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Dancing on the Razor’s Edge — Reflections on a Client’s Suicide

I shouldn’t have been surprised when Red shot himself in the heart, but I was. On our first visit, he’d been clear that he intended to reserve the right to kill himself—to use what he called his “escape hatch”—if life got too tough.

During that visit, Red and I spent considerable time exploring what was driving his negative thoughts as well as their specific content, intensity, frequency, and duration. We looked at the personal storyline he was using to interpret and define what suicide meant and what was happening as cancer ate away at his lymphatic system. We talked about the irreversibility of death and the possibility that there may be something worth sticking around for that he hadn’t anticipated.

I assessed Red for depression, a family history of suicide, PTSD—all the standard risk factors. We discussed the impact suicide has on families. We talked about free will, choice, and responsibility. I pushed him to avoid letting the bastards at the life insurance company stick it to his wife by not paying out his policy because he killed himself. (OK, it was unfair to call them bastards, but when wading in such waters, I’ll use whatever I can to motivate someone to move away from the edge.)

Red refused to remove his guns from his home or disarm them. I asked if anyone would help him kill himself if he grew too weak to do it personally. He said no, adding grimly that if he decided to kill himself he would do it before he needed help.

Clearly, he had an elevated risk of suicide. At that point, however, he was doing fairly well physically and had made it clear he was talking about killing himself if he was bedridden, dealing with intractable pain, or entered that netherworld where his mind was altered in ways suggesting confusion. These were the triggers that my fellow team members and I needed to watch closely.

Red’s wife had listened silently to our conversation, resisting my invitations to be more actively involved. As we walked out to the door, she said he wasn’t serious about his suicide threat. I told her I disagreed and rattled off some of the more obvious red flags (advanced age, being male, ideation, terminal illness, intention around specific triggers, loss of important roles, a history of being in control and impulsivity when angry, access to lethal means, and clarity about how he would do the job). I reviewed some of the signs she should watch for and report, such as sudden, seemingly inexplicable changes in mood; direct statements or indirect allusions to being dead soon; giving away personal items; or prematurely saying good-bye.

Changing Course
What happened in the next months surprised me. Red’s hard-nosed exterior gave way to reveal a thoughtful, sensitive soul. He spoke about his sadness and shame over his role in the tensions between himself and his adult children. He started making overtures of reconciliation, even telling them he loved them. He began expressing gratitude and affection for his wife in ways, as she verified, he had never done before. He acknowledged that he often had been difficult to be around and asked her forgiveness for the times he’d hurt her with his criticism and judgments.

Red even began exploring his suffering and the challenges of illness in spiritual terms. “Maybe there’s something in all this for me to learn,” he wondered aloud.

I asked what he thought that may be. “I think the message is that there’s still time for me to become a better person before I croak,” he told me.

I asked how this insight squared with suicide. “It doesn’t,” he said.

He appeared to be doing all the things professionals in my field hope clients will do: openly processing his experience and using his remaining time to gain insight, deepening relationships, and focusing on what is most meaningful.

In the course of this apparent transformation in perspective he said confidently and repeatedly that he no longer was considering suicide. He had a “better escape hatch.” When his needs increased or if his mind began to alter, he would go to a local palliative care center. We’d spoken with the director, who had assured Red he could move there when the time came. “That way I won’t be a burden to my wife and kids, and they can visit me without having to change my damn diapers,” Red noted.

In the back of my mind, I remained concerned about that narrow window of time when those triggers were being pushed and he still had enough strength and energy to commit suicide. When his physical condition began deteriorating rapidly and his need for pain medications increased, I pointed out that I thought he was standing at the spot when, as he had told me during our first visit, that he planned to kill himself. He acknowledged this was the case but said he no longer was having such thoughts.

When I gave him a skeptical look, he reflected on all he had learned: his comfort in knowing the care center was an option, his confidence that we were managing his pain, and his identity as “a fighter” now determined to go down swinging.

I asked what he would do if he started having impulsive thoughts about using one of his guns. “What would stop you in a moment like that, Red?”

He looked at his wife and said, “I’d think about what it would be like for my wife. That would stop me in my tracks.”

Wanting to Believe
I’m not ashamed to say I believed every word Red spoke, so when he shot himself shortly thereafter, I was surprised. Years ago, I would have been flooded with doubt and second-guessing: Did I miss something? Did I do something wrong? Would another social worker have found a way to better help him? These days my perspective has changed and the major question in my mind is why was I surprised?

One possibility is that I was all too eager to believe Red when he told me he was out of the woods because it abated my own anxiety. What social worker will not confess, if being honest, feeling inward relief when a client says he or she no longer is considering suicide? Did I simply fall into the trap of taking him at his word because it was easier or from my own sense of relief? To still any inclination or pressure to push harder and perhaps have to continue dancing with him on the razor’s edge? Maybe, but I don’t think so.

