Insight
Essay
Inside the mind of a suicidal person
Many days, I have only grabbed the pen but could not write
a word. I also thought I would not disclose the relationship
between me and the person I am writing about. But how
can I separate myself from him? We share thoughts, we
share foods, and we share genes. This person is my dear
little sweet brother—who is no more. Ah! My heart aches
and I am not going to write this line again.
My younger brother, let’s call him Danny, first sought
help when he was about 14–15 years old and had already
attempted suicidal injuries. One day, he came out of his
room and, bursting into tears, he told our mom that he
needed help badly. After seeking help, he was diagnosed
with borderline personality disorder and major depressive
disorder. Danny was diagnosed early and properly, and
he received the best treatment possible in a developing
country, within our limitations. He received medication
and therapy to adjust his emotions from immediately
after his initial diagnosis, and he had a support system of
his well wishers. His family represented a large portion of
typical subcontinental Asian families, and every member
of the family bestowed him with love, which Danny
acknowledged. We tried our best to help him. He tried his
best to live, too.
A month before going to God at just 22 years old, Danny
said “Didibhaiya, I am in so much pain, I torture myself to
feel the physical pain, so that I can take my mind off my
mental pain. It seems my physical pain is not enough to
stop myself.” I replied “But you haven’t tasted the best duck
in the town yet. It is not fair. Also, I will never let you go no
matter how much you try.” We both laughed—we loved
food so much. Danny told me:
“I am more empathetic than all of you. I focus to live for
helping people. Otherwise, I might end up doing terrible
things to the world. I need to stop myself. I don’t share
because nobody has the depth to understand me. Even my
psychologist has reached a point where she can’t help me
anymore. If I share my problems, people will leave me. My
threshold is much higher than yours. I have already gone
through many bad things. This happened. That happened.
I went on. One day I felt whatever is happening to me is not
right. This is bad. I felt empty, angry, hollow, sad, and I just
wanted to end these ongoing feelings. I have no worth. I
just wanted to die. That’s how I started my first suicidal
attempt. I never recovered. I just acted with myself. I am
very afraid, Didibhaiya. If you really want to help me, just
tell me how I will feel no pain while dying”.
I was with Danny night after night at the hospital. I saw
him crying out and saying, “Yes, I am going to die, just
a moment”, even in his dreams. Danny was so private
regarding his last trigger; we found out about it only after
his departure from our world.
920
Danny was a very intelligent, meritorious, creative, and
funny boy. He loved animals very much. He was a giver. He
cared. He was good at maintaining relationships, which
links to another characteristic that some people called
manipulative power. I felt he suffered problems in building
relationships with the people he was closest with. Both
Danny and I are overweight, which doesn’t help much for
dealing with self-loathing. Although he was an extrovert,
there were months when he did not do anything, other
than being low. During the last 15 days, Danny was very
impulsive, flipping his mood within 30 minutes. He coloured
his hair with me before the night of his last attempt. He was
constantly struggling with high and low points. He tried
to live with this. On high points, he recorded his hopes for
tackling upcoming low points. And he was afraid that he
would not be able to stop himself. Unlike some other people
with borderline personality disorder, he could see there is
not always only black and white; a lot of life is just grey. He
even taught me to accept the grey portion of life. He could
counsel other people wonderfully. He had no history of
hallucinations or substance misuse.
Looking back earlier in Danny’s life, he was delivered as a
premature baby at 7 months and 13 days. Our mother was
controlling and persuasive, and Danny was very dependent
on her. Our father always says negative things about children
and had depression in his earlier life. Their relationship had a
disrespectful, blaming tendency. And I, Danny’s only sibling,
am an overachiever. Although Danny was naturally very
talented, I think this was why he set high expectations for
himself and pushed himself to perform as well as me. Our
family is a nuclear family with limited exposure to relatives.
Various other factors acted as stressors in Danny’s life as
well: pressure, compliance to a long schedule (like the exam
period), high self-expectations and a fear of not fulfilling
them (he was a top student), new environments, and finding
adaptation difficult. The peak stress was at school, when
his best friend moved to a different class and their attitude
towards Danny changed. After successfully completing
the first term of 11th grade in college, when he was around
17 years, Danny became so afraid of going to college that
he stopped attending for months, and he was admitted
to a hospital with rehabilitation facilities. He was under the
supervision of experts there. Danny led a controlled, happy,
and okay life with no episodes for about 2 years after that.
He was on a low level of lithium, and the dose was adjusted,
tapered, and again adjusted.
