It was a Monday morning, and I was seated in my therapy room and suddenly all the color in the room turned to black and white. And then I began to feel cold chills.

Sitting in front of me was Nancy. I had been seeing Nancy for six months, a few times a week, and I didn’t think I was making any progress, yet that was the longest she had gone without a suicide attempt or needing to be hospitalized.

Prior to seeing her, she had made three attempts the most recent one – jumping off a two story balcony, requiring many subsequent surgeries – that certainly should have killed her. She had also been an inpatient in psychiatric hospitals for weeks at a time (patients often stayed that long in those years) during the prior five years.

She had been referred to me, as had many of my suicidal patients, by Dr. Edwin Shneidman, one of the preeminent pioneers in the study of suicidal behavior and its underlying psychology.

This particular day followed a weekend of “moonlighting” at Metropolitan State Hospital in Norwalk, California where once a month I would spend the weekend covering for staff psychiatrists, doing admissions and attending to emergencies on the inpatient units.

On occasion I would be up 24 hours as was the case preceding this particular Monday.

Nancy came into the room as she always had and sat quietly, rarely looking me in the eye, not quite catatonic, but fairly lifeless.

It was on this Monday however when the above experience occurred. When it did, I thought I might be having a stroke or a seizure and proceeded to do a neurological exam on myself (it wasn’t rude, because Nancy rarely looked directly at me). I proceeded to tap my knees and elbows, look at my outstretched index finger (to see if I was seeing double or if it were blurred) and flexed my feet and wiggled my toes.

All present and accounted for and I concluded I was neither having a stroke nor a seizure or any other neurological condition.

I then had this crazy notion that somehow, I was looking out at the world and experiencing the feelings that Nancy was feeling, especially a sense of wanting to scream because it was so bad, but not being able to as shown in the famous painting, The Scream by Edvard Munch. And all that wanting to scream from the pain, but not being able to instead turned inward and eviscerated her hope and desire to live.

For some reason, I leaned into the feelings I was having and they worsened and as I watched her gaze staring 30 degrees to my right, it continued to intensify.

It reached a point where sleep deprived, instead of thinking the following thoughts, I blurted them out:

“Nancy, I didn’t know it was so bad and I can’t help you kill yourself. But if you do, I will still think well of you, miss you and maybe understand why you had to in order to get out of the pain.”

Realizing I had said that instead of thinking it, I thought to myself that I had just blown it and essentially given her permission to kill herself.

Within a few seconds, her head and eyes hesitantly shifted towards mine, until they locked onto mine. And I mean locked (as I later realized it was for dear life as a drowning person might lock onto a lifeguard).

Being worried that I just given her the go ahead to kill herself, I anxiously asked her, “Nancy, what are you thinking?”

I thought she was going to thank me for giving her permission to take her life and tell me that she was long overdue.

Instead she said, “If you can really understand how I might have to kill myself to get out of the pain, maybe I won’t need to. She then smiled but continued to lock onto my eyes.

At that point I replied, “I will tell you what we’re going to do. I’m not going to offer you treatments and medications that have already been tried that didn’t work and have you not follow through and then have to come back and tell me guiltily you hadn’t tried them. That is unless of course you tell me that you want those treatments. Would that be okay?”

Nancy kept me locked in her gaze and her eyes communicated, “Keep talking, I’m intrigued.”

At that point I said, “What we’re going to do instead is that I’m going to find you wherever you are and wherever it hurts most and I’m going to keep you company there for as long as it takes because you’ve been their alone too long and I don’t want you to be alone there anymore. Would that be okay?”

At that point Nancy’s eyes teared up and began crying with relief – and beginning to feel more alive – that indicated to me an acknowledgement that I got it right. It was the turning point in her getting better.

What Nancy taught me is that sometimes, deeply suicidal people are locked where they’re at and can’t come towards us. Instead, we need to to go where they are – as scary as it may be – to feel the depth of their hurt, pain and despair with them.

In fact, if you look at the word despair as des-pair, many suicidal thinking people are feeling unpaired with reasons to live. Hope-less, unpaired with hope. Worth-less, unpaired with worth. Helpless, useless, meaningless, purposeless and when they all come together, pointless to go on. It is at that point that “death as an option” to take away that deep hurt, “pairs” with them and feels their pain and offers to take it away.

I believe that what happened with Nancy is that she “felt felt” by me in Dark Night of her Soul, as opposed to feeling “treated” by me and therefore disconnected from me.

For forty years I have been trying to figure out what occurred with Nancy and the approach I used with many people feeling suicidal since, without any of them dying by suicide.

After all this time, I think I may have discovered it and have even given it a name that I have introduced to the world in a recent book, co-authored with Dr. Diana Hendel, called, Why Cope When You Can Heal?

It’s called Surgical Empathy.

Surgical Empathy is an approach to freeing people psychologically and emotionally from being attached to dysfunctional mindsets that lead to counterproductive and self or other destructive behaviors.

It utilizes a process of Empatholyis, where by using targeted, specific and deeply compassionate empathy it is able to “lyse” internalized psychological attachments and fixations resulting from abuse, neglect or overindulgence (coddling), with one of those attachments being to death as a way to take away the pain. This enables people to release themselves from those attachments and fixations and to attach to that accurate, specific and compassionate empathy being given to them.

Such empathy serves as a transitional object and experience that they can hold onto until they can internalize what amounts to not just empathy, but also love to dilute and dissipate the previously internalized coddling, abuse or neglect and land in a more functional (dare I say beginning to heal) mindset which results in productive and satisfying behaviors and eventually a fulfilled life.

That’s what happened with Nancy and what we are now taking around the world to teach worried parents and interested therapists and counselors – after fifty years, I am currently retired and do not see patients directly – who would like to add Surgical Empathy to what they are already using.


  • Mark Goulston, M.D.

    Author, speaker, podcast host, psychiatrist

    Dr. Mark Goulston is the inventor and developer of Surgical Empathy an approach that helps people to break their attachments to counterproductive modes of functioning and frees them to connect with more productive and healthier alternatives. He is the host of the “My Wakeup Call” podcast where he interviews people on the wakeup calls that changed who they are and made them better human beings and at being human and the host of the LinkedIn Live show, "No Strings Attached." He is a Founding Member of the Newsweek Expert Forum. He is one of the world’s foremost experts on deep listening, radical empathy and real influence with his book, “Just Listen,” becoming the top book on listening in the world, translated into twenty languages and a topic he speaks and teaches globally. He is an advisor, coach, mentor and confidante to CEO’s, founders and entrepreneurs helping them to unlock all their internal blocks to achieving success, fulfillment and happiness. Originally a UCLA professor of psychiatry and crisis psychiatrist for over 25 years, and former FBI and police hostage negotiation trainer, Dr. Goulston's expertise has been forged and proven in the crucible of real-life, high stakes situations including being a boots on the ground suicide prevention specialist and serving as an advisor in the OJ Simpson criminal trial. Including, “Just Listen,” he is the author or co-author of nine books with multiple best sellers. He writes or contributes to Harvard Business Review, Business Insider, Biz Journals, Fast Company, Huffington Post, Psychology Today and has appeared as an psychological expert in the media including: CNN, Headline News, msNBC, Fox News, Wall Street Journal, New York Times, Forbes, Fortune, Psychology Today and was the subject of a PBS special. He lives with his wife in Los Angeles, California.