Self-cutting is next, promise. But this is more pressing: I just had a long tete-a-tete with a patient of mine who's had suicidal thoughts lately. He's an ex-athlete, ex-alcoholic, who's suffering from, among other things, a bad case of depression. What can I do about it, other than start him on antidepressants? Nothing much. He needs serious treatment right now, but the only way to get the psych department interested would be to convince them he's gone completely bonkers and thinks he's the President of Romania or something. Well, you know, he's just a guy who's depressed. I tentatively asked him whether he might entertain the notion that he's the President of Romania, to which he suggested that I should go see someone myself. I think he's probably right. Know any good shrinks?
He said he's come this close to doing the deed a couple of times, but that his love for his family keeps him from doing it, for now. So we made a deal: If he does decide to chuck up the sponge, he will call me on my cell first, just to let me know he's going for it. He gave me his word, we shook hands on it, and I think he's the kind of guy who will not go through the embarrassment, even posthumously, of not having kept his word.
Another thing I usually tell my suicidal patients: We have the power to end our own lives at any given time. Therefore, if we choose not to do it now, we will always have that option later. We can take comfort in that -- no one can take that option away from us, and therefore it's not absolutely necessary to do it right now. We can always postpone it, and still keep that option. So - don't do it now, because it's final, and you should definitely look at the other options first.
Of course, the rational approach often fails, especially when the depression is so deep that it's beyond the reach of any rational thought. But a couple of times I've found I've managed to get my point through.
I'm no shrink, and I wouldn't mind some more ammunition for these encounters. So help me out: What would you tell someone who's contemplating suicide?