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Book Forum: Suicide   |    
No Time to Say Goodbye: Surviving the Suicide of a Loved One
Am J Psychiatry 1999;156:653-653.
View Author and Article Information
Vancouver, B.C., Canada

by Carla Fine. New York, Doubleday, 1997, 252 pp., $22.95.

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Few psychiatrists have not lost a patient, loved one, classmate, colleague, or friend to suicide. In this small book, Carla Fine speaks to all of us—as clinicians and as grieving human beings—with compassion, wisdom, and an exhaustive analysis of this exquisite and uniquely personal loss.

Ms. Fine’s husband, Dr. Harry Reiss, a Manhattan urologist, killed himself with a massive intravenous infusion of sodium thiopental and heparin on December 16, 1989. He was 43 years old. In her first chapter, she writes,

My once-familiar world exploded with his suicide; in an instant, the life we had built together during our marriage of twenty-one years ended, without discussion or time for goodbyes.…I had entered into a surreal world where accepted forms of mourning did not apply.…The lives of those of us who are left behind have been shattered into thousands of tiny fragments, and we do not know how to begin cleaning up the devastating damage.

Such powerful statements clutch the reader’s attention immediately and throughout the book.

No Time to Say Goodbye is both a first-person account of Ms. Fine’s journey of healing and a presentation of her research on the lives of more than 100 women and men who have lost loved ones to suicide. She also interviewed a number of mental health professionals and others who specialize in the field of suicide survivors. The book is full of stories. Stories of pain and heartache, struggle and loss, courage and inspiration. I know of no other work on this subject that is so comprehensive and rich in exposition.

Some of the pearls for psychiatrists are these: Always remember that the survivor, not the deceased, is your patient; it is the deceased who has brought the person to you, but it is the survivor who needs the therapeutic help. Survivors live with tremendous shame and guilt, including feeling like "damaged goods." The aftermath of suicide is a twofold process—coping with the impact of the suicide and grieving the loss; look for heightened shame when the survivor is a mental health professional. Self-blame and blaming others are not uncommon in survivors. Feelings of hurt and betrayal, inadequacy, and powerlessness are common. The effects on the family are profound, especially denial, fear, and contagion—and the ever-present risk of divorce in parents of teenagers who commit suicide. Depression in survivors may resonate with the despair of the deceased. Survivors may fear and avoid mental health professionals because we are perceived as having failed the deceased or as labeling the survivors as mentally ill. Survivors live with the psychological challenge of forgiving first the deceased and then themselves.

The book concludes with lots of resources—a list of organizations with resource material, a list of support groups in the United States and Canada for survivors, and a very good bibliography. Ms. Fine writes well; her story and those of others are gripping. She speaks with heart and authority—for we in the psychiatric profession are survivors too. No Time to Say Goodbye is a work of hope and great love for those who have killed themselves and those whom they leave behind. This is a must-read for all psychiatrists and their patients.




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