During rehabilitation in a private rehabilitation centre,
Danny was kept in the same room as other people who
were violent and had addictions, which created trauma
for Danny. He was afraid of some of the other patients but
www.thelancet.com/psychiatry Vol 10 December 2023

also afraid to complain about anything in case this created
more problems for him. After leaving the rehabilitation
centre, Danny was sold medicine by a pharmacy without
a prescription. There is strong social stigma here in
Bangladesh around boys sharing emotional vulnerability.
All of these factors—the fear, unprescribed medication,
and lack of empathy towards males—all played a role
for him.
At university, Danny was top in his class, and everything
was going smoothly. He was happy. But then, after
3 months at university, he began not to trust his
surroundings anymore. Danny said, “Didibhaiya, I tell
different persons different versions of one story. So, if any
person breaks my trust, then I would be able to track back
the person.” As he was growing up, he had wanted to set
boundaries, and eventually, he stopped sharing everything
with his previous circle of close friends and trusted no one
for sharing his personal feelings in his university.
Meanwhile, Danny began to help other people who were
suicidal. He pointed out to me that one group was just
using his kindness and did not intend to harm themselves;
they were just threatening and tricking others to get their
work done, he said. But another group, he explained, was
suffering like himself or had undiagnosed mental illness
and abusive histories. He tried to channel positivity toward
both groups, empathising with their pain, but in return,
he felt used and that negativity was being dumped onto
him. Facing others’ suicidal attempts was a big driver of his
relapsing low mood.
Let me tell the ugly truth, because if you are living with
someone or diagnosing someone, you must know the big
picture. Danny was loved. He had a wonderful support
system of kindness, help, and empathy from his parents,
siblings, some friends, and college and university teachers.
There was never any pressure on him for anything from
his family. So what happened? He mentioned a rape
history by a housekeeper boy. As far as I remember,
Danny was 1–2·5 years old when that housekeeper boy
used to live at our house. Danny was always a fan of him.
I cannot alleviate my brother’s pain. The only thing I can
do is believe him. After starting school at age 6, a year later,
Danny moved to a better school with an admission test,
but he was not happy about the change and preferred the
old school. Some of his new school teachers were brutally
physically and verbally abusive. My poor sensitive brother
did not utter a word. When he did express himself, it was
already too late.
There was a final specific trigger. Danny made repeated
suicide attempts during his university days, his problem
relating to a person he adored. After being released from
hospital after one attempt, Danny went to university. He was
hitting rock bottom, so he sought help from the girl he loved,
who had promised to help him when needed, but at a crucial
time, she did not. She told him that to her, he is already dead.
www.thelancet.com/psychiatry Vol 10 December 2023
Insight
Ah! My heart is wrenching. That evening, Danny made his
last, successful suicidal attempt.
I can’t stop thinking that one hopeful word from one
appropriate person could have stopped the tubes piercing
all over Danny’s body in the intensive care unit. He recorded
his gratitude, before his last attempt, towards those people
who supported him. But yet, we failed. During the final
days, he started conversations logically with me, but while I
was discerning his issues with logic, he just wanted to die—
like a stuck cassette—he just wanted to die. Danny was sold
medicines by pharmacies without prescriptions multiple
times.
His case shows that once a resistant, progressive, and
repetitive self-harming pattern and borderline personality
disorder have formed, it is much harder to intervene.
Knowing predisposing genetic factors and using medical
interventions are not enough. People need to be educated
about risk factors. Today, parents are educated on obesity
and its potential harms, but my plea, to psychiatrists and
psychologist, is to join your expertise with that of social,
public health, and government workers to intervene on the
risk factors. Let parents, teachers, and other people know
how some young people can form a personality disorder,
major depressive disorder, or other mental illness, and the
environmental factors that can contribute to them ending
their life early.
Danny could not taste the best duck in the town. I was
present during his resuscitation, and he was in so much
pain. I prayed to God to have mercy on him if it means to
let him go away from me, because no one knew more than
me how much Danny was afraid of death pain!
Most people would say they are always available
for sharing if someone feels off, but from what I have
experienced personally, I think that someone who is
suicidal does not tend to share with just anybody. They
want to connect with one specific person and keep on
going until one specific trigger is reached. People have
every right not to help, but my plea would be that they
they at least say something to a suicidal person’s support
system if there is any warning sign. A lot of people might
be fighting day and night to save the life a suicidal person,
and the support system might be able to help by reaching
them at the right time from the right angle.
He will remain 22 years old forever. Here is the last song
Danny shared with me in the hospital:
“If I could start again
A million miles away
I would keep myself
I would find a way”
Hurt, by Johny Cash
Labannya Das Puja
921