The constant fear of losing a patient to suicide

This article was originally written on August 11, 2015.

My psychotherapy supervisor taught me a tip during residency: to pay close attention to the very first thing a patient says, and more importantly, the last topic they bring up towards the end of session. (Because it’s likely that the subject weighing most heavily on their mind is too uncomfortable to discuss at the very beginning.)

I struggled to come up with a topic to discuss on my blog today.  At first, I uploaded chipper, smiley pictures taken from a recent spontaneous trip to the coast, but there was something about my grin and carefree expressions that didn’t seem quite appropriate to post today.  I try my best to ensure that my blog posts are reflective of my current state of mind, and my current mood is actually quite solemn.

Today marked the one-year death anniversary of Robin Williams. I avoided news articles, tweets, and Instagram posts that paid tribute to the iconic, inspirational actor.  While sitting on the couch and staring blankly at the television screen, a short reel of Robin Williams popped up on entertainment news.  Not content with the mainstream, flowery, piece which strung together brief clips of some of his finest, Oscar-winning work followed by a quick moment of silence in remembrance, I picked up my phone.

While scrolling through Instagram, I focused on a long, detailed post written by a young man in which he describes his own personal battle with depression and multiple, near-fatal suicide attempts.  Robin Williams’ lost battle to mental illness motivated this man to share his story rather than isolate in shame and silence.  The words authentically describe the powerless experience of succumbing to the disease.  The depression takes exclusive command and overrides any attempt at rationalization.  And I know the story to be true because the writer is a dear friend of mine who miraculously survived.

Several of my patients have described similar experiences.  Several people living with mental illness whom I follow on social media share similar stories.  Every morning that I arrive in clinic, I log on to my electronic medical records and pray not to see a message from the coroner’s office.  As a psychiatrist, getting that dreaded phone call from the medical examiner is probably my equivalent to the oncologist receiving a call from a family member or hospice staff.  As a young teen, I vividly recall accompanying my family for routine, frequent visits to my grandparents’ apartment, where my grandfather passed away, rid of the suffering he endured from colon cancer.

A few years later, my grandmother peacefully died from multiple myeloma.  Her last words to me before she passed was that she wished for the opportunity to pay for my education and witness me become a doctor.  My other grandfather, as he approached the end stages of his battle with cancer, fulfilled his wish to fly back to the Philippines, where he comfortably spent his final days in his homeland with our large, extended family by his side.  When the medical examiner’s call ends, my immediate response is to shut the door and sit in silence.

Finally recognizing the mixture of emotions that I suppressed the entire day, I could no longer hold in my tears.  Rather than isolating (as clinicians tend to do when it comes to coping with patient loss), I attempted to share my thoughts and emotions on social media, with the goal to make others aware of the difficult emotions that we, as mental health practitioners, face when dealing with patient suicide.  The loss not only permanently impacts us professionally in our practice, but also as human beings.  I left the post on my feed for 20 seconds, then immediately deleted it.  Shame, embarrassment, and fear of judgment overrode my hope to break the norm of silence and connect with others too afraid to open up about their own experiences losing a patient to suicide.

I waited a few days to publish this post after much contemplation.  The truth is that the fear of losing a patient to suicide weighs heavily on my mind almost every day.

Vania Manipod is a psychiatrist who blogs at Freud and Fashion.

Image credit: Dan Holm /

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