Reflections

I recently stood in a grove of cottonwood trees overlooking the Platte River Valley in central Wyoming. It was early December and the thermometer would have a hard time making it into the low 20s that day. But on the high Wyoming plains, the sun is unusually intense, and I felt comforted as I looked out over the river to the mountains gently rising a few miles to the south. Three days earlier, my younger brother sat down under one of the cottonwoods, pulled an antique Colt 45 out of his satchel, and ended his life.

As I stood on the bank of the river, I reflected on having returned to my home town 30 years earlier as medical director of the local private psychiatric hospital. At that time, I was one of only three or four psychiatrists providing care to patients scattered over the entire state of Wyoming. My patients would often drive 100 to 200 miles to receive psychiatric care. At the end of my first year, I had lost 12 patients to suicide, and it had become intensely personal to me. I spent the next 10 years recruiting psychiatrists to Wyoming, in the hope to never again witness such an epidemic of completed suicides.

But on that cold December day in Wyoming, I now more fully understood the pain of both my patients and their families. I was crushed by the intensity of my own loss. In an instant, I had lost both my brother and one of my best friends. My soul was filled with tears, and my whole body ached as I struggled through the ensuing days.

In the aftermath of my brother’s suicide, I have struggled with many very human emotions: sadness, anger, guilt, self-doubt, but most of all the pain of the inexplicable loss. My brother was an accomplished attorney who had become a prominent political figure in both his community and the state. Several months before his death, he answered an early evening knock at the door. As part of a sting operation, he was then arrested and charged with possession of a computer hard drive containing child pornography. For the next three months, the local newspapers, television, and online services relentlessly ran only one picture: my brother, dressed in a bright orange jumpsuit, awkwardly sandwiched between his two attorneys.

In the following months, I spent many hours encouraging him to get mental health care. He eventually was started on antidepressants, but developed severe side effects and quickly stopped them. He had limited access to therapy; but did manage to see a psychiatrist for two sessions, shortly before his death. I urged him to seek help at a respected Minnesota treatment program, but he became more discouraged when he reportedly was told that they “might” have an opening in February.

After his death, I was soon forced to face my own perceived failure to be of help when I got off the plane in my hometown and was immediately confronted by a newspaper headline reading “Clapp Found Dead in Park.” My brother, Larry, had gotten up early one morning, dressed in his finest “going to court” clothes, and driven to the park, where he took his life. Back at his house, he had left a simple note for his wife: “I’ve gone to my rest down by the river. I love you Carla, and I love Sadie [his beloved dog]. Sorry.”

In the end, I believe my brother died not from depression, but from shame. Although this “reflection” is painfully personal, it also is the story of all our patients and their families as they confront the tragedy of suicide. It is a story of depression, anger, shame, guilt, and self-inflicted violence, often complicated by poor access to quality mental health care. It is too often a story of prejudice and discrimination directed toward our patients who frequently have a history of inadequately treated mental illness.

Yesterday, I sat with a patient whose son had recently committed suicide. She looked at me intently and said, “Dr. Clapp, you can never understand what it means to lose a son to suicide.” In my heart, I know that she is right. I also know, however, that as psychiatrists, we have an ethical and professional duty to help develop more easily accessible systems of mental health care, responsive to the individual needs of those at risk. If I can eventually contribute in some small way to this effort, I will have better honored the memory of my brother. As part of that effort, I encourage all physicians, patients, and mental health specialists to bring suicide further out of the shadows and to deal with it more openly as an urgent life and death matter that can cruelly touch any one of us, at any time. ■