How to Save a Life

Caveat: This may make you feel bad. If you know someone who killed himself, or herself, and you feel badly about your part in it somehow, get therapy. Or talk to someone about it. You matter, too, and despite what you might think after reading what I write below, you probably couldn't have helped that person, probably could not have saved a life. It's one of those things, best to take yourself off the hook.

Sometimes you get a break in your day.

One night last week FD said to me, "We should make a shiva call tonight."

Someone who sits shiva has lost a parent, sibling, or child, a member of the family of origin. From burial to "getting up" from shiva, friends have a week to stop by and sit together with the mourners, console. Or to call on the phone, if the mourners are out of town. My parents call it a condolence call.

I felt badly for not being on board, but it had been a long day. I just didn't want to sit anymore, not with anyone. I wanted to eat some dinner, make a few calls, work on taxes, try walking a little on the treadmill, see if I could ride a bit on the stationary bike. I told FD I had a break the next day and intended to visit our friend then. Maybe do some shopping afterward. Did he want to come along?

Call me.

So I did, and he went with the program. We visited our friend who had lost his father, a dear man in his eighties. He talked about his mother, alone now, missing him, to be missing him forever, for what will be the rest of her life. To her he died prematurely.

Sad but a relatively easy shiva call, as shiva calls go, easy because we know that no one is going to live forever, and a father passed on before his children, as it should be. There's a certain order that makes life just a little easier to take, sometimes.

After the visit we grocery shopped and had some lunch. I dropped FD off at his office and started back towards mine.

And I heard the song. I'd heard this song maybe three or four times before, and each time would think, Catchy, but what's this he's saying? Is the refrain really, how to save a life? Is this song about suicide? It sounds like he's blaming himself, this mournful, plaintive singer in the band, the one full of regret.

But honestly, all due respect, words run together for me and I don't want to think this. I'm on my way to work thinking, How to Save a Something, wondering where am I going with my next patient. Have I got this correct, my treatment plan? One false move. . . These are people I'm dealing with, not fish, although I worry about my fish, too, and lost three last week, one to an attempted homicide. The Bat Fish just didn't make it through the mauling, mistaken for a leaf in the tank. And the clowns died of broken hearts, in sympathy, I feel. They just couldn't smile anymore.

I get to the office early and log onto YouTube, because there's really nothing to worry about with the patient and I know this, truly the job is in hand, the work's been done. We're in middle phase, putting together a few pieces, not resuscitating anything or anyone anymore.

And there it is, on YouTube, obviously a hit, a clear winner, it pops right up, this song, and many of the videos are tagged "with lyrics." So apparently I am not the only one who didn't get them, listening to the radio. Once you know the words, like everything else, they are clear as rain.

Where have I been? Why haven't my kids told me about this? Don't they know I need this stuff? It's like oxygen for me, a song like this. I Googled the lyrics and printed them out, then watched the video maybe five times, lyrics in hand, then watched the other version, too, once or twice. Mesmerized.

Fray, the band, won't let us embed it, so you have to click here to watch the music video. The second is slightly different, but basically the same idea.

Here are the lyrics.

How To Save A Life :
Step one you say we need to talk
He walks you say sit down it's just a talk
He smiles politely back at you
You stare politely right on through
Some sort of window to your right
As he goes left and you stay right
Between the lines of fear and blame
You begin to wonder why you came

CHORUS:
Where did I go wrong, I lost a friend
Somewhere along in the bitterness
And I would have stayed up with you all night
Had I known how to save a life

Let him know that you know best
Cause after all you do know best
Try to slip past his defense
Without granting innocence
Lay down a list of what is wrong
The things you've told him all along
And pray to God he hears you
And pray to God he hears you

CHORUS:
Where did I go wrong, I lost a friend
Somewhere along in the bitterness
And I would have stayed up with you all night
Had I known how to save a life

As he begins to raise his voice
You lower yours and grant him one last choice
Drive until you lose the road
Or break with the ones you've followed
He will do one of two things
He will admit to everything
Or he'll say he's just not the same
And you'll begin to wonder why you came

CHORUS:
Where did I go wrong, I lost a friend
Somewhere along in the bitterness
And I would have stayed up with you all night
Had I known how to save a life

CHORUS:
Where did I go wrong, I lost a friend
Somewhere along in the bitterness
And I would have stayed up with you all night
Had I known how to save a life
How to save a life
How to save a life

CHORUS:
Where did I go wrong, I lost a friend
Somewhere along in the bitterness
And I would have stayed up with you all night
Had I known how to save a life

CHORUS:
Where did I go wrong, I lost a friend
Somewhere along in the bitterness
And I would have stayed up with you all night
Had I known how to
Save a life

A critical thinker would watch the video and say, No way. This is so emotionally manipulative. These children, surely, are actors, they have been hired to look sad, to draw attention to a problem affecting youth today, but there is no way that any of them would really want to die, would voluntarily take their lives.

