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Attempt at Suicide of his fear of loss of control, yet he quickly came to label his sui-
The patient decided to suicide. He copied the method of a cide attempt “a mistake.” I reworded and reframed that label by
noted physician who had successfully committed suicide in reiterating that it was the state that limited the ways in which
another New York hospital. Mr. X waited until after midnight, the hospital staff was allowed to respond and that the term
well after the change of shift, and then slit his wrists and throat. “mistake” was not an accurate or useful description of his
He was discovered before death, taken to surgery, repaired, and behavior.
transferred to the intensive care unit. From this point Mr. X was moved to talk about his parents,
with whom he had had positive relationships but who had
Consultation passed away many years before. He volunteered that he believed
Immediate psychiatric consultation was requested from the in a concept of an afterlife and that he believed he would join
author. Mr. X was lucid and courteous. He was slightly puzzled his parents. He freely offered this belief and acknowledged the
about why he was not being allowed and would not be allowed to comfort that it gave while voicing concerns about the interven-
complete his suicide. His affect was not overtly depressed. He felt ing time and events before death. In response to these concerns,
that his suicide attempt was rational given his condition and prog- I offered a guided meditation series designed for hospice
nosis. With gentle probing, the patient admitted to recent shifts patients.
in sleep and appetite, some anhedonia (inability to feel pleasure),
and diurnal variation of mood. I explained that whatever one’s GOING HOME
individual views on “rational suicide” might be, New York State GOING HOME is a two-album series produced by
did not allow the hospital to condone it. Then I explained that for Monroe Products of Lovingston, Virginia. Elisabeth Kübler-
the time that he was in the hospital, the staff would have to try to Ross, MD, Charles Tart, PhD, and Robert Monroe, the
keep him alive. He was then told that although he had a rationale founder of The Monroe Institute, created GOING HOME.
for suicide, he nevertheless seemed to exhibit some signs of clini- The tapes use guided meditation techniques with an open, per-
cal depression and that an antidepressant might relieve some of missive style, but with imagery borrowed from accounts of
his suffering. He was quite agreeable. Sertraline® (Zoloft), 100 near-death experiences and from meditations and trance jour-
mg each morning, was prescribed. neys concerning death and the afterlife. There are no specific
Mr. X was invited to talk about his life experiences and their images of any one religious group or system. My previous expe-
meaning for him, including his illness, which was currently riences when using these tapes with hospice patients have been
labeled as “terminal.” He spoke of the satisfactions during his life, successful. Mr. X accepted the offer.
his twin brother, his work, and his enjoyment of sports. He spoke
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Winter/Spring 2006
Placement Issues and the Nursing Home ance. Where a person’s beliefs render it acceptable, projective
Clinically, the patient healed from his wounds during the next work, meditation, and trance work focusing on death and the
month. His depression syndrome improved on 100 mg per day of afterlife can be useful components of therapy. Technological
Sertraline. The hospital administration believed they were in a adjuncts, such as the Hemi-Sync tapes in the GOING HOME
precarious situation and at risk for the liability of potential suicide. series, can provide useful support, amplify other techniques, and
The patient had promised cooperation, but the circumstances that empower patients in the last phase of their lives.
had created the situation still remained. The administration was The concluding comment that I would make, overall, is that
reluctant to accept the patient’s assurances, as were a number of there is an important role for psychiatrists and Hemi-Sync in
local nursing homes, including the home officially associated with cancer care and research, though the road is filled with obstacles
the hospital. The consultant advised the patient’s treatment team and detours.
to involve the local hospice organization, which was affiliated with
the hospital itself. This hospice organization had unfortunately References
just entered a period of organizational turmoil. At a staff team
meeting called to address treatment and placement issues for Mr. 1. J. Holland, “History of Psycho-Oncology: Overcoming
X, a hospice administrator stated: “This man must be taught a les- Attitudinal and Conceptual Barriers,” Psychosomatic Medicine
son. There are consequences for his actions.” They did not accept 64, no. 2 (2002): 206–21.
