HOW NOT TO COMMIT SUICIDE
8 of 9 pages 
What happens afterwards?
How, according to people who work with them, do suicide attempters feel when they wake up in the hospital? Glad they were saved. Convinced that suicide was a mistake. Angry they were saved. Angry at the friend or neighbor who betrayed them by calling emergency. Eager to get out of the hospital so they can try it again. Embarrassed. Relieved. Happy to be taken care of. Eager to start taking care of themselves again. Unwilling to think about it. Wondering what everyone else they know things about it. Wondering if the person they were trying to reach will finally pay attention to them.
"A lot of what I hear in the emergency room is hostility towards a specific person," Dr. Bedard said. "Once they know they're not going to die, they go out of their way to talk to me about it. 'I'll show that son of a bitch. He didn't think I had the guts to do it.' A lot of these people fantasize about seeing themselves at the funeral. 'The whole world's going to be upset.'"
There are people who get ignored repeatedly until they attempt suicide. One woman I heard about tried to kill herself six times in one year. "My husband says he's too busy if I ask him to take me out to dinner," she told the emergency room staff. "But for this he makes time."
If it isn't the attention of a particular person, it might be the emergency room staff. Sadly, many people can only get a lot of paid professional people to notice them by threatening their own life. "A lot of people we see are repeaters," Bedard said. "They might come in 20 times in five years. To them it's a game. 'Either you take Ipecac and vomit or we'll have to do gastric lavage', we'll say. 'You know and I know it'll hurt, so why don't you take the Ipecac?' Sometimes you see the same people so often it's like visiting an old friend.
Other people take a pill overdose not to risk their lives, but to find a place where they can be taken care of and forget their problems for a while. "People want time out," said Temple University psychiatry professor Michael Simpson, who ran the emergency psychiatric service at Guy's Hospital in London. "That's why sometimes they'll seek psychiatric support but leave in a day or two. They used to be able to do it more freely in the drug culture by finding a crashpad. Now the medical model is one of the few excuses for going away and lying around and having people be kind to you that is seen as a valid reason to leave work. Maybe we need other ways to legitimize that."
People who attempt suicide are almost never arrested, but they lose their right to decide what happens to them. In every state, being a possible danger to oneself, in the opinion of the psychiatrist who interviews you, is cause for being held for psychiatric care for a limited period of time. In California, the period of time is three days; it can be followed, with an application to a judge, by a 14-day period. Beyond that, the regular rules for entering a mental hospital voluntarily or being committed apply. Clearly, how you act at the initial interview with a psychiatrist has a lot to do with how long you stay under psychiatric care. So does the attitude of the psychiatrist who examines you and the availability of good or bad psychiatric facilities in your area.
Rarely are patients held longer than three days for psychiatric reasons. In fact, some hospitals send more than half of the suicidal patients home as soon as they can go. Some patients are routed to state or private psychiatric hospitals; some go to local board-and-care homes or halfway houses or outpatient clinics or nowhere at all. "The only generalization you can make," said Ed Hamell, a senior psychiatric specialist at a private psychiatric hospital in Washington, D.C., "is that people who find themselves in hospitals following suicide attempts will be treated as not able to be responsible for their own safety."
Howard Blackstone, the clinical director of the Marin County mental health crisis unit, told some of the things that happen in the initial psychiatric interview. "We're trying to find out what happened. Was it well thought out or was it impulsive? What kinds of problems led up to that point? What state were they in when they tried to do it? How likely are they to try it again? Oftentimes someone will come in upset, but after a day or two hold they will look back and say 'Why the hell did I do that?' If we believe that someone is still perturbed and still ruminating about how to kill themselves, we are required to hold on to them. We evaluate reasons less than state of mind. The purpose of what we're doing is to help someone out of a state of mind where they may do something not in their best interest."
Beyond that, I can't generalize about the psychiatric consequences of suicide. There are too many possibilities, they differ too much from place to place and the patient has too little control over where he or she ends up. In many psychiatric institutions (and other social welfare institutions, like nursing homes) suicide is a sensitive issue, because a funding agency may investigate an institution if a suicide happens within its walls. Or a psychiatrist may be held responsible for a suicide if it can be proved he knew about it beforehand and didn't act reasonably to prevent it. Here as everywhere else, the main priority is keeping the person alive.
That may be changing....