The Mystery Known as Depression, Part 10/12

10. THE BIRTH OF SUICIDE

The Centers for Disease Control and Prevention recently reported an alarming rise in the number of suicides among middle-aged Americans, especially men in their 50s who suffered a 50 percent increase between 1999 and 2010. (MMWR, 2013) Overall, suicide has now surpassed auto accidents as a cause of death in the United States. In developed countries, it now tops cancer and heart disease as the leading cause of death for people 15 to 49, according to the recently released report, “Global Burden of Diseases, Injuries, and Risk Factors Study 2010,” from researchers at the University of Washington. (IHME, 2010) Worldwide, suicide has come to claim more lives than war, murder and natural disasters combined, as detailed in an alarming Newsweek cover story aptly titled “The Suicide Epidemic.” (Dokoupil, 2013) Clearly, suicide has become a major public health concern. Yet, professionals struggle to explain the cause. In a New York Times article about the rising rates, (Parker-Pope, 2013) experts cited multiple possible factors, including the bad economy, increased availability of drugs, and even the unique world view of the Baby Boom generation. The real explanation escapes them because it is hidden in the victims’ remote past.

Suicidal depression is not a different disease but rather a breakthrough of feelings through the gating system. It is an agitated sensation where great and intolerable pain surges forth, having broken through the gates. The system does its best to hold it down but to no avail. Then the attitude arises – “the only way to stop the pain is kill myself.” The need is not to die but only to end the misery. The more severe the depression, the more likely there are to be thoughts of "what's the use of it all." There is a sense that there are no options and no alternatives, leading to a preoccupation with death and suicide. In the worst case scenario, the denouement of the infant’s original drama meant death at the very moment of birth. It meant death then and it means death now through the imprint — that is, the lingering sense of impending doom. The suicide attempt brings the sequence to its logical conclusion— death. In one way, pain establishes a marker for an unfinished sequence that was originally cut short due to its massive load of pain. Our system keeps returning there to finalize and integrate what could not be integrated early on.

It is difficult, perhaps, to believe that birth problems can give rise to suicidal tendencies years later. This is because we are not used to thinking about physiologic memory. Nor are we used to thinking that the most powerful memories we have are those without words; memories of events which predated our ability to understand what was happening to us. As we have seen, the despair during a birth trauma never goes away. It melds into later behavior and exacerbates it. Later in life, adversity provokes hopelessness and despair, a desire to give up, the direct run-off of the birth sequence. “Run-off” is a key concept here because once something in the present resonates with an old memory, we are forced to act out the entire sequence until its logical conclusion. That is why once into the feeling, there is obsessive rumination about death and suicide. The difference is that the newborn can only sense death in a vague way because it has no behavioral options, whereas the suicide case uses death as the behavioral option to end the agony.

Suicide typically involves the run off of the birth sequence in the same way that Pain insinuates itself into sex and carries the sex act out. We saw how, for the parasympath, the birth prototype ended in a near-death experience: death being the only way to end the agony. Being strangled by the umbilical cord or being deprived of oxygen by an overwhelming anesthetic makes the birth struggle agonizing and futile, a sequence with its own irrevocable logic: struggle, suffering, and failure leading toward death. Suicide finishes the evolutionary sequence. The imprinted preoccupation with death occurs in the present while immersed in the past. For those who think about dying as if it were about to happen now – that is, when the current agitation/agony reaches a certain level – it can set off the prototypic feeling. The body is indifferent to the current source of the agitation – the wrenching loss of a spouse. Once the valence of the present trauma is high enough, the old sequence will kick in and then begin its run-off. The result can be death by hanging. Many depressives insist that they could not wake up one more morning in pain. Because they had no idea what was happening or what to do about it, suicide became the logical option. There is rarely a preoccupation with death without resonance occurring, triggering off first-line pain.

Not only does death linger on as a memory in the nervous system, but suicides will often choose a method that reflects the prototype of their birth experiences. So, those strangled on the umbilical cord may hang themselves, or an overdose of pills is chosen by someone who was drugged at birth. Why? Because of the prototype; for a neonate strangling on the cord, further strangling would have ended the agony. Those drowning in amniotic fluid at birth will opt for death by drowning. Case in point: the writer-actor Spalding Gray had a lifetime obsession with drowning. He used to swim in the ocean as far out as he possibly could until the point of exhaustion and then struggled to try and make it back. He killed himself by jumping off the Staten Island Ferry in the middle of the night. I hypothesize that he may have been drowning at birth and the end of the original sequence would be drowning. In other words, I think he died like he was born. This is never to minimize the pain in the present; sometimes it is most devastating and can reach suicidal levels. In Spalding Gray’s case, the actor had a terrible auto accident some time before his suicide and I believe that his high level of pain may have set off the original agony. The accident caused a skull fracture and damage to his frontal cortex, which may have further impaired his ability to repress pain. (Williams, 2004) The current trauma is just the trigger; it is the early pain add-on that is often what can push one into a suicide attempt.

