An open letter to Dr. Michael Marcus about how institutional corruption in psychiatry led him to violate my inalienable right to liberty

Dear Dr. Michael Marcus,

Screen Shot 2017-01-18 at 6.04.54 PMBack in 2002, I had some ideas on July 31st and August 1st that led me to get into a pickup truck, and drive to Langley, Virginia, from my home in Philadelphia.  Before leaving, I grabbed a glass pipe with a hunk of hashish in it and a poster of Albert Einstein with his tongue sticking out.  A few hours later, after slowly driving past a large sign informing me that I was trespassing onto CIA property, I told the first federal police officer that I encountered, that I had driven there, in part, to identify myself as the person who had just registered the domain name: iamosamabinladen.com.  

I explained how I had lost my Internet connection at home earlier in the day, just seconds after registering the bin Laden domain.  I was questioned by a few different federal officers over the next hour as I remained in my truck, and was eventually surrounded by four armed officers, with weapons at the ready—three on foot in front of me and on either side of me, and one atop a military humvee, behind me.  After that an officer wearing body-armor asked me to get out of the truck, and frisked me before cuffing my hands together behind my back.  Then four officers escorted me inside, through a metal detector and down a hallway into a small room with a table and two chairs.  There were two cameras in opposite corners of the room, near the ceiling, that were aimed at the chair they sat me down in.  

Then an officer came into the room and read me my rights, and then, an unassuming, middle-aged man not wearing a uniform came into the room, sat down in the chair across from me and asked me to explain myself.  We had a cordial, cogent conversation for over an hour, during which I explained my reasons for doing what I did, in detail.  After that, one of the federal officers removed my handcuffs, and gave me a citation for misdemeanor possession of marijuana, and for trespassing at the CIA.  Next, my questioner escorted me out of the small room and down the hallway again towards the door I had originally entered the building through.  To my complete surprise, he extended his right hand, as if to shake mine, and said, “Thanks for your cooperation tonight.”  I instinctively reached up, and started shaking his hand.  

“There’s a difference between wisdom and intelligence.  You only made one mistake. You should have thrown the pipe out the window before you pulled up to the gate,” he said.

We were still shaking hands when I responded, “That’s what you think.”  Our handshake ended.  Neither of us said anything else, and I got back in my pickup truck, and headed home to Philly.

Thirteen days later I arrived at the Pathways office at Wilmington Hospital with my mother and older brother.  You told us that you wanted to speak to my mother and brother first, in private, before speaking with me, your patient.  They went into your office, and I accompanied a patient, whom you had just met with, outside for a cigarette.  

“So, what’s up with Dr. Marcus talking with your family without you in there?” he asked.

“I’m pretty sure I’m about to be committed,” I replied.

“Really?  What for?” he asked.

“It’s a long story,” I said.

“Well, for what it’s worth, you don’t look crazy to me man,” he said smiling wryly.  I smiled back.

“Hey thanks man, I’m not.  I just…”

“You just what?” he asked.

“I just don’t think like most people think, I think.  You know what I mean?” I said.

“Sure,” he said.  “Maybe you should get away for awhile.  Bus station’s just a couple blocks from here,” he said.

“I know,” I said, as I reached into my pocket, and pulled out a train ticket to Penn Station in New York City and smiled.

“Even better!  What are you waiting for?!” he asked.

“I don’t know… there’s part of me that wants to be on the inside again,” I said.

“Why?” he asked.

“The last time I was inside a mental hospital I was miserable, but I’m not miserable now.  You ever heard of Nellie Bly?” I asked.

“No, who’s that?” he said.

“She was a reporter in the late 19th century who feigned madness in order to get committed so that she could write about what was wrong with mental health care back then,” I said.

“Is that what you’re trying to do now?” he asked.

“Sort of… I just think I might be in a better position to help the people inside than the doctors who work there,” I said.

“Is that what you’re going to tell Dr. Marcus?” he asked.

“No.  He thinks I have bipolar disorder.  I’m sure he’d think I was suffering from delusions of grandeur if I said that,” I said chuckling.

“I think you’re right about that.  Do you think you have bipolar disorder?” he asked.

