Over the line, mark it zero

[DudelyBear]

Dudes, I'm at a loss. What should have been a strike rolled right into the gutter, I didn't even have a chance to pick up the spare. A little background before we roll into things; I'm a Behavioral Health Technician in the Navy, which means I work with shrinks of all shapes and sizes(psychologists, social workers, psychiatrists). The vast majority of the population I deal with is between the ages of 17 and 21, so lots of Urban Achievers just setting out into the world, most of them just now having to face the fact it's already the 10th and rent is due. The number one thing these kids are seen for is homesickness or problems adjusting to a new lifestyle. Sometimes they come in and tell us that they're thinking of suicide, but most of the time what they really want is to get out of the military. Occasionally though we get a big toe in the mail, someone who really is at risk of harming themselves and we catch it before it happens. But every time there's a sign, something I can call out to keep them from stepping over the line. I feel like I'm losing my train of thought, so I'll get to the point.

I recently had one of these young people come into my office. He was quiet, seemed down, but nothing out of the ordinary. I talked with him for about an hour not getting much out of him, but one thing he kept to was that he didn't want to hurt himself. Now I'm used to following lots of threads, lots of ins and outs, and this kid seemed pretty normal. He didn't want to speak with my docs, all good women and thorough, and he told me time and again he was ok, just stressed and homesick. Like I said earlier, I see that a lot. So after asking everything I could, I did what I do with all of my patients like him: I gave him our card, told him about the other services available to him and that we're here anytime he needs to talk, and sent him on his way after asking one more time if he was going to hurt himself. Once again, he said no and he would come see us if he thought about it.

Two days later we get a call about a student who offed himself in the barracks. Turns out it's the kid who came to see me before.

It's been a couple of weeks, but it still pops into my head. This is first time in 4 years I've let someone step over that line, the first time I missed something. I feel like I fucked a stranger in the ass and it's made me question myself and my abilities. We pulled a Brother Shamus and looked at his record, he had seen a psychologist before and reported the same things to the doc he did to me. Logically I know that if a PhD didn't catch anything, how could I be expected to? But that's just not how it works, is it? Hind sight is 20/20, everything seems obvious to me now. It doesn't stop me wishing for a time machine though.

Sorry for rambling Duders, thanks for hearing me out.

[jgiffin]

That's shitty, man. But you can't save everyone. Particularly those who won't meet you halfway. You clearly did all you could - the rest was on him. Keep caring and helping those you can.

[BikerDude]

Don't beat yourself up over it.
His life was not in your hands Dude.

[Brother D]

That's a real bummer, mang. It sounds like you did what you could, no reason to blame yourself. Take 'er easy, dude.

[StAugustineDude]

It's a really shitty hand to be dealt Dude, but it doesn't sound like there were any signs, or indications that things would lead where they did.  You've done what you could, and that's all anyone could ask.  Sometimes people are already there, and have their actions set in their heads and there isn't anything anyone could have done to prevent it. The person who really wants to end it and doesn't want help, generally doesn't talk about it to anyone, and I could see where this would be that case.  To the point of even attempting to deceive you about his intent.  You cant hang on to it man, it's not your bag to hold.

[Reverend Al]

It's entirely possible that you didn't miss anything because there was nothing to miss.  Speaking from personal experience with clinical depression, I got very good at putting on the "party face", i.e. pretending that nothing was wrong.  I did it for years--well over two decades, in fact--and nobody knew.  Not my parents, not my closest friends, not even my wife; she knew I was "moody" and could tell when I was feeling a little "down", but didn't realize the full reality of it until much later.  And I never talked about it with anybody until I was in my mid-30s and my wife and I became friends with a woman who saw through my "party face" because she had dealt with it herself and did the same thing.

The fact that this young man reached out in the first place is significant, but unless he had completely opened up to you there would be no reason for you to suspect he was different from the other young men (and women, I presume) you've spoken with.  Also, when you saw him he might have been having a "good" day ("good" being a comparative term in this context) and felt like talking a little, but wasn't ready to be completely open.  But two days later...who knows?  Clinical depression is irrational and illogical and, in my experience, doesn't require any triggers; you can be having a good day and, for no reason whatsoever, it suddenly feels like someone has dropped a lead overcoat over your shoulders.

That being said, hindsight is nonsense.  If there was anything to notice on the day, you would have noticed it.  Again, some people who suffer from clinical depression are very good at hiding it.  The fact that he'd seen a psychologist before means he knew what you would look for, which means he'd be even better at hiding those things from you.

Above all, you need to know and believe this is not your fault.  You could have taken the most extreme measures available, and if he was determined to "step over that line" he would have regardless of any intervention.  If there's something to be learned from this, learn from it and carry on; that's the best thing you can do.

[DudelyBear]

Thanks for the words, dudes. I took a nice, long soak in the tub last night and threw on some whale music (actually I just took an hour long walk with my headphones in) and took the time to really process things. I can honestly say I don't feel as responsible or guilty, and I think a little bowling will bring me back to Dudeness.

[Reverend Al]

By the way, welcome to the forum DudelyBear!  Bar's over there.

[RustyMarmot]

Maybe the final straw didn't happen until after he met with you.  Double white Russian, and a plate of bacon sitting at the bar for you. 

[RandoRock]

More times than not the ones who are turely suicidal are the ones that hide it the best. You spoke with him and gave him an outlet to express his feelings, he chose to keep them to himself and take another route. There is nothing you could have done in this situation beyond what you did do. The happiest person I ever knew blew his brains out after the company Christmas party this last year and all of us were left with the same feelings and questions of what could we have done to stop it, but the sad fact is there isn't anything anyone could of done. It's a raw deal but it's not you or anyone else's fault.

[PriorRestraint]

It's been a couple of weeks, but it still pops into my head. This is first time in 4 years I've let someone step over that line, the first time I missed something. I feel like I fucked a stranger in the ass and it's made me question myself and my abilities. We pulled a Brother Shamus and looked at his record, he had seen a psychologist before and reported the same things to the doc he did to me. Logically I know that if a PhD didn't catch anything, how could I be expected to? But that's just not how it works, is it? Hind sight is 20/20, everything seems obvious to me now. It doesn't stop me wishing for a time machine though.

Sorry for rambling Duders, thanks for hearing me out.

Hey dude, I'm a clinical psychologist who works with people all day in that age range. I've been there. I've had patient kill herself after our work together, and those doubts and what-ifs can really haunt you if you give them that truth/power.

I agree with what the other dudes have posted. It sounds like you did all you could, but at the end of the day, that amounts to creating a space where if someone wants to open up and do the hard work of facing themselves, they can. But if he couldn't, or didn't want to, there's nothing you can do to force him.

Focus on all the people you've helped and supported. Only in the mental health field do medical personnel hold themselves soooo responsible for deaths. These are medical conditions with mortality rates; people will die. I've never heard a cardiologist hold himself to a zero-tolerance standard for saving every patient.

Just abide dude, and if you want to chat or message off board, let me know your details and I'll be in touch.