There are times when we all feel cursed by fate. A person who has experienced suicidal ideation knows this feeling well. That person often believes that he or she is fighting an unwinnable war, a rearguard action not only against fate but also against biology.
Members of the media can exacerbate our angst by using sensationalized terms like “epidemic” in reporting on a proliferation of suicides, particularly among young people.
After taking images of a brain, neuroscientists sometimes make dire pronouncements, by concluding with seeming certainty that a person has the cortex of a suicidal individual.
Epidemiologists attribute the country’s many suicides to factors that make the brutal deed more likely, underlying causes that appear to seal our fate.
Ultimately, though, the act of suicide, perhaps the most hideous and devastating act a human can commit (and yes, I will use the word, “commit”), defies the limitations and reductive quality of statistics, science, media coverage and policy.
I am not suggesting that we don’t have a suicide problem in this country. Recent studies indicate that, while heart disease and cancer remain the leading killers of Americans, suicide ranks in the top ten.
Nor am I suggesting that there is not an acute mental health crisis concerning young people, who can be easily influenced by their peers into copycat behavior or suicide contagion, a harrowing reality.
Besides hot lines and potential barriers or nets on bridges, there are other things we can do to reduce the risk of suicide.
Because suicidal people frequently act on impulse, I am against having guns in a home.
And if at all possible a suicidal person should never be left alone.
Having said all that, when it comes to the mental health of a suicidal person, what we in society need is not so much a change in policy as a change in perspective, from the coldness of data and 15 minutes of psychopharmacology a month to the warmth of long-term, compassionate therapy, whether on a clinical basis or not.
The suicidal person needs our empathy.
He or she requires time and understanding from others in order to stabilize and ultimately to recover.
And yet, as much as we offer help, the suicidal person has the greatest power of all, the power of free will.
While the suicidal person may seem helpless, and while in many cases that person is unable to do basic tasks to take care of himself or herself, he or she plays the single biggest role in healing, a process that often has a two-steps-backward-for-every-one-step-forward trajectory.
This trajectory can be frustrating, maddening to the suicidal person, to his or her loved ones and even to some inexperienced or unsophisticated therapists.
But recovery is not a linear process. It takes time, months, in some cases, years, to get out of a suicidal frame of mind, and then it takes more time to restore a modicum of mental health.
But it can happen, and I am living proof of that.
Still, I would never attempt a statistical, scientific or policy-based model to explain my recovery from a diagnosis of schizophrenia, two psychotic breaks and periods of intense suicidal ideation.
That is because suicide, like mental illness, which is almost always its forebear, has more than an element of mystery to it.
Consider that in the past few months researchers discovered 97 (you heard that right!), 97 new regions of the brain!
Medicine has been around for a long time, and it has benefited our lives over the centuries, but, when it comes to suicide, an act so seemingly irrational, counter-intuitive and contradictory, we need to look to artists to help us understand the subject.
There is so much about the brain, let alone the soul, that we are only now discovering. And there are some aspects we will never know.
Mental illness is not like a mathematical formula or a science experiment with one solution.
And treating mental illness truly is more of an art form than a science.
I was told by some people years ago that my diagnosis of schizophrenia was one from which I could not recover.
Fortunately, my then-psychiatrist, Dr. Michael McGrail, was not one of those people.
Trained at USC, Dr. McGrail flowed with empathy and had more than a sophisticated understanding of and appreciation for creative people.
In 1997, as I was leaving the USC psych ward, following my first psychotic break, Dr. McGrail said that he was “99%” certain that I would recover.
He was right, even though two years later, in 1999, during my relapse, he gave me a 20 on the GAF score when I was admitted to the UCLA Neuropsychiatric Institute.
As anyone familiar with a global assessment of function knows, my score was extremely low and indicated just how severely psychotic and debilitated I was.
All of which is to say that when it comes to matters as mysterious as mental illness, suicide, the brain and the soul, we need to heed the words not only of artists in the psychiatric field like the late Dr. McGrail but also of geniuses like Shakespeare.
More than any other character in Western literature, Hamlet understands what it is like to be depressed, psychotic and suicidal. When he says, “There are more things in heaven and earth, Horatio, than are dreamt of in your philosophy,” he is pointing out that it is the ghost, not the machine, that rules our world.
Just as some regions of the brain remain invisible, even after being subjected to dyes, our souls can never be pinpointed, not to one spot in the cortex, nor to any other place in the body.
We can make all the deterministic predictions we want and devise all the policies we can, but the suicidal mind lies to a large extent outside of these bailiwicks because the suicidal mind is subject to the idiosyncrasies of the individual.
There have been three suicides in my family, including my grandfather, after whom I was named in Hebrew.
I was probably named after my grandfather because he took his life within a few days of my birth, though he did so many years before I was born, at the time of the Holocaust.
For years, I felt cursed by this link to my grandfather.
Although my grandfather did not die in the concentration camps, he hanged himself during World War II, when overseas mail service was interrupted, when he may very well have thought that his whole family had perished in Babi Yar, the ravine in the Ukraine where the Jews of Kiev, reportedly more than 30,000 people, were rounded up and butchered.
In the years since my hospitalizations, I have read about Second Generation Syndrome, in which Holocaust survivors pass on their trauma to their children and sometimes name their offspring after loved ones who died in the concentration camps.
There may be a similar dynamic at work in the case of my family, even if it does not directly involve the Shoah.
Back in 1997, when I was recovering from my first psychotic break, my father saw me in my bathrobe shuffling from my childhood bedroom to the bathroom.
