process of psychotherapy is as different as each therapist-patient combination. The chemistry between patient and therapist is undeniable and plays a key role in the process. My approach has been to address each patient as an unfolding life story, with its own unique narrative, and not as a diagnostic exemplar. As we work together, I listen for and identify recurrent themes, with their moments of triumph, as well as depths of despair; with their areas of strength and resilience, and their places of weakness and flagging hope.

As a therapist, my job is to assist the patient in writing a new chapter in his narrative. Perhaps his past has been marked by repeated failures at valued tasks. Perhaps her undertakings in life have been tinged by fear and self-doubt. The therapist is a companion on the patient's journey of self-discovery and healing.

As the companion on the patient's journey, I look at the elements of the patient's life as the pieces of glass in a kaleidoscope. When the kaleidoscope is held in one way, one picture emerges. However, when the patient rotates the kaleidoscope, a different picture comes into view. And with that different picture come new possibilities. New ways of understanding what has gone before in one's life and what could lie ahead. And this is where the therapist brings her experience and psychotherapeutic tools to bear.