In March of this year I had been a mental health associate at McLean Hospital for about 18 months. I was working the evening shift at the Schizophrenia and Bipolar Disorders Program, a locked inpatient unit. From the start, it seemed like it was going to be a peaceful night. The census was low, and no one was on five-minute checks for safety. About an hour into the shift, one of the nurses gave me an envelope. Addressed to me, it was from a patient who had been discharged earlier in the day. Inside the note read: “…In some way, I was hoping [this message would] reciprocate all the support you offered to me during my stay. This time was relatively dire, and I was struggling to find how to approach and accept my illness. You provided a rational and persuasive voice, one that my doctors struggled to find….”
Reading this testimonial had been the highlight of my experience at the hospital. The gratification and sense of fulfillment I felt at that moment was indescribable.
At the end of the shift I noticed several missed calls and a voicemail on my cell phone—“Daniel, it’s mom. You need to call me before you come home. It’s very important.” Her voice was acutely distressed. I knew immediately something terrible had happened. I dialed my mom, and when she picked up, I said urgently, “What’s wrong? Are you OK?” She didn’t answer my questions. Instead, she asked me where I was and if I was in a good place to talk. My anxiety skyrocketed. I begged her to tell me what had happened.
“Your brother is dead.”
Adam Jae-Lim Aldrich, my beautiful older brother, took his own life earlier that day. My mother found him in the garage of our home with a gunshot wound to his head. Adam was only 26.
During the funeral service, I spoke with Adam’s close friend Shannon. She told me she was infuriated with Adam. “How could he do something so incredibly selfish?”
When she said this, I remembered a patient I had met the previous year, Alex. A stoic man in his 40s, he was admitted to McLean presenting with depression and suicidal thoughts. He did not strike me initially as someone who was particularly ill, whose condition warranted inpatient care. He was bright, articulate and social, and he took good care of himself. His suicidal thinking, he assured the staff, was passive and not something he would ever act on.
I began meeting with Alex regularly to discuss his symptoms. In every interview, he ranted furiously about the futility of his treatment and protested his doctor’s decision to keep him hospitalized. Weeks passed and there was no change in his attitude.
Then one day, in the middle of his tirade, I sharply dissented. I wasn’t prepared for what happened next. Alex burst into tears. He admitted that his disposition undermined his recovery and that it was ruining his life. Only a week earlier, his wife had threatened to leave him if he couldn’t control his anger and negativity. “I know I need to change, but my brain won’t let me! It’s like I’m trapped behind this tinted window, and I just can’t escape.” Alex was sobbing uncontrollably. His suffering was palpable. Speechless, I fought back my own tears.
Like Alex, my brother Adam was suffering profoundly. What Shannon didn’t understand was that depression does not simply affect how one feels; it determines how one thinks and what one thinks. It’s a devastating disease that subjugates a person’s mind and distorts all areas of thought—including the ability to reason. My brother did not commit his fatal act simply because he suffered excruciating pain but because irrational thought processes dictated his response.
What Adam must have gone through in those final days troubles me deeply. I’ve lost my only sibling, the only other person who truly understood a very important part of my life. But what hurts me the most is the conviction that my brother could have been saved. Alex is a good example. Eventually he began electroconvulsive therapy, and his condition radically improved. No longer the bitter and sullen pessimist, he smiled, cracked jokes, and was able to enjoy life. His transformation was absolutely beautiful. Witnessing Alex and many other sick patients recover from illness has given me a profound understanding of the importance of medicine and has shown me its incredible power to alleviate the worst suffering a person can endure.
Daniel Aldrich is an associate in psychiatry at McLean Hospital, working as a research technician at the hospital’s Mailman Research Center and a mental health specialist in its Schizophrenia and Bipolar Disorders Program.
The patient names in this column are pseudonyms, and the opinions expressed are not necessarily those of Harvard Medical School, its affiliated institutions, or Harvard University.