Depression and the Patient's Will to Live
January 27, 2006

I commend the Journal for its prominent and detailed coverage of the suicide death of Arthur Zankel, despite a loving, caring family and an excellent outpatient psychiatrist ("Tragic End: After Long Battle, a Wall Street Star Loses to Depression," page one, Jan. 17). The article stimulates discussion about how we might prevent other such tragedies.

The most important protection of a suicidal patient is the hospital. Just as we would all expect a medical patient to be hospitalized during an acute, life-threatening stage of illness in order to receive aggressive treatments that need close watching by professional staff, the same is true for the profoundly depressed patient.

It is common for depressed patients to refuse to admit themselves to hospitals because their symptoms make them feel pessimistic about anything being helpful, including hospitalization. Prominent individuals will often worry about stigma, privacy and other concerns that pale in comparison with the risk. It is very difficult for anyone to say, "I am calling 911 to have the rescue squad come to take you to the hospital because your life is in jeopardy." Yet, every patient I have known who was committed due to suicidal ideation has later thanked me for making that call directly or telling the family to make that call. People generally feel enormous relief once they are in a psychiatric hospital because they are removed from all the pressures of everyday life and know that they are safe. Psychiatrists are able to be more aggressive with medication combinations or may opt to suggest electroconvulsive therapy. Recently, vagal nerve stimulation, requiring a surgical procedure, has been approved by the Food and Drug Administration for treatment of the most refractory patients.

Your readers should be informed that the race to save a life is between the psychiatrist finding a treatment that will be successful and the patient giving up because hopelessness is almost inevitable and worsens over time. Although relief of all symptoms may take weeks or months, the beginning of treatment for patients who are at high risk for suicide often requires the use of a briefer involuntary hospitalization to treat the most dangerous phase of this life-threatening disease.

Paul E. Alexander, M.D.
Clinical Associate Professor of Psychiatry and Human Behavior
Brown Medical School
Providence, R.I.

Thank you for the extensive article about the life of Mr. Zankel and his long battle with depression. Last year, I lost a friend and our community lost a strong leader, who, like Mr. Zankel, battled depression. We both served on our Chamber of Commerce's board of directors, and I worked with him on many civic activities for a number of years. Like most people around him, I didn't have any idea he suffered from depression.

It is imperative that our society extinguish the stigma associated with depression and mental illness. If we dealt with depression more openly, maybe my friend's family and our community wouldn't have suffered the great loss that they did, and there would be fewer such stories.

Depression needs to "come out of the closet." Rather than the more widely reported faceless statistics, I hope to see more individually focused stories like the one on Mr. Zankel.

John R. Snyder
Coudersport, Pa.

I was first diagnosed with chronic depressive episodes 20 years ago; your article was a sober reminder to me of the seriousness of this disease and the need for additional research into its causes and treatment. But I worry that Mr. Zankel's tale might dissuade some who suffer from seeking professional help. As your story points out, millions of Americans afflicted by this illness can resume and maintain normal and productive lives through medication and psychotherapy. While depression and related mental illnesses are a major trigger in the majority of suicides, the percentage of depressed people who take their own lives, while indeed tragic, is small.

Andrew Patner
Chicago

It was sobering that Mr. Zankel didn't ultimately overcome his illness despite the presence of a loving wife, family, friends and access to the best the medical establishment has to offer. Notably, however, faith or religion weren't mentioned in the article. One is thus left wondering whether patients, such as Mr. Zankel, for whom medical treatment has proven ineffective, might find some help and hope elsewhere.

Jeff Mitchell
Washington

I am very disturbed by the article, and I feel you were irresponsible and insensitive with the approach taken. Of major issue is the abruptness of the ending. Instead of easing the reader out of an emotionally charged story and providing some insight for others who may be dealing with this issue, you ended with a visual of the poor man's shoes. I was stunned and searched to see if the article really ended there or if it continued on another page. If this was a made-for-television movie, that might have been high impact. But for a journal of this caliber it is inappropriate.

From the reader's perspective, I would have liked to have known what I could do if this situation impacted me and my family to perhaps see it through to a different outcome.

Mindy Miraglia
Scottsdale, Ariz.

I would like to thank the Journal for doing such a thorough story and thank Arthur Zankel's family for openly sharing the events that occurred prior to his tragic death. I am sure it was extremely difficult for the family to tell their story, but it is so helpful for others struggling with depression and suicide to read your article and know they aren't alone.

Julie Totten
President and Founder
Families for Depression Awareness
Waltham, Mass.