by Jane Engleman
There has been another suicide in the Pasadena area on the Gold Line train tracks. The tracks are clearly marked with anti-suicide messages and it was in broad daylight. Eight people jumped off Suicide Bridge last year. Last week, a student parked his car at Pasadena City College, mixed some chemicals and suffocated himself. Why, when there is a counseling center at PCC with excellent staff? Why, when there are numerous mental hospitals, clinics and community mental health centers in Pasadena?
At the Crisis Point
One solution to this Crisis Point is an emergency space in Pasadena that is caring and helpful. As it is, a person who has reached the crisis point when they are having to make a DECISION to stay alive have the unattractive option to call the police. People in emotional pain are not criminals. We need responsive emergency measures which include the use of peers who have been through crises.
The Pasadena HOPE team used to consist of one police officer. Groups of officers in uniform are sent to “coax” someone down off Suicide Bridge. It is like trying to encourage a cat into a shelter with a broom. The levels of rage, fear and discouragement soar.
Furthermore, people who are in emotional trauma cannot be treated like a any other medical emergency. We must take effective psychological measures. It is only value-added that if we learn to treat all persons in crisis as humans, accident victims will also receive better psychological treatment, but today I want to focus on the person who has had so much mental and social trauma that he or she has begun to opt to jump off a thirty-foot bridge, shoot herself or stand in front of a train. People who have not yet made that choice may show up in an emergency room. Look at what happens when someone goes in with extreme emotional distress to the emergency room.
There are teams of doctors for cardiac arrest and car accidents. There is a social worker for suicide crisis. First, you are asked if you are suicidal. Not, “Are you in pain, do you need help?” It is as though you are being asked, “Are you going to be a nuisance today and kill yourself, leaving a body to clean up?”
You are encouraged at the Emergency Room to admit that this is just a false alarm. You are repeatedly questioned if you are going to cause a problem with a suicide or not. If you finally say, “Yes,” then you are admitted. You will sit on a gurney for five to ten hours while the real crises around you are cleaned up. If you try to leave, you will have guards placed on you. You may be handcuffed. The lights are bright, and the noise is terrible. You have decided to try to get help, but there is no help. You have your demons to talk to. There is no available support group of people who have found a reason to sit up, stand up and walk on after it seems there is no hope and no future. TRAUMATIZED PEOPLE NEED TO BE ACCOMPANIED, and not in spaces surrounded by bright lights and yelling technicians. People need to talk, in any halting manner that they can.
If you do not have the right insurance, you will be whisked away by ambulance to one of the Bad Hospitals. These are several hospitals and jail wards in L.A. and Orange County to be avoided at all cost.
After several hours, if your insurance is intact, you will be sent to the hospital mental ward, where you will be told, “Remove your shoe laces and your belt. Sign this form.” If you are admitted to the mental ward, you will be placed in a room and left there. You may or may not be given food. You will spend the night with your demons and the screaming in the hallway. The next day, the questioning will begin. “Are you still suicidal?” Not, “What happened to bring you here?” It would be better to ask a survivor of severe trauma questions like, “What are the things you think you need to stay alive? What resources do you think would help you want to begin the process of living again?” You came to the hospital seeking an ALTERNATIVE to suicide. GIVEN A CHOICE, PEOPLE CHOOSE LIFE.
The questioning continues. “Are you currently considering suicide?” If you say, “Yes,” to that question, they can keep you in this place of screaming for three days. The question continues, “Are you still suicidal?” If you say, “No, I am no longer suicidal,” then they will say you are in denial. There is no right answer; they have decided that, to force you to want to stay alive, they will keep you in the place of screaming for two weeks. During this time, you are forcefully encouraged to take drugs for two weeks that will make you think you are okay. Then when you come out, you can then behave appropriately, go back to school and get to work, possibly on drugs that will make you constipated or vomit or make you so dizzy you are unable to drive.
There are many books that have been written, on every level, by people who have suffered unimaginably and went on to do things. An appropriate offering for a trauma survivor might be, “Here is a book that talks about mental suffering. Would you like to take a walk and talk about it?” It is incredibly helpful to express some of the pain in the presence of others who are also experiencing pain. One question could be, “Can you paint a picture of the pain inside? Can you write me a letter and tell me what you want me to know right now?” Massage therapy and acupuncture is extremely helpful for persons experiencing psychosis.
If a person was suffering from bipolar disorder, if you are experiencing sustained trauma, or if you have more than one trauma in your life, it would take a tremendous effort to return to an emergency room for treatment. Unless, of course, you really, really, do have a compulsion to want to stay alive in spite of everything!
People do not have to come to the Crisis Point in the droves that exist now in our emergency rooms. People can be healthy. Quality health care includes every person in both the public and the private sectors, from peer-run support groups and continual trauma-based psychotherapy and CBT. Medicine should be offered after careful counseling by a competent psychiatrist and by consent of the person. Competent psychiatric treatment emphasizes individual choice and the fact that crises can be managed on a maintenance level in groups. The effectiveness of the arts, writing and music are unequivocal. Voluntary, termed residential treatment programs are being discussed.
Alleviating Suicide in Pasadena
In the meantime, what are the alternatives at the Crisis Point of suicide? The medical model of putting people to bed and stuffing them full of sedatives seems cheap and easy. It is almost easy, if totally ineffective in a person who has suffered trauma. When such a person wakes up in twenty years, will she be well, or continue to need to be sustained?
Suicidality, just as cardiac arrest, is crisis. It requires its own effective modalities of treatment.