Even though I had run the L.A. Marathon only a week or so before, I could barely walk.
It brought back memories for my father of his own father, who at the end of his life was so incapacitated by depression that he too could barely move.
One might think that I was destined to die, to replicate the path of my grandfather.
But I have come to realize that we can reconfigure our supposed fate.
We can transmute what seems like a curse into a blessing.
Many years ago, Dr. Michael McGrail, who was my psychiatrist from 1996 until 2007, suggested that when my father named me in Hebrew after my grandfather, he did so because he wanted to preserve a positive memory of his dad.
I believe that this is true.
From what I can glean, my grandfather was a sweet soul, an immigrant to this country, the first one in his family to come here.
He was burdened by a shrew of a mother, who guilt-tripped him about many things, including no doubt his apparent inability to get his family out of war-torn Ukraine.
Unbeknownst to my grandfather, his family had moved to Tashkent for a job opportunity. They were spared the massacre at Babi Yar.
Tragically, my grandfather did not spare himself.
His name was Samuel, which in Hebrew means one who hears God.
I never got a chance to communicate with my grandfather, but my father and I have spoken to and even heard each other over the years.
To his credit, my father picked up on my suicidal ideation in 1997, when we were staying at a hotel near LAX, before we flew back East.
He and my mother had checked me out of the USC psych ward, where I had stayed for a week; and my father, attuned to my illness, attuned to my desperation, decided that they should not go downstairs to dinner that night at the hotel.
He and my mother stayed in the room with me.
That was a good thing, because I was hoping that they would leave, so that I could jump out of a window.
Paradoxically, it is also true that I was hoping that they would sense my suicidal despair and that they would stay with me in the room.
As Dr. Edwin Shneidman, who co-founded the Suicide Prevention Center in Los Angeles, wrote years ago in The Suicidal Mind, roughly 90% of suicidal people are ambivalent about taking their lives.
They want to be saved.
Of course, we have the ability to save ourselves, and we can start by doing our best to live and work in environments where we can be safe.
Freud cited work and love as being the keys to psychic health.
We do not always have such an ideal situation. And sometimes we contribute to our own problems.
But even if we do not have work and love, we can try to stay away from stressors and surround ourselves with goodness and nurture.
While the suicidal person may deny it, we all want, as E.M. Forster once said, only to connect, specifically with other human beings.
And that can mean having the courageous conversations, which are the subject of this conference.
It can also mean getting out of the house and appreciating the daily pleasures of life, which should be the aim and province of all of us, not just poets, as the Stage Manager said in Thornton Wilder’s Our Town.
I can recall reading an article about the high incidence of suicides on the Golden Gate Bridge, where one man, who was considering taking his life, revealed that he broke off his plan when another individual smiled at him as he was walking to the bridge.
That act of warmth, that connection with another human being, heartened the suicidal man, who decided against killing himself.
Just as there is no one reason why a person commits suicide, there is no one reason why I have healed and subdued my depression and psychosis.
But I do know that free will can overpower curses, and that is not just true of Theo Epstein’s Chicago Cubs, who could very well join his former team, the Boston Red Sox, in ending a championship drought by winning the World Series this year.
Free will means that we can control and own our actions, that we can delay our gratification, that we can come back from the depths, although, as Bob Dylan once said, “You can always come back, but you can’t come back all the way.”
We may not be able to come back all the way. But we can come back from the precipice with a fierce love.
That does not mean that we don’t screw up on meaningless matters. We sometimes seek immediate gratification for what we perceive to be basic needs.
We should keep in mind, though, what Dylan said of “transient joys.” As he wrote, “I know they’re not what they seem.”
It might sound bizarre and garish in a talk on suicide to speak of transient joys.
But the suicidal person should pause for a moment and realize that, while committing suicide may seem an act of defiance, of liberation, even of revenge against family members or the world, it has consequences that are not transient or joyful at all.
The consequences are permanent and dire.
And they can reverberate over the generations.
That is why we must fight suicidal despair with wisdom.
We must look at the long-term consequences for our families and, if you believe in such things, for our souls.
Let me conclude by turning once again to Hamlet, as we all should in these moments. In the “To Be or Not to Be” soliloquy, he speaks of the “undiscovered country, from whose bourn no traveler returns, puzzles the will and makes us rather bear those ills we have than fly to others we know not of.”
That soliloquy is not and never has been strictly about suicide. It and Hamlet himself cannot be reduced to anything, a stance with which Harold Bloom, author of Hamlet: Poem Unlimited, would concur.
Like mental illness, like suicide, Hamlet, the most paradoxical character ever written, cannot be figured out, certainly not in any simplistic fashion. He is ever expansive, like the brain and the soul, which we will never be able to chart conclusively.
They will always defy reductive explanations, for the brain and the soul cannot be mapped like geographic territories. They remain, at least, in part, “undiscovered countries,” ghosts in the machine.
But they present us with an infinite variety of opportunities to heal and thrive, none more so than our ability to harness our free will, a fierce love, and put ourselves in safe environments.
If we do those things and maybe get a little lucky, we can subdue our depression, psychosis and suicidal ideation.
As Hamlet says, “There’s a divinity that shapes our ends, roughhew them how we will.”
Need help? In the U.S., call 1-800-273-8255 for the National Suicide Prevention Lifeline.
This article was adapted from a speech I gave today, Saturday, Sept. 10, on the occasion of Worldwide Suicide Prevention Day.
