Mindy Schwartz-Brownis a suicide attempt survivor.
"I survived a suicide attempt."
My career was primarily in pediatric health care.
There was a little bit of mental health work, but I wasn’t comfortable working in my own backyard, so to speak. Although, you encounter mental health where ever you go, I find.
First of all, I’ve known about your site. I’ve been interested in the increase in survivor participation in the movement because I’ve been telling clinicians for a long time that they need to listen and learn. I’ve had a lot of experience working with various clinicians. I’ve found that the most successful relationships have been very collaborative, as opposed to authoritarian. Based on that experience, I’ve felt that it’s important for us to get out there as educators.
My parents didn’t know about it until the yearbook was published. They never said anything about it.
I’ve had a history of depression since I was a kid. The first time I ever thought about suicide, I was about eight. I didn’t really talk about it or tell anybody about it, except my high school graduation quote was, “If you’re convinced of your despair, you must act as if you do hope after all or kill yourself. Suffering gives us no special rights.” That was by Camus. I did go through a fascination with existentialism in high school. I had a lot of good relationships with teachers, and they kind of knew my preoccupations, but nobody said anything about that yearbook quote. My parents didn’t know about it until the yearbook was published. They never said anything about it.
The first time I made a suicide attempt was more of a gesture. That was around age nineteen. That was the first time I was hospitalized and got into treatment. I was in Boston in college with a really good psychiatrist. I got a good understanding of things, got on medications, and had some really good success with MAO inhibitors.
That’s one of my pet peeves: because they’re off-patent, they’re not used, but I’ve had some magical responses to MAO inhibitors. I think the pharmaceutical industry controls treatment in this country. A lot of people who could benefit from a class of drugs are not exposed to it.
At some point, they stopped working [for me], which happens. I got really depressed, went through a series of hospitalizations, and ended up hanging myself in the hospital. [Being] in a hospital caused it not to be lethal. It was pretty close to lethal. That was in 1981.
Hence the effect of Robin Williams’ death. It was a little bit too close, although not surprising.
Des: Not at all.
Mindy: No. I was not the least bit surprised to hear that. I think I would have been more surprised had he not, at some point, either died by suicide or some other dangerous behavior. That was a significant event. I read your piece afterward, but I thought exactly the same thing as you did: we’re all at risk, and once you’re at risk, you’re always at risk. Once you’ve considered suicide as an option, it doesn’t go away. I guess that motivated me to say, “I’ve got to do something.”
That’s pretty much it. I’ve had other episodes of depression. I’ve been hospitalized for them. I’ve had ECT—shock treatment. The reason I’ve been hospitalized is because of suicidal thoughts, but I’ve never made a subsequent suicide attempt. That’s my history.
Des: Tell me more about Robin Williams in terms of the media coverage.
Mindy: I was not as disturbed as [some people] seemed to be about the press revealing the cause of death. They pretty much do it with everybody. That’s the press. There’s no expectation of privacy when you [die by] suicide. Another problem is the distinction between substance abuse and mental health.
Des: They’re usually co-morbid.
Mindy: Right. Of course, I immediately e-mailed the psychopharm guy I see now, who is wonderful, and he said that he fears that celebrities get lesser treatment.
Des: I read something about that. Someone said something about celebrities having lesser treatment because clinicians don’t know how to handle them.
Mindy: How to set limits.
Des: Yeah. It had never occurred to me.
Mindy: What are you going to say if they say, “You need to be in the hospital,” and they say, “No?” Unlikely to be committed unless it’s a teenage girl, but not Robin Williams. It’s often a dichotomy where drug and alcohol users get sent to the twelve step programs and not traditional mental health treatment. I remember it being much worse where anybody who used substances wouldn’t be admitted to a standard psych program.
I definitely thought that Robin Williams was always self-medicating. There are the experimenters and there are the self-medicators. I thought John Belushi was a risk taker. Robin Williams just always had this sad look in his eye. I have this thing about some people being too sensitive to live in this world.
Des: You hated it? Okay, tell me why.
Mindy: That was much too positive. Making it seem like suicide is a legitimate way out. I’m not saying that it should be stigmatized. I’m saying that you want to encourage people to find other ways to get relief. I don’t think that most people who [die by] suicide want that to be their end. I don’t think, looking back, Robin Williams would feel good about having been a suicide. I think he was in so much pain that that’s what he did. I don’t know how much of it is choice. What did you think?
Des: I didn’t think it was glorifying suicide. I felt like maybe a teenager could take it that way, but I guess I got it. It really did feel like, “You’re free from that awful pain.”
