When Therapists Struggle with Suicidality


When Therapists Struggle with Suicidality

Releasing Ourselves from Stigma and Shame

By Stacey Freedenthal

September/October 2021


A phone call at three in the morning comes as a siren, especially when you work at a crisis hotline. I was alone. Newly awakened, lying in a pull-down Murphy bed in the university counseling center, I pressed the phone against my ear.

“I have a bottle of pills, and I want to take them now. I want to die.” Sobs punctuated the caller’s words.

“You must really be hurting,” I said. “Can you tell me more about what’s going on?”

The caller was a graduate student in a counseling field. After struggling with depression for months, she condemned her goal of becoming a therapist as absurd. How could she help others who had mental health problems when she suffered so many herself?

The pain she felt now could be a gift later, once she was a therapist, I told her. It could help her understand, empathize, and be fully present with clients who want to die.

More sobs. More snuffling into the phone. “You really believe that?”

As a graduate student in social work, I had to believe it. Only a year earlier, in 1996, I’d also wept in my apartment late at night, tormented by the thoughts drumming inside my head: People would be better off without me. Things will never get better. Nobody could ever love me like this.

Depression had smothered me for months, and finally, I could bear it no more. Sitting on the sofa in my tiny living room, I sobbed as I wrote a letter to my parents.

Dear Mom and Dad, I am so sorry. I tried. You tried. My friends tried. Even doctors tried. It’s just too big for any of us. It hurts so much. I am so sorry to hurt you like this. (But do think how awful I would be over the years to come.)

The letter listed my bank account, mutual funds, and 401k, as well as the names and numbers of friends to notify of my death. I put the note on my dresser next to a stack of bank statements.

In my boxcar apartment, the living room, bedroom, and kitchen were arranged in a straight line, with no doors separating them, only arched doorways. I didn’t want friends who had a key to my apartment to find my body, so I ran tape across the bedroom doorway and hung written instructions at eye level. Do not go into my room. To spare yourself, call 911 and have them take care of it. I’m so sorry!

All that remained was for me to top off the food and water dishes for my cat and dog. And then, no longer sobbing, with my dog sleeping at the foot of my bed, I tried to kill myself.

Wounded Healers

Our culture has paradoxical expectations for those of us who work in the mental health field. On the one hand, we’re expected to have it all together, to have transcended the problems that we treat in those who pay us for our expertise. On the other hand, we’re recognized as “wounded healers,” an archetype popularized by Carl Jung but created long before him. We are, at once, expected to be perfect and broken, dispensers of sage advice while requiring sage advice ourselves.

Psychotherapists are real people with real lives marked by trauma, loss, illness. Therapists can become submerged in intolerable anxiety, steeped in grief, riddled with obsessive thoughts. Many of us wrestle with the same problems we help our clients tame: psychosis, addiction, personality disorders, suicidal thoughts.

Clinical psychologists and other therapists experience depression and anxiety at higher-than-average rates, according to studies conducted over the years. Bearing witness to others’ suffering can wound the witness, and many people come to the work already wounded. Compared to the general public, mental health professionals report more adverse childhood experiences, such as family violence, mental illness, substance use, and suicide. Numerous books, such as Breaking the Silence: Mental Health Professionals Disclose Their Personal and Family Experiences of Mental Illness, have documented therapists’ membership in the imperfect tribe of humanity.

A significant proportion of therapists have contemplated suicide at some point. Studies of psychologists have found that at least 18 to 25 percent have experienced suicidal thoughts since they began practicing clinically. In a study of therapist trainees attending a suicide prevention training, 59 percent reported they’d experienced suicidal ideation, and 5 percent indicated they’d attempted suicide. There’s some evidence that psychologists, and perhaps other mental health professionals too, may be at higher risk for suicide than the average person, though studies have yielded mixed results.

The myth that therapists are masters of their own mental health makes it especially shocking when one dies by suicide. The very person tasked with helping others resist suicidal urges has succumbed to the same impulses. To some, it may seem as though a salesperson has rejected the product they earnestly sold. What, then, does that say about the product they’d been hawking?