“I don’t know… I mean, my energy and mood ebbs and flows sometimes, that’s for sure… but I like to think of myself as more of a… bipolar explorer, you know what I mean?” I said.

“Yeah… I think I do,” he said as he took the last drag on his cigarette.  “Well, wherever you end up… I wish you luck,” he said.

We shook hands.  “Thanks brother.  You too, and be well.” I said.

“Same to you,” he said and walked away.  

Next, I headed back inside the hospital and took a seat again in your waiting room.  A few minutes later, you opened the door to your office, and invited me to come in.  I went inside, sat down in front of you with my brother and mother seated behind me, and you proceeded to ask me questions about my mood, my appetite and how much I was sleeping.  You also asked me if I was having any suicidal thoughts.  I told you that my mood was elevated, my appetite was fine, I was sleeping a little less than usual and that I hadn’t had a suicidal thought in years.  Next you asked me if I’d be willing to admit myself to a psychiatric hospital for awhile.  I said no, and told you there was no good reason to do so.  You asked me if I would be willing to participate in an outpatient, day-program, and I said I was willing to consider it.  Then, you said that we were done talking, and that I was free to go.  I opened the door to leave your office, and I was greeted by two police officers who took me into custody.

In spite of my anger, I cooperated completely with the cops.  It seemed apparent that they were pros adept at handling people in my situation—someone who had just been summarily stripped of his inalienable right to liberty by an agent of the state with considerably less due process and civil rights protections than suspected violent criminals are afforded.  The two cops and I had a convivial conversation on the ride from the hospital to MeadowWood, the private, for-profit psychiatric hospital you committed me to.  It had been four years since I’d been in a mental health care facility.  I was in a genuinely good mood by the time I was admitted, and shortly thereafter I was chatting idly with my fellow patients in the common room of the adult ward.  Within half an hour of arriving I was standing in front of a whiteboard distinguishing Einstein’s theory of special relativity from his general theory of relativity for a small cadre of my fellow patients, as staffers sized me up.  

I excused myself from the group when a staffer asked to speak with me in private.  She explained that MeadowWood’s resident psychiatrist had issued an order for me to begin treatment immediately by taking a dose of Risperdal, a powerful antipsychotic medication.  

“So the doctor wants me to begin treatment before meeting or speaking with me?” I asked.

“That’s right,” the staffer said.

“Well, that doesn’t seem right to me.  I’d like to meet with my doctor before he decides how best to treat me,” I said.

“Dr. Ekong is a woman,” she said.

“Fine.  Her gender has nothing to do with why I want to meet her before I begin taking a new medication.  How can she prescribe a course of treatment for me without ever meeting or speaking with me?” I asked.

“Dr. Ekong reviewed your file–”

“My file?  I have a file already?” I said, cutting her off.  “I’ve been here less than an hour and haven’t spoken with a doctor yet.  What’s in my file?  Can I see it?” I asked.

“You can discuss that with Dr. Ekong during your time with her tomorrow when she’s here,” she said.

“Okay great. That’s all I was asking for.  Thank you,” I said and turned to walk away, feigning that I thought I had sold her on me not taking the Risperdal.

“Wait a second!  Dr. Ekong’s order still stands, and if you don’t take your medication, I have to report back to her,” she said calling after me.

“I thought you just said that I could wait to discuss this with her tomorrow when she’s here,” I said, continuing with my feigned misunderstanding.

“I said that you can discuss your file and your treatment plan with her when she’s here.  That doesn’t mean that I don’t have to do my job, and administer the medication prescribed for you by your doctor,” she said.

“Okay.  I’m assuming you can reach her by phone then?” I asked.

“Yes,” she said.

“Then why can’t I speak with her?” I asked.

“That’s not how it works,” she said.

“Okay… well…  can you please explain to her that I would like to meet with her before she unilaterally decides on a course of treatment for me?” I asked.

“I can, but if you continue to refuse to take the medication prescribed for you, she’s likely to order us to treat you with a different one.  One that can be injected with a needle,” she said.

