I Think I Finally Get It's A Wonderful Life
Thanks to Tyler Black, M.D. and the Psychiatry Bootcamp Podcast
The Frontier Psychiatrists is a daily health-themed newsletter. It’s written—largely—by Owen Muir, M.D. I have a partner in most things,
, who has—much to her credit—insisted today that I write this piece.“Have you written anything today?” She just said, just now.
“No.”
“That is awful. Go write those things about It’s a Wonderful Life,” she said a moment later. It’s 9:12 pm the day after Christmas and one long drive back from Connecticut later for us. She is my wife, I will add.
It’s A Wonderful Life is a strange movie for a holiday classic. It’s the touching tale that wouldn’t be made today— but has somehow flown under the radar as a Christmas classic ever since. Some highlights that seem strange in 2023:
The main character is physically assaulted as a child in the opening scenes of the movie, leading to a lifelong disability (deafness in one ear).
The plot is pretty hostile to private equity. I am surprised the movie hasn’t been digitally upgraded to recast Mr. Potter and his contempt for those who need to debt-finance their lives as the real hero?
Jimmy Stewart plays a banker who has encouraged members of his community to get into debt and has done a poor job of checking for appropriate collateral in his bank manager role. This is portrayed as heroic and cute in the movie; nowadays, it seems slightly more like he would've had a great job at SVB.
Regardless, he lends out a lot of money and gets into a financial bind, and apparently, nobody has told him about the role of bankruptcy? He gets pretty abusive to his family, verbally, at least. This mercurial man considers suicide. He has a guardian angel who saves his life by showing him the alternate universe in which he had never been born. This alternate universe turns out to suck and be a lot darker than the one in which he was living, which gives him a new zest for life.
His problems are solved when an analog version of a crowdfunding campaign solves financial problems, and he doesn't end up going to jail or becoming insolvent.
This is a weird movie. Don't get me wrong, it's a good movie. It's a better movie than some of that three-hour-long garbage we've been forced to sit through these days, and there aren't another 900 sequels in the cinematic universe that we are forced to put up with.
It's a wonderfuler life, reloaded, II.
(It is loosely based on A Christmas Carol, so this isn’t exactly true.)
This movie always made me deeply uncomfortable. There's something about being forced to contemplate suicide every Christmas that, for somebody who worked as a psychiatrist with suicidal individuals— for many years taking crisis calls on Christmas— makes this all rather garish.
We listened to an awesome podcast on the drive back to New York. It is for psychiatrists but accessible to everyone. Tyler Black, M.D. is a child and adult psychiatrist. He appears as a guest about suicide risk assessment on the Psychiatry Boost Camp Podcast. Mark Mullen, M.D. is still a psychiatric resident and the host of the show, which is a baller, Frontier Psychiatrists-y move, if I don’t say so myself.
A few myths are dispelled:
Suicide is not more common during the holidays. It’s more common in the summer.1
Death by Suicide is not bimodal in distribution; it peaks at age 45 in males.2
Psychiatric Hospitalization doesn’t modify suicide risk for the better, as far as the confounded data can tell us.
Suicide risk assessment is complex.
One of the things that stood out to me, having both watched our national meditation on death by suicide for the holidays AND listened to this podcast? I am struck by how astute an interventionist Clarence, the guardian angel, is for George Bailey—the main character. He doesn’t try to stop Bailey by hospitalizing him. He doesn’t try to reduce his risk of drowning—the Angel fakes drowning to abruptly jar Baley out of his “I’m going to jump to my icy cold death” reverie, at which point he jumps in to save Clarence.
He leans in—hard—on life's existential nature and its meaning. He focuses on Joyner’s interpersonal model for suicide (affiliate link).
This model focuses on two drivers of death by suicide:
1) that perceptions of burdening others and of social alienation combine to instill the desire for death;
2) that individuals will not act on the desire for death unless they have developed the capability to do so – a capability that develops through exposure and thus habituation to painful and/or fearsome experiences, and which is posited by the theory to be necessary to overcome powerful self-preservation pressures.3
Clarence focuses, as an angel of suicide prevention, on paranormal underscoring through an elaborate challenge (according to an MBT framework, as I wrote in my book on the topic, affiliate link).
Clarence showed George how much he did belong and wasn’t a burden by dramatically creating a world for George in which he had never been born. People weren’t just bereft. They were profoundly without. It wasn’t good.
This was a bold choice. I can hardly imagine any health professional earning their wings this way!
More often than not, this can be accomplished without hospitalization. Very shortly, I hope our hospitals can include SAINT, if not angels, and other rapid-acting treatments. It doesn’t escape my notice that the kind of paranormal perspective shift presented for the traumatized Charles Bailey sounded a lot like what I wrote about just the day prior in this column vis a vis psilocybin treatment of PTSD. I’m hosting a conference on the topic in a few weeks—Jan 7th.
It’s fiction, of course. But in the excellent podcast, Dr. Black makes the point repeatedly: be a person first. The theory can come later. Most people won’t die by suicide when they are thinking about it. Can we relax a little? It might help us focus on the wonderful life our patients might have on the other side of a suicidal crisis.
Woo JM, Okusaga O, Postolache TT. Seasonality of suicidal behavior. Int J Environ Res Public Health. 2012 Feb;9(2):531-47. doi: 10.3390/ijerph9020531. Epub 2012 Feb 14. PMID: 22470308; PMCID: PMC3315262.
Phillips JA, Robin AV, Nugent CN, Idler EL. Understanding recent changes in suicide rates among the middle-aged: period or cohort effects? Public Health Rep. 2010 Sep-Oct;125(5):680-8. doi: 10.1177/003335491012500510. PMID: 20873284; PMCID: PMC2925004.
Joiner TE, Van Orden KA, Witte TK, Selby EA, Ribeiro JD, Lewis R, Rudd MD. Main predictions of the interpersonal-psychological theory of suicidal behavior: empirical tests in two samples of young adults. J Abnorm Psychol. 2009 Aug;118(3):634-646. doi: 10.1037/a0016500. PMID: 19685959; PMCID: PMC2846517.
George Bailey’s hearing loss was due to a childhood infection, contracted when he saved his drowning brother, I think. Not when the druggist hit him in the ear.