A therapist’s suicide shatters the naïve assumption that therapists are immune to life’s troubles. In an essay for Vice, writer Court Stroud described his experience of losing his therapist of 10 years to suicide. He felt stunned, sad, panicked, and horrified all at once. Stroud wrote in the 2019 essay, “I also felt angry and betrayed. . . . I wondered, If my therapist couldn’t hack life, what chance did I have?”

There’s a sense that a therapist’s suicide negates the wisdom they imparted. Almost 10 years ago, a psychotherapist named Bob Bergeron wrote a book on happiness at midlife. In 2012, just a month before his book was supposed to go on sale, he died by suicide. According to The New York Times, Bergeron left his book turned open to a note he’d scrawled on the title page. He wrote, “It’s a lie based on bad information” and drew an arrow pointing to the title: The Right Side of 40: The Complete Guide to Happiness for Gay Men at Midlife and Beyond. The publisher cancelled the book.

“The myth that therapists are masters of their own mental healthmakes it especially shocking when one dies by suicide.”

The inescapable humanity of mental health professionals, their responsibility to clients, the occupational hazard of witnessing trauma and suffering, and the examples therapists set for others amplify the need for therapists to seek help when they struggle emotionally. But obstacles block many mental health professionals’ path to a therapist’s or psychiatrist’s office. One of these obstacles is stigma.

Professional Stigma

On the phone with the suicidal graduate student almost 25 years ago, I didn’t dare tell her about my personal experiences with suicide. My focus was on her, not me. Still, I like to think that my own experiences with suicidal urges helped me understand, not panic, and speak freely about her wish to die. A half hour into the call, while I was still on the phone with her, she flushed the pills down the toilet.

I presented her case during group supervision a few days later. Like me, almost all the hotline counselors at the University of Texas Counseling and Mental Health Center were graduate students in a counseling field. A psychologist led our supervision, and we sat around an oblong, mahogany table in a conference room as I described the call. When I mentioned the caller’s goal of becoming a therapist, a fellow counselor sitting near me, a doctoral student in psychology, guffawed.

“She’s suicidal, and she wants to become a therapist?” he scoffed.

Another psychology doctoral student interjected, “She needs to go to a therapist, not become one.”

It hurt to hear. Even though none of my colleagues knew of my own mental health challenges, I felt ashamed, exposed, afraid. What if they knew? They might laugh derisively about me, too.

I also felt profoundly disappointed. Of all people, mental health professionals ought to regard people in pain with respect and hope. To regard despair as temporary, not an irrevocable reflection of a person’s skills and intelligence. To honor the possibility that the sufferer could emerge from the crisis with more hope, strength, and wisdom.

In my classes and readings at grad school, in supervision and consultation at my internship, and in my own personal psychotherapy, I was being taught empowering messages: Mental illness isn’t a personal failing. It’s the product of stress, trauma, and biology, not character. Respond with compassion, not judgment. Stigma is damaging and must be called out, defied, dissolved.

Now, I was discovering that many mental health professionals didn’t take their own advice. That day in the counseling hotline office wasn’t the only time I encountered colleagues and supervisors who maligned or spoke insensitively about people with mental illness, especially those with suicidal thoughts or behavior. I heard comments like “People who attempt suicide just want attention.” “He’s being manipulative.” “She’s just borderline.” (Never mind that people with borderline personality disorder have one of the highest suicide rates of any diagnostic group, much higher than those with major depression.)

Stigma fuels these judgments. Stigma brands a person as defective, undesirable, or bad on the basis of a condition or attribute. Research shows that stigma inhibits people from seeking help for psychiatric problems and can worsen such problems by fueling discrimination, isolation, shame, and despair about the scorned condition.

