Tag Archives: Suicidal

Must we help/save the person despite his/her will?

I recently called a sister of a new patient to check how the patient had been doing with the medicine and whether his state had improved, and came to know that the patient hung himself that very morning.

I’m not sure if I’m too sensitive, but I’ve received this kind of news considerably frequent in my job, the sister just didn’t sound sorrow (of course some people hide their emotions very well). In fact she later said that it was a relief not just for the patient, but also for the family.

The patient has 4 siblings who are all married with children. Their parents have passed away for few years. He was the only single and he lived on his own. Though the sister went to see him thrice per day, bringing him food and taking care of him. He had suffered from depression for many years, also done ECT quite a few times. The sister always did her best to help him. She said some siblings had given up on him, but she wouldn’t.

Now that he is gone, she just felt a weight off her shoulders. Then she started to wonder if she had done wrong all these years.

If it meant suffer to live longer, do you still want him to live longer? Just because people all should live as long as they can? Or just because you think it’s your duty to help him to live longer? So you would feel better? So you wouldn’t be blamed for not helping him if something happened? You could say that you tried your best? So you go against the person’s will (partially the illness), you save him no matter what?

It is a bit similar to those family members of terminally ill patient who decide and some even beg the doctors to save the patients, but when you really check, a lot of those sufferers would rather leave in peace, stop the pain and the carers’ suffer, than going through all those operations and chemicals and injections and medication and machines, while at the end still leave, in pain and with holes all over the body.

So what’s considered as selfish act here? And what’s considered right? Who can decide it? Who is the one to make the decision?

Related read: Can we allow a severely depressed patient to make the decision?

A supposed-to-be successful and inspiring insurance agent

He became a millionaire in his early 30s, although primarily an insurance agent, he was known with his skills in investing. He had a wife and a daughter. They went on holidays all over the world every year.

In his mid thirties, he got depressed and suicidal, due to stress of work and some other problems. He attempted suicide several times, buying ropes to hang himself, overdosing himself on drugs but was always found early enough to save his life. Perhaps this wasn’t how his life meant to be.

His family took him to temples, hoping that the power of religion could help him to recover. They were told that the money he’d earned was “dirty money” (money obtained unlawfully or immorally). So by instructions, he went to China and donated almost all his money to the temples. At this point, the wife left him. He got even more depressed, he didn’t recover donating his money away.

Recommended by friends, he seek professional help and came to see psychiatrists. After weeks of medications and a course of ECTs, he got better. On the following years, his condition was maintained with medication. He would come to see doctor once he felt unwell. He rebuilt his career and became wealthy again. He even supported his ex-wife financially, although he also soon got married with another woman. Over the years he had had another 2 courses of ECT at times of difficulty.

He even went on press to talk about mental illness. He shared his stories including his suicidal attempts and helped raising the mental health awareness in the public, telling others not to discriminate them, but also encouraging those with mental illness not to give up, motivating them to seek help actively, telling them it’s recoverable, and they have the opportunities to lead a normal and fulfilling life just like him and anyone else!

He wasn’t just a normal successful insurance agent, but also one of the most motivating and inspiring speakers in the town.

Years later, in his mid 40s, he got into some troubles. This time he didn’t come back to see doctor, he checked himself in a hotel, jumped off from the window of the washroom in his hotel room. There ended his colourful short life.

People may think someone as motivating as him couldn’t and shouldn’t end his life that way, but it’s based on a true story. When the illness hits, it really hits, no matter who you are and what you are. Perhaps for cases like this, maintaining on medication and education on relapses are utmost important, including educating patient’s immediate family.

Supports for family members in grief

Sometimes when we don’t hear from a patient for long, we’ll start worrying about them, especially if they are depressed, or worse, with suicidal caution. But too many patients come and go every day in the clinic, it could be difficult to remember everyone.

Sometimes I think we wouldn’t even know if and when a patient ends his or her life, unless we read it from the news or the family member contacts us.

Yes family member does contact us and tell us about the news when it happens, not all the time, but they do. And one main reason they usually call us and inform us regarding the patient’s suicide, is that they want to question us.

“He’s been taking the medicine prescribed by the doctor regularly, how did this still happen?”

“How come the medicine he was prescribed with wasn’t helping?”

“The last time when she went to your clinic, did doctor say anything? Did she say anything?”

Yes, I understand this and that (sometimes I think they just need someone or something to point their fingers at). But we’re only an outpatient clinic, all we can do is not much, though we do try our best including using phone calls or emails to reach and support them in their daily lives.

The sister was in tears when she called. The last time I heard from the sister was almost a year ago. She said he’s gone, their brother, the six sisters’ one and only brother. He jumped off from the balcony of an apartment.

They still couldn’t accept the truth.

And no, she didn’t call to question us, to blame it on us. She called to ask if she and the other sisters should come for an appointment as they are all feeling really low and depressed.

She was explained that they can certainly come for an appointment if they feel the need, but this is part of grieving, absolutely normal for people to feel depressed, guilty, lost, empty, angry … And the duration of this period could be few weeks, or even up to few years (some research suggested 4 years as an average of grieving period after losing a love one). Some people can function absolutely well during this period (though never take that these people are cold-blooded, they just deal with loss differently) while some need to take some time off or even go for professional counselling services or help.

Sometimes it’s the part that we often overlook – the needs of the immediate carers and family members of our patients – alive or dead.