Mindy: Yeah, I got it. I guess the demographic I always think about is the nineteen year olds.
Des: Right. My thought was also that was a character he embodied. That meme never would have existed if he hadn’t played Genie, or if that hadn’t been a line in that movie. I think that if he had died from Parkinson’s, that meme would have come up.
Mindy: Right, and I could see them doing that for Michael J. Fox at some point. I hate all that stuff. I hate all the euphemisms that people use about death.
Des: I tweeted about that earlier. Someone tweeted something at me. They said, “It really does get better.”
I was like, “This is not real. It’s not honest.” It gets better and then it gets worse. It’s life.
Mindy: It gets better, and I think the message is that you have to learn to take advantage of the better times because there’s just no guarantee.
Des: You said that some people are too sensitive. Tell me more about that.
Mindy: I’ve been having a lot of episodes lately. Like the war in Gaza. I have a big connection to Israel, but I’m also absolutely horrified. I hate Netanyahu and I’m a left-wing person, but I have good friends who toe the line. They’re posting stuff on Facebook, and I’ve been crying because these are people who love kids, have been teachers, have grandchildren, post pictures, but somehow are able to distance themselves from the fact that babies and children are being killed by this elective process called war. I’ve just been crying because how can they do this? How can they create this separation in their heads? How can this kid in Gaza be different from their grandchild?
Then, the kid getting killed in Ferguson. It’s like I don’t want to live in this world. When I first went into the hospital, it was 1972. Nixon was president. I’d been really active in anti-war stuff. Nixon got re-elected. I said, “Well, the people out there are crazier than the people in here.” A lot of times I’ll blame political things or external things for my being depressed, but then people don’t usually kill themselves over those things, except for Vietnamese monks who used to self-immolate. It’s not an appealing image. Not my number one choice. I’d choose ice over fire.
There are times that I feel like there’s a level of not being able to use defenses that other people use to not let things get to me.
Des: For people who are too sensitive to be in this world, does that mean that suicide is an option? Should it be an option?
Mindy: I found out about Robin Williams from [my husband]. The way that he told me was the best way that anybody could wish. He just kind of walked in, hugged me, and said, “Did you hear?” and told me. He knew that I was going to be upset. The news usually just kind of goes past him, but for some reason he knew that I was going to be really upset by that.
So, no. There are ways. You have to surround yourself with people who are sensitive to your being sensitive. Knowing that you have that tendency, you need to do what you can to protect yourself. I think it would be a really terrible world if very sensitive people didn’t stay in it for as long as they could.
Des: What do you think of general practitioners prescribing medication?
Mindy: I’ve had horrible reactions to medications, so I am definitely opposed to people who are uneducated just kind of handing it out. If they get to know one medication, maybe, but I think they have to be really connected to somebody to refer.
I would much rather have general practitioners less phobic about talking to mental health practitioners, which is a major problem. The understanding in the medical community of mental health issues is just zero to negative numbers. Prozac was a good drug, but there’s a percentage of people that get these akathisic reactions or toxic anxiety, and they get more suicidal. You don’t like hearing, “These drugs make you suicidal.” What about it? What are your symptoms? I don’t think the general practitioners even know that much about it.
Des: Right. It’s just being thrown at them to give out to people.
Des: Tell me more about the MAOIs.
Mindy: Initially, people were afraid of prescribing them because they have dietary interactions with certain things, like aged cheeses. What is it? Tyramine? It’s a substance. They’re in fava beans, banana peels. I always thought it was really condescending that they didn’t think that people could manage themselves well enough to be careful about their diet, but that was the number one reason that people were hesitant to prescribe them. Also, they’re just not profitable.
They found out that they were effective because they used isoniazid for TB, and they found that TB patients would start getting euphoric or, if they were depressed, their mood would improve. Then they started using that class of drugs as an antidepressant.
That’s how most psychiatric drugs have been [uncovered]. Thorazine was used for nausea. They’ll take the side effect and say, “Let’s use this,” but it’s just a class of drugs that works on a subset of treatment resistant depression. Your standard psych residency doesn’t do much education in it.
Des: Well, because the SSRIs are the thing now.
Mindy: Yeah. It’s what gets marketed because they have the fewest side effects.
Des: When did you have ECT?
It was hard to know what was medical, what was depression, and what was being in pain and being sick.
