Several years ago I was working in an inpatient psychiatric unit in the Pacific Northwest. As a psychology intern, my job was to come in early, read through the charts of the patients admitted the previous evening, and be prepared to do their intake interviews by 8:00 a.m. After six years of doctoral training, this was my first exposure to persistent and severe human suffering of the type that frequently turns into a crisis.
Often, patients were admitted because they had attempted to harm themselves, or they were at risk of harming themselves, or they had begun to lose touch with reality in a variety of ways. As tragic as each of these individual cases was, there were certain similarities that kept returning as I read about more and more of them. In many of the cases the patient was a woman. There was often overt relationship conflict involved, either with a significant other or with family members. Frequently there was a fairly lengthy history of psychiatric treatment in the patient's file. Patients were also often strapped for resources and living at or below the poverty line.
One morning, in mid-winter, I picked up a chart that struck me as quite different from the very first page. Patrick was a white, middle-aged, married man with no history of previous psychiatric illness. His chart contained only a brief description of the events that preceded his admission to the hospital. Apparently, Patrick's wife was out for the evening, and his teenage son was supposed to be spending the night at a friend's house. However, following a change of plans, Patrick's son returned earlier than expected and discovered his father sitting on the couch with a loaded shotgun pointed at his head. His son called 911, the police came, and Patrick was taken to the E.R. When asked what he was intending to do with the shotgun, Patrick replied simply, "End it." In response to my question asking why he wanted to take his own life, he stated only "Enough is enough" and refused to elaborate.
That morning I interviewed Patrick one-on-one. When he walked into the room I immediately knew that it was going to be difficult to connect with him and to find out what was really going on. Although he was dressed in hospital clothes and apparently had neither shaven nor combed his hair for several days, I could immediately see that Patrick was (or had been) a handsome man who surely stood out in a crowd. His short salt-and-pepper hair, dark green eyes, tanned skin, and muscular physique made an impression even in his current condition. Patrick looked like someone who could have been a football coach, a banker, a politician, or a mountain climber. Yet now he was clearly half of a person; someone whose former life was a distant and painful memory, and someone whose current life wasn't particularly worth living.
Patrick looked down at his lap during the initial part of the interview. He answered my questions in a courteous fashion, but his tone was matter-of-fact and he did not elaborate on any of his answers. He identified no reason for wanting to take his life other than what he had stated previously ("Enough is enough"). All of my attempts to empathize with Patrick seemed to clam him up even more. I began to wonder if a sense of having failed in some way had played a role in leading Patrick to consider suicide.