This is a book review of the story of a mother who imagines she is talking to her dead son. Many of us have experienced a lack of closure when someone near to us dies. We wish we had more time to have that one last conversation. We may even imagine speaking to them to thrash out our lifetime of unsaid words, which are mostly grievances.
If we had not said it during the lifetime of the deceased, would we have said it now to them, when they have become a ghost? Does it matter? What we desire to say can only be defensive arguments.
Where Reasons End by Yiyun Li:
This is a fiction inspired by the authoress’ experiences processing her grief after the suicide of her son, Vincent Kean Li, at the age of 16, in 2017. She has one another living son named James. Yiyun Li is a professor teaching creative writing. Ms. Li wrote her book, Where Reasons End, to pay tribute to Vincent.
In the book, the author’s son is named as Nikolai. This is also the name of a boy which the character Nikolai wrote, in a short story. In using the same name, Ms. Li may have desired to convey the message that her fictional character Nikolai wrote his story of a boy named Nikolai, to hint that the self written story was about himself. In the course of the novel, the author revealed that the character’s teachers had warned her that her son Nikolai had written about boys dying in a school project. To Nikolai’s mother, this meant nothing. She even asked Nikolai about this and he said they were only made up stories.
Here, I would like to point out that in the study of psychology, we are asked to pay attention to signs of severe depression, self harm, and talk of suicide; which is similar to talk of dying. I would interpret this episode as a sign of depression, and nurturing thoughts of suicide. I would raise the alarm. The person needs a psychiatrist.
A working mother has less time to spend on her children. She does not harp on trivial incidents. Until the crash.
The author does not explain how her female character is able to talk to her dead son, until quite late in the book. Her encounters are in dreams of him. She wrote that she dreamed of him. Yiyun Li (the author) writes that Nikolai’s ghost comes and goes.
I have mixed feelings about recommending this book. The character Nikolai’s mother, may be having unfinished business with him. Maybe she could not understand why he chose to commit suicide. Maybe that was why Yiyun Li named her book, “Where Reasons End”. There were no reasons to explain and justify suicide.
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- Intervention for attempted suicide.
Suicide is an act of behavior. A person who is psychotic may show one of its typical features, which is negative symptoms. The patient shows “marked reduced amount or fluency of speech, and loss of the will to do things (avolition)” (Morrison, p.60). This may influence the person to commit suicide, because of psychotic symptoms, due to schizophrenia. So, a patient with schizophrenia may replaced on the suicide watch. - A negative mood may be due to another medical condition, as “A variety of medical and neurological conditions can produce depressive symptoms” (Morrison, p.109).
- Secondly, the low mood can be caused by “substance/ medication-induced depressive disorder” (Morrison, p.109). Lastly, “Other specified, or unspecified, depressive disorder” may be the reason.
- Resources to manage a patient who’s attempted suicide, or exposed thoughts of trying suicide:
Clinical InterviewThe patient is observed and questioned on their feelings, thoughts and areas of difficulty. A person who harbours thoughts of self-harm, may be in distress, have tangible problems, lack family support and network of resources. The therapist should ask specific questions on depression, self-harm, suicide ideation, suicide intent and history of self-harm and suicide attempts. - Interview of family members
- Informed consent is obtained from the patient, to speak to their immediate family members. The therapist should ask about the patient’s behaviors, moods and history of illnesses. The family’s history with psychiatric illnesses should be recorded. Medical historyThe country has a database to store patient’s clinical records, if they have used the state run clinic and hospitals. It is best for the patient to visit the same clinic, which can retrieve medical records, to understand the patient’s background and problems. Depression and suicide ideation can be caused by medical conditions like deficiencies in red blood cells, thyroid hormone, and other vitamins. The blood test and analysis will show the results. Neurological testsIf the patient has suffered brain trauma, they may experience decline in cognitions, and increase in negative effect. The MRI would indicate this. In the absence of brain injury, one should examine closely the genetic and diet factors.
- Laboratory Test:
- The patient must submit to blood and urine tests. The results will show the presence of substances or medication-induced depressive disorder. The treatment/ intervention will be designed according to counter the presence of discovered compounds in the samples.
- Physical examination:
- A GP is required to conduct a physical checkup. Blood pressure is recorded. Blood sugar level can be measured using a portable blood glucometer. The result is immediate and emergency treatment can be administered, to counter the low or high blood glucose. The doctor asks questions on the patient’s appetite, sleeping pattern, level of stress, presence of problems and etc. Problems may cause a patient to feel negative mood.
- Money:
- The patient or caretaker must have money, to pay for access to resources like a doctor, laboratory tests, psychotherapy with a psychiatrist/ psychotherapist/ psychologist. The type of resources available to them will depend on how much they can afford to spend. Without the primary resource of money, the patient has to find a free resource, like a free clinic. There are agencies and organization who run free clinics. There are also state-run clinics which charge nominal fees for consultation, tests and prescriptive medication.
- Psychological evaluation:
- The cheapest form of mental health evaluation can be obtained from the state’s Institute of Mental Health.
- Information on the next-of-kin:
- The patient should supply basic information like his ID number, address, home telephone number, name of next-of-kin, and their contact numbers. If the patient had attempted suicide, they will be detained and hospitalised, under the suicide watch. The next-of-kin will be notified. The police will be able to trace and inform the family members.
- Hospital bed:
- It is compulsory to admit patients who have attempted suicide, to stay for around two weeks. The patient will be observed and treated during this time. A hospital bed should be available in the facility which has done the lab tests, physical checkup and psychiatric evaluation. If a bed is unavailable in a desired ward, the patient should be housed in the next suitable ward. If the facility fails to meet basic requirements, the hospital should consult another hospital, to arrange for the transfer of patient.
If the patient is unable to give consent for treatment, permission is sought from the next-of-kin. If the patient is unable to sign on forms for decisions, the signing can be done by the next-of-kin. - Legal issues:
- If the person is in a position that needs protection from cheating, then the next-of-kin may have to file an application, like a court petition, to get appointment for Power of Attorney, to be in charge of the personal affairs of the patient.
- Moral support:
- During the patient’s stay in hospital, their family members, close relatives, and friends, should pay regular visits, to see the patient. This will help to boost the morale, confidence and self-esteem of the patient. Support from a wide network of people will help the patient to recover from mental and emotional stress.
- Counseling:
- Patient is counselled. Clinical interviews will help to get feedback, to monitor the progress. The treatment plan can be modified to take care of necessary areas. Psychological tests and other assessments are conducted to ensure that the patient has returned to normality. The doctors, nurses and all other healthcare professionals in contact with the patient, must be in agreement that the patient is well enough to be discharged. The patient is advised of the polo resources available, to assist in the recovery.
- Telephone helplines in Singapore:
- Samaritans of Singapore (SOS)1800-221-4444
- Tinkle Friend for school students1800-2744-788
- Singapore Association for Mental Health1800-283-7019
- Mental Health Helpline6389-2222
- Aware SOS Helpline1800-221-4444
- Reference
- Morrison, J. (2014). DSM-5 Made Easy: The Clinician’s Guide to diagnosis. The Guilford Press: New York.
If you have dreamed of dead people and wonder why, read this book. Available at the link.
Tags –
grief, death, suicide, depression, processing grief, afterlife, The Other Side, conversations with ghost