“Can we please cross that bridge if and when we get to it?  You just said you would explain that I want to meet her before beginning treatment, and I appreciate that.  I really do… so thank you,” I said.

“Fine,” she said with a smirk as I headed back to the whiteboard to resume my impromptu lesson on relativity.  As I rejoined the group, another patient asked me how long I had been working at MeadowWood.

“Me?  Working here?” I asked smiling.  “I’m a patient just like you brother!” I said.  

“If you’re a patient here…  I’m the Pope,” he replied.  

“Well, it’s nice to meet you… your Holiness,” I responded, smiling even wider and winking.

About five minutes later, the staffer called me over again and told me that Dr. Ekong had confirmed that I was to begin treatment immediately.  She said if I refused to take the Risperdal, that Dr. Ekong had instructed her to give me an injection of Haldol.  I told her that I would not willingly take any medication before having the chance to speak with Dr. Ekong, but added that I would not physically resist being injected against my will.  I asked the staffer if I could make a phone call before being given the injection.  She said yes, and I called my father and explained to him what was going on.

Five minutes later, in a private room, a woman gave me an injection of Haldol.  After giving me the shot, she began preparing a second injection.  

“What’s that?” I asked.

“It’s called Cogentin.  It’s to counteract the side-effects of the Haldol,” the nurse said.

“What side effects?” I asked nervously as I felt my pulse quicken.

“Muscle spasms… muscle rigidity… stuff like that,” she said.  Then she injected me with the Cogentin shot.  

I was already feeling dizzy and nauseous just seconds later as I went back into the common room.  I walked right by the patients still gathered around the whiteboard, ignoring their calls to rejoin them, and headed straight for my bed in my room.  I laid down, my whole world spinning, and quickly lost consciousness.  The day following my harrowing experience with Haldol I began swallowing the Risperdal tablets originally prescribed for me by Dr. Ekong.  I’m grateful that I didn’t know then what I know now:  having Haldol injected into me and swallowing a single Risperdal tablet could have killed me via Neuroleptic Malignant Syndrome.  Imagine my utter lack of surprise when Dr. Ekong released me from my involuntary psychiatric care experience ten days after you committed me.  This was the same day that my case would have necessarily been reviewed by a judge in a court of law, if Dr. Ekong had not released me.  I don’t believe it was a coincidence in timing.

Imagine if judges in our legal system could imprison suspects and order them to be injected with potentially life-threatening substances without meeting or speaking with them.  Imagine if imprisoned criminal suspects and criminals were financially responsible for paying fees for being in prison, including one to the judge who jailed them.  Even though you are referred to as a doctor, and not a judge, these ideas are just as absurd as a reality in our mental health care system as they would be if they were part of our legal system.  To be clear, I do not blame you or Dr. Ekong for treating me as you did.  I blame the poorly designed system that empowered you to mistreat me as you patently did.  I share this true story publicly with the intention of trying to improve an improvable system.  

I harbor zero ill will for you or for anyone else involved in my mental health care mistreatment.  I believe that you and Dr. Ekong were necessarily influenced by forces of institutional corruption at work within our mental health care system.  Robert Whitaker and Lisa Cosgrove have written masterfully on this subject in Psychiatry Under the Influence:  Institutional Corruption, Social Injury, and Prescriptions for Reform.  I’m simply playing my role by highlighting a perfect example of what institutional corruption in psychiatry looks like in reality.  I don’t seek attention for my anecdotal experience with mental health care mistreatment for the purpose of retributive justice against you, or for sympathy for myself, and unlike some survivors of less than optimal mental health care, I do not want to burn the existing system to the ground.  Rather, my motivation is to increase awareness about human rights violations occurring within our mental health care system in order to inspire social change and systemic reform.  I can’t help but wish that I had been compelled to share this true story earlier.  Dr. Caroline Ekong might still be alive and Christopher Frick might not be in custody for the rest of his life, if I had done so.