Why do so many of us—including therapists who should know better—stigmatize people on the basis of mental illness, suicidality, or other psychological vulnerability? Nobody knows for sure, but it’s possible that labeling others is a way to manage anxiety. In a world of “us” and “them,” people typically yearn to belong to the favored group, not the maligned, the injured, the vulnerable. The reality is that everybody is vulnerable. The drive to protect oneself from that frightening truth may confer, if unconsciously, comforting feelings of power, control, and protection.

Patrick Corrigan, an expert on stigma related to mental illness, writes that there are two types of stigma: stigma enacted by others—people, media, institutions, society itself—and internalized stigma, which involves feeling shame and self-hate as a result of one’s stigmatized condition. For me, the stigma that others attach to therapists with mental health problems made me fear discovery. Even so, the harshest judgments about my psychological wounds came from me.

Impostor Syndrome

After I graduated from my MSW program, I worked as a psychotherapist for an agency and as an intake counselor at a psychiatric hospital. Almost every time I pulled into the parking lot of the hospital for my shift, I was reminded of my own psychiatric hospitalization a couple of years before I’d started graduate school. There were two versions of me: The me who was once locked in a psychiatric hospital where I couldn’t use the toilet without somebody watching me at arm’s length, where I couldn’t be trusted with shoelaces or a cloth belt for my robe, where I had to wait for a nurse with jangling keys to unlock a door to the world outside the ward. And there was the me who now worked at a psychiatric hospital, free to wear a leather belt around my waist, to speak with a psychiatrist as a colleague, to enter and leave the unit any time with my own set of keys.

It was hard for me to reconcile these two different aspects of myself. One day, weeping on the sofa in my therapist Susan’s office, I told her that I felt inferior. My repeated depressions, which had first visited me as an adolescent, rendered me defective. I was an impostor. It’s not that I felt unqualified: I worried that others would condemn me as unqualified because of my psychiatric history.

“What would happen if somebody called one of my jobs and said, ‘Psst, Stacey Freedenthal attempted suicide and was in a mental hospital?’” I asked.

“Oooh, that’s why she’s so empathic,” Susan said, without hesitation. “That’s what I’d say: ‘Oooh, so that explains it.’”

I cried even harder. Shame had blinded me to what I’d urged that hotline caller to hold in mind several years earlier: Our painful experiences can help us as clinicians to understand, empathize, and connect. It hurt to recognize how hard I was on myself. At the same time, I questioned whether people who weren’t my personal psychotherapist would give me the same grace.

A few years later, as a doctoral student in social work, I made my first pilgrimage to the annual conference of the American Association of Suicidology. In a windowless meeting room at a hotel in Bethesda, Maryland, I took a day-long class on conducting suicide research. At one point, a researcher stood up to ask a question. She complained that her lab’s focus on suicide attracted research assistants who themselves had been suicidal in the past.

“How do I weed these people out?” she asked.

In the discussion that followed, nobody raised the possibility that people with a suicidal history could enrich her research with insights based on their personal suffering and triumphs. Nobody warned her not to discriminate. I’m sorry to say that I didn’t, either.

I couldn’t give people any reason to suspect I had vulnerabilities. I was too afraid to publicly share that, in the false dichotomy of “us” and “them,” I was both “us” and “them.” The judgments I heard from my colleagues taught me an important lesson: Stay quiet. Hide. If you show yourself—your real self—to people, you’ll be laughed at, judged, discredited. Weeded out. After all the years I’d spent studying in graduate school, earning my hours to become a licensed clinical social worker, crafting a new career, and wrestling with my own feelings of shame about my psychiatric history, I couldn’t take the chance.

Hiding the Past

Guarding a secret requires constant vigilance. You watch what you say, what you do, what you reveal. Your subterfuge can keep awareness of your secret uppermost in your mind, a prickly reminder of shame. It’s exhausting. Lonely, too. A vital piece of you is invisible. That’s the point, of course. You hide what you hope nobody will see. Still, at the same time, you ache to be seen and accepted for who you are.

