ANYONE LIVED IN A LITTLE HOW TOWN

     Mr. Rinker's twelfth-grade English class was an exercise in intellectual one-upsmanship. The competition was formidable. The students came from families sired by the likes of A.H. Maslow and Herbert Marcuse. We read Sartre, Dostoievsky and Woolf. Our discussions covered all the artsóliterature, painting, music.

     "Ingall, what is your favorite violin concerto?" Rinker fired at me, his tiny kyphotic frame looming over my desk.
 
     "Tchaikovsky, I answered, with smug satisfaction.

     "Tchaikovsky!" exploded Ellie Langer, on her way to becoming
a famous literata, "How plebian!"
 
     Penny always sat in the front row, a hook nose affixed to a large head, mounted on a short round body. A beauty she was not. But she was among the brightest; she knew it, and everyone else did, too. In class, she was brilliant and competitive, but outside the classroom she was a social isolate and outcast.

     One morning, her seat was empty. White-faced and shaken, Mr. Rinker announced that Penny had died.

     "How?" we asked, "What happened?"

     He did not answer, and proceeded with the lesson of the day, a poem by e. e. cummings:
 

     Word spread quickly that Penny had killed herself. Noone knew the details, the method, the reason. Noone knew her.

     In college, everyone knew Becky. Her laugh was a cackle. From a nice family, a good student, a good friend, she could talk for hours on matters serious and mundane. I dated her for a few months, made out with her. And suddenly, with an overdose of pills, she was gone. We were stunned. Everyone knew her.

     When I reached medical school, there was an intern at the hospital, a black woman of twenty-four. The time of affirmative action had not yet begun, and the runways had not been smoothed for her. She had achieved her position by leaping hurdle after hurdle, and she ran the race alone. You could get just so close to Marilyn, and then a wall went up. One night, after too many pills and too much alcohol, she died. Noone knew her.

     I was now twenty-one years old, and three people I knew, or did not know, had killed themselves. I began to think about a career in psychiatry. I talked about it with Paul, who was a first-year resident in psychiatry.
 
      Paul had preceded me in a research fellowship in immunology. He dated one of my co-workers, hung around the lab for hours, and knew everything. Puffing serenely at his pipe, he could expound on any topic with complete self-assurance. He confirmed for me the notion that psychiatry would open my eyes to the mysteries of the human soul. During his second year of psychiatric residency, he put a pistol in his mouth and blew his head off. Everyone knew him.

     Shaken, but undeterred, I began my studies in psychiatry. And the suicides continued. Young and old, they passed through our ward, through our therapeutic community, endured five hours a week of empathic psychotherapy, and then took poison, slashed their wrists, jumped from roofs and bridges, and shot themselves. Psychiatrists have a suicide rate that is higher than other professions. Other specialists claim that it is because we are so screwed up. I think that it is because we know so many people who have killed themselves. When most people speak of a suicide, they lower their voices and employ euphemisms. Jews enforce the taboo against suicide by reserving the far corner of the cemetery for those who have done themselves in. But for psychiatrists, the taboo and the horror of suicide are gone, and it is part of the day's business,

     During my first year of training, visiting professors would come from around the world. They would give a scholarly lecture, and would demonstrate their interviewing skills for the staff. A highlight of the visit was lunch with the residents. Halfway into the year, the visiting professor was one of psychiatry's greatest figures. His lecture was brilliant, his interview incisive. At lunch, he asked if we had any questions for him. Having recently suffered through the suicide of a patient an the ward, we asked him how he dealt with his feelings when one of his patients killed himself. He scratched his head in wonder. "I really don't know," he answered, "because I've never had a patient suicide." Thirty years in practice, and not one suicide. We had been been in practice for six months, and already we had three suicides. We were devastated,

      Three months later, another distinguished visiting professor spent the day with us. During rounds, he asked, "How many suicides a year do you have at the hospital?"

We stared at our shoes, and someone mumbled, "Five or six."

     "That's good," he exclaimed. "That means you are willing to take sick patients here." Perhaps there was some hope for us after all.

     In twenty years of practice, I have seen too many patients who have killed themselves. After each one, we would hold a psychological autopsy, reviewing the history, the course of treatment, what was done, what should have been tried, what mistakes were made. For some, death came as a welcome relief for their pain--for them, and, I confess, for me.

     But for a few, death came unexpectedly, to my astonishment and horror. I thought I knew them.
 

 Home