I got a terrible shock when I heard the news that the famous director Tony Scott had apparently committed suicide by jumping off the Vincent Thomas Bridge in San Pedro, California.
Not because I knew Scott, and certainly not because it is a rare thing for people who seem to "have it all" nonetheless to kill themselves.
No, I got a shock because I knew the bridge.
For the better part of a decade, I trained and then worked as a psychiatrist in Los Angeles. For several of those years, I did psychotherapy with a young woman who drove over that same bridge every day. The bridge became almost a third person in our work together, because she talked about it constantly.
Every morning and then again every evening she faced huge anxiety as she approached its yawning span because it was all she could do not to stop her car and throw herself off it. Just seeing that bridge made all her pain and despair intensify, and it came to represent everything that was wrong with her life.
On the other hand, it's a beautiful structure, in an industrial sort of way, and it also seemed beautiful to her because it was always there, silently waiting, always offering an easy out. When things were really bad, she'd drive 20 miles out of her way just to avoid that bridge and the terrible temptation to jump or crash her car off the side.
Fortunately, my patient avoided Scott's fate. She came to grips with a history of abuse and her depression eased. She married and left Los Angeles. I also left Los Angeles, but a few years ago, I returned to the San Pedro area to give a talk and crossed that bridge with a mixture of relief and distress.
It is that strange mixture of relief and distress that characterizes many of the responses to Scott's apparent suicide that have been posted on CNN.com.
Many comments come from family members of people who have committed suicide, some defending the loved one's decision, others decrying it as the ultimate selfish act. Although I've spent my life battling suicide, I find myself empathizing with both points of view.
Perhaps the first thing to say about suicide is that people make suicide attempts for all sorts of reasons. Sometimes people want to die, or half want to die.
But just as often in my experience, suicide attempts are a cry for help, or a way to punish people they are upset with, or a means of controlling a situation. I've known more than a few married people who kept a husband or wife from walking out on them, at least for a while, by making a suicide gesture.
On the other hand, people really only kill themselves for three reasons.
Occasionally people will commit suicide because they are facing some incurable condition that promises a brief future filled with nothing but pain.
Although many mental health clinicians will disagree vociferously with me, I have seen suicides that I felt were in this sense justified. For example, I knew a grand old fellow who, in the midst of unbearable physical pain from inoperable cancer, took his life when he had a life expectancy of two to three months.
Occasionally people will commit suicide because they are psychotic and believe they must die for some reason that makes no sense to anyone else. I had a patient once who made a very serious suicide attempt because she believed that if she died, the mysterious private investigators who were stalking her would leave her family alone.
These types of suicides are heartbreaking, because they are so futile and can often be prevented by appropriate treatment.
The vast majority of people who choose methods of suicide that are almost guaranteed to succeed -- like a gun to the head or a plunge from a high bridge -- do so because of they are losing a battle against major depression. These are the suicides that haunt and hurt worst of all, and that almost to a person are the most tragic.
I hate suicide.
I've been fortunate that suicide does not run in my family. But it runs in lots and lots of families and I've known -- and known of -- more people who have killed themselves than I can easily count.
There was the shy kid who shot himself in high school, the young punk who drove his car off a particularly bad curve, the wonderful hard-working father of the class valedictorian, and various in-laws across a couple of marriages.