Those who received a massive dose of anesthetic at birth may take an overdose of barbiturates, or they might gas themselves in their garage. And so on. I remember one patient who saved up dynamite; having experienced anoxia at birth, he was going to put a stick to his head and blow his head off so that he wouldn't have one second of pain and hopelessness. He laughs at that now, but at the time it spoke volumes of his desperation. Another patient was obsessed with jumping off a building. During her birth by Cesarean, this person had felt wrenched into space with nothing to hang onto. Another patient, battered and squeezed at birth, obsessed about jumping off a bridge head first.

It's not always the case that the suicide method mimics the birth trauma, of course, but it is often what we discover in talking to and observing our patients. If we want to get an idea about our birth, look at our imagined choice of suicide. Conversely, if we want to know the origins of depression, we might examine the birth epoch. Eventually, we will discover the secrets of our beginnings in life. I state this after treating, observing or supervising many hundreds of patients over decades.

I recently conducted an informal survey in which I asked my patients about their suicide attempts or their fantasies regarding the mode of suicide. Almost without exception the parasympaths chose the passive way out--sleeping pills. They preferred waiting for a slow, sure death. Also, without exception, they were the ones who were drugged at birth. The most drugged, incidentally, would prefer to lie down in the back seat of a car with the motor running and allow themselves to be gassed in death by the exhaust. Another patient, born at home in the freezing winter in Europe where there was little heat, preferred marching out into the snow and letting herself freeze to death. She heard that was the most peaceful way to go. By contrast, the sympaths chose the most active kinds of death: a bullet to the head. One said, "I can't imagine sitting around waiting for death like those who sit in a car." Another sympath said that drowning takes too long and there's too much fright in anticipation: "I prefer jumping in front of a train. It's quick and sure." He was all "smashed up" at birth – total body damage, as he was twisted and turned in order to get out. He knows there was external rotation as he was "presented" in the wrong position and had to be straightened out. Each of two sympaths wanted to blow their heads off with a shotgun, so there would be no wait but a big mess.

Most of my patients had fixed ideas about their suicide that was mirrored in their births, and they never considered alternate ways to die because there was no alternative at birth. (This has been studied at length by a team in Sweden, led by one of my students, Dr. Bertil Jacobson, director of medical engineering at the Karolinska Institute, a leading medical university and research center located in Stockholm.) (Jacobson & Bygdeman, 1998)
Dr. Lee Salk of Cornell University Medical Center undertook a study of adolescents who had attempted suicide. (Salk, Lipsitt, Sturner, Reilly & Levat, 1985) He found that 60 percent of them had three major risk factors occurring simultaneously around the time of birth: respiratory distress, chronic disease in the pregnant mother, and lack of prenatal care for the first 20 weeks of pregnancy. Incidentally, one of the ways we know about the relationship between imprinted pain and suicide is from brain research where several studies indicate that the suicide victim generally has a higher number of serotonin receptors in the brain, but less serotonin activity in the prefrontal cortex where key defensive maneuvers are located. This means less ability to suppress. An extraordinary amount of these receptors were discovered in the blood of those who had recently made suicide attempts; underscoring how the system automatically goes into inhibition in the face of pain. Instead of measuring pain, we measure the repressive forces it provokes. Our study of imipramine binding of blood platelets seem to mirror brain serotonin levels. Interestingly, the greatest risk of suicide is when serotonin levels are at a low ebb; when repression is at its weakest and when the feeling looms near the surface. That is why the depressive has a constant feeling of impending doom and thoughts of killing herself. So long as the gates hold there will unlikely be suicidal thoughts. There is danger when the gates weaken. Because what rises and obtrudes are those very same hopeless feelings hidden in the imprint.

