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Death Wish

After graduate school, I worked at a community mental health center where I encountered people from all socio-economic strata. It was the first time I was exposed to adults who had been traumatized during their formative years.  The  scars they bore were brutal, with healing requiring insight, self-acceptance, and a willingness to enter a portal to new ways of thinking.

Unfortunately, though exposed to options, not everyone chose to travel through a tunnel to reach them.  I witnessed cases where the tension created during the transformation process was so great that rather than becoming energized and willing to strive for a hopeful future, the client became depressed and desired death instead.  This was especially true when risk and adrenaline highs were reduced causing the person to become more reflective.  Three examples follow.

While at the center, a 21 year old football athlete visited my office during his senior college year after injuring his knee.  He had anticipated turning professional upon graduation but his injury forced him to change course.  Presenting clinical symptoms were dramatic, for not only was he depressed, but he thought his body was eating away at itself.  I hospitalized and medicated him for a short while, which enabled his symptoms to subside and allowed him to become open to counseling. Over the course of many months he improved, seemingly accepting his fate, and ready to complete his final college year.  His parents and I were very pleased with the willingness he showed to reevaluate options and redirect his career. Two days after his return to school I received a call saying that he had taken a gun to a distant park and killed himself.  He had become strong enough to end his life. 

At the time, I was a young counselor and was devastated by my patient’s death.  The question of who was responsible went to the forefront of my mind and it was hard not to blame myself.  His death was a brutal way to  learn how vulnerable people are during the process of healing and that caution must be taken before believing that someone is “out of the woods.”  This is especially true of those who survive trauma for in order to do so, their flight and fight responses become well developed to help them react quickly. They may find it difficult to slow down for rational analysis to take place.  

When terror strikes, whether due to nature causing floods, fires, or drought, human induced circumstances around war or gangs, or abuse within families, the body responds by increasing adrenaline in preparation for immediate response. If the situation continues for an extended period of time, some people begin to crave being on the edge and so increasingly add risk to their days.  Risk cravers (adrenaline junkies) disproportionally land in hospitals and in jail. They find it difficult to live without adventures that put them on the edge, repeatedly daring fate.  Each time they survive they admire themselves for being skillful but also become reinforced in the belief that they are intrinsically lucky and could never fail.  “After all,” they rationalize, “I overcame trauma or tempted fate so many times that I am invincible and know I can survive future tests of fire. “ And so, their risky behaviors become a way of life which continues while parents and loved ones worry and eventually suffer the consequences of their mishaps. 

I read a book written by an Afghan refugee whose mother courageously sent him out of their community in a Taliban war zone.  At the age of twelve he embarked on a hazardous journey to safety that was almost as bad as living with constant shelling.  Gulwali Passerlay’s story is brilliantly told in his autobiography “The Lightless Sky.” His mother paid a great deal of money to ruthless smugglers traveling a dangerous route to Europe.  During the way he was tortured, walked miles over treacherous mountains, put in jail, starved, frozen, and nearly drowned.  Occasionally he was shown courageous acts of kindness by good people who went out of their way to help the youth.  In order for Gunwale to overcome a difficult condition he was forced to rise to the occasion or perish.  He used his wits to beg for steal food and to find places to hide.   At the end of his journey, when finally given safe shelter, adequate food, tender care, and admission to  new school, his mind collapsed inward. He became severely depressed, trying suicide on several occasions. Though once again he was physically healthy and not running on pumped up adrenaline, when his brain had a chance to focus, he primarily thought only of the losses and trauma he had experienced.  In other words, while living in fear and with risk, he did not have time to think, but when settled, he relived the nightmares and trials he had faced. As they surfaced they gave rise to a wish to end his life.

Today I am sitting in a rehabilitation center in Omaha, Nebraska meeting case workers and parents who encourage maimed youth to reinvent themselves. Forty percent of the young men in the facility are here because of motor cycle, car, and sporting accidents.  Another third were hurt due engaging in dangerous work.  “A tree fell on my son while climbing as an arborist,” said one mother. “A crane landed on my husband while moving paper in a factory,” said another.  “The last 20 percent had mishaps of fate, such as being hit by an automobile which was well beyond their control.  Some of the risk craving youth come from disturbed backgrounds, but not all. Perhaps it is in their genes making them crave the excitement promoted in action movies and on internet.

Though seriously maimed, many in rehab remain tuned into their high risk demons rather than listen to more cautious advisors.  One problem I recognize is that when they slow down to take time to consider the causes of their accident and accept that their life has changed, they run the risk of depression. Most of us accept that being sad as a reaction to such circumstances is reasonable and can even be a motivating factor for change. But in some instances, when reality can not be faced, a death wish is not far behind.  Without maintaining an adrenaline rush that comes from risk taking and not having to think analytically, they perceive the game as over, and have no desire to live.

It is important to acknowledge that after a dreadful accident caused by risky behavior, once strength is regained, the person may still crave to do the same dangerous activities that caused the incident in the first place.  As a care giver I am reminded that change is a struggle that does not happen over night. Highs and lows are part of the mending process as the person struggles as past demons are overcome and a more mature outlook is achieved, yet as onlookers, we too are called upon for  atience and adaptability to changes in your loved one as he or she heals.