The interviews for my book on men’s depression were hard, very hard. But a few of them were harder than others. I want to write about one of them. The man I interviewed was in his seventies and I met him after his suicide attempt.
The interview happened not long after he was transferred from an acute ward to an open one (that is to say, he would spend nights at home), as he was no longer considered a risk to himself. As ever, he agreed to talk to me probably because there was nothing better to do. And so, in came a man, sat down, smiled at me and asked me whether he could speak openly and nothing he would say would find its way to the hospital staff. I confirmed strongly and we started talking.
His story was quite simple. He was a successful man who lost it all, well, almost all. His much younger wife had left him, he had very little contact with his children, their relationship had broken down earlier, and so he lived on his own in a small flat. After a couple of years of loneliness, he had enough of it and decided to kill himself. He described the decision as rational. To his disappointment he was spotted by a neighbour who phoned the emergency services.
And here the story got very interesting. When he came to on the ward, he was in restraints. He was released and taken to see a psychiatrist. The psychiatrist asked him a few questions and finished by asking the crucial one: “Do you still want to kill yourself?” to which my interviewee said something like (I quote from memory):
Of course I do. What’s changed in my life? Has my wife returned? Has she paid the money back? Am I no longer lonely?
On saying which he was put back in restraints. His comment was:
I’ve never told them the truth again.
And then came a story of toeing the line, providing answers that his shrinks wanted, always denying suicidal ideation. Basically, he became a new man. Well, so he told everybody, after all he never told them the truth. What was the truth, though? I don’t know. I didn’t ask and he never said anything about suicide directly. Was he thinking about it? Probably. After all, nothing changed in his life, did it? He just stopped saying it.
I’m bringing this story because it raises so many issues.
1. The first and most obvious: what happens when you disclose your intent to kill yourself? Well, for this interviewee what happened was that he was put in restraints. He didn’t report much more therapeutic activity. Anything else? Well, you can argue that there was, after all, the patient survived the few weeks till I talked to him. But then, things are more complicated, aren’t they? Whatever was done, was not helpful enough to make him give up suicide, I think.
Indeed, when you read on what happens after you say you want to kill yourself, there is quite little, especially in suicidological literature. In a feed from a conference a few days ago, I read that the idea is to focus on the ‘risk factors’ you can control. Right.
2. I am making this point to show the helplessness we face. As suicidology studies the next risk factor, correlating it with umpteen others, it offers very little to my interviewee. Indeed, all those of you who got indignant reading about putting the man in restraints, just think that not much has changed. Think of the restraints as ‘controlling the risk factors you can control’.
3. The third issue is – can I, the patient, tell you the truth? Well, apparently, I cannot. What I think about the restraints is irrelevant, for the interviewee’s story is more about the patient’s inability to tell the truth. What the hospital managed to do is to silence the patient, to deprive him of his story. The experience so many psychiatrists underpinned by their psychiatry books bang on about had, in fact, been excised. A narrative amputation!
4. The issue of telling the truth is wider, though. Most psychiatrists I have ever talked to are aware that their patients may lie. And yet, how they decide whether someone lies or not is, however, not clear at all. I remember a patient who approached her consultant and said she didn’t want to be in hospital anymore. She actually put it in writing (as a letter); she said she would be better off if she were to be at home with her family. It was a perfectly well-crafted argument. Unfortunately, the psychiatrist asked her to go back to her ward and said they would talk the following day. Nothing happened the following day.
Ever since witnessing that scene I have wondered about the truth. Or shall I say, the psychiatric truth. If a patient says they have delusions, you tend to believe them (so many years after Rosenhan’s experiment), if they tell you they want to go home, you don’t. The logic escapes me.
This post was mainly inspired by the campaign “It’s OK to talk.” and my opposition to the slogan. Well, tell it’s OK to talk to to my interviewee. Not only is it not OK to talk socially (stigma), but for him it was not even OK to talk to those who were supposed to help him. The slogan is supposed to put a spell on reality. If I tell you it’s OK to talk, it’s OK to talk. It doesn’t work like that.
The second inspiration came from a discussion with Philip Sheridan and Joanna Holmes who made an interesting point. In her work, she hears “it’s OK to stutter.”, and yet research into attitudes towards stammering suggests it’s not. No matter how often we say it is.
And here comes a conclusion from the linguist. Whenever you ask me to talk, consider whether I am actually allowed to say things, and what the consequences of what I say might be. Both for you and me. Is it OK for me ‘to talk’? And instead of such, I believe, empty assurances, it’s better to say, you will listen. And if I am in doubt, I will either say nothing, or I will ask you if it’s OK, no, not to talk, just to say something. Channels of communication are never fully open and it’s probably a good idea not only to realise that, but also to set parameters both for you and for me. But that’s for another blog.