JR V1

Chapter 1
Jacob's Depression

A door slamming in the distance jolted Jacob from his sleep. While he waited for the pounding in his chest to pass, he heard distant yelling that confirmed his suspicions. Must be my neighbors fighting again. Dammit.

The young man stretched on his bed and pulled his cellphone out from under his pillow. He'd slept through the entire morning, only ever getting up to use the bathroom. After clearing the notifications on his phone, he tossed it over on the other side of the bed. 

Jacob was only moments away from returning to his slumber when an alarm went off on his phone. He slid his arms around the bed until he found the aggravating device. Silencing the reminder that he set for his therapy appointment, he rolled out of bed, groaning the whole time. Even though Jacob had slept for almost twelve hours each day of the past week, he was physically, emotionally and mentally exhausted, and he knew there was no relief coming any time soon. Tomorrow, the day after that and every day next week, he'd wake up and continue the cycle of drowning in his depression. That was unless he decided to do something about it.

Jacob couldn't escape the compulsion to fantasize about how much simpler it would be if he could just stop waking up. He was sure it would be a blessing, but for some inconceivable reason, he just kept opening his eyes every morning. Letting out a heavy sigh, he walked out to the living room of his small apartment and lit his last joint.

Looking around, he took in the current state of his small apartment. Clothes, bottles, cans and to-go boxes littered the floor, and his stained sheets desperately needed to be washed. The terrible smell of the residual smoke mixing with his funk was enough to make his eyes water, but Jacob didn't have the desire to clean anything. He simply wiped the tears from his eyes and pulled on the pair of jeans that he left lying on the couch before shuffling back into his bedroom to look for a shirt.

Standing in front of his dresser, he caught sight of his reflection. He stared at the pimples decorating his caramel brown skin and his jet-black Afro that had grown out to be about three inches higher than the two inches he normally kept it at. His beard needed a trim. The hairs were uneven and sticking out in random directions. Sighing and shaking his head, he fished out the last clean shirt from his dresser. Pulling it on, he walked out of his apartment headed for the bus stop.

****

Sitting in the lobby of his therapist's private practice office, he thought about how pointless his existence was. He was twenty-two years old, and he had absolutely nothing going for him. With no family, no job and no dreams, Jacob wondered what the point in continuing to live could be when he had absolutely nothing to look forward to. It only made sense for him to prematurely end his misery.

His therapist, Simon, was a short West Indian man from Trinidad in his late thirties who had expertly assisted him in navigating his grief after he tragically lost his family a few years ago. During the last session on Tuesday of last week, they were working through creating some new life goals, and by the end of the last session, Simon had been pleased with how well Jacob was progressing.

When Simon went to the waiting area to usher Jacob in for his session that Friday, he could smell the strong scent of weed emanating from his client, and he was already disappointed. From his uncoordinated walk to the therapy room as well as his bloodshot eyes, Simon knew Jacob was already so high that the session wasn't going to be very worthwhile. He decided he would at least try to get to the bottom of what happened before he sent him home.

After Jacob finally made it to the sofa having been guided a bit by Simon so that he didn't accidentally damage anything, he rested his head on the back of the sofa and closed his eyes.

Simon sat in his chair directly across the room from Jacob, and when the younger man didn't try to start conversation, he decided to initiate the discussion.

"Jacob?" he asked. 

His client opened his eyes, sat up a little and slurred, "Oh heyyy! Wassup bossman? I forgot you were there for a second."

Seeing that he now had Jacob's attention, Simon leaned forward in his and asked, "What happened Jacob? Why are you high?"

"I'm stoned because I wanna be, Simon," he adamantly declared.

Simon sighed. He knew that it wasn't going to be easy to get direct answers from Jacob when he was intoxicated.

"Jacob, you decided to stop using cannabis a year ago," he reminded him. "Last session, you seemed to be very happy and hopeful. What changed between then and now?"

Annoyed, Jacob looked through the window above his therapist's head. He wasn't ready to be reminded of how quickly his happiness was ripped right from under him.

"I stopped being an idiot, Simon," he said. "Now, I see the world clearly. That's all."

"Yes, Jacob I know," Simon began. "Now the world is terrible, and everything is bad. But what in particular about your life changed that caused you to begin to feel this way?"

The twenty-two-year-old rolled his eyes, sat back in the sofa and crossed his arms over his chest. Simon ran a hand through his hair in frustration. He knew that Jacob normally had classes on Fridays a few hours before the session, but he presumed there was no way he attended them like this.

"Did you go to your classes today?" Simon asked. 

The aggravated young man shook his head. "No, fuck that school," he said. "Fuck class."

"Fuck class?" Simon asked. "If I remember correctly, Jacob, during the last session you talked about how you were planning to take your class attendance much more seriously. So, I'll ask you again, what happened?"

Jacob took a moment to dejectedly look at the floor. "I got kicked out of school. I'm a fucking loser with nothing left," he whispered with a tinge of sadness evident in his voice.

