There was an extraordinary commenting discussion about suicide as reader responses to a NYTimes column by the physician and writer, Danielle Ofri. In her essay, she laments the death by suicide of a patient and expresses frustration about the seeming non-suicidality of him making the death an unexpected shock.
Two weeks ago, I called one of my patients to reschedule an appointment. A family member answered and told me that my patient had been found dead in his apartment, most likely a suicide. This robust and healthy 54-year-old had screened “negative” for depression at every visit, despite having risk factors: being unemployed, living alone, caring for an ill relative.
Here she makes a clinical error: screening for depression and suicidality are two distinct entities. Once does not necessarily presage the other. In terms of perceived burdensomeness, thwarted belongingness, isolation, hopelessness, helplessness and worthlessness, this gentleman was existing in a stew of toxic risk factors.
Maslow’s hierarchy of needs is old, but useful, in my view. This person exhibited unmet basic needs – financial burdens, caregiver burdens, physical burdens, social isolation burdens. The question becomes, where art thy neighbor? Who is thy neighbor?
One of the risk factors for suicidality is that physicians increasingly treat rather than care for patients. Because the care is missing, patients aren’t supported around anything other than medications, surgery and medical procedures. One thing Dr. Ofri could have addressed is linking the patient to a home health nursing agency or to a social worker who could help him access caregiver support, perhaps home delivered meals and financial and job search supports.
The bottom line is that it appears that no one was this man’s neighbor, or brother, or fellow citizen.
Now to the commentary:
Readers addressed a wide variety of insightful and thoughtful aspects around suicide and suicidality. The right to end terminal suffering – psych ache – is addressed quite compellingly.