"All I Really Want to Do Is Sleep"

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"All I Really Want to Do Is Sleep"
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"All I Really Want to Do Is Sleep"
A recent article in NYTimes [1] declared that the rising rate of suicides among our baby boomer generation now made suicides, by raw numbers alone, a bigger killer than motor vehicle accidents! Researchers quoted within the article pointed to complex reasons like the economic downturn over the past decade, the widespread availability of opioid drugs like oxycodone, and changes in marriage, social isolation and family roles. Then I scrolled down, as I always do, to peruse some of the readers' comments, and that's when I paused.

I suppose in hindsight that I had expected readers to exclaim at the shocking statistics (suicide rates now stand at 27.3 per 100,000 for middle aged men, 8.1 per 100,000 for women), or lament over personal stories of relatives or friends who took their own lives. While I certainly saw a few such comments, I was amazed to discover the number of readers who were sympathetic to the idea of suicide.

"Molly" wrote "Why is suicide usually looked upon as a desperate and forbidden act? Can't we accept that in addition to poverty, loneliness, alienation, ill health, life in world [sic] that is sometimes personally pointless means that death is a relief? I believe the right to die, in a time and place (and wishfully peacefully without violence) is a basic human right."

This post was 'recommended' by 351 other readers at the time of this essay being written.

"MB" wrote, to the approval of 394 of fellow readers, "Has anyone considered fatigue?.... Stress and overwork (and the prospect of continuing to do so until my health gives out, without any realistic hope of retirement, assuming that I want to keep on eating when I get really old) have taken a toll. All I really want to do is sleep. I'm tired of fighting, tired of running on adrenaline for years at a stretch. Adrenaline was designed for short bursts of energy, not a multi-year slog. I dream about suicide chiefly because it would enable me to take a long rest."

Such comments proliferated.

My first thought was to worry that by acknowledging the appeal of suicide, the NYTimes readers would somehow descend into suicide advocacy and subsequently, actual suicides. As a student of psychiatry, I watched patients create 'chain analyses' where they mapped out for themselves how an emotion led to a thought, which led to a behavior, and subsequently an action. After all, the whole field of cognitive behavioral therapy rests on the principle that governing thought patterns is critical to staying safe and maintaining control.

Why aren't the NYTimes editors moderating and removing these comments? I thought.

But then I remembered something else that I learned in psychiatry: asking patients about their suicidal impulses does not actually encourage the act. Asking depressed patients about a thought or a plan does not remind them to leave your office and buy a gun. If someone is thinking about taking his or her own life, your questions will not result in an iatrogenic increase in those thoughts [2]. If anything, patients welcome the opportunity to confide in someone they trust about these intrusive thoughts, and the possibility of talking through their emotions in a safe environment.

The weight of depression is often compounded by the conviction that patients carry of not being understood. While shadowing my preceptor in an in-patient psychiatric unit, I often saw patients offer bland responses or false, brave fronts in response to our probing about mood and activity. The ability to refuse to accept such superficial facades and demand to understand the truth of a person's internal life is of the utmost significance in any psychiatrist's office, and is the hallmark of this profession. After all, a patient who understands completely the undercurrents of his or her thought processes will likely not need a shrink.

But an empathic understanding of suicide need not be the sole province and possession of psychiatrists. As one of the great psychiatrists of our times, Leston Havens, once noted in an essay titled "The Anatomy of a Suicide," such empathy can grow from an open-minded review and understanding of our own lives, for most people have had suicidal thoughts, perhaps even suicidal impulses [3].

Often, it is up to peers, friends and strangers on the Internet alike, to listen to and try to understand each other. As many of the NYTimes readers acknowledged, the slow burn of aspirations meeting harsh reality, the progressive compromise of our deepest wishes, and surrender of hope for change in the future is the disappointing but normal trajectory of a human life.

On the NYTimes readers' page, I saw exactly this transpiring. I began to see other readers both acknowledge the existence of suicidal thoughts within themselves, but also point to protective factors present in their lives - a family, a home, a job. They began to protect each other. There was hardly any of the "oh banish such thoughts from your heads" but rather, comments like these: "please go hug your friend, tell him that you are there for him, and take him to the emergency room."

One reader expanded on this sound advice by recommending walks through one's city. "These walks, if no more than around the block, are always interesting," he wrote. "Incredible and changing sights, a constant and changing background of sounds, smells - and a gratifying reminder of the human race, of which we are members, even yet. We are not alone. It ain't over 'til it's over. Meanwhile, it's all - all, every aspect of it, pain and pleasure - interesting."

References:

Parker-Pope, Tara. "Suicide Rates Rise Sharply in US." New York Times. N.p., 2 May 2013.

Mathias CW et al. What's the harm in asking about suicidal ideation? Suicide Life Threat Behav. 2012; 42(3):341-51.

Havens LL. The Anatomy of a Suicide. N Engl J Med 1965; 272:401-406.

Image: Jonathan McIntosh.

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