Some years ago my friend Sarah and I went on a leisurely canoe trip along the shores of the Wye River. The locusts buzzed in the fields and the July air was dense as wet gauze. We would stop paddling and drift. At one point she turned around, sat, and wanted to talk. She talked music most of the time. She was 34, a gifted solo musician and had made half a million dollars from her very first recorded song.
I knew her enough to know that she never used drugs. And, as for alcohol, she was one of those people who’d rather sip and stare at a glass of wine rather than drink it. At worst —or so I thought at the time—she wrestled with the kind of mild doubt and insecurity that in a healthy context of self-observation can fuel artists as “arguments with God.”
As we dragged our hands in the tepid river, Sarah asked, “so what do you think about suicide?” I shook my head. We’d had intense conversations before about the cardinal events that take place in human life, so we launched into it full bore.
Is suicide selfish? Can it be a fully informed, rational decision or is it always the result of mental illness?
I think we got as far as considering suicide an “illness that complicates thinking and feeling even though it sometimes appeared to be a rational decision.” Our default position was that suicide was a permanent solution to a temporary problem even if we didn’t know the problem.
We were fishing in the dark, of course, but artists fish in the dark for subjects to unveil. Besides, it was just a philosophical discussion on a hot afternoon and it was clear that we wouldn’t be challenging Albert Camus anytime soon.
We’d heard about the terminally ill taking their lives and decided that we could not judge. We’d heard about teenagers taking their lives, but surmised that they were ill equipped to deal with sudden emotional trauma.
We agreed that while some people appeared to have planned their deaths, there seemed to be much impulsivity in many acts of suicide— but wasn’t some type of mental illness still operating in the background? One just doesn’t jump off a cliff without a cauldron of depression, addiction or some other mental affliction bubbling in the background, do they?
Neither of us had known anyone personally who had committed suicide. Our guesswork ended at a locked door, with no key. Strangely, we thought, we could identify suicide only by the trauma it left behind — that terrifying jolt like lightning too close, and the widening sphere of shock and grief of those affected.
We drifted a while and paddled back to the dock. A recording company had contracted Sarah and their rep was waiting for her to deliver the goods. She was amped on promise and exhilaration as she stood on a precipice of creative possibilities and wondered if she had the wings for this next challenge.
Four months later, Sarah committed suicide.
First there was the gut-wrenching shock and the primal despair that shreds language down to a few syllables of anger, guilt and bewilderment. All of her friends searched through emails, recalled conversations, theorized and tried to solve the puzzle of our grief.
None of us found satisfactory answers. We knew she’d been somewhat despondent over a relationship issue, and that big decisions like house purchases didn’t come easy, but who among us had never felt the undertow of depression?
We were looking for a shred of light on the dark side of the moon.
Suicide is the tenth leading cause of death in the U.S. According to the American Foundation for Suicide Prevention (AFSP) one million people attempt it each year and 40,000 people complete the act. That would be the entire population of Talbot County. Each year. According to the World Health Organization, 800,000 people worldwide end their lives annually.
Just days ago, WHO’s Director Margaret Chan was quoted in a Reuters article for dailymail.co.uk, as saying that the WHO’s report—prepared for world suicide prevention day on September 10—is “a call for action to address a large public health problem which has been a taboo for far too long.”
Globally, and in the US, the demographic most vulnerable for suicide is the 70+ age group, but for the 15-29-year bracket, suicide is the second leading cause of death.
According to the report, men die by suicide more than women and that in more affluent countries three times as many men kill themselves as women.
Can effective prevention measures take place? The answer is yes.
Like addiction and mental illness, the taboo of discussing suicide are still powerful roadblocks, but talk and listen we must, especially to those we feel might be vulnerable.
Suicide is complex. One anecdote and one article can hardly knock on the door of the subject. We jump to conclusions—”he (or she) just lost her job,” etc.—and overly simplify. Studies indicate that psychiatric illnesses and/or substance abuse are powerful influences in 90% of suicides.
Gerald Beemer, licensed clinical professional counselor at UM Shore Regional Health, believes that in addition to the complexity of someone’s state of mental health, therapists can overlook a key element in identifying a person’s vulnerability to suicide.
“I think it’s important to find out if, during their developmental years, there has been a family suicide. This can turn out to be a joker in the emotional deck of cards and they might not even know it’s there until triggered,” Beemer says.
Beemer explains that part of what we learn during our adolescent years is the interpretation of other people’s responses to life events. We learn from how they react. If a family member commits suicide, the experience can be filed away without context or understanding.
“It’s how they deal with the joker later in life that becomes critical. If at some point a person experiences a crisis—a breakup, the loss of a child, the loss of a home with all their possessions—causing a depression, and the joker pops up as a solution to their pain, then we have a very dangerous situation,” he notes.
Psychiatric geneticists are looking at suicidal behavior as patterns running in families; major suicide studies also point to childhood abuse as a key risk factor. Like a soldier’s Post Traumatic Stress Disorder (PTSD), childhood abuse can cause changes in brain chemistry that regulate stress and leave the brain in a heightened stress-sensitive state.
Abusing alcohol and/or drugs also play a dangerous part in increasing the risk of suicide. About the younger side of the 15-29 year old age group, Beemer pulls no punches. “Young people’s brains are not ready for alcohol and it makes suicide easier by lowering inhibitions and allowing riskier behavior. That and the easy access to weapons can make for a deadly combination.”
