And Then There Were None

Mary Collins, a 49 year old woman who looks at least 10 tens older, sits across from me, tears streaming down her face, unable to speak. Although I have never seen or spoken to this woman before – her husband made the appointment - I feel the intensity of her pain and find myself similarly at a loss for words. Finally I decide on the most basic of human responses.

“I’m so, so sorry for your loss. I can only imagine the depth of your suffering.”

Mrs. Collins shakes her head again and again, her straight brown hair falling forward over her face. “I can’t …,” she says, continuing to shake her head.

I wait.

“I can’t stand it. I can’t!” she says more loudly. “I can’t stand the pain. I have nothing left, nothing to live for.” Pause. “I know you’re going to say it will get better. My husband says that all the time. But this? How can this get better?”

“Can you tell me about your son, Mrs. Collins?”

“Mary,” she says, still shaking her head.

“Mary, can you tell me about your son?”

“Billy. He was a good boy. A little wild as a kid, but what boy isn’t? He always wanted to be a policeman. I don’t know why.” A blank, distracted look comes across her face. She repeats, “I don’t know why. I don’t know why. I don’t know why.”

“You don’t know why he shot himself?” I ask.

Wailing she beats her fists into her thighs. “Why? Why? Why?”

Without thinking I get up from my chair, kneel in front of her and take hold of her hands. “Hurting yourself won’t bring your son back,” I say softly.

She stops hitting herself and sobs.

After a few moments I return to my chair.

She hides her head in her hands and continues sobbing.

“He didn’t want a divorce. Til death do us part. That’s what he wanted. That’s what he saw in our family. But she, she didn’t want to be married to a policeman, although she knew that’s what he was when she married him.” Pause. “And maybe it was more the boys for Billy, two little boys. Tore Billy to pieces.”  

She pauses. I think about what she said and wonder what her words will trigger for her. I watch the awareness go across her face.

“No! Not both of them! God couldn’t be so cruel. How could he take both my boys? Blown to bits by one of those IEDs. Who cares about that godforsaken place? Why do we keep sending these children to Afghanistan? It’s all so senseless, senseless.”

“I imagine Billy was pretty broken up by his brother’s death.”

“Sure was. And angry. Like me, angry. Ron was his baby brother. Billy kept saying he should have gone first. And now they’re both gone. And I have nothing.”

“Can you say who you’re angry at Mary?”

“Everyone.”

“Can you be more specific?”

“God. The government. The universe. Sue. I’m definitely mad at Sue. That’s Billy’s wife.”

I suspect she’s also angry with Billy for killing himself, but know it’s way too early to broach that topic. “Are you going to maintain contact with Sue? I imagine you’ll need to in order to see your grandchildren.”

She shrugs. “Who knows what she’ll do.”

“You saw each other at the funeral?”

She nods. “But I didn’t know what was going on that day. I don’t think she brought the boys, although I think I saw them later at the house.” Knitting her brow, she pauses. “I don’t know. What difference does it make anyway? Nothing matters anymore.”

“Do your grandsons matter?”

“I guess.” Pause. “Yes, they matter. They carry part of Billy.” Pause. “They’re the only grandchildren I’ll ever have.”

I can see Mary’s despair and rage begin to build, her hands in fists.

“Remember,” I say quickly, “Hurting yourself won’t bring your sons back.”

“But it’s easier. The physical is easier, easier than thinking, easier than remembering.”

“I do understand, Mary. But I don’t want you to hurt yourself. And I’m sure your husband doesn’t want you to hurt yourself either. I know the pain often feels intolerable, but you can survive it. As awful as it is, you can survive it.”

Mary sobs.

“And we can talk about your pain, Mary, your pain and your anger. I know that won’t bring your sons back either, but talking does help. And maybe us talking together will make it easier to bear the pain.”

Suicide

“I’m sure you know what I’m going to talk about today,” Evelyn says, her eyes expressionless, her voice flat.

I nod. As soon as I heard about Robin Williams’ death, I thought about Evelyn, a depressed woman whose suicidal thoughts are a consistent part of both her life and her treatment.

“I saw that animated clip online, where Aladdin frees the genie – Robin Williams - from the lamp and Williams dances around saying ‘I’m free.’ Made me think of Martin Luther King’s, ‘free at last, free at last.’ Maybe that’s what it would be like. I’d be free, free of constantly being drawn down into this abyss.”

I watched that clip myself and immediately worried about Evelyn. Definitely not a good message to give a suicidal patient. “But the genie is set free to live, Evelyn,” I say. “To live without having to be restrained in a lamp. It’s about expanding your life, not destroying it.”         

Evelyn ignores my comment and continues, “I’m having hard time sleeping. I keep thinking about him hanging himself. He had everything. At least it seemed that he did - fame, success, money, family, adoration. And still he killed himself. I don’t have any of that, well not most of it anyway. What’s the point? Why should I keep going? I have nothing to add to the world. I’m just taking up space.”

“But this isn’t always the way you feel, Evelyn. There are many times you enjoy your children, your grandchildren, your painting.”

“It’s meaningless.”

“It feels meaningless today, Evelyn. It doesn’t always feel meaningless. Can you remember when it doesn’t feel meaningless?”

“It’s hard.”

“I know. When you’re in this dark place it’s hard for you to remember the good times, the pleasurable times, like playing with your granddaughter in the pool, or sitting on your back patio painting. Can you tell me what you first felt, what you first thought when you heard about Robin Williams’ suicide?”