The run-off of the birth sequence remains true to itself and usually does not deviate. When a present-day event is strong enough – such as the death of a spouse or loss of a business – it may trigger off the birth sequence, and then the action of the person is predictable. One might wonder how it is that the loss of a business, no matter how grave, could lead someone to try suicide. It is because the early trauma has infiltrated the adult's behavior so that he cannot distinguish between past and present. The person tries everything to keep the business going, even though logically it should have closed down long ago. Finally, it becomes a hopeless situation and great despair is felt. One of my patients continued pursuing a lawsuit although he was advised that loss was inevitable. He fought and fought and then lost everything, all the while accumulating debt for more lawyers’ fees than he could ever hope to pay, which provoked a deep depression. He had many sympathetic features – not recognizing defeat or obstacles when they were apparent – until he could no longer run from the truth. The original truth he ran from was death, which lurked just behind his continued struggles.

When confronted in adult life with no more options, when one has lost one's means of livelihood, a spouse or child, or when one's friends have turned away, one will tend to follow the prototype to its logical conclusion. When there is no one to help and give support, no one to understand and be encouraging, death seems the only way out. The great problem is that the person never knows where the agony comes from. "It is just such a comfort to know that I can end the pain whenever I want to," remarked one of my patients who was obsessed with death. She did not conceive of and could not adopt new approaches, such as moving to a new city, finding another mate or job, because the imprinted lack of alternatives confines one’s vision and imagination within its boundaries.

There are levels of futility that build with each trauma when we are young. Losing a mate at the age of 30 is simply the last straw if we suffered a similar trauma – the loss of a parent – as a young child. The force of this accumulated primal pain can reverse the most basic tendency of life – survival – and make anti-survival (suicide) seem logical. The survival instinct can only be defeated when one's psyche is so damaged that the instinct for life reverses itself, and death becomes the goal. Suicide is the option of an organism that has been defeated by life, by experience. It is the logical act of an unloved (ruined) organism, of a childhood so bereft of warmth, caring, kindness and, most of all, hope, as to be non- recoverable. It is saying: "Nothing that I can do now will work. Nothing will take me out of pain. Nothing will make me feel loved and wanted. There is nothing more to do, no more act- outs, no more hope." Then there is suicide, the ultimate act of self-destruction – destruction of the self that hurts.

So long as there is a flicker of hope, death can be avoided. But if the ex-spouse files for divorce and plans to marry someone else, the last vestige of hope is gone. It is shattering when a mother leaves home and deposits her child in the hands of a tyrannical, drunken father or an unfeeling stone of a man who has no emotional reactions to anything. If that child grows up and is again abandoned by his wife who runs off with someone else, the combined pain will be overwhelming, making the agony fatal. For the child there is no logic to it. He can't imagine life going on because, in his feelings, he is still the wretched young boy all alone, helpless, alienated -- hopeless. We can, as therapists, give hope to the adult, but the little boy inside the man is still there, hurting.

Even a glimmer of hope can make the difference between life and death. Look at movie stars such as Marilyn Monroe who seem to have had everything, including adoring fans, and still felt completely unloved and miserable. They don't need more love; after all, the love of a million people isn’t lacking. Although this may seem counter-intuitive, what they need is to feel unloved...by the people who counted in their lives – their parents. This is key, because re- experiencing that feeling unblocks the system and is liberating. If we bring the mother of a suicidal patient into a session and she hugs and kisses him all the way through, it will make no difference. But if he lets himself feel completely unloved by her it will make a great difference. Feeling unloved unlocks the defenses that can let love in. And the result of this reliving is a lowering of cortisol levels and a normalizing of vital signs.
People who attempt suicide just don't know what to do anymore to live. They want to end the suffering; but since it is the self who is suffering, the choice is to end life. If they could be promised an end to the suffering, they would not want to die. What hurts is not feeling. The hurt is the clash between upcoming pain and the defenses pushing it down. Once into a feeling there is no more hurt; it is now a feeling.

In order for the person to continue to believe that there is a reason to stay alive, to not revert back to suicidal thoughts and planning, she must eventually feel, in a proper therapeutic setting, the original feelings which underlie her hopelessness. The patient must separate current feelings of loss and sadness from old feelings of despair. Giving hope alone without the patient feeling the hopelessness is not curative. It’s only superficially helpful. But in the experience of hopelessness lies the ability of the person to end depression and suicidal tendencies. "Well," one might say, "I've been feeling completely hopeless about losing my girlfriend. That should be enough." Not so; the hopelessness must be felt in its original context, otherwise it is not curative. It is only palliative. It is the original feeling that is stored away and must be brought to consciousness so that it won't be triggered off anymore.
Hope lies in the original hopelessness—felt in a safe, warm atmosphere. After a person has felt the complete hopelessness from early on, it becomes automatically transmuted into hope. No one needs to offer any more hope to her. The person is on the road to health where it is less difficult to live than to kill oneself. The hope she now has is reality, not some fantasy.