Simon kept a neutral expression on his face, but he was inwardly pleased to have finally gotten a helpful answer from the young man. However, he still needed a few more details.

"When did you find this out?" he asked. 

"I got a phone call and email the day after our last session informing me that I was kicked out," Jacob answered.

Simon sat up a little straighter in his chair and crossed his leg. He needed to keep the conversation moving quickly, knowing from past experience that Jacob's cooperation was only going to last so long.

"Since then, what have you been doing?" he asked. 

"Oh, I've just been chilling, smoking and making plans," Jacob enthusiastically responded while resting his head against the back of the sofa.

The seasoned therapist was aware that Jacob had gone back to masking his emotions. He watched him sit back with a fake smile on his face, but Simon knew that this was something Jacob only did when he was feeling especially emotionally volatile. Nonetheless, he opted to bite the bait.

"What kind of plans?" he asked.

"Final plans," Jacob said, uttering the words slowly and deliberately.

Simon knew where this was going. After the loss of his family, Jacob had attempted suicide a few times. Before his most recent attempt, Simon had him involuntarily committed to a local psychiatric hospital, but to Simon's shock and dismay, Jacob was able to weasel his way out of the hospital within a few hours. Jacob had attempted suicide again that night.

"Jacob, have you made plans to end your life?" Simon asked directly, hoping to stage an intervention.

Jacob rolled his eyes. "Listen Simon. We don't have to do the whole shebang again." He paused for a moment before he continued, "You're good. I'm good. Everything is good."

"Have you given up on therapy?" Simon asked. "This is just another rough patch in your life. You can move past it."

Jacob sat forward in the sofa and crossed his leg. "I actually came here to tell you that I won't be coming back, but I did want to let you know that I appreciated having you as a therapist. You're really good, better than most."

"Jacob, after your last suicide attempt, you agreed that you would see me for a closing session to discuss the work we accomplished together, rather than just leaving the same day you choose to quit," Simon quickly reminded him.

He shrugged. "I mean if you really want to waste your time like that. I'll come."

"Good, today is Friday." Simon said. "I can see you on Monday at 6:30 pm. Does that work for you?"

"Yeah, I'll be there," Jacob confirmed and stood up to leave.

As the young man was about to walk through the door, he heard Simon call out to him, "Jacob, please at least try to be sober for the next session."

"Sure, Simon. Sure," he responded, staggering through the main office door to the bus stop.

On his bus ride back to his apartment, Jacob solidified his suicide plans. Having no real family or friends left made the whole process so much easier. There was no need to even leave behind a suicide note. 

A few years ago, Jacob had watched a TV show where the main character chose to die by heroin overdose on a beach, and he wanted to go with that same route for this attempt. He already had a dealer in mind, and he intended to sell his electronics to come up with the cash. 

Before unlocking his apartment, he noticed an eviction notice on the door meant to inform him that he had until next week Wednesday to clear the premises. But that was fine, he'd be out of there by Tuesday at the latest, and they'd at least get to start on the cleanup quickly. 

****

It was late evening when Simon had finished seeing his last client of the day. He sat down in his office and back to his session with Jacob. He didn't actually plan to see any clients next week. In fact, the private practice that he shared with his wife was closed for an entire month. It was almost the fifteenth anniversary of their marriage, and they intended to leave for their vacation home on Wednesday.

Simon couldn't help but feel guilty that he couldn't seem to figure out how to help Jacob. He saw so much of his younger self in him. After he immigrated to the United States, leaving friends, relatives and loved ones behind, he remembered being in a similar dark place. That's why he didn't hesitate to try to see Jacob for one more session. He just had to explain the decision to his wife when he got home. 

****

Angelique had always supported Simon after Jacob's suicide attempts. She knew from her own experience as a seasoned therapist how difficult it was to process the guilt that surfaces after a client's suicide attempt. When Simon came home and explained to her why he intended to see Jacob before they left for their vacation, she was understanding.

Simon and Angelique spent some time talking about contingency plans should Jacob still choose to try to end his life. Simon was less than hopeful that his next session with Jacob would be an effective intervention. With their laptops, the couple looked into psychiatric hospitals in Washington that specialized in rehabilitating patients who experience persistent suicide ideation.

From their research, they learned about Saint Ives psychiatric hospital and the hospital's intensive care unit for chronically suicidal patients. The project was led by Dr. Kelly, the chief psychiatrist of the hospital. The unit was pioneering a new and robust treatment method that involved drug-assisted physical age-regression. In her work, Dr. Kelly asserted that often the only true cure for chronic suicidal ideation in patients is a chance to re-experience childhood in a family free of any form of dysfunction.

Initially, the couple was doubtful about the efficacy of the program, but the more that Simon and Angelique read into the intensive care unit at the psychiatric hospital, the more confident they were in the treatment approach. If there was a chance to help Jacob, they had to take it. That night, Simon sent an email asking for a consultation with Dr. Kelly on Monday morning, including a few details relevant to Jacob's case.