As you must know, in October of 2015, Christopher Frick, at age 21, stabbed Dr. Caroline Ekong to death, three years after she had committed him to the Rockford Center, claiming that he was a danger to himself.  I share the true story of my forced “care” at the hands of you and Dr. Ekong to highlight her tragic death with the aim of preventing others like it.  Despite the apparent fact that she ordered that I be treated before ever meeting or speaking with me, I saw her as a caring and conscientious mental health care professional.  I write apparent, because I can’t know for sure if the staff that treated me was actually in touch with her that day.  Despite the apparent fact that you decided to hospitalize me against my will before you examined me, and despite the blatant incompetence or dishonesty you clearly documented on my committal paperwork, I see you too as a caring and conscientious mental health care professional.  

I share this true story, Dr. Marcus, so that you, and other doctors empowered by the state to suspend people’s liberty, will be less likely to use that authority in a way that leads some patients, to want to kill their psychiatrists.  Caroline Ekong and Christopher Frick were both victims of a broken, reformable mental health care system.   I come in peace brother, because that is what I see you as, a brother.  All those who dedicate themselves to caring for the well-being of others are my brothers and sisters.  You and I are brothers on the front line in the battle of trying to bend the U.S. suicide rate curve.  I am in a special position, given my considerable professional experience in systems quality assurance to provide valuable critical feedback on the mental health care system, as a result of my interactions with you and Dr. Ekong almost a decade and a half ago.  Feel free to consider me your personal Nellie Bly.

You necessarily took action to have the police waiting outside your office prior to your examination of me, and to this day, you and I have still never exchanged a single word about my unauthorized visit to CIA headquarters in 2002.  Four federal CIA police officers and a staffer from the CIA questioned me for about three hours with a degree of professionalism that still blows my mind, especially considering that I pulled this stunt just forty-one days before the first anniversary of the 9/11 attacks.  It’s worth pointing out that these men, despite the fact that I was in possession of a controlled substance when I illegally trespassed at the CIA, decided to release me on my own recognizance versus throw me into a jail cell for the night, pending arraignment.  Things played out the way they did for me at the CIA because the people there that I spoke with were open to hearing a reasonable explanation for my actions… which is precisely what they received from me… and precisely why they let me go.  

committal documentYou and Dr. Ekong on the other hand, were patently not open to even attempting to reason with me. You failed to give me a chance to explain my actions before stripping me of my liberty, and she treated me with a potentially life-threatening medication before ever meeting or speaking with me.  It is clear to me, as I am confident that it will be to many others, that the forces of institutional corruption in psychiatry were at work in your respective decisions.  The knowledge that you had about what happened at the CIA was the by-product of a five-person game of Telephone or Whisper Down the Lane.  I told my father some of what happened that day, without much explanation as to why at all.  My father told my mother.  My mother told my brother.  And then my afraid-for-the-life-of-her-son mother told you.  You did what you did, and then Dr. Ekong became Telephone/Whisper Down the Lane player number six. The assumptions that you both necessarily made about me are gross examples of professional misconduct.

While you were very sympathetic about the anxiety experienced by your patient’s mother, you failed to even try to understand me, your patient, whom I believe you assumed was psychotic.  The fact that I was exhibiting some of the symptoms of a “mental disorder” described in the Diagnostic and Statistical Manual of Mental Disorders—a nosology disavowed in 2013 by Dr. Thomas Insel, the former Director of the National Institute of Mental Health—is a pathetically inadequate justification for involuntarily subjecting me to forced care that could have ended my life.  If you failed to notice this label on the committal form:  “as observed during my examination of the patient” you were reprehensibly incompetent when you filled out the form.  Not one scintilla of information about my unauthorized visit to the CIA or about anyone breaking into my home was provided by me to you.  If you did notice the aforementioned label, then you were necessarily reprehensibly dishonest by claiming that any of that information was discussed during your “examination” of me.  Why I willingly trespassed at the CIA with marijuana and a big poster of Einstein was, and still is an absolute mystery to you.  

I invite you to speak with me, in front of a live microphone, for a podcast—a frank talk about mental health—to provide me the opportunity that you denied me years ago.  If you meet with me, I will also explain my version of the stories that you were apparently told by my mother and/or brother that prompted you to write down what you wrote about me on the aforementioned form.  

