Patti Smith

Chapel of the Chimes: Death, the Son

There is but one truly serious philosophical problem, and that is suicide. Judging whether life is or is not worth living amounts to answering the fundamental question of philosophy.
The Myth of Sisyphus, Albert Camus
If temperamentally we are on the depressive side, we are apt to be swamped with guilt and self-loathing. We wallow in this messy bog, often getting a misshapen and painful pleasure out of it. As we morbidly pursue this melancholy activity, we may sink to such a point of despair that nothing but oblivion looks possible as a solution. Here, of course, we have lost all perspective, and therefore all genuine humility. For this is pride in reverse. This is not a moral inventory at all; it is the very process by which the depressive has so often been led to the bottle and extinction.
— "Step Four," Twelve Steps & Twelve Traditions, Alcoholics Anonymous
But suicides have a special language
Like carpenters they want to know which tools.
They never ask why build.
— Anne Sexton

“In a clinical setting, assessment of suicide risk must precede any attempt to treat psychiatric illness or prevent suicide. Asking a patient directly about suicidal thoughts or plans is an obvious and essential part of history taking. In addition to an individual’s stated plans about suicide, there are other major risk factors that need to be evaluated: the presence or absence of severe anxiety, agitation, or perturbance; the pervasiveness, type, and severity of psychopathology; the extent of hopeless- ness; the presence or absence of a severe sleep disturbance or of mixed states; current alcohol or drug abuse; ease of access to a lethal means, especially firearms; lack of access to good medical and psychological treatment; recent severe causes of stress, such as a divorce, job loss, or death in the family; a family his- tory of suicidal or violent behavior; social isolation, or a lack of friends and family; close proximity to a first episode of depression, mania, or schizophrenia; and recent release from a psychiatric hospital.

[...] Suicide usually requires multiple 'hits'—a biological pre- disposition, a major psychiatric illness, and an acute life stress—but only some of these 'hits' are amenable to change. There is, for example, relatively little a doctor can do to control many of the major stresses in a patient’s life: they occur too randomly, and thus are difficult to predict and even more difficult to govern.” [3]

“While depression is by no means unknown when people stop drinking, it is usually on a scale that is not menacing. But it should be kept in mind how idiosyncratic the faces of depression can be.

It was not really alarming at first, since the change was subtle, but I did notice that my surroundings took on a different tone at certain times: the shadows of nightfall seemed more somber, my mornings were less buoyant, walks in the woods became less zestful, and there was a moment during my working hours in the late afternoon when a kind of panic and anxiety overtook me, just for a few minutes, accompanied by a visceral queasiness--such a seizure was at least slightly alarming, after all. As I set down these recollections, I realize that it should have been plain to me that I was already in the grip of the beginning of a mood disorder, but I was ignorant of such a condition at that time.

When I reflected on this curious alteration of my consciousness --and I was baffled enough from time to time to do so--I assumed that it all had to do somehow with my enforced withdrawal from alcohol. And, of course, to a certain extent this was true. But it is my conviction now that alcohol played a perverse trick on me when we said farewell to each other; although, as everyone should know, it is a major depressant, it had never truly depressed me during my drinking career, acting instead as a shield against anxiety. Suddenly vanished, the great ally which for so long had kept my demons at bay was no longer there to prevent those demons from beginning to swarm through the subconscious, and I was emotionally naked, vulnerable as I had never been before.” [1]

“He began having trouble sitting down. After only a few minutes in the chair the blood inside his legs would thicken. His thighs would become tight and hard until he couldn’t feel them. When he tried to stand he would often fall unless he waited posed and frozen like a urinating dog to let the platelets loosen up and flow back through his body. The mornings were the hardest. Sometimes getting out of bed took longer than the increasingly spotty sleep itself.

He went to the doctor. The doctor didn’t look at him, but rather beside him, even when he spoke, like there was someone else there he couldn’t see.

‘You’re getting older,’ the doctor said to the almost empty space. ‘Your shape is changing. It’s nothing new. All those years of food and sun and work, they’re all crammed in there, thrumming in your body. This will go on till you die.’

The walls seemed very near around them, white and edgeless.

‘And it doesn’t get better. It gets worse,’ the doctor said. ‘No matter how much you do, there’s always more you haven’t done. Those masses of inaction become trapped inside the brain and incubate and cloud your sense of self. So that by the time you start to feel you understand how or who you are or where or what you’ve been, that person is already gone. It’s happening to everybody, always, even now.’” [2]

"The doctor wrote out some prescriptions — pills for the morning, pills for night. He told him to exercise more, and to rest more.

The pills didn’t help. No matter how much he took or how often, at night when he got home and tried to sit, he found his blood continued thickening, getting harder even faster than it had before, his legs staying numb even longer.

It never happened at work, during the hours he’d have been just as glad to not be able move through. It was only when his time belonged solely to him that his flesh seemed to have decided doing nothing was better than doing anything.

Soon it wasn’t just the legs. He felt the blood begin to cluster in his ribcage, in his shoulders, up the inside of his face. He felt it pulsing in his jaw, lapping at his skull. The more he tried not to let it bother him, to focus elsewhere, the faster it gathered, the more deeply in his body it would reach. As long as he kept moving he could stay clear, though often even standing too long in the same place made his blood begin to stick.

He did his best to keep himself busy, doing stretches, drinking caffeine, eating the pills. But still he’d get hung up bending over to take the paper, putting his shoes on. It was becoming very hard to read a book or kneel to pray." [2]

"Over time, he seemed to have less and less control of what he was doing. He watched himself eat food he did not want to eat, read books he did not wish to read, go places even knowing he’d much rather have been most any other place. Colors would sometimes fill his vision, obscuring what parts of the world around him he could see. The colors looked like splattered paint, then like decades of sky stacked on top of one another, each with its own earth underneath it. The time the colors lasted grew a little each time, as did the amount of time required to make his body remember how to move.

He began to walk to work. He was always late then, and always sweating. He couldn’t find ways to make his mouth say what he meant. The blood seemed to cave in over his thinking, gathering intensity and definition the more he thought. It grew harder to remember where he’d been, which room in the house led to what other room, how many years he’d been alive. What clear thoughts he did have were almost worse; he imagined home invasions, fires, earthquakes, knives flying from the sky, against any of which he, held there in the increasingly long bouts of immobility, would have no defense and no escape.

He called to set up another appointment with his doctor and was given a date three weeks in the future.

By then, whole nights would pass with him unable to move. He could still feel his brain inside him thinking, waiting for the blood again to turn him loose, but the way time passed while he waited didn’t work right. What felt like a half an hour would by the clock’s word be five, then 15, day’s date shifting like a frail panel underneath him." [2]

"The time he could manage to keep moving before he gave in to the inertia kept getting shorter, closing the window of what he could cram in to any day. Gaps began appearing in his understanding of how he got from moment to another. He’d be there at the mirror in his bedroom, then he’d be tending to the lawn or, having climbed up on the roof once, shouting at no one. Bruises appeared on his arms and thighs. He had a new haircut. He’d bought a pickaxe. He was walking slowly through the mall. There’d be other people sometimes, though he couldn’t understand what they were saying.

At some point he tried to write down what was happening to him but the words that came out didn’t seem like what he meant.

Each time he sat or lay down it was with the understanding this time might be the last, that when the final sliver of the difference between who he had been and who he was now wholly vanished, he wouldn’t know enough to notice, nor would anybody." [2]