Psychiatry and Suicide

Regarding the suicide of Princeton professor Alan Krueger, Frank Bruni wrote the following:

I was struck by two sentences in my colleague Paul Krugman’s tribute on Tuesday to the renowned Princeton University economist Alan Krueger, who just died — reportedly by suicide — at the age of 58. Krugman, who taught at Princeton, wrote: “I thought I knew Alan reasonably well and never saw a hint that something like this might be coming. But people’s lives often feel very different from the inside than they look on the outside.”

Let’s not just let those sentences zoom by. There’s such an important reminder and such a profound truth in them. It’s the same reminder and truth in the stories, less than a year ago, of Anthony Bourdain’s and Kate Spade’s suicides. He and she were spectacularly successful people whose lives inspired envy. Bourdain, the star of the popular CNN show “Parts Unknown,” had an image of limitless brio and unstoppable swagger. But that’s only what was easily visible. That was what he flashed in public, at what were possibly his sunniest moments. His weather — everyone’s weather — is more variable than that.

On the day we all learned of his death, I wrote a version of what Krugman just did, noting “how powerfully it speaks to the discrepancy between what we see of people on the outside and what they’re experiencing on the inside; between their public faces and their private realities; between their visible swagger and invisible pain. Parts unknown: That was true of Bourdain. That was true of Spade. That’s true of every one of us.”

And we should bear that in mind not merely in terms of people’s hidden capacity to self-destruct. We should remember it in our daily interactions, before we come down too hard on people, make hasty judgments about their motives, shrug them off too easily or let ourselves be drawn into fights.

The person whose aloofness, arrogance, passiveness or combativeness frustrates us to the point of complaint: We have no idea where it’s coming from. We have no idea what that person might be going through. And the impossibility of knowing his or her interior from the surface recommends more patience and compassion than we often muster.

Heartfelt, even if neither Bruni nor Krugman has any credentials or experience dealing with suicidal people. It’s nice to opine about the invisible pain that these people might or might not be feeling. In truth, we do not know what they were feeling and we do not know if their feelings were the authors of their actions. When you talk about the fact that the listed suicide victims were all very successful, you are also intimating that they died because they worked too hard or succeeded too well. Is this the message you want to put out? And you are also suggesting that they really needed a perfusion of faux spirituality and deep meaning, the kind offered by psychiatrists. 

And  yet for all we know, psychiatry might have been the problem, not the solution. The feelings that might have led to the suicide might have been induced by psychiatry or even by psychiatric medication.

Moreover, and perhaps more pertinently, especially in the context of my post yesterday, we do not know what medications the named victims were or were not taking. Suicidal ideation is a risk factor in some psychiatric medications. As long as we do not know about the psychopharmacological aspect of their problems, and the extent to which biochemistry provoked self-destructive thoughts, we do best not to opine on why someone committed suicide.