Mindy: The last time I had it was about four years ago, and before that, [around] 1980. The first time I had bad side effects, like memory loss. They did bilateral, which is a real mistake. I thought that I would never get my memory back. It made me more suicidal. Last time, I think it had some beneficial effect, but I got really sick medically and had to stop the maintenance treatment. It was hard to know what was medical, what was depression, and what was being in pain and being sick.
Des: What made you decide to do ECT either time?
Mindy: Well, the first time was not my [decision]. I had to sign a paper, but it was kind of, “This is what has to be done.” Last time, I had gotten to the point where no medication was working. I was feeling more and more suicidal.
I always look at research programs. What’s going on? Who’s studying what? There are very few on suicide. There was one at Columbia where a guy was studying people who were suicidal. I got involved in that study and that was just a comparison between two drugs—neither one was effective for me.
Des: What year was that?
Mindy: 2008. There were benefits of having been in the study, but I kind of expected them to be more attuned to issues about suicidality than they were. They were just trying different drugs.
They took blood for DNA and stuff like that and said, “Maybe we’ll use it in the future, but right now there isn’t anything.” Now they’re finding markers, supposedly.
Des: Yeah. What are your thoughts on that?
Mindy: There are too many. I don’t think they’re ever going to find one marker. I’ve had my genome done and any time they come up with a new marker, I look to see what it is. It’s not like I wouldn’t like it [if they found it], but nobody understands the brain. There were traumatic events that had some influence on how my life went. I do believe in the theories that people who experience certain traumas have changes in their brain in reaction to that, like PTSD kind of stuff.
Des: Right. The trauma-informed care community has really opened up my eyes a little bit.
Mindy: It’s really interesting. I’m kind of a historian for psychiatric treatment.
I was anorexic for a long time when I was in the middle of treatment, but I was wearing my coat throughout sessions. The guy I was seeing didn’t notice it until I had a really bad reaction to a drug and fainted. Then he said, “Boy, you’ve lost a lot of weight.”
It’s the same thing with trauma stuff. Years after, I kind of remembered an episode of sexual abuse. I contacted him and said, “Did you ever have any inkling about this?”
He said, “You know, we never got exposed to that stuff.”
It just wasn’t even a thought in anybody’s mind. Anytime something is introduced, it’s overemphasized. Then you get this focus on the medical model crap because nobody wants to get re-educated. There’s always somebody who’s going to grab onto something and sensationalize it. It’s not to anybody’s benefit.
Des: Right. It’s navigating a whole new world, the idea of mental illness. Do you have a mental illness? Does it matter?
Mindy: The thing that made a big difference for me is not being in the work world anymore and not worrying about it. When I was working, I’d always be worried that whatever antidepressant I was taking was going to show up on the drug/urine test, and that I was not going to get a job because of the drug I was taking. Or, I’m working with all these clinical people and they’re going to know my diagnosis. Even positive experiences [with] having to take time off for depression didn’t really mediate that very much.
Des: Did you know anybody who disclosed in your work life at all?
Mindy: I started disclosing, [but otherwise], no.
Des: Do you think it would be different now? How long have you been retired?
Mindy: I don’t know. Five years, maybe? No. I think there are individuals, and we see most of them. I think depending on where you are, like in the New York area or in the Boston area, it’s not a big deal to say you’re in therapy. It’s not a big deal to say you’re on an antidepressant anymore.
Des: I feel like things will start to change even more rapidly once we’ve got some professionals starting to talk about this stuff in detail.
Mindy: What I’ve seen is that so much of the emphasis is on how to get the message out there. What’s the message, and what’s your plan? I don’t want to read your white paper. Tell me in fifteen words.
Des: I think visibility is the first step. Visibility, I think, will reduce stigma and then start educating from an early, early age. Telling kids, “This is how you can be compassionate,” which is kind of a shame.
Mindy: Bullying is the issue now that they’re addressing with kids. There’s a major association with having been bullied and ending up suicidal. I see stuff that is really impressive online like these messages, “If you see a kid at school that’s sitting alone, go up to him.” I think those are great messages for kids. I think from there, approaching the mental health stuff… I think it’s another “seize the moment” time.
Des: Terminal illnesses versus mental illnesses and their long-term effects. What do you think about the difference?
Mindy: You’re never going to get a physician to say, “Your depression is so bad that I’m going to let you euthanize yourself.” That’s just never going to happen. Did you see it [during the SPSM chat? People were talking about the right to die.
Des: I want to talk to those people more.
Mindy: Which people?
Des: The physician-assisted dying, end of life people.