the patient, but a brave nursing home near the hospital did. He 2. W. Breitbart, “Spirituality and Meaning in Supportive Care:
had agreed to a “no suicide” contract. A nurse clinician from the Spirituality- and Meaning-Centered Group Psychotherapy
hospital and I agreed to visit him in his new setting. Interventions in Advanced Cancer,” Supportive Care in Cancer
The patient started to listen to the GOING HOME tapes, 10, no. 4 (2002): 272–80.
and I did some trance exercises with him. Some were adapted 3. E. Hilgard and J. Hilgard, Hypnosis in the Relief of Pain (Los
from the “conscious dreaming” exercises of Robert Moss12 and the Altos, CA: William Kaufmann, Inc., 1975).
creative dreaming techniques of Patricia Garfield.13 Others were 4. D. Brown and E. Fromm, Hypnosis and Behavioral Medicine
adapted from Margaret Cerney’s hypnotic work on grief that uti- (Hillsdale, NJ: Lawrence Erlbaum Associates, 1987).
lized imagined visits with the dead.14 I also adapted techniques 5. H. Spiegel and D. Spiegel, Trance and Treatment: Clinical Uses
from LIFELINESM graduate and author Bruce Moen15, who had of Hypnosis (New York: Basic Books, 1978).
in turn adapted techniques from The Monroe Institute. Those 6. O. C. Simonton, S. Simonton, and J. Creighton, Getting Well
exercises focused on dreamlike scenarios in which the patient Again (Los Angeles: J. P. Tarcher, 1978).
encountered and dialogued with his late parents and other 7. B. Siegel, Love, Medicine, and Miracles (New York: Harper
deceased persons of emotional importance. Furthermore, some Collins, 1986).
exercises allowed the patient to explore spontaneous imageries of 8. D. Spiegel, J. R. Bloom, H. C. Kraemer, and E. Gottheil,
possible positive afterlife environments. It should be noted that “Effect of Psychosocial Treatment on Survival of Patients with
such work does not depend on there being an afterlife or on there Metastatic Breast Cancer,” Lancet no. 2 (Oct. 14, 1989):
being proof of an afterlife—though recent research is thought 888–91.
provoking16—but in the interest of the patient in meditating on 9. R. Wiseman and M. Schlitz, “Experimenter Effects and the
the subject. Mr. X reported satisfying meditative and trance expe- Remote Detection of Staring,” Journal of Parapsychology 61, no.
riences concerning dying, meeting his parents, and ideas of the 3 (1997): 197–208.
afterlife. He reported a cessation of depression symptoms and sat- 10. J. Holt, “Hemi-Sync in My Psychiatric Practice,” Hemi-Sync
isfaction with his life at the nursing home. The nursing home, in Journal 17, no. 3 (2000).
turn, reported that the patient was active in physical therapy and 11. J. Holt, “Practical Geriatrics: Psychiatry and Spirituality at the
other activities. Mr. X became one of the most beloved members End of Life: A Case Report,” Psychiatric Services 55, no. 6
of the nursing home community. His twin brother, who lived in a ( June 2004): 618–22.
nearby state, visited multiple times despite his own severe illness. 12. R. Moss, Conscious Dreaming: A Spiritual Path for Everyday
The patient reported that he and his brother achieved a sense of Life (New York: Random House, 1996).
closure. About four months after the start of hospitalization, the 13. P. Garfield, Creative Dreaming (New York: Fireside, 1974).
patient experienced one day of increased weakness, and then died 14. M. S. Cerney, Presentation at the Annual Scientific Meeting
peacefully in his sleep. of the Society for Clinical and Experimental Hypnosis, St.
Louis, MO, Nov. 1989.
Summary 15. B. Moen, Voyages into the Unknown, vol. 1 of Exploring the
Several principles are demonstrated in this case. “Rational Afterlife (Charlottesville, VA: Hampton Roads, 1997).
suicide” can have aspects of depressive syndrome, which can 16. G. Schwartz et al., “Accuracy and Replicability of Anomalous
respond to traditional pharmacotherapy. Existential or experien- After-Death Communication across Highly Skilled
tial psychotherapy can have a particularly satisfying role in “end of Mediums,” Journal of the Society for Psychical Research 65,
life” therapy. Even organizations dedicated to “end of life” treat- no. 1 (2001): 1–25.
ment sometimes fall short and can benefit from psychiatric guid-
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