On a lazy Saturday morning, my husband Eddie and I were lying in bed, not quite yet awake, when his cell phone rang.
“I’m a friend of Mark’s,” the caller said. Mark was a therapist Eddie and I had seen for a decade, as a couple and individually. “I’ve been asked to call his patients. I’m sorry to tell you Mark died yesterday.”
“Oh my god, what happened?” Eddie asked.
“He’d been very depressed.”
Eddie paused. “Wait, he killed himself?”
We were stunned. Eddie wanted to talk, but I couldn’t. My mind was a flush of conflicting emotions, all jumbled together—sadness, shock, panic, and horror.
I also felt angry and betrayed. I’d felt so close to him, put so much trust in him, and I thought this undermined everything. I didn’t know him at all anymore, and thought he'd been doling out advice when he couldn’t handle his own problems. I wondered, if my therapist couldn’t hack life, what chance did I have?
It was not an offhand question. In my 20s, despondent over a breakup, I shoved a revolver in my mouth, set on pulling the trigger. I put it down after thinking about the people I would hurt, namely my family and friends. I vowed to seek help and entered psychoanalysis. It was then that I came to terms with the reality that I would probably spend a lifetime battling depression.
By the time I met Mark some years later, I had seen a few therapists. Some were great. But Mark was outstanding, willing to stretch the boundaries of a traditional therapist/client relationship. He opened himself up to his patients by sharing some details about his personal life, as a friend might, when he thought it would build trust and assuage fear. In seeing his struggles, he believed that we as patients could better put our own struggles in perspective. He was there to guide us, as one of us.
Mark had gone through a divorce, which, I sensed from the anecdotes he told, was brutal on him. When Eddie left for a three-month residency in Arizona, I felt abandoned. Mark talked of how he missed living with his ex-wife and daughter.
Here was a man coping, we thought, working his way through a major life crisis. Eddie and I were rooting for him. I’m sure his other patients were, too. And then, just like that, he checked out of life.
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Maybe Eddie and I should not have been so shocked by Mark’s suicide. As it turns out, doctors have the highest suicide rate of any profession. The number who take their own lives (28 to 40 per 100,000 people) is more than twice that of the general population (12.3 per 100,000). And among all the medical specialties, psychiatry ranks close to the top. One study by the American Psychological Association (APA) showed that nearly one in five psychologists (18 percent) reported having suicidal thoughts while confronting a personal or professional difficulty.
The loss of a therapist under any circumstances—but particularly from suicide—can be especially acute. “Losing a therapist to suicide is sadly not that uncommon,” said Charles Nemeroff, professor and acting chair of the department of psychiatry at the University of Texas Dell Medical School. “The data is pretty clear that this is an at-risk group of individuals,” he says. And while they may do well treating others’ mental issues, they’re slow to seek help when they need it. Many don’t. "Doctors are terrible patients.”
Also, stress is built into the job. “You see patients from eight in the morning until five in the afternoon. It's a solitary practice. The patients come in, 45 or 50 minutes, five days a week,” Nemeroff said. “They're pouring their heart out to you.”
Many patients respond well to counseling, and that can be rewarding for the therapists treating them, but many also do not. “In the same way that cancer doctors have to deal with losing patients, psychotherapists, psychiatrist, psychologists, social workers—all mental health professionals—have patients that don't do well. We lose patients to suicide. It's tough dealing with it.”
When it’s the therapist who dies by suicide, Nemeroff explained, it’s natural for their patients to feel anger and betrayal. “The patient-psychotherapist relationship is a very intimate and special one. It becomes a microcosm of all of one's relationships. Losing a therapist to suicide is tantamount to losing a family member or a close friend. This is someone who knows the most intimate inner thoughts that you have,” he explained.
A loss to suicide can be especially difficult for some clients. “Some people come to therapy partly because of fears of abandonment. So, what could be worse than having your therapist abandon you by killing himself? The cornerstone of the relationship between a patient and a mental health provider is trust and intimacy. The ultimate breach of that contract is a suicide,” he added.
It’s been a year and a month since Mark’s suicide. In that time, my perspective has changed dramatically. The anger and feelings of betrayal are gone. Now, I miss and admire Mark.
Thanks to him, I’ve become a more compassionate person. I now see that while dealing with his own problems—and very serious problems—Mark found it within himself to give his all to his patients.
What I’ve also come to realize is that we didn’t really know Mark at all. We just thought we did because of the depth of our conversations and the vulnerability they stemmed from. Do we ever really know a person whose job it is to help us, beyond what they want us to know? But in any case, my faith in the process of self-discovery is stronger than ever.
I’ve started seeing a new therapist named Amy, who also believes sharing details about her life can help the session space feel safer and build a client’s trust. At first, it was a challenge to open up after what happened to my last therapist. But talking about what’s going on inside my head is vital—Mark showed me that. And I know he’d have wanted me to keep going, even after a loss like this.