But the truth is otherwise. Although these are probably actors, they are representative. There is an ennui that affects young people, like old people, a psychic pain that affects the leaders of tomorrow. And I see them in the office and we talk and talk and talk, and there was a time, when I was young, that I would be on the phone all night with one or two of them.

I'm more aggressive now with my treatment, so I haven't done that in a long time. And it is not only the youth who are at risk, of course. Many people, recently, have lost everything. There are many at risk, middle-aged men and women who have no savings, no jobs. This happened in the thirties. We can't let it happen now. These are fathers, mothers, grandfathers, grandmothers. People.

So let's say you who have a friend who is clearly distressed, withdrawn, glassy-eyed, a friend of any age, who has changed. And let's say you have this chance, somehow, to stay, to help your friend through one night in particular, one awful night. It is a horrible position, to have to do that, to make that choice. And with grown men, it's not as if anyone is asking you to stay, not usually.

If one is isolated it's worse, it's easier if there is family around. They are built in, don't always need taxis, even. On the other hand, people can be in the next room and not be there, not be very much help at all, might even be a part of the problem.

This is why friends, for sure, have to stay to save a life, as Fray tells us. You may have to call someone, explain why you'll be late, maybe why you'll be out all night. Mention that you might need some assistance, too.

But you have to stay, and you might have to stay up all night.

You never want to be in charge of someone's life, it's not a great position, it's not usually what we sign up for when we say, I'll be your friend. But sometimes, by staying, we make it a little easier for a friend in trouble to hold on. Just a little longer, until bigger shoulders move in.

You have to really think about hanging in there, holding with a person who is seemingly smiling politely back at you. (Lyrics like these strike a familiar chord. We've seen this smile). You can't politely look right on through, go your own way. To be trite, you may not pass this way again.

And you can't be hoping that as you walk between the lines of fear and blame that you won't have to touch either of them.

Touch them. It's okay; do it for your friend. Your fear is nothing compared to his, and no one, really is to blame. Depression happens. But mostly, we professionals can fix it. It takes time, and we have other things to do, so do this for us, play a quiet understudy, be a stand in for a few hours, keep your friend alive, watch to be sure the impulsive senseless act never happens, and then find help, the bigger guns than yours, to fight your friend's depression.

Anyone can sense a death wish, you know, if the Spidey sense is tingling. It is fearsome, sensing a death wish, because we know that we can only control our own actions, not those of others. But if self-destructive behavior is evident, if a friend has been hurting himself, or has been hurting for a long time, that the direction of his mood won't spontaneously lift, the negativity won't fly away, without intervention.

There is a greater chance of suicide when this is the case, when a person has found a certain comfort level with self-destructiveness, a cocktail of negative thoughts and accessibility, in our wonderful culture, to drugs and drink, bullets, ropes and blades. We can't walk away from this truth. It is a violent world. We have what to fear.

The other line, blame, is what Fray tells us not to do. But it's also something therapists are very familiar with, and it is associated with self-blame, feeling that we could have done more, wondering why we didn't call, reach out, stay. But the song goes, You wonder why you came.

They make us wonder why we came when we do reach out, is the problem. This is how they make us feel, depressed people, like we're useless and powerless, like we can't help them. Why bother? This is how they feel, useless and powerless, failures, better off dead, not worth bothering about. It is called projection, and a sensitive friend feels what is in the heart of another, this feeling that there may be, truly, nothing that can be done.

Such a trap, and so wrong! Over-rated, powerlessness, hopelessness. Get them help, find social service people, professionals. We'll think of something. That is the rational way of seeing despair. The social scientists can't treat everything, not every time, but G-d knows, we can treat depression, and more often than not, we win the battle.

Someone has to stay rational, unafraid, and above all, hopeful. You, the friend, the lover, the sister, the brother, the parent, the spouse, are elected. Maybe it won't work, maybe you will lose this person in the end, but you don't really know that, do you? So you can't run home and go to bed, that's for sure, hoping that in the morning your friend will be okay.

You can't stay right if he turns left. This is the projected abandonment he is hoping for, your validating his worthlessness with your leave-taking. Don't fall for these words, I'm okay, go home. Be sure someone else is on call. Or stay.

This is not to say you should be manipulated to stay by suicide threats designed to control you in a relationship. This is entirely different, and sometimes not an easy call to make. But threats are threats, and as such need to be taken to a higher court. There is a fine line between dependency and despondency, but if you sense that you are walking that line, then you want to be out of the helper/rescue role.

It is too big for you. It is too big for most of us. That is why such people are so lonely.