I genuinely believe that a public conversation between you and me could be very valuable for people besides you and me, and that is my aim—to create value for others as I try to improve the mental health care system in this country.  If you have no interest in engaging in a public conversation with me, to provide the reasons why you behaved as you did, I will offer up my best guess as to what I believe motivated you, when I explain my own actions, in a subsequent message.

Sincerely,

Francesco Bellafante
American Foundation for Suicide Prevention Philadelphia Chapter Board Member
Zero Suicide Champion
frank talk about mental health ~ leveraging the genius of Einstein to end suicide and to maximize well-being
iameinstein.com

 

A letter to the man who killed the psychiatrist who treated me before ever speaking with me

November 4, 2016

Dear Christopher,

On August 14th 2002, I was civilly committed to the MeadowWood mental hospital by a psychiatrist who worked at Christiana Hospital.  The doctor who committed me failed to ask me one single question about the incident leading to my involuntary psychiatric treatment.  After being admitted to MeadowWood and prior to meeting or speaking with the psychiatrist who was responsible for my care, Dr. Caroline Ekong, I was informed that she had directed the staff to treat me with Risperdal, an oral antipsychotic.  I respectfully refused to swallow the Risperdal, and asked if I could at least speak with Dr. Ekong prior to commencing taking any psychopharmacological  drugs.

Dr. Ekong refused my request to speak or meet with her prior to commencing treatment. Staff at the mental hospital told me that I would have the chance to meet and speak with Dr. Ekong the following day, but that I still had to begin taking the Risperdal immediately.  I was told that if I refused to swallow the Risperdal that I would be given an injection of Haldol, another antipsychotic.

I told the staff I thought it was wrong for me to be treated against my will by a doctor who hadn’t even spoken with me yet, and I told them that I would not willingly take the Risperdal.  I also told them that I wouldn’t physically resist being injected with the Haldol if they were compelled to treat me without my consent.  They were so compelled, and I did not resist.

Subsequently I began swallowing the Risperdal to avoid receiving any additional Haldol injections.  Ten days later, the same day that my involuntary commitment would have been reviewed by a judge, Dr. Ekong released me from the hospital.

In May of this year, while working on a memoir manuscript about my mental health care journey, I Googled “Caroline Ekong” and first learned about your story.

A couple days after learning some details of your mental health care journey I posted this on Instagram.

screen-shot-2016-10-12-at-10-53-08-am

Christopher Frick stabbed Dr. Caroline Ekong to death in October of last year at her home in Hockessin, Delaware, three years after she civilly committed him to a private psychiatric hospital.  I just learned of this event this week.

Dr. Ekong was the same caregiver who ordered me to be injected with Haldol before ever meeting or speaking with me after I trespassed at CIA headquarters five weeks before the first anniversary of the 9/11 attacks back in 2002.

Imagine if judges in our legal system could imprison suspects and order them to be injected with potentially life-threatening substances without meeting or speaking with them.  Imagine if imprisoned criminal suspects and criminals were financially responsible for paying fees for being in prison, including one to the judge who jailed them.  These ideas are just as absurd as a reality in the mental health care system as they would be if they were part of our legal system.

I do not blame any individual for my harrowing experience with Haldol, even if their actions were illegal.  On the contrary, I am exceedingly appreciative of anyone who dedicates themselves to caring for the well-being of others.  They are my brothers and sisters on the front line in the battle to bring about the beginning of the end of suicide.

I don’t seek attention for my anecdotal experience with mental health care mistreatment for the purpose of retributive justice or sympathy, and unlike some survivors of less than optimal behavioral health care, I do not want to burn the existing system to the ground.  Rather, my motivation for sharing this story publicly is to increase awareness about human rights violations occurring within our mental health care system in order to inspire social change and systemic reform.

Caroline Ekong and Christopher Frick are victims of the same thing: a broken, but fixable behavioral healthcare system.

I’m sorry that you’re in the position that you’re in, and I’m sorry that I wasn’t compelled to share publicly about my experience with Dr. Ekong prior to last October.  I can’t help but imagine how telling my story could have been the cause of you thinking and acting differently than you did.  But that is not how our stories played out unfortunately.

