Psychologist Margaret Clausen's article "What Remains: The Aftermath of Patient Suicide" is a remarkable account of a clinician losing a client to suicide -- and I recommend it as a first-person report that communicates vital information on several levels.
As literary memoir, it is a tragic, real-life story told in plain language.
"Are you aware of the events related to Jill?"
"No," my heart now pounded from my chest into my throat.
"Jill killed herself by handgun ..."
I do not remember what he said next, just that he was still talking. I gasped, crying, while simultaneously attempting to hide my upset.
And it shares the wisdom of a host of sage voices, from mental health practitioners to poets:
The great Jungian, James Hillman, stated that the suicide of patients is a "wrenching agony of therapeutic practice." It is also a reality of practice that we fantasize will not touch us, despite the statistics.
As an example of bearing witness to suicide loss, it covers the entire landscape. We learn that Clausen has lost two siblings to suicide, and we are given revealing insights into several of her colleague's very profound experiences with clients' suicides.
Todd had 15 years of clinical experience and ... was well versed in suicide prevention and intervention. After his patient's death, he refused to ever work with a patient again who even mentioned suicidal feeling states ... His stance is maintained to this day, six years later.
And it also goes deep, for instance, in Clausen's retelling of how, after the suicide, she did not schedule anyone into her deceased client's appointment time, and eventually used that hour to journal about her experience of loss:
Answering all the questions is not the point of such a process. If there is an aim, it is the recognition that the clinician continues in relationship without her (or his) partner in the dyad.
As a handbook for other clinicians who have experienced a loss, it is a concise yet comprehensive primer, including giving encouragement and caution about sharing one's loss with other practitioners. For example, regarding joining a listserv for clinician-survivors, Clausen writes:
Coming out ... on the [listserv] and in this article are acts of advocacy for other therapists in a direct way, and ultimately also, I believe, advocacy for patients. Coming out in these ways are antidotes to shame as well, although revealing oneself carries with it a chance of being judged or shamed.
As a philosophical reflection, it is superb, for it finds that rare intersection of philosophy and practical application. There are many examples -- including her commentary on mindfulness and ritual -- but most striking to me is the lengthy section "Being with Groundlessness," in which Clausen observes:
There is ineffability ... in this kind of traumatic loss ... The suicide of a patient shatters illusions of therapist omnipotence, shaking expectations of potential positive influence upon patients, and calls into question core identity as well as identity-in-relationship to other patients and colleagues ... It rocks our assumptive world as therapists: questioning whether our endeavors are life giving, whether our efforts possess meaning and influence; and whether our chosen profession is worthwhile.
Finally, I hope that survivors who have wondered about the role of their loved one's caregiver in the suicide and its aftermath read Clausen's brave and penetrating article as a source of insight into the caregiver's experience. My family's experience with my father's caregivers was one of those nightmarish scenarios where, it seemed to us, everything that possibly could go wrong, did, and very badly so. It is now more than 37 years since my father killed himself, and I was reminded by Clausen's testimony -- by her bearing witness -- that there still might be room in my psyche to invite in empathy and compassion for everyone who was touched by the tragedy that befell us.
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