Unit 4  Section 2Exercise 8 Stigma and impactThe death of Matthew Allen
Read the following story written by the childhood friend of the suicide victim. Answer the study questions.
Aaron Kheriaty,
The Death of Matthew Allen
Manic-depression is a disease that interrupts a young person’s life—usually beginning in their late teens or early twenties—without warning, and is typically chronic and unremitting. It descends like a tornado, overturning years of life’s work and plans, often leaving destruction in its wake. The disease involves both biological factors—dysregulation of the brain regions responsible for “affective states” of mood and mental energy, as well as psychological and social factors—adverse life events and stressors. Its hallmark is mania, a chaotic state of psychosis where the person experiences racing thoughts, grandiose delusions, pressured speech, extraordinary physical and mental energy, extreme agitation, and loss of sound judgment. When in a manic state, patients can go days on only a few hours of sleep, yet not feel fatigued. Manic patients are typically euphoric, full of chaotic energy. They frequently get in trouble with the law, or spend all their money on foolish projects, so impaired is their capacity for rational thought. The manic states last a week or more, and are inevitably followed by a plummet into severe depression. Here, suicide is common. Half of all bipolar patients attempt suicide; one in six kill themselves.
During my first year of medical school, I learned that a close friend from high school had been diagnosed with bipolar disorder. A bright student and talented in sports, Matt had gone on to a prestigious military academy, where he was a varsity athlete. Shortly before graduation, his mental illness became manifest. Symptoms began with mood instability, difficulty concentrating, and poor judgment. He became something of a class clown, even making wisecracks toward military superiors in front of others.
Despite this, Matt somehow managed to get his degree from the Academy. He continued post-graduate training for a career as a pilot, something that he had talked about since our high school days. This did not last. As his manic-depressive illness became progressively worse, he decided to self-eliminate from pilot training—a decision that haunted him for years afterward. He was given an honorable medical discharge from the military. “Our pilots do not have bipolar,” they informed him. After returning to his hometown, his professional dreams were shattered, and his erratic moods made it difficult for him to hold down a job.
Matt had tried lithium treatment. An old medication—actually, a naturally occurring salt, lithium is still the gold-standard medication treatment for bipolar. One summer, as we walked along the road next to the lake where we grew up, he explained to me that he could not stand the side effects. “It clouds my mind. Nasty stuff.” He had not stayed on the medication. After his brief stint with lithium, he tried another mood stabilizer, called Depakote. This drug, like lithium, helped clear up what he described as his incessant “mental chatter”; but it too came with side effects, and Matt refused to continue taking it. He searched for a possible nutritional solution to his mental disorder, trying supplements touted for bipolar, to no avail. After giving up on this, Matt remained medication-free, although his mind was anything but free.
One year, when I visited my parents for a holiday, Matt had stopped by to say hello. My eyes were immediately drawn to his neck. I did not have to ask what happened. I knew. On either side was a symmetric pair of three-inch horizontal scars. After a few minutes of conversation, I broached the subject, gesturing to his neck.
“Knife,” he said, running his index finger over both scars. “Landed me in the hospital for a week. Very bad.”
I could not fathom it, could not get my mind around it. The gregarious kid of my high school days, who loved life and running and fishing and joking, had taken a knife to his jugulars. He had wanted to bleed. Matt had tried to kill himself. This knowledge crushed me. The Matt I had known from high school was the last person I would have expected to opt out of life, to turn in his ticket. But such is the havoc wrought on one’s personality by manic-depressive illness. Matt’s natural temperament, prior to his illness, was one of tireless tenacity combined with easygoing joviality. He loved joking around, and was always the first to laugh at jokes we played on him.
The following anecdote illustrates his character. We were on a ten-day backpacking trip in the mountains of British Columbia, with seven other high school buddies and two guides. On day six, we decided that Matt, with his indomitable endurance, was hiking too fast for the rest of us. Despite the already heavy pack on his deceptively wiry frame, we could not keep pace with him. So we played a bit of a cruel joke on him by secretly burying fifteen or twenty pounds of rocks in his backpack. Matt hiked all day, oblivious to the extra weight. When we stopped to make camp, he opened his pack and yelped out a Homer Simpson-esque, “Doe!” He immediately suspected the prime culprit, and yelled, “Kheriaty!” For a brief moment, I regretted the prank. But Matt’s easy-going temperament got the best of his initial irritation, and he was the first to start laughing at the folly. Because of his good-natured reaction, we did not feel so bad laughing with him. He was always an easy guy to laugh with.