Mindy: I was really involved in an EOL chat group for a long time. I think it really has a place in health care. But getting somebody to participate in your suicide is not—
Des: What about Oregon?
Mindy: They’ve found they’ve had a much lower number of people who have used it than they expected. For a lot of people, just knowing that it’s an option is a way of them keeping on going.
Des: A lot of them get the medication and sit on it and never use it.
Mindy: Right. I think hospice is a really underutilized movement. Somebody mentioned something about palliative care in the discussion and I just said something like, “Living is palliative care.” You just kind of have to figure out how to make it better.
I was going to have remissions, but it was something that I was going to have to deal with on a very active basis, like somebody with diabetes deals with blood sugar and insulin.
At some point, I came to the realization that I was never going to cure my depression. I was going to have remissions, but it was something that I was going to have to deal with on a very active basis, like somebody with diabetes deals with blood sugar and insulin. [If you] deny that it’s going to happen again, when it does come up and slap you in the face, then you just feel like you failed as opposed to feeling like you’re managing it. There’s an element of control that is absent when you’re depressed.
Des: What did it feel like when the MAOIs stopped working?
Mindy: I was young and it was just devastating. I was in no way equipped to deal with that. If somebody had said to me, like the guy I see now said, “At some point, your brain gets smart enough that it’s going to not respond to this,” that makes all the difference in the world.
Then I can say, “Okay, so what are you going to do then?”
If he said, “We’ll figure it out if we get there,” I wouldn’t be very reassured, but he’s smart enough to know that at least I know he’s thinking. That’s what I mean about the collaborative stuff.
I’ve met a bunch of incompetent, not sensitive people, but I’ve also been lucky. I’ve always had somebody to call. When Robin Williams [died], I wrote, “Shit,” to my psychopharm guy and I sent a message to the guy I’m seeing. He’s a therapist, and I just said, “This is hitting hard.” It wasn’t like I wanted anything more. I just wanted them to know.
I don’t feel like I can function without that kind of a support system. I don’t want it to be [my husband] or family members.
Des: Tell me more about the history of dealing with the mental health system for forty or so years. What are the biggest changes? What was it like back then versus now?
Mindy: The first time that I was in the hospital it was for six months.
Des: They don’t do that now.
Mindy: No. I got educated about lots of things, how to contain this uncontainable stuff. I don’t think it could have happened in any other way.
The first time that I was in the hospital was in this mass mental health center like a Boston public hospital that was run by Harvard. All the staff, even the aides and everything, were college students. It was a horrible place, physically, but it was a very progressive, caring place.
Ten years later when I was there again, it had been taken over as a state facility and civil service, and the quality of care was just down the tubes. Pretty much the people who are important are the people you encounter every day, not necessarily the primary care people.
Now, the options just don’t exist for people. There are fewer and fewer inpatient beds and the goal is, “Get them in. Get them out.” People aren’t being trained in psychotherapy anymore. They’re trained in throwing medication or short-term psychotherapy, like, “How do we do it within eight sessions?” Somehow people’s experiences can’t conform to the insurance payment system.
I think the whole insurance system in this country just has changed dramatically where people expect that their insurance is going to pay for everything. If you need help, sometimes you have to pay for it. Should it be $250 a session? No. Should our tax money be going to provide good health care to everybody? Yeah.
Des: I feel like you’ve answered this question already, but this is the one question I do ask everyone. Is suicide still an option for you?
Mindy: Well, yeah. It’s an option that I do everything I can to avoid. As soon as it comes up, I let the people who are important know about it.
I have a really good life. I have a lot of support. I’m not poor. There isn’t really anything that I’m hurting for.
People die. I miss people, but that’s life.
Even under the best of conditions, I’ve found myself in the basement thinking, “Where’s that noose going?” or something like that. I have to be really aware that I need to let somebody know that those thoughts have come up. Again, I don’t want it to be [my husband]. I’ve got two people I can talk to, and they let [my husband] know if they think he needs to know. I’ve given them the carte blanche.
Des: When I put your story up, what do you want the people reading it to know?
Don’t just survive—prevail. Surviving’s not good enough.
Mindy: Don’t just survive—prevail. Surviving’s not good enough. That’s not what I want as my identity. It’s not a manic, “be Robin Williams, exhaust yourself, and not be able to go on.” It’s, “How do I use what I have the best way I can when it’s available to me?”
Everything for me is about making an impact, making changes, and giving back. All that kind of paying it forward crap. Maybe it has something to do with having a second or third or fourth chance on life, you know?