Fortunately we are both still in a position to try to improve the mental health care system that treated us without our consent.  I would appreciate the opportunity to learn more about your mental health care journey if you’re open to communicating with me.

Warmest regards,

Francesco Bellafante

Why do people without trauma in their past become suicidal?

In this post I will answer some of the questions that I posed in frank talk about mental health, episode 7 | Why do people attempt suicide? 

As a reminder, I am a suicide attempt survivor who had a near death experience due to semi-intentionally caused acute carbon monoxide poisoning eighteen and a half years ago when I was 27 years old. 

As I explained in episode 7, I’m aware that my answers to these questions don’t apply to everyone who becomes suicidal or who dies by suicide.  With that said, I still don’t believe that my answers are unique, and apply only to me.  While my answers may not resonate with you or with what you think your loved one was thinking and feeling when he or she attempted or died by suicide, I’m convinced that they apply to many people.  A growing number of suicide attempt survivors are sharing about the circumstances leading up to their suicidal crisis.  While it’s impossible to know for sure precisely what someone who died by suicide was thinking, I believe it’s possible to gain insight into the state of mind of a loved one or associate who died by suicide by exploring the growing number of personal accounts provided by suicide attempt survivors like myself.  By revealing insights about my suicidal mindset, I hope to provide, at the very least, a modicum of understanding and peace to those left to mourn and remember loved ones who have died by their own hand.  

I also hope to be a source of hope for those who may be feeling hopeless and suicidal.

1.  Why do people who have every single thing that they need and almost everything that they want have suicidal thoughts?

If you are a human being that has a sense of self, if you have a sense of personal identity or an ego, I think you are susceptible to having suicidal thoughts.

The problem of suffering arises from our reaction to what-is, our resistance to it, or our interpretation of it, which is a function of our conditioning.

Lionel Corbett

My paternal grandfather died when my father was just thirteen years old.  Within a year of his father’s death, my father worked two jobs to help support his family to the tune of $350 a month (in 2016 dollars).  Neither of my parents went to college, but they were determined to provide my siblings and I with the highest quality education possible given their middle class income.  I went to private school from the time I was in fourth grade through college.  I graduated from the University of Notre Dame in just three and a half years, and by the time I was twenty six years old I was working for an information technology consulting firm a couple of blocks from Wall Street.  My bill rate was $250 an hour.  While on assignment in Toronto, I had a troubling experience at work.  The genesis of the crisis that nearly resulted in my suicide was a single, negative interaction with the senior client on my sub-team in Toronto.  At our first meeting, the senior client manager on the team asked me if I had any prior experience working with commercial lending, credit risk management systems.  The way he framed the question indicated he assumed I would respond affirmatively, but I had no such relevant experience.  I balked at saying no, and then pivoting to explain why I would still be a valuable asset to the team and the project as a whole.  Instead, I responded, “Excuse me?” as if I didn’t hear his question.  The man was less than five feet away from me, and he spoke quite clearly;  I was instantly and irrevocably mortified.  By the time he had finished rephrasing his question slightly, I was ready to give him my “no” which I did, but I failed miserably, in my view anyway, when I tried to pivot back to why he should still be pleased to have me on his team.

I began to suffer as a result of this interaction, not because of what had happened, but rather because of my interpretation of what had happened.  My self image and my sense of self-worth had been based on what authority figures in my life thought of me.  This worked fine for the first twenty six years of my life.  My parents were the first authority figures in my life, followed by my teachers and then my superiors at work.  My sense of self-worth and self-esteem was probably higher than average because the feedback that I had received from these people was overwhelmingly positive.  This incident at work in Toronto changed all of that.  I became convinced that an authority figure (my client) thought very poorly of me.  He never said this, but I believed that he was thinking thoughts like this:  I can’t believe that we’re paying this guy two hundred and fifty bucks an hour!  He’s not worth $2.50 an hour!!   Whether he thought this or not really wasn’t important.  It’s what I thought an authority figure thought about me, and in a very short period of time, I believed it as the irrefutable truth.  I came to see myself as an under-qualified, over-compensated fraud.