Matt made not one, but three suicide attempts.
The first occurred after experimenting with marijuana for the first and only time at a party one night. After smoking, his thoughts of suicide, undisclosed to anyone else, returned with greater force than ever. After three straight days of constant self-condemning thoughts, Matt could not stand the mental torture any longer. He emptied an old bottle of Depakote, swallowed the sixty pills in his hand, put on his scuba gear, and jumped into the lake behind his house. He sunk to the bottom fifteen feet down, and lay face up. The frigid January water seeped into his wetsuit and chilled his bones. Matt watched as bubbles from his respirator cascaded to the surface above. He could feel his heart beat more rapidly in his chest as his vision faded slowly in and out of focus. After an hour and a quarter, his wetsuit no longer adequately heating his body, Matt’ teeth began to chatter against the oxygen regulator in his mouth.
He changed his mind.
Matt inflated his equipment, floated to the surface, swam ashore, and painfully crawled up onto the beach in his backyard. After removing his mask and regulator, he doubled over with abdominal cramps, vomiting partially digested pills into a nearby hedge. Too weak to remove his wetsuit, he crawled into bed with the wetsuit on for the worst night’s sleep of his life. At first, he awoke every few minutes to vomit the remaining contents of his stomach. After an hour of this, his stomach was empty; but the dry heaves continued, burning his throat with gastric acid.
When he awoke the next morning, Matt vowed never to experiment with drugs again. He attributed his suicide attempt solely to the effects of marijuana, rather than his manic-depressive illness. He naively assumed that his mental state would spontaneously normalize if he stayed clean and sober.
The next fall, Matt enrolled in community college, and he began taking courses in instrumentation; but his mood remained irritable, and his thinking erratic. When one of his teachers asked for written critiques from the students, Matt described the teacher as a “tinhorn dictator who turns a seemingly placid environment into a quagmire of human indignance and tyrannical domination.” The teacher found this feedback quite humorous, and for some reason this endeared Matt to him. Not everyone found Matt’s increasing irritability so funny, least of all Matt. During this time, his self-critical thoughts returned, and the incessant mental chatter increased.
I suspect every suicide attempt, however determined the suicidal person appears, is accompanied by some degree of ambivalence. Poet Robert Lowell wrote, “A doubtful suicide should choose the ocean,/Who knows, he might reach the other side?” For his second attempt, Matt chose, not the ocean, as Lowell recommended, but the same lake as his first attempt. Although his reason told him he could not, perhaps Matt unconsciously knew that he could reach the other side. This time, he hiked out with his dog to a trail at the end of the road, stripped stark naked, said goodbye to the dog, and dove in. The March water was still frigid from the winter—surely too cold for him to last. He began to swim, assuming that hypothermia would overtake him somewhere in the middle of the lake.
It did not. He once again crawled onto the beach, blue and shivering, this time at the house of a stranger. The bewildered but hospitable residents took the naked young man in. While Matt emptied their hot water tank with a long shower, the kind strangers called his mother, who came to get him.
Even after this attempt, Matt refused to continue with psychiatric treatment. He could not accept his mental illness, could not see the obvious truth that bipolar disorder was the driving force behind his tormented thoughts and black melancholy. It took a third, more nearly deadly suicide attempt, for him to see this. This time, he headed out on another trail, not to a lake, but toward the mountains. He was alone.
For this third attempt, Matt had first considered overdosing or drowning, but these had already proved unsuccessful; then he considered using a gun, but did not have immediate access to one; finally, he decided on a razor blade. Earlier that day, while sitting in class, Matt thought to himself, “This will all be over by this afternoon.” He slipped out of class early, and purchased a bottle of whiskey, a can of paint thinner, and a razor blade. Then he drove immediately to a remote hiking spot, a place familiar to him. A mile or so up the trail, he stopped hiking, and knelt beside the river.