How much courage does one need to jump off a building?

There are various ways people can use to end their lives, but when it comes to jumping from height, it always makes me wonder how much courage it requires to take that step, and do they regret as they are falling down before hitting the ground? Are they terrified? Do they think about going back?

This is the third patient in the past 3 weeks.

The first two both were longstanding depressed patients, both had attempted suicide in their history, so though it was heartbreaking, at least it didn’t shock us as much as the one who chose to jump off from an apartment far away from his house this week.

He had been diagnosed with paranoid schizophrenia for years. Never a negative person, he could function well in work and with family, maintaining with medicine.

Nobody would have anticipated that. Not even his caring sister. And with the method he chose to terminate his life, he does show how determined he was.

So never think that people with depression are the only ones who would attempt suicide.

So never think that those who think about suicide would always mention it before the attempts.

So never think that long-term mentally ill patient without previous suicide attempt are very unlikely to commit suicide.

Also, never think the reason everyone suffering from mental illness end their lives due to their mental illness, there are still various other possible explanations, and suffering from mental illness, is just one of them.

Can we allow a severely depressed patient to make the decision?

She’s gone, on Tuesday (more about this patient here: Depression & ECT).

As written on my previous post (link above), she underwent a course of six ECT and got much better. During the past year, she did voluntary work, travelled around (to South Africa, Japan etc). Every time she came back for follow up and saw me in the clinic, she had this big wide smile on her face, including the last time I saw her, last week.

Past few weeks she’d been calling me a lot, since her house renovation, which put her under some pressure. Then slowly all her negative thoughts came back. Lacking drives, lying down a lot, negative and suicidal thoughts, all returned, like how she was before the course of ECT last year, despite the increase of her anti-depressants.

She started to ask if she should come for another course of ECT. We kept helping and supporting her, and supporting her extended family to support her. Last week she asked again. And finally the consultant psychiatrist had also agreed that she should undergo ECT. When she was told that she could have it, she became hesitant and indecisive again. So she came for consultation and was told that she could take her time to think about it, and if she wanted it, she could call us and we’d arrange it (of course we also arranged what she should/could continue doing every day).

Few days later she rang me in the clinic, telling me she’s feeling much better, just did voluntary work in the temple. She was feeling quite positive and thought she’d make it. So much relief in me.

Few days passed and I was busy. This morning I heard from her cousin. She was gone, with medicine and half a bottle of herbal liquor. When they found her (the patient lived alone in KL, her family couldn’t reach her on phone all weekend long and came all the way from Malacca to see her), she was still conscious, but with white foam coming out from her mouth. They called the ambulance. But the patient refused to get into the ambulance. The medical staff said it’s against the law to force someone into the ambulance, so they left! The patient went back to sleep later and …”rests in peace”, as the way her cousin put it.

Is it right for us to leave the decision of whether to do ECT with her? Should we be the ones who make the decision for her? Could we be the ones?

Is it right for the ambulance staff to leave, just because the person refused to? Despite knowing that she most probably need a stomach washout, is it right that they let her make the decision herself?

Is she capable to make these decisions? She’s severely depressed, despite the medication, could she judge and reason then decide?

Practically I’ve always been told that we can’t really make any decision for patients, all we can do is to explain the options, treatments and procedures to the patients and family (if applicable). But how if they’re single and suicidal, with not much familial support? Are there exceptions? Can we push them to go for ECT?

What a patient learnt from Robin Williams’ death

Got a phone call from a long-standing depressed patient who is now maintaining well with medication, the first thing she asked me,

“Do you know the American actor who committed suicide?” (I personally dislike the phrase “committed suicide”, it sounds like they deliberately chose to do it, like “committed a crime” which I don’t quite agree – they didn’t willfully choose to do it, although it may appear so)

“He’s also suffering from depression [like me], right? Why would he commit suicide?” Back in year of 2004, this patient had had ECT done due to her depressive mood with suicidal ideation. I think she understands how that feels, very well.

“Perhaps nobody has paid enough attention or has realized someone like him, a comedian who brought so much laughter to the world, can be so severely depressed.” I also told her that I didn’t know much about his biography (his personal life, history with addictions etc), that was just my guess, but I kind of think that his death must have triggered a lot of thoughts in the field of mental health.

“Imagine a celebrity like him, with that much of fame, popularity, wealth, well-liked by the world. He, too, suffered from depression [or bipolar?] just like you, and many on the streets. Just that they may not show it, but they may cry alone in the corner in their room, or their symptoms are at residual at this point”

“For mental illness, it’s so much harder [for people to understand and sympathize], unlike high blood pressure, gastric, cancer etc. You get a report, a figure telling you and everyone else that something is not right. It’s like boarding a bus with a plaster bandage after a fractured ankle, people would offer you a seat. If you take away the plaster but still suffer the fracture and pain internally, would people still offer their seat? And if you ask they may even think that you fake it! Being depressed is sort of like this, only you know it best.”

“So I should really not care about what my relatives said [of me taking those medicines] and be so grateful. My depression is all under control now. Occasionally when it hits me I’ll just meditate or do some exercise. My son bought the family this house. All 3 of my children are finishing their studies and doing good…

People may think you own the world and should be so delighted, but deep inside you want to just end your life! So let’s just be grateful, show more love, understanding and respects!”

15/8: A comic of what somebody else learnt from Robin: I want to live.