It still seems incredible to me how quickly I unraveled; how quickly hope and excitement for the future were replaced by fear and apprehension.  Within a month’s time, my internal monologue became almost unrecognizable to me.  The voice I was accustomed to hearing, one brimming with confidence, resourcefulness, excitement and determination was replaced by one saddled with uncertainty, doubt, indecision and distress.  Thinking and feeling so negatively about myself for an extended period of time was a novel experience for me.  I searched my psyche in vain for something to reverse my psychological and emotional slide, but the unrelenting pessimism of the voice in my head stripped away my self-esteem and hope for things to come.  Silencing my fearful, troubled, constantly-questioning self-talk at night was so difficult that getting sound sleep became impossible.  Night after night I only slept between zero to three hours at most thanks to the ceaseless barrage of dark, automatic thoughts that bombarded my consciousness, and ate away at my sanity.  As I continued descending a downward spiral of disempowering thoughts, I began to ruminate over what I was doing with my life.  I remember the first glimmer of my very first suicidal ideation.  It happened on a particularly turbulent flight home to New York from Toronto on a Friday afternoon.  Normally unnerved by turbulence, I found the unlikely prospect of crashing oddly comforting.  I remember thinking:  If only this plane would go down, I wouldn’t have to worry about this miserable assignment any longer.  

Within just a couple of weeks of my professional faux pas in Toronto, I had discounted all of my prior accomplishments, as my formerly steadfast belief in my ability to intellectually tackle any problem waned.  Some bad luck left me socially isolated as my five closest friends all coincidentally moved away from New York City over the course of a few weeks.  The lack of reassurance received from my usual sounding boards to bolster my flagging self-confidence paved the way for my suicidal crisis.  My ability to concentrate was so impaired from lack of sleep, that completing simple tasks—like deciding what to have for dinner, or packing my bag for the week ahead in Toronto—became cognitively burdensome.  Not surprisingly, given my deteriorating mental faculties, effectively performing the duties of my job became impossible.  I became certain that I wasn’t ever going to be able to live a life that would honor my parents and all of the sacrifices they had made for me.  In a short period of time, my thoughts of death gave rise to thoughts of suicide, followed eventually by a practical plan to end my life.

2.  What goes wrong with someone that has so many gifts, talents, privileges, and advantages?

The good fortune that I experienced through the first twenty-six years of life left me with high expectations for myself and my future.  The incident in Toronto caused me to confuse being unknowledgeable in a particular subject (commercial lending risk management) with being un-intelligent in general.  This cognitive mistake and my faith in the veracity of my conclusions due to my track record of being a high performer in school and at work led me to believe that the expectations that I had for myself were beyond my reach.  I became consumed with feelings of guilt, embarrassment and shame as a result.  I felt guilty that I was even considering the idea of checking out given the depth and breadth of suffering experienced by countless others in the world.  I felt guilty that I had achieved so little in life after having been given so much.  I was embarrassed that I had ever thought I was intelligent and that I could achieve anything that I set my sights on.  I was embarrassed that I was in a situation where I obviously needed help and was mortally afraid to ask for it.  I was ashamed that I was considering ending my life because I feared that I wouldn’t be able to earn an above average living.  I was ashamed of the imagined prospect of having to move back home to Delaware to live with my parents, and get a job in the local shopping mall.

Guilt involves falling short of one’s own moral standards.

Embarrassment is the feeling of discomfort experienced when some aspect of ourselves is, or threatens to be, witnessed by or otherwise revealed to others and we think that this revelation is likely to undermine the image of ourselves that, for whatever reason or reasons, we seek to project to those others.

Shame arises from measuring our actions against moral standards and discovering that they fall short.

Dr. Neel Burton

3.  How can someone who has love for his family and friends and whom is loved by his family and friends be suicidal and not tell a loved one?  How can they not reach out to a loved one for help?