Normally an avid outdoorsman, Matt viewed this as a final act of defiance. Anger churned inside him. He could not take any more mental torment—the racing, irrational, confused thoughts, the endless mental anguish, the critical voice inside that constantly reminded him of past shortcomings. This “voice” never spoke of anything good or pleasant or funny; the voice delighted only in his pain. It needed to be silenced. Matt downed the whiskey, to the last drop. Then he drank half the can of paint thinner. Finally, he removed his razor blade from his pack. His movements were impulsive, rapid, determined.
He began by opening a three-inch gash over his right wrist, then his left. His lips pursed angrily as he raised the blade with his bloody hand to his neck. In pace with his now rapidly beating heart, blood pounded in his carotid and jugular vessels, feeding his diseased brain. Quickly, he drew the razor across the right side of his neck, then the left. More blood dripped into the river and over the rocks at his feet.
The alcohol, paint thinner, and blood loss conspired against his senses: his vision blurred, his thoughts subsided and his feelings went numb. Matt laid down on a rock and fell asleep. Next to him was the empty whiskey bottle and half-empty can of paint thinner; beside these, blood pooled around the razor blade—a shimmering island in a sea of red.
Matt did not know how long he lay there before he awoke. A familiar cold chill had set in over his body. Opening his eyes, he could see the last glimpse of daylight shining through the trees. Again, for reasons only he can know, Matt changed his mind. His will obeyed his reason, but only reluctantly. With slow, trembling hands, he raised himself off the rock. Then he began the mile-long hike back to his car. Often, his vision would blur and he would take to his knees to regain his strength. Matt eventually made it back to his car, and somehow managed to drive himself to the emergency room.
His clothes were filthy and caked in blood as he stumbled into the ER. Upon opening the door, he stammered “suicide attempt”. The sight of him alone was all that the receptionist needed: Matt was immediately escorted past triage and into a bed. After three bags of rapid IV fluids, he slowly regained some lucidity. Both sides of his neck, and both arms, required numerous stitches. When his parents arrived, Matt could not look them in the eyes. He was overwhelmed by feelings of regret, remorse, and guilt.
He spent two days on the medicine ward, during which he had to struggle against weakness and fatigue to rise out of bed. A nurse sat in his room on a twenty-four hour suicide watch. This was the low point in his struggle with bipolar disorder; the memory of it still motivates him to continue treatment. After his stay on medicine, Matt was transferred to the psychiatry unit. The psychiatrist there, also a military academy graduate, developed a good rapport with Matt. His no-nonsense, “damn it, take your medicine” approach worked.
Matt stabilized on lithium for a time.
Four years later, during my second year of residency, I was at the hospital late evaluating an adolescent psychiatric consult. My wife paged me. “Your mom wants you to call her when you get home,” Jennifer said. “She said to call her on her cell.” I was standing in a crammed nursing station, filled past capacity with residents, attendings, nurses, and medical students. Now in my second year of residency, I was a licensed physician in the state of California, humming smoothly along my career path. I could barely hear my wife amidst the noise. She also had a buzzing background of noise: our two sons, ages four and (almost) one, were tugging on her pants and asking her questions while she tried to relay the message. “She sounded kind of upset, so don’t forget.”
“I’ll call as soon as I get out of here. I’m trying to wrap up a consult… kind of a complicated case. Sorry I’m late home again… I’m trying to finish quickly, so I can leave.” Jen had heard this before. She understood.
I connected with my mother just as my car merged onto the crowded freeway. It was Friday traffic in the dark. “Why don’t you call me again when you get home?” Mom suggested.
But I could hear something in her voice. I would not wait. “Tell me now, Mom.”
“… committed suicide.” Was it the static of a bad cell phone connection, or the static of my mind, blocking out what I did not want to hear?
“Who?”
“Matt Allen committed suicide.”My cry was stifled, choked. I do not recall the rest of the hour-long drive home, except that it was dark outside. And inside.
Jennifer opened the door for me when I got home. “Are you okay?” It was plain to her by my expression that I was not.
“No,” I shook my head.
She knew before I told her. “Is it Matt?”
“Matt Allen killed himself…”
She fell into my arms, and I fell into hers.
