From the Editor

“By the time my father died, it wasn’t a surprise. It was scary and sad, but it was also a terrible sort of relief.”

So begins a short and honest essay by Dr. Phoebe Danziger. Our American colleague’s JAMA paper doesn’t require much of an introduction. She speaks about her father, his mental illness, and his death. She also touches on her own depression. And she speaks candidly of a childhood coloured by her father’s illness.

36yts2xd_400x400Phoebe Danziger

In this Reading, we consider Dr. Danziger’s essay.



“The Language of Suicide”

Phoebe Danziger

JAMA, 25 December 2018  Open Access

By the time my father died, it wasn’t a surprise. It was scary and sad, but it was also a terrible sort of relief. It was an unglamorous death in the Canal Street apartment he had chosen for its expansive, unfinished rooftop on which he tended his clivia and miniature lemon trees. Empty bottles of antidepressants and antihypertensives stood next to his computer, on which the browser history revealed a final Google search that read: ‘how to commit suicide with Paxil.’

No one talked much about how he had died. As is often the case with suicide, it was mostly an open secret, though some suggested that perhaps I was wrong, that it was not intentional after all. As a society we’ve come a long way with respect to suicide, mental illness, and addiction, but we have a long way yet to go. When the topic of his death comes up, I often hesitate, pulled between the desire to share openly that my life, like so many others, has been impacted by suicide and that the topic remains heavily stigmatized, emotionally burdensome, and susceptible to all manner of unsolicited—and frequently erroneous—opinions and narratives.

I can never settle on what language to use—‘he killed himself’ sounds too violent; ‘committed suicide’ too clinical; ‘died by suicide’ too affected; ‘took his own life’ too romantic. There is no easy way to accept condolences while also honoring the reality that while he was in pain, he also caused great pain.

So begins a JAMA paper by Dr. Danziger.

Dr. Danziger discusses her father’s depression and his use of alcohol.

Once, we were driving on a quiet dirt road in Connecticut. I was about 6. He stopped the car, got out, and lay down on his back in the middle of the silent, snowy, one-lane bridge. I screamed at him to get up, over and over and over again, but he didn’t, and I didn’t know why. As a child, I didn’t understand why the story being told around me didn’t seem to match the story that I lived. My childhood contained much beauty and privilege for which I am grateful, but the presence of mental illness and alcoholism meant that it was also a hazy morass of half-truths, partial truths, truths that I absorbed into my being the way a spider absorbs every vibration of its web but which I could not name or understand until I was much older.

There is still significant anger on her part.

When I think about my dad, I think about my daughters and wonder if I will somehow fail them the way he failed me, whether his legacy of sadness will course directly through me into them.

And perhaps guilt. She ends:

The last email I received from him arrived a few weeks before his death. For inexplicable reasons, it was written in a comically oversized lavender font. The subject was ‘Hey Daughter,’ and it read: ‘I tried calling you earlier but was unable to leave a voicemail. Your phone just rang and rang. Call me? love, your pa.’ I didn’t call.

A few thoughts:

  1. This is a very raw and moving essay.
  1. There is something human about her ambivalence – and readiness to admit her ambivalence about her father’s death.
  1. We often think about the impact that mental illness has on patients. In this piece, our colleague describes well the chaos of her childhood, and the long shadow that her father’s mental illness cast over her life.


Reading of the Week. Every week I pick articles and papers from the world of Psychiatry.