© Jerry Cooke/Corbis
© Jerry Cooke/Corbis

On the morning of September 21, 1993, a shy and intelligent American woman who had never practiced Buddhism took an elevator to an upper floor of Duke Medical Center in Durham, North Carolina. Her name was Susan Kandel, and she was 37. Panicked and miserable because her trusted therapist had recently moved to another state, she walked onto an open breezeway and jumped, expecting to fall ninety feet to her death. She landed instead on a maintenance workers’ platform forty feet below and was taken to the emergency room with three broken vertebrae. A month later, wearing a body brace but not paralyzed, she was involuntarily committed to John Umstead state psychiatric hospital, an aging brick building on the outskirts of Durham, N.C. She, the hospital staff and her family all expected her to be there for a long, long, time, and she was in deep despair.

It was her fourth commitment to John Umstead hospital and her seventh serious suicide attempt. She had been given the damning psychiatric diagnosis of Borderline Personality Disorder as a teenager and had spent much of her life turning on a wheel of suffering from suicide attempt to mental hospital to halfway house to suicide attempt. Much like a distressed monkey gnawing its knuckles in a small cage at the zoo, she had discovered at 17 that cutting her forearms with razor blades made her feel somewhat better. At 19, she was sent to a mental hospital for the first time and there she first tried to kill herself.

Nearly two decades passed and therapy fashions changed, but nothing made any appreciable difference—not shock treatment, talk therapy, or psychiatric drugs; not self-medication with sex, wine, or cannabis. At 35, a few weeks before a scheduled oral presentation for her Ph.D thesis in molecular biology at Duke University, she drove alone to the North Carolinia shore, shoved a bureau against her motel room door, and swallowed chloroform, more than 25 times the lethal dose. Two days later, she was discovered in a coma and sent for her first long stay at John Umstead state hospital—the place to which she was returned after she jumped from Duke Medical Center two years later.

By then, she was like a cat with nine unwanted lives: she had lost faith even in her ability to kill herself. “I had given up on pills, “ she says. “Guns are foreign to me, and I knew I couldn’t get a license even if I’d wanted one. I decided that it wouldn’t matter what I did; I would be brought back to the hospital and have to start all over again. I wanted to die, but the powers that be, the gods, were not going to let go of me.”

That fall, she was forced to take part in a psychotherapy that integrated western behaviorism with Zen, mindfulness practice, and what its developer, Marsha Linehan, a Catholic psychology professor and Zen practitioner, called wise mind and radical acceptance. Ten months later, Kandel left the hospital. In the eight years since, she has never come close to being re-hospitalized or to killing herself.

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