Jennifer and I made several phone calls the next day to friends who knew Matt. I called my fellow psychiatry resident and close friend, Matt Steiner, to ask if he could take my call the following week so that I could fly up for the funeral. Although he did not know Matt Allen, Steiner understood better than most. He knew what I was experiencing. It was a feeling familiar to doctors, even young doctors: a physician feels more strongly what he cannot do than what he can.
“He never really accepted the fact of his mental illness,” I explained to Steiner. “He took lithium for a while, but has been off meds for at least a year now. He’s been searching for some other medical cause of his symptoms, always doing research on the internet. He would call me every now and again to ask me medical questions. You know, like, ‘do you think it’s hypothyroidism?’ or ‘I think it’s just gluten insensitivity: if I don’t eat wheat, and exercise a lot, I’ll be fine.’ He always tried to find some esoteric explanation… something other than bipolar.”
I continued, “I talked with him on the phone, just two weeks ago. It was the typical questions, and I told him I thought all his symptoms could be accounted for by depression; they were all aspects of his depression, but he wouldn’t accept that.”
Steiner offered some words. He knew what bipolar disorder really entailed; he had seen what it could do to a person. There was some comfort in being understood.
As I spoke to my fellow resident about Matt, I began to feel not just sadness, but anger as well. The anger was not directed toward my deceased friend—no, it was directed toward the disease that claimed his life. I hated mental illness. “At least he’s finally free of that demon,” was all I could think to say.
We talked on for a few minutes. Then Steiner said, “It makes you grateful—to be doing what we do.”
“Yeah,” I replied. “It’s easy to forget what we are really dealing with. You see it when you’re on the other side of things.” I paused. “It’s life and death.”
Just a few weeks prior to his death, I had visited my parents in Washington for Christmas. Matt lived down the street from them. I could not remember the last time I had visited my family without also seeing Matt. But this time was different. We brought a stomach virus with us on the plane, and my parents and siblings all caught it. Not wanting to infect anyone else, I decided to lay low until I felt better. It was then that Matt called me to ask if I wanted to go down to the local pool for a swim while I was in town. I said yes, and told him I’d call him in a few days when I was feeling better. I did not call until the day before we left. Matt was not home. I left a message.
I had heard something different in his voice when he initially called to invite me. I did not grasp what it was, not at the time. Looking back, I think he wanted to go swimming because that is what we used to do together in the summer, on the lake where we both grew up. In retrospect, it is now clear to me: Matt wanted to see me again one final time. He wanted to say goodbye.
We flew out the next day. Matt called me back just as our plane was about to take off. The stewardess asked passengers to turn off all portable electronic devices. “I’ll call you when we land,” I told Matt. “I’m sorry things didn’t work out this time,” I said, and offered some feeble excuses. “We’ll get together next time I’m in town.”
Matt said that he understood; he sounded cheerful and forgiving. We spoke on the phone again a week later, but I never saw him again.
I did not know it then; I had missed my opportunity.
In every one of his prior suicide attempts, there was a core, deep within Matt, that remained untouched by his illness. No matter how overwhelming the effects of his diseased brain, no matter how ruthlessly his illness drove him toward oblivion, in his heart, I am convinced, Matt never really wanted to die. This is clear from the way that he—not just once, but three times—clawed his way heroically back from the brink. I believe this final time was no different.
Among all Matt’s endearing character traits, one stands out in my mind: his simplicity, his wonder, his delight in the beauty of the world. He never lost the simple gaze of a small boy. Camping with a group of high school buddies, Matt would sneak up behind someone and pelt him with a snowball. The victim of his ruse would turn to see Matt howling with laughter; for Matt, this prank was hilarious, not just the first time, but the tenth time. He was so innocent, it was impossible to be irritated as you brushed off the snow. You just shook your head at him and smiled, or better, laughed with him. How had he managed to hold onto the delights that no longer amused the “mature” among us?
Matt delighted in created things. He loved snow, lakes, rivers. He loved running, fishing, diving, flying. Through his rigorous military training, through his competitive higher education, through his torturous illness, Matt always remained a wide-eyed boy. And the world was his playground.
