Suicide of a Patient--The Psychiatrist and Grief

(Published in the Northern California Psychiatric Society Newsletter, December 1998)


This week was a difficult one for me. My normal schedule was interrupted by attendance at the memorial service for a patient of mine who leapt from the Golden Gate Bridge the day I returned from a week-long vacation.

I don't remember being so saddened by the loss of a patient. Throughout the course of most of her treatment, she remained suicidal, despite extensive medication, ECT trials, and intensive psychotherapy. But I had come to believe that the power of our close therapeutic relationship would overcome her pain. When I was told of her death, I was not wholly surprised, and actually felt some relief for her. But when I went to her memorial service, I could hardly believe she was gone, and I felt an enormous sense of loss. My disbelief was so great that I had numerous fantasies of her showing up at my office during the following days because she had not really killed herself.

What surprised me most, was how attached I apparently was to my patient, despite the presumed mastery of "detached concern" I thought was so much part of my professional makeup. After the cermony, the patient's sister and I, not ever having met, mutually embraced, instinctively knowing each other's need for comfort. The sister, who looked and sounded so much like my patient, held on to me, and I to her, and for a moment I thought I was embracing my patient, now in death, the way I knew I never could in life. It was a profoundly emotional moment, a "cleansing" moment, and one which I will not soon forget.

I have re-learned many lessons from this tragedy: the limits of my powers as a physician, the extent of some of my patients' dependency on me, and not the least, the magnitude of my own attachment to some of the people who make their weekly trip to my office. I hope that the peace that so eluded this person in life is with her now, as no amount of my understanding or attention to her psychiatric condition was sufficient to bring her that relief in life.