I envied mental health professionals who were public about their own struggles. The psychologist Kay Redfield Jamison, an expert on bipolar disorder, chronicled her own bipolar disorder and suicidality in her 1995 book, An Unquiet Mind: A Memoir of Moods and Madness. She wrote in the introduction, “I have no idea what the long-term effects of discussing such issues so openly will be on my personal and professional life, but, whatever the consequences, they are bound to be better than continuing to be silent. I am tired of hiding, tired of misspent and knotted energies, tired of the hypocrisy, and tired of acting as though I have something to hide. One is what one is, and the dishonesty of hiding behind a degree, or a title, or any manner and collection of words, is still exactly that: dishonest. Necessary, perhaps, but dishonest.”

In some ways, it’s a privilege to be able to hide your mental illness. Not everybody can. Some people might cry uncontrollably in meetings. They might speak with such swiftness and tangentiality that their colleagues or clients grow concerned. They might have telltale scars on their arms. If a therapist visibly struggles, colleagues may worry about the professional’s fitness to practice. Mental health challenges, especially during a crisis, certainly can affect a therapist’s ability to function effectively. But it’s also true that a great many mental health professionals with a psychiatric diagnosis manage just fine—so fine, in fact, that nobody suspects that they struggle now or once did.

I hid my past so well that some people faulted me for not possibly being able to understand what it’s like to feel suicidal. Almost 10 years ago, I created a website, Speaking of Suicide. To date, it’s been visited more than 5 million times, and readers have left 7,500 comments. Some of these comments come from people who regard me as an outsider whose knowledge of the suicidal mind comes only from books, research, and the other side of the therapy couch.

“I truly wish that suicide prevention people could stand in the shoes of the ones that suffer emotional pain for a few weeks and to see how they’d cope with it,” one person commented.

Another addressed me directly: “Yes, you might have read about mental illness. Sure, you may have a degree in whatever. But if you’ve never had depression or felt suicidal, then you have absolutely no right to write an article.”

“When enough people from diverse walks of life disclose their own struggles, the stigma will buckle. At least, I hope so.”

For so long, I’d felt like a fraud for being a therapist with a suicidal past. Now, increasingly, I felt like a fraud—even a coward—for hiding. I saw how sharing my secret could help suicidal individuals reading my site by showing them, first, that I did know of what I wrote and, second, that it’s possible to make it out of the darkness.

Coming Out of the Closet

For a three-week period in the spring of 2017, I was so anxious that I had difficulty breathing and sleeping. The New York Times had accepted an essay of mine about my suicide attempt in graduate school. After so many years of secrecy, I was about to broadcast my past in the most prominent newspaper in the United States.

A secret is like a splinter. It festers beneath your skin. And, eventually, it wants to work its way out. I finally made the decision to come out after I’d finished my book, Helping the Suicidal Person: Tips and Techniques for Professionals. Publishing the book gave me new confidence; I’d proven myself. Now, if people judged me, their scorn would be only a piece of a much larger picture, crowded out by concrete evidence of my competence. My expertise wouldn’t magically vanish once people knew of my past.

Just as not everyone can hide their mental health challenges, not everyone can reveal them. Doing so can jeopardize a parent’s ability to retain custody of their child, an immigrant’s ability to obtain citizenship, a physician’s ability to maintain a license. Though I wish it weren’t true, the risk of being harmed by disclosure is real for many people. As an associate professor with tenure at the University of Denver, I had a secure job. I felt a responsibility to stop hiding.

I see parallels to LGBTQ+ people coming out of the closet. Harvey Milk, the first openly gay supervisor of San Francisco, reportedly said, “I would like to see every gay doctor come out, every gay lawyer, every gay architect come out, stand up and let the world know. That would do more to end prejudice overnight than anybody could imagine.” The same applies with mental illness and suicidality. When enough people from diverse walks of life disclose their own struggles, the stigma will buckle. At least, I hope so.

In the weeks between acceptance and publication of the essay, I was terrified of my colleagues’ reactions once they knew my story. I’d walk down the hall to my university office, see another professor standing by the elevator, and a brick of anxiety would slam into my belly. What will he think of me? Or, What will she say to me? I made an appointment with my dean to tell her in advance about the essay. I worried she might disapprove, and in case I brought negative attention to the school, I wanted her to be prepared.