You don't want to have to wonder, Is this manipulation, am I being emotionally blackmailed? If you have to wonder this then let the professionals, perhaps the police, even, be the ones to take the brunt of the emotional blackmail. Call them in to see if this is real. Let them determine who should help. If it smacks of manipulation, the one to help, that friend, isn't you.

Oh, so much to say. Why did I start?

Because so many people, after a suicide, say, I knew.

I tell people to talk openly about it, about this idea that most of us have had, at least once in our lives, that life is too tough. That we wouldn't mind finishing it. And discuss meaning, while you're at it, why choosing life is the better alternative because there is meaning. It is our job to find it.

It is not your job, finding meaning for your friend, the one who wants to die. It is the job of professionals. But of course you can play with it. It is a wonderful, rich, very intimate conversation we're talking about. Therapists have no corner on these. And if you help a friend to find it, if together you find it, meaning within the throes of discussing depression, you are golden, a prize, perhaps both of you are, and should consider this profession.

In the process of this philosophical discussion, should your friend mention a suicide plan, then this is a heads up, don't take it lightly. There is real risk. Your friend, believe it, is capable, and armed, can exact a suicide. If this feels possible, you have to communicate that you have a car, a phone. Help is available. More drama now, less later.

We therapists have all kinds of tricks and still, they don't always work. One of the more powerful tricks is cognitive, explaining that suicide really is not like any other death. It is more violent, more traumatizing, and grants permission. One example tells others in the family that there is something okay about it. But people who can't climb out of the pit need a huge hand. Big muscles.

You can and should call parents, if there are any and these people aren't criminals, and they are around. Real friends know how to find them, aren't afraid of these people, the ones who birthed a suicidal buddy, who brought a suicidal friend into the world. It is possible that these people hold the key to something very elemental to your friend's survival.

If there are no relatives nearby, then you may be the closest relative, the mother, the father, right now. If you had an infant and the infant were sick with fever, you would not abandon him to his bed. The doctor might say, Get the fever down with a cool bath and baby Tylenol. It's a virus. But that doesn't mean you leave your baby alone in her bed. Not with a high fever.

Where did I go wrong, I lost a friend
Somewhere along in the bitterness

Whose bitterness? Suicide is an angry act, a vitriolic act. At some point there's energy, enough to make it so, that decision, the one that spells relief. It takes a lot of psychic energy to kill yourself, you know. So we watch people when they say they're feeling better, watch them more closely. We're thinking, the energy is available, the time is now. He's going to go left. But there's energy in the bitterness and anger. Toxic stuff.

Let him know that you know best
Cause after all you do know best

Silly, of course. Your friend knows himself, you do not know him. Such a chutzpah (nerve) to give advice to a sick person. Even we, the professionals, the ones who know, don't give advice. We listen. We teach from experience and we do it gently. Maybe, if we do it at all. Psychoeducation is an art. And when we are finished working with someone, maybe teaching, maybe listening, when our Spidey sense says, You're not getting through, this person is going to try it again, we call for reinforcements. I've had kids never see me again because I forced a hospitalization.

I don't want to go any farther. You get the idea. You know the symptoms, loss of interest in the usual activities, not caring about school or work, not caring about hygiene, expressing hopelessness and helplessness, giving away possessions, revealing a suicide plan.

You don't want to be an armchair therapist, here, not a self-appointed self-helpnik at this point. You don't want to beat on someone's short-comings, not ever, especially, like Fray warns you in his song, you don't tell a person what he doesn't want to hear.

But unconditional love and support feels good, anytime, if it doesn't take the place of professional help. It is all we can do, sometimes, care-take. No ultimatums, they tend to fail. No bargains. Get the help for your friend, don't talk about it.

It's tough, of course, especially since some people have had help. And maybe it didn't work. Maybe the doctors said, Do this, do that, and he did this, did that, but it isn't helping, and whatever it is that isn't working is the focus, when something else should have been the focus. So he didn't come back to therapy, lost faith in the system, or perhaps never gave it a real try.

Or maybe your friend is on medication but it doesn't help, and the scheduling is proving difficult somehow, and the doc has waited a month between appointments, a month too long, and your friend is taking his feelings into his own hands, dosing out his own medicine, not caring if it helps or not. And you're there and you can tell, he's too drugged up, or he's drinking too much, that this isn't good.

So you call 911.

And there, you've saved a life.

You don't have to wonder about any of it, you don't have to wonder why you came, why you stayed. The untimeliness is what we're talking about, the premature death, the one we want to avoid, no different in its importance than the one we talked about earlier, the man in his 80's who still died prematurely, if you were to ask his wife.

We want to save a life at any age. That's why you come and that's why you stay. You're a part of it.

therapydoc

September, I realize, is suicide prevention month, but I'm always a little slow on the uptake.