Suicide and the Doctor-Patient Relationship

After almost eight years of psychotherapy, it was with disbelief and shock that I learned about Jack's death. I knew immediately that the suicide he had so frequently threatened had finally taken place. After all the years of effort, agony and expense, I had failed. I was filled with grief, guilt and self-recriminations, and reviewed all the steps that I should have taken; I should have known that this time his intent was serious … I should have instituted more frequent sessions … I should have had him call me daily as was my practice … I should have placed him upon some medication. In those hours following my learning of his death, I blamed myself for the act he had taken. And in the intense guilt that I experienced I felt that there would be certain punishment to come. I anticipated charges of incompetence being leveled against me by his family, and public ridicule, notoriety, and perhaps a lawsuit charging me with malpractice. It reached the point in my fantasy where I was having to leave town, shunned like a leper for the terrible act I had committed. I was harsh with myself, filled with self-contempt, feeling guilty at the bubbling anger which I stifled for what he had done to me; and yet almost contrite in trying to devise ways to make amends. I jumped at an opportunity to present a paper on the whole problem of suicide, as an act of restitution. I revived him in fantasies and dreams, momentarily feeling relieved that the dreadful fact was no longer true. For a short period of time I clung to the hope that he had died for reasons other than by his own intent. But the coroner's report left no doubt about what had happened: his blood and gastric contents had lethal quanties of barbiturates. This mixture of feelings of grief, failure, anger, guilt and self-contempt were just those experienced by other therapists, as described by Litman,¹ whose patients had committed suicide.

The grief, guilt and hurt pride gradually subsided, but did not quite totally