Magazine article Clinical Psychiatry News

Fink! Still at Large: Surviving Patient Suicide. (Opinion)

Magazine article Clinical Psychiatry News

Fink! Still at Large: Surviving Patient Suicide. (Opinion)

Article excerpt

One of the most painful experiences for a therapist is figuring out how to proceed when a patient commits suicide. Have you ever experienced this? How did you cope with the tragedy? How did that incident change the way in which you approach your practice?

Learning Is Key

As the medical director of the American Foundation for Suicide Prevention, I worked on a databank project that studied therapist reactions to patients who committed suicide while they were in treatment, in addition to the patient's suicide itself. We worked with therapists on 34 cases.

Or there's a tendency to say the suicide was inevitable and was no one's fault. That doesn't help the therapist who thinks he or she could have done things differently The therapist wants a chance to explore the tragedy with someone who is not in a position to judge and has no say over his or her career. We get the therapists to write a case narrative and fill out several questionnaires. Normally, we spend several hours with each therapist. All of them have felt that the experience permitted them a kind of closure that hadn't occurred in the several years since the suicide.

We learned that if you work in an institution, it's often not a good place to get help. The institution tends to protect itself and is often hostile to or critical of you, particularly if you work on an outpatient basis without a team and have a primary responsibility to oversee patients.

When therapists come in to see us in person rather than only sending in the questionnaires, we learn much more. If they feel that some behavior on their part contributed to the suicide, they don't write that on the questionnaire, but when they come in, they're dying to tell us.

Many therapists describe patient suicide as the most traumatic experience of their professional lives. Unlike physicians in many other specialties, psychiatrists are not used to dealing with death.

For 20 of the 34 therapists, the shock of the suicide was a big issue. Eleven of them were aware that the patient was imminently suicidal, and even though everything they wrote and said showed that they knew it, they said that they still were profoundly shocked. It's as though one part of their brain knows that there is an extreme likelihood of something happening while another part denies that it will happen to them.

What relieves psychiatrists is learning from the suicide. Guilt is not a terribly helpful emotion, but it can be if it motivates you to learn something.

Herbert Hendin, M.D.

New York

Tap Into Colleagues' Support

About 20 years ago I had a patient who committed suicide. It sensitized me to the pain that leads who those commit suicide to think that there isn't any other way to deal with their problems.

Afterward, I did several things to get over the shock. I redoubled my efforts to understand what suicide is about. I talked to several colleagues about it and went to see what the literature had to say about it, which was very little at the time. I started a support group for therapists who bad patients who committed suicide. I modeled it on support groups for survivors of family members or colleagues who had committed suicide.

The American Association of Suicidology is a great resource for those who have experienced a patient's suicide. A link from the AAS Web site to a clinician survivor task force ( mainpg.htm) provides resources on surviving patient suicide.

Frank Jones, M.D.

Franklin Park, N.J.

Dr. Fink replies:

When your patient commits suicide, it is very painful. The emotions that the psychiatrist feels--sadness, concern, shame, guilt--make the doctor question his ability and try to understand what he did wrong. Guilt is the first and strongest emotion that a physician feels, since a patient's death is the antithesis of what "should have happened. …

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