I’ve probably had more than one hundred such conversations. I’m aware of this trap. I was careful about language, verbal and nonverbal, so as not to send any messages that I was uncomfortable with or judging his experience or that I was fishing for easy, reassuring answers.

Did Red’s early frankness and honesty about suicide lull me into believing he was being just as frank when he said suicide was off the table? He was a direct man who typically said what he meant. Did I assume that since he’d appeared so honest during our early conversations that the same must be true of our latter ones? Just because someone appears transparent today doesn’t mean he or she isn’t hiding something or won’t become more secretive tomorrow. It’s worth thinking about. I knew from the start, though, that he was capable of secrecy. Did this paradoxical blend of frankness and secrecy throw me off the trail?

Thinking vs. Feeling
It’s possible that we became too focused on exploring Red’s experience from a cognitive perspective, losing track of the intensity of the affect stirring beneath. Red was an intelligent man who liked to think. He avoided feelings, other than anger, that had an action component and reinforced his tough guy image.

We’d spoken about his sadness, fear, and guilt. We’d explored some of his loneliness and the way close relationships confused him and often raised his defenses. Looking back, I realize Red often was analyzing his emotions rather than actually feeling them.

However, there were profound moments during which feelings surfaced—the tears he shed as he told his wife how much he appreciated her courage, the open sobs when he spoke about the pain he believed he had caused his children—but these moments were rare.

Is it possible that by not better tracking these deeper affective layers I forgot to test the story of transformation and insight Red was telling against the heat of his interior experience? Although I did routinely push him to go deeper, get out of his head, and avoid intellectualizing, during that last visit when he told me he was standing on solid ground, I did not.

Thinking about why I didn’t push him gets me closest to what I think is the source of my surprise. I didn’t push him because I believed him, and I believed him not because I was anxious or because I was unaware of the deeper energies beneath the surface but because the story he was telling was so alluring to me. I was readyto believe it, I suspect, because it was so harmonious with the lens through which I understand the work I do.

We all have lenses—assumptions, beliefs, stories, and values that frame how we understand, interpret, and respond to the work we do and the world around us. In my work, I try to create a safe nonjudgmental place for people to explore, find language for, and share their suffering, but I am careful not to get lost there. I trust that each person, however frightened or depressed he or she may be, has inside strengths, creativity, and resilience with which to make sense of their challenges and begin to live in a way that, to borrow Victor Frankl’s term, allows them to take a “stance” toward their suffering that brings insight and new possibilities for growth. This is exactly the story Red was telling.

Blind Spots
As with any lense, there is bound to be limitations. The one that I use runs the risk of minimizing the extent or intensity of a person’s emotional and psychological pain, trying too quickly to help a patient access strengths he or she may not even believe he or she has, or obscuring an awareness of just how desperate, helpless, or without options a person may feel.

I’ve worked over the years to be sensitive to these and other blind spots, expanding and changing the lenses I use and cultivating nonattachment to personal agendas. Usually, I’m pretty good at this. But I think with Red I became overly enthusiastic about his narrative of growth, insight, and relational healing. After all, it’s what I hope for everyone with whom I work, and he was a persuasive storyteller. Did his story entrance me? Or did I somehow telegraph my hopes in a way that engaged Red’s willingness to play out this role without really believing it?

Some people at my agency felt like Red had lied to them. How could he say all those things while still planning to shoot himself? I don’t believe this is true. I think one reason I was ready to believe him when he told me he was OK was that he believed it, too. What Ralph Waldo Emerson once said when responding to criticism, that he often contradicted himself, is true of all of us. We “contain multitudes.”

I have no doubt that during our last visit Red was telling me the truth (at that moment). If there is anything I would do differently, it would be to make sure I was not being enchanted by a story I wanted to hear and deliberately push harder to see what other truths lay hidden within.

There’s a well-known, sometimes-only-whispered-about belief among those of us who regularly work in such situations: There are times when a person decides to commit suicide when, barring a rationale for involuntarily hospitalizing them (absent in this case), there is nothing we can do or say that will stop him or her. Maybe that was the case with Red.

Do I feel guilty or in any way responsible for Red’s death? Do I think I failed by not stopping him somehow? No. Red’s choices were his responsibility, not mine. Like the rest of the team, I tried my damnedest to help him keep a foothold in life even as cancer slowly was killing him.

I do feel responsible, however, to learn what I can and to remember and tell Red’s story in a way that bears witness to his larger journey and the deep personal work he did, not simply the story of the way he ended it.

— The client's name and identifying information have been changed to protect confidentiality. The author is anonymous by request.