“I was surprised. Like I said, he seemed to have everything. And he seemed like such a happy person. I guess I always thought he was kind of manic, but I didn’t know about the depression, or all his drug problems.” She pauses. “Maybe I even felt a little mad, like why should he kill himself? He’s not the one who should be depressed, he’s not the person whose life is meaningless. I’m the one who should kill myself.”

“What do you mean you should kill yourself?” My anxiety is increasing. I’ve seen Evelyn through years of on and off depression and many times when the possibility of her killing herself increased. A few times she went into the hospital. Mostly I’ve trusted her to contract with me to not kill herself. I want to talk about that kind of contract now, but hold myself back. It’s early in the session. Evelyn seems to have a lot of feelings roiling around today. I need to give her time.”

“Well, like I said, I have nothing compared to a man like Robin Williams.”

“You also said that you felt mad when you heard about his taking his life.”

“I said a little mad.”

“So it feels uncomfortable for you to be mad.”

“We already know that.”

Surprised by the sharpness in Evelyn’s voice, I realize that she’s angrier today than I realized. “Are you a little mad today, too, Evelyn?” I ask.

“I guess.”

A few moments pass in silence.

“It’s so confusing,” she continues. “If someone like Robin Williams can kill himself, there’s absolutely no reason in the world I couldn’t or shouldn’t.” She pauses. “But that Aladdin video made me sad and not only because Williams killed himself. I felt sad that he and Aladdin were saying good-bye, that they’d never see each other again. And that’s what happens if you kill yourself, you never see anybody you love again. I don’t want to think about that. I don’t want to think about never seeing my children or grandchildren again. I just want to think about ending my misery. It makes me mad that you brought them up, mad that seeing that video made me think about them. That’s why I’m mad.”

“Mad and sad,” I say, very aware that I too am feeling sad, reminded yet again of the finality of death. “Death does mean saying good-bye and, yes, that’s very sad for both the person who dies and those left behind. And you’re right, Evelyn, that is the other message in the video. Goodbyes are painful, definitely something to consider when you feel suicidal.”

The Ones Left Behind

March is a difficult month for Lillian. It has been over 20 years since her first husband killed himself, but the anniversary invariably brings up feelings of guilt, pain, remorse, and anger.  

Today she seems depressed, distracted, not quite in the room with me. 

“My daughter called last night. Told me she started having her nightmare again – a loud noise, a blood splattered room, people screaming. I know she never saw that. Dave didn’t kill himself at home. And she was only a baby.” Lillian sighs, tears beginning to well in her eyes. “I can’t understand how he could do that to her, to us. Billy won’t talk about his Dad; he won’t even acknowledge him. Says that Philip is his father. I know he’s angry. They’re both such good kids.”

“And you?” I ask gently. “How are you doing?”

Lillian shakes her head. “I don’t know. I’m sad. I wonder if there was any way I could have stopped it.” She pauses.  “I’m such a liar,” she suddenly exclaims. “I can’t stand myself. I told myself I was going to tell you today. I was going to come clean. Clean! I don’t think I can ever be clean! I don’t deserve the life I have. I don’t deserve Philip. I don’t deserve anything!” Lillian says, shifting from side to side in the chair.

“The grieving widow, right?” she continues. “That’s what you always thought? That’s what I’ve always portrayed! Except it’s not true. I killed him. It’s my fault. It’s as much my fault as if I had fired the damn gun myself!”

I breathe. For a moment I thought Lillian was actually confessing to murder. Now we’re on safer ground. Lillian, I assume, is again caught up in her guilt. But then a patient I had seen much earlier in my career makes her way into my mind, a patient who often came into my thoughts when I was seeing Lillian. 

My earlier patient, who I saw only briefly, wanted to divorce her husband who she described as depressed and withdrawn. She was involved with another man who was vibrant, alive, exciting. She wanted out. I asked what kept her in her marriage. The children, she said, as well as her mother. They’d disapprove. Given her description, I asked if her husband was suicidal. She didn’t know.

In fact, her husband did kill himself. She came to see me one last time. There were no tears, no guilt. She was free. She destroyed the suicide note, she told me. It wasn’t a nice note. I never saw her again.

I suspected Lillian would tell me a similar story. And she did. Similar, but not identical. 

“Dave was a good man,” she begins. “He was a good provider. But we’d married so young. Our life had become boring, routine. Sex was a chore – for both of us I think. I’m not trying to defend myself. I know what I did was terrible. I started having flings. One of the flings turned into something more. Were we in love? Who knows. I didn’t think Dave knew. I thought I was careful and he never said anything. And then he killed himself. I stopped seeing my fling immediately. I never told anyone. I never thought I’d be with anyone ever again. But then there was Philip. He’s more than I deserve.”

“I’m really glad you told me, Lillian. What a tremendous amount of guilt you’ve been carrying around.”

“Yes, but it’s a burden I deserve to carry.”

I think about my earlier patient, about her cavalier reaction to her husband’s suicide and contrast it with the burden of guilt Lillian has carried with her for so many years. Am I looking for a way to lighten Lillian’s burden? No doubt.

“I can’t take your guilt away, Lillian, but I wonder if you haven’t suffered enough. Do you ever get to forgive yourself?”

Lillian stares at me intently. “You don’t think I’m evil,” she says matter-of-factly.

“No, Lillian, I don’t think you’re evil. Many people have affairs. I’m not saying that’s right or wrong. It’s not up to me to make that determination. But I do know that not everyone who has an affair has a spouse who commits suicide. It was Dave who pulled the trigger, not you. But I’m sure we’ll have lots to talk about in the coming weeks.”