Opinion | The Candle Singed the Moth of Suicidology

Note to readers: I have appreciated the psychological mindedness, rhetorical traps, and other occasional acerbic comments you have taken the time to post in response to my columns.

My Jan. 18, 2022, article “Is There a Case for Anaphylactic Suicide” has received 11,447 pageviews to date. I was clearly astonished to receive this news. Perhaps personal and professional ego drove the reader to overcome my caveat: “This article may make your brain hurt.” I prefer to think the title kindled an intellectual curiosity about IT (imminent self-toxicity). In so doing, many readers may have shared the belief that answers, or at least a creative concept, could be found in unexpected places where questions have not yet been asked and methods not yet invented.

Therefore, it is time to seriously challenge our beliefs, the public’s beliefs, as well as the beliefs of research and evaluating professionals, that all suicide is either conscious, rational, or a consequence of a mental disorder. Surely, some suicide cases define purposeful and appreciated components. Clearly, depressed persons and unstable personalities are represented in the population of people who have attempted suicide. But not all are defined by these characteristics. If one assumes there is no rational thinking during an unconventional suicidal event where ideation is absent, equivocal, or variable, then it stands to ask, “What are we missing?” “Is more of the old definitions and stale methodology better?”

But surfacing these questions again is not my primary intent here. Rather, in my writing, I have shared that my primary conscious stimulus for entering the field of psychiatry was familial — that is, losing an uncle “with a bullet through his brain.” Other motivators for me, not all of which were inspired by others, included accidental, serendipitous, unusual, and likely unconscious. For example, from my Dec. 11, 2019, MedPage Today article “How I Became a Suicidologist,” I wrote: “Maybe I overidentified with Sir Thomas Willis? Or, simply, I was too proud to ask for help from trusted friends. Or, terribly, a destructive and codified unconscious drive had kindled a deserved and lifeless destructive ride, compounded again and again, into medical oblivion.”

The framework of the poem I share with you below predated my psychiatry training. I completed it (lower case) — the poem — many years later. Intriguingly, young destructive impulses represented the early palmar grasp of the IT (upper case) construct. Now, I more deeply understand that I entered the field to save myself, and after so many years of tribulation, I do “believe” I have a “feel” for this work.

My unusual personal theory is that I am “like a moth to a flame,” irresistibly attracted to improve this field. Hopefully, this will not lead to my inevitable downfall, but my wings have been singed: as Shakespeare wrote, “Thus hath the candle singed the moth.” Indeed.

As I attempt to close this out-of-the-ordinary article, it is well to note that although weary and “singed” in this work, I trust you believe as I do that it cannot be left to untried and inexpert others, untrained in emergency presentations from which many tragedies evolve. I remain sadly reconciled to our country’s insolvability. Its incapacity to change considerably will present a future that does not look bright toward a hopeful comforting of its residents. Yet, it is not quite time for me to go. I continue to celebrate Sir Winston Churchill: “If you’re going through hell, keep going.”

Again, thank you for reading. Your comments sustain me, and occasionally annoy. But the point of commentary is to “challenge and be challenged, and celebrate or be humbled…” (Milton Packer, another MedPage Today contributor). The focal point of my column is to reclaim robust competition, with championing of skills, data, and scientific discourse. I look to readership as attendance in what once was testimony and qualification by fellow professionals. Our patients benefit when we actually meet in discussion and act and argue together, shedding unexpected light on traditional and unconventional problems.

A Suicidologist’s Soliloquy

Created By “Rusty” Copelan

Completed by Russell Copelan, MD

For how can I still better

The storm within my brain

Then place a high brink nearer

And leap to lessen pain.

To write a note intreating help

No, this cannot resolve, the

Swirling ache within the depths

Too weary to absolve.

Yes! I am committed

As persons long before

IT often pulls me by the hair

Not thinking to restore.

The time, the date cannot be met

For impulse does prevail

The circuits scream to take the place

Of me, “consigned to misery” *

*Last three words from Abraham Lincoln’s Suicide Soliloquy

Russell Copelan, MD (Ret.), lives in Pensacola, Florida. He graduated from Stanford University and UCLA Medical School. He trained in neurosurgery and completed residency and fellowship in emergency department psychiatry. He is a reviewer for Academic Psychiatry and founder of eMed International, an originator and distributor of violence assessments.