The day of his death, my mother spent four hours with Matt’s mother, holding her hand. My mom was one of the few with whom Matt confided. He would drop by her office or home every now and again to chat and unburden himself.
I spoke with Matt’s mother and brother that night. She told me, “I want you to know, Aaron, that you did everything you could to prevent this. I’m a psychiatric nurse; I knew what he needed. I would beg him, ‘please, Matt, just take a little bit of lithium.’ I’ve seen it work, but he refused.” Later she explained, “We had a conversation after his prior suicide attempts. He told us that if he ever harmed himself, it would not be our fault. He told us not to blame ourselves. Matt knew that his family and friends loved him, and that he loved us. He wrote a suicide note that said he still loved us, and loved God, and this did not change that.” In our brief conversation, she gave me more consolation than I could possibly have given her. She prayed for me, right there on the phone.
I wished there was more I could have done to help Matt, to help his family. That old feeling still has not left me. I feel more strongly what I cannot do than what I can.
I had not always felt powerless to rescue Matt. Several years before, on a mountaineering trip with a group of friends, I did—quite literally—rescue him. One evening, after making camp and pitching our tents, we all agreed to go on a “solo” excursion for the night. We each took our sleeping bags, along with one meal, and ventured off alone, each in a different direction. We settled far enough apart to be unable to see one another, or to see the camp. The plan was to sleep alone and return to camp in the morning. I suppose this was a kind of man-in-the-wilderness rite of passage.
The plan was thwarted by rain. The weather turned sour just before sundown. Most of us lingered a few minutes by ourselves, hoping the drizzle would subside. But one-by-one, we all made our way back to the shelter of the tents while there was still daylight, and before our sleeping gear was soaked through. All of us, that is, except one.
Just as I was drifting off to sleep, our guide asked, “Where’s Matt? Did anyone see him come back?”
“Maybe he’s in the other tent,” someone offered.
I stuck my head out and yelled to our companions, “Is Matt with you guys?”
“No. We figured he was with you,” came the reply.
“Damn.”
I offered to go look for him. The guide handed me two flashlights as I bundled up. Outside, there was no moon; clouds veiled the stars. The light drizzle had turned into a heavy rain. “I think he went off that way,” the guide pointed. “You have ten minutes. If you haven’t found him by then, come back. Stay within earshot of the tents. I don’t want two people lost out there.” I went in the general direction the guide gestured. Before long, I was well beyond earshot of the tents, which was not that far, considering the noise of the wind and rain.
“Matt!” I yelled continuously for my friend, with no discernible reply. “Matt!” My voice sounded muffled against the elements.
Finally I heard—or thought I heard—a faint reply. “Kheriaty…” I moved forward, still calling Matt’s name. “Kheriaty! I’m down here!” As I shined the flashlight down the hill, Matt’s figure came into view. To this day, many years later, I still have a distinct impression of what he looked like at that moment. I can picture him from head to toe. His bare wiry legs stuck out the bottom of his blue running shorts. He wore no sweater, fleece, or jacket. He carried no flashlight. He was utterly alone.
This image of Matt has become for me a sort of metaphor for his mental illness. He stood alone—alone in the dark, shivering in the rain. Matt’s predicament of bipolar disorder, unlike his predicament on the mountain that night, lasted not just a few hours, but five agonizing years. On the mountain, I led him back to camp, back to warmth and light and peaceful sleep. This time, I could not lead him back, could not really even find him. Perhaps I did not search him out diligently enough. Perhaps I could have done more. Perhaps not.
In any case, I have confident hope that he is no longer buffeted by the elements—that his air is no longer frigid and dark. The day I learned of Matt’s death, words from a favorite poem by Gerard Manley Hopkins kept repeating in my memory.
I say that we are wound
With mercy round and round
As if with air…
The poem ends:
Stir in my ears, speak there
Of God's love, O live air,
Of patience, penance, prayer:
World-mothering air, air wild,
Wound with thee, in thee isled,
Fold home, fast fold thy child.
In loving memory,
Matthew Douglas Allen
1977-2005
“I.A. Richards 2. Death,” lines 7-8, History. London: Faber and Faber, 1973, p. 202.
Study Questions
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