I did reach out to a few close friends to express that I was having trouble, although I never went so far as to explicitly say that I was in need of help.  I even told my closest friend at the time that I had gone as far as considering ending my life.  Regarding reaching out to members of my family, I had a single conversation with my parents from my hotel room in Toronto several weeks before I nearly killed myself, where I expressed concerns about my performance at work.  In each case, my communication was only as effective as the responses that it elicited.  I received constructive advice from one friend—he suggested that I quit my job and try doing something completely different for awhile like go work at a ski resort or on a cruise ship.  Another friend was moved to discuss his concerns about my situation with his father who subsequently telephoned me to check in on me.  The friend I explicitly shared about my suicidal thoughts with became emotional as a result of my revelation, and was supportive in the moment, but he still wasn’t compelled to talk about our conversation with anyone else.  As far as the interaction with my parents, as novel as it was for me to express concerns about work to them, they too didn’t grasp the severity of my situation.  Me engaging in suicidal behavior wasn’t an eventuality that they seriously entertained.

I viewed my deteriorating mental health as a character flaw, because I believed other people would see it the same way, and I believed that asking for help to deal with what was going on in my head was a sign of a personal weakness. Thoughts and beliefs like these lie at the heart of the stigma surrounding mental illness, and explain why many people suffering like I was back then never seek help.

4.  What motivates someone without traumatic experience who has access to loving support from family and friends to harm themselves?

Unsubstantiated beliefs about myself and my future coupled with irrational thinking due to sleep deprivation motivated me to engage in suicidal behavior.

5.  What could a loved one (or anyone else) of a suicide attempt survivor or someone lost to suicide have done to prevent the suicide attempt or suicide?

Obviously, there’s nothing anyone can do to change the outcome of an event in the past.  As a free will skeptic, I don’t believe that human beings consciously author their thoughts or intentions.  We live in a cause and effect physical reality that is governed by immutable laws.  Like Albert Einstein, I too believe that the thoughts and intentions that arise in consciousness do so according to these natural laws.  Given this view of reality, there’s no coherent way to explain how an organism, human or otherwise, makes freely-willed conscious choices.  Einstein believed that the subjective experience of making “choices” was a “delusion of consciousness.”  As a result, Einstein believed that thoughts and feelings like regret, guilt and shame are all based on a gross misunderstanding of reality that arises from an egocentric view of life.  I think Einstein’s answer to this question would have sounded something like this:  There is nothing that a loved one (or anyone else) could have done differently to prevent the suicide attempt or suicide of someone.  The person who blames him or herself for not behaving in a way that he or she thinks would have or could have prevented the suicide attempt or suicide of someone is misunderstanding how the universe works.  For that person to have done something other than they did, the universe would have had to have been in a different state than it was in at the moment in question.  

The universe is going to unfold how it is going to unfold based on the immutable laws of physics, whether we can foresee what’s going to happen or not.  In simple cases, we can accurately predict the future.  In unfathomably more complex cases—predicting the thoughts that arise within a human being’s consciousness and what she is going to do as a result—we cannot reliably make accurate predictions yet.  Our understanding of neurobiology has yet to reach the point where we can accurately predict the output of the most complex object in the known universe:  the human brain.  

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Make no mistake, I still believe that preventing suicides from occurring in the future is possible and worthwhile work.  Knowledge of the warning signs and risk factors for suicide and vigilance can be the cause of someone avoiding a suicide attempt altogether.  Also worth noting, there is always help available for someone in the midst of a suicidal crisis.  You can always call 911 or the National Suicide Prevention Lifeline at 1-800-273-8255.

6.  Why was I “gripped by fear” about life?

Fear seems to have many causes. Fear of loss, fear of failure, fear of being hurt, and so on, but ultimately all fear is the ego’s fear of death, of annihilation. To the ego, death is always just around the corner. In this mind-identified state, fear of death affects every aspect of your life.

Eckhart Tolle

I don’t recall precisely when I came to understand that my lungs will cease drawing breath and my heart will stop pumping blood and I will die.  I also don’t remember when I realized that absolutely no one has any certain knowledge about what is going on in existence.  The apparent unknowability of the answers to the “big picture” questions that homo sapiens ponder can be unsettling to some.  The certainty around the inevitability of the death of the body coupled with the uncertainty around what is going on in existence is enough to give any contemplative person pause.