If any colleagues thought ill of me after the essay was published, they kept it to themselves. Both inside and outside my university, many colleagues responded with hugs, support, and stories of their own hidden depression, bipolar disorder, addiction, and other struggles. Strangers sent heartfelt missives. I heard from people in Germany, Greece, Australia, and throughout the United States: the social work professor with a long history of bipolar disorder, the therapist in her 60s who hid her depression from her peers, the psychiatry resident who felt deeply ashamed after his chief resident had visited him while he was a patient in a psychiatric hospital. People emailed me to say that reading my account helped them feel less alone and more hopeful about their own futures. My dean sent an email to faculty and staff praising my “courage and impact.” She ended with, “I am reminded of Marianne Williamson’s quote, ‘As we are liberated from our own fear, our presence automatically liberates others.’”

What Now?

It’s not easy to kill yourself. I don’t describe the suicide method I used that long-ago night in graduate school, because experts warn not to publish specific details, lest they serve as how-to instructions for vulnerable people. So I’ll say only that what I did made it impossible to breathe.

Somehow, I expected to peacefully drift off to sleep and never wake up. But the body rebels. Deprived of air, my chest and belly heaved with efforts to suck in oxygen. My lungs ached. Panic filled me. Soon, my mind rebelled, too—not the sadistic, depressed part of my mind, but the healthy part. The part that wanted to live. With my hands growing more flaccid and tingly from the loss of oxygen, I frantically rushed to undo my suicide attempt

The next morning, I tucked the suicide note and the sign for my friends into my journal, put the bank statements back into my metal filing cabinet, and called my therapist. In the months that followed, my mood improved with an antidepressant, twice-a-week psychotherapy, mindfulness meditation, and a steady diet of Buddhist readings. And for many years thereafter, I did a lot of personal work to constrain the forces of my mood disorder. I still do.

I kept my story secret for almost two decades, but over the last four years, I’ve shared it many times. Telling my story is an act of defiance against stigma. Before an audience of hundreds in university lecture halls, at conferences, and in media interviews, I’ve talked about my suicidal experiences, my recovery, and the lessons I’ve learned along the way. I don’t volunteer my history to my clients, but I do answer questions if asked. (So far, precious few have asked.)

A couple of years ago, in the living room of somebody’s elegant home, I gave a talk in Denver on chronic suicidality. Students and professionals sat on the arms of sofas, on the floor, and on folding chairs as I dispensed clinical tips on countertransference, power struggles, and self-care when working with a client whose suicidal thoughts persist for months or years.

Afterward, when almost everybody had left, I went to the dining room and scanned what remained of the potluck refreshments. I was alone, at first. Then, as I put a brownie and a couple strawberries on a paper plate, a young woman approached me. She introduced herself and told me in a hushed voice that, a year earlier, she’d experienced depression and suicidal thoughts. A graduate student in social work, she’d worried her mental health troubles disqualified her from becoming a therapist.

One day, she told me, she’d been in the shower with the radio on when she’d heard a Colorado Public Radio interview with a therapist discussing her challenges with depression and suicidality, along with her recovery and her career as a mental health professional. It was me.

“I couldn’t believe what you were saying,” she said. “I turned off the water just to make sure I was hearing you right.”

Learning my story gave her hope, she told me. She thanked me for sharing, and as we hugged, a quiet joy spread through me. It’s true, what Marianne Williamson wrote: As we are liberated from our own fear, our presence automatically liberates others.

***

Stacey Freedenthal, PhD, LCSW, is a psychotherapist, consultant, writer, and associate professor at the University of Denver Graduate School of Social Work. She authored the book Helping the Suicidal Person: Tips and Techniques for Professionals, and she’s currently writing a self-help book for loved ones of people with suicidal thoughts.

ILLUSTRATION © ILLUSTRATOR SOURCE/KARI VAN TINE



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