Among the elderly, studies have discovered a unique constellation of “reasons” suicide is contemplated. The American Association for Geriatric Psychiatry finds that older Americans blame health issues, disability, anguish over a lost loved one and financial difficulties as causing their depression. One New York study suggested that treating depression alone might not be enough without understanding the unique problems facing older adults.
Prevention:
There are warning signs of suicide. The National Suicide Prevention Lifeline publishes this list:
• Talking about wanting to die
• Looking for a way to kill oneself
• Talking about feeling trapped or in unbearable pain
• Talking about being a burden on others
• Increasing the use of alcohol or drugs
• Acting anxious, agitated or recklessly
• Sleeping too little or too much
• Withdrawing or feeling isolated
• Showing rage or talking about seeking revenge
• Displaying extreme mood swings
(Note: The more these signs a person shows, the greater the risk. Warning signs are associated with suicide but may not be what causes a suicide.)
What you should do:
• Do not leave the person alone
• Remove any firearms, alcohol, drugs or other sharp objects that could be used.
• Call the US National Suicide Prevention Lifeline at 800-273-TALK (8255)
• Take the person to the ER or seek help from a medical or mental health professional
Think of it. We live in a world of advanced science and medicine, breakthroughs and advancements in mental health applications and yet, since the early 1940s the US suicide rate has done nothing but rise across the demographic spectrum, especially among active duty soldiers and the middle-aged (30 percent!). Despite what we know about warning signs, we usually have no clue when someone else has decided there is no other way out of his or her anguish.
“Sometimes it’s a matter of six seconds only when that impulse hits,” Beemer says.
Getting to the vulnerable before that impulse is acted upon and safeguarding them with correct diagnosis and mental health or addiction support is the key.
And there is a growing movement dedicated to getting the word out nationally.
On Saturday, September 6, The American Foundation for Suicide Prevention, in partnership with Mid-Shore Mental Health System’s Defeating Stigma Coalition and Queen Anne’s County Partnership for Suicide Prevention hosted an “Out of the Darkness” fundraising community walk on Kent Island’s Cross Island Trail. More than 500 people made the 3.5-mile walk to honor the lives of family members and friends who had committed suicide, along with mental health professionals and individuals who felt the need to help make a difference.
“I just heard about it today and wanted to support the effort to talk openly about suicide and erase the stigma surrounding it. I lost my beloved uncle and I’m tired of his death being a shameful family secret when we could further our understanding of mental health issues by discussing it,” said Annapolis resident Carol Brinner.
There are many local resources. One of the most immediate is Eastern Shore Mobile Crisis Team, a service of the affiliated Santé Group.
As mental health first responders, the team provides emergency psychological assessment, immediate intervention for individuals and family.
“We have a clinician available 24/7 to talk to people in crisis. They can be people with suicidal thoughts, substance abuse or mental health issues. Our Mobile Crisis team can go on site to help individuals in crisis and we can do that between 9 a.m. and midnight, seven days a week,” says Director Carol Masden.
Eastern Shore Mobile Crisis provides service for all nine counties on the Shore. Madsen says that Kent County’s loss of Upper shore Mental Health spurred a strong community advocacy for services and the state responded with funding for the crisis service. ESMC’s Hotline is 1-888-407-8018. The Spy will be interviewing Carol at a later date.
Mid-Shore mental Health Systems, Inc. also provide a 24/7 Crisis Hotline at 1-888-407-8018
Eastern Shore Operations Center (ESOC) Serves as the behavioral health emergent, urgent and information and referral call center for all nine counties of the Eastern Shore: Caroline, Cecil, Dorchester, Kent, Queen Anne’s, Somerset, Talbot, Wicomico and Worcester Counties. The ESOC is available 24 hours a day, 7 days a week to assess and respond to calls from consumers, family members, community members, businesses and human services agencies. ESOC staff provides linkage to community resources through referral to all appropriate and existing behavioral health and human services.
1-888-407-8018
Life Crisis Center Hotline Provides counseling for victims of domestic violence or sexual assault, suicide prevention, support groups, emergency shelter, shelter referral, medical care, and assistance with the process of prosecution. 1-800-422-0009 or 410-749-HELP
Suicide Hotline Provides counseling for suicide prevention 1-800-SUICIDE or 410-742-9424
Youth Hotline Crisis intervention, support and referrals 1-800-422-0009
For more about the American Foundation for Suicide Prevention, go here.
Here are a few minutes from the “Out of the Darkness” community walk on Kent Island, September 6, 2014.
Marge Fallaw says
A moving, first-rate piece.
Jim Landskroener says
Beautifully written. Kudos to Jim
Stephan Sonn says
Excellent piece, proving that not all of genius
is anchored by the trappings of the dark side,
but suicide does, as in when our harshest judge
comes from within, without abate or witness.
faith wilson says
Thank you, Jim, for a powerful piece. My small family’s life has been irrevocably affected by the suicide of one of us. All of the feelings you described: anger, bewilderment, guilt and grief became a part of our (my) life for a long time. Talking about it helped. To be honest, frank and open about it helped. To make it not something to feel ashamed about, but recognizing the act as the culmination of a disease (life-long, grinding, debilitating depression) helped. Even at a young age, my son recognized his father’s act as the end result of that disease.
I know that not every person who commits suicide suffers from chronic depression, but we have to recognize that just like cancer, even if it’s treated with every means available, sometimes death is still the outcome.
Thanks again for the recognition that suicide isn’t something to be afraid to talk about.