Free Dante's Poison by Lynne Raimondo

most skilled clinician may find it hard to differentiate between benign and lethal suicidal thinking. And locking up every person who ever entertained a suicidal thought would not only stigmatize a large portion of the population but also quickly overwhelm the system.
    My personal experience with suicide questionnaires (taken purely out of curiosity, you understand) should have had me running forthwith to the nearest emergency room. But despite what many might consider ample provocation, I had never seriously—or very seriously—considered taking my own life. For that reason I tended to doubt it when someone claimed that a psychiatrist should have seen it coming. Most experts on the subject agreed, saying the issue wasn’t whether the patient’s death was foreseeable—in hindsight it would always seem that way—but whether the psychiatrist had done a thorough-enough assessment of the risk factors.
    I started down this road, asking Levin whether he had screened Danny for suicide risk when he first came in.
    â€œAbsolutely,” Levin said. “And I wasn’t concerned. For starters, he denied any suicidal intent or plan. I asked him all the standard questions: whether he had ever tried to hurt himself, whether he had ever wanted to die, whether he’d ever thought about or tried to commit suicide, etcetera, etcetera. All negative answers. I also got him to agree to a ‘no harm’ contract.”
    That much was standard and in Levin’s notes. But it wasn’t nearly enough, since as many as a quarter of patients deny suicidal ideation to their mental health provider, particularly when they’ve already made up their minds and don’t want their plans interfered with. And “no harm” or “safety” contracts—where the patient signs a written agreement promising not to harm themselves—often create a false sense of security, leading practitioners to overlook other troubling signs.
    â€œWhat other factors did you consider?” I asked.
    â€œOn the plus side, Danny hadn’t made any previous attempts, wasn’t a substance abuser, and had a strong social-support system in his swim team. He had reasonably good self-esteem and was hopeful about his future. As I mentioned, he was responding to the antidepressant and wasn’t withdrawn or aggressive. Also, his activities were for the most part heavily supervised. He had a stay-at-home mom and there were no firearms in the house, nor so far as he knew a family history of suicidal behavior.”
    â€œAnd on the negative side?”
    â€œHe was male and over sixteen, which put him in the worst statistical grouping. As I’ve mentioned, his family situation was less than ideal, and he may have been physically abused by his father, although the literature suggests the last isn’t all that significant.”
    Levin paused here, as though he had something else to add but couldn’t make up his mind whether to say it.
    â€œAnything else?” I prompted.
    â€œYes. Something I didn’t put in my notes at Danny’s request. I’m not sure I should be talking about it.”
    Rusty jumped in then, pointing out that we needed to know all the facts, both the good and bad. “And anything you say in this room will be covered by the attorney-client privilege.”
    â€œIt’s not a bad fact,” Levin said. “Oh, all right, some say it is, but I didn’t think so. Not in Danny’s case, anyway.”
    I thought I knew what he was about to tell us, but I wanted to hear it from him.
    â€œHe was gay,” Levin said finally, slowly and uncomfortably. “And very anxious that his parents not find out about it.”
    â€œUnderstandable,” Rusty observed, “given the family situation you’ve described.”
    â€œWe talked about it extensively,” Levin continued. “When he first came to me, Danny was fairly sure of his sexual