Suicide Prevention: Trust Pulled Woman Back From Brink

PHOTO: Portrait of Dr. Joseph Shrand. Acknowledging suicidal tendencies and giving value and respect to a person go a long way to preventing tragedy.

Editors' Note: This is the second of three stories featured during National Suicide Prevention Week to explore not only what motivates people to kill themselves, but to highlight those who survive suicide attempts, witness them or work to prevent them.

When Jan finally got psychiatric help for her depression at 34, she had been hospitalized twice for cutting and purging and had made multiple suicide attempts.

She held many dark secrets, including sexual abuse as a child, a violent husband and a "difficult" daughter that she couldn't manage to love.

After a variety of treatments failed, she plunged into despair so deep, she held a gun to her head, ready to pull the trigger.

"I was completely numb and in so much emotional pain," said Jan, who did not want to use her real name. "I had so many flashbacks that seemed so real to me, and I wanted them to go away. I thought my life was totally worthless."

But that rock bottom was soon to be her turning point for recovery when Jan's psychiatrist, Dr. Joseph Shrand, demonstrated his respect and trust for her.

"I see myself as a survivor," said Jan, who is now 54, remarried and living in Kentucky.

Though she has "good days and bad days," Jan is no longer on medications and the suicide urges have waned. And when the dark moments come, she seeks help.

Broadly speaking, a federal study shows, 8.3 million Americans -- 3.7 percent of all adults -- have serious thoughts of suicide each year; 2.3 million make a plan and 1.1 million attempt suicide, resulting in an estimated 37,000 suicide deaths each year.

Jan credits Shrand, who teaches at Harvard Medical School, for helping her to survive on that critical night when she was ready to take her life.

"The best thing you can give someone is trust and to believe in them," she said.

His novel approach, called Imax, is based on a simple theory that, "It all starts with respect."

Shrand said that studies find that two-thirds of those who think about or attempt suicide never seek help because of the stigma of mental illness.

"They are resistant because they worry about being judged as sick," he said.

The "unpredictability" of mental illness makes people nervous, he said: "It scares us."

From a biological standpoint, Jan's depression can be seen as a coping mechanism to external influences, or domains, over which she has no control, such as her abusive home life and marriage.

"It is always remarkable that people are not doing worse," Shrand said. "The imax approach truly sees people doing the best they can."

Shrand, who today works as medical director for the CASTLE, a treatment program for at-risk youth, met Jan when she was struggling to raise her daughter, a "feisty" 10-year-old.

Her own mother brought them in for a consultation, but Shrand's attention immediately turned to Jan, who was sullen and didn't seem to have much interest in her daughter.

Jan told him that she had a history of cutting, as well as binging and purging her food and admitted she was tormented with "emotional pain."

She was institutionalized in a locked ward after her first suicide attempt. Shrand wrote about Jan in a story, "Lady With a Gun," which is part of a future book: "Jan may not have been mistreated in the hospital, but she did feel very, very alone," wrote Shrand.

There, she fell in love with another patient, but when they were discharged and later married, he beat her and forced her to have sex, once at gunpoint. Eventually, he abandoned Jan and their daughter.

The girl shared her father's blond hair and blue eyes, as well as his temper. Jan could barely summon up the emotion to love her daughter, who was a reminder of the violent and disrespectful relationship.

Eventually Jan became Shrand's patient and after 18 months, they built a trusting relationship, meeting once a week at 9 a.m. As her emotional state worsened, he put her on antidepressants and antipsychotics.

"I was a walking drug store then," admits Jan, who continued to have flashbacks. Her cutting also escalated from just her arms to her thighs and abdomen.

She was briefly admitted to the hospital after a cutting incident took her to the emergency room again. As a result, Jan decided to give up custody of her daughter to her mother.

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