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Archive for July, 2012

I have held in my hands two suicide notes. My daughter Mary left hers in her bedroom after overdosing on anti-depressant medication in 1995. An elderly medical patient of my husband’s sent his in the mail just before shooting himself in 2009–the subject of my last three posts.

My daughter wrote that she hoped every night she wouldn’t wake up the next morning, that she couldn’t take the “hassle” of life anymore, that she was weak and hated herself.

My husband’s elderly patient said he could hear the “rapids” in the distance leading him–all alone in his canoe–to the waterfall of death. Before reaching the waterfall, however, he planned to go ashore by means of a revolver.

There is a certain composure in both notes; neither comes off as the product of extreme mental agitation. Studying them, however, I have to remind myself not to underestimate the pain underneath the words. “In almost every case,” writes Edwin Shneidman, “suicide is caused by pain, a certain kind of pain–psychological pain, which I shall call psychache” (Edwin Shneidman. The Suicidal Mind. New York: Oxford University Press, 1996, p. 4).

As professor at the UCLA School of Medicine and founder of the American Association of Suicidology, Shneidman maintains that the keys to understanding suicide are “made of plain language . . . . [They are] the words that suicidal people say–about their psychological pain and their frustrated psychological needs–that make up the essential vocabulary of suicide.”(The Suicidal Mind. New York: Oxford University Press, 1996, viii) These “keys” to understanding someone’s suicide usually appear in their suicide notes.

If anything might have given my daughter and the elderly gentleman hope before their deaths it was having someone ask them, “Where do you hurt?” and “How can I help you?” (p.6)

If only anyone had known to ask those questions.

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Just days before he commits suicide, the 88-year-old man of the two previous posts is writing about his “biological life” as a stream on which he rides in a canoe. He goes on to say that downstream are rapids–“biological problems of severe injury, disease, disability, Alzheimer’s”–rushing to a waterfall which marks the end. “When a person’s canoe gets there, everything vanishes–stream, shores, canoe, and passenger. That life is over.”

Two years prior, in 2007, he himself had begun to hear the rapids in the distance, calculating that by mid-2009, he might be near enough to the rapids to consider “quitting while he was ahead.”

“My timing was sound; now I have entered the rapids. ‘Paddles up!’ When the prow of my canoe touches shore, the result will be the same as reaching the waterfall. But, I will have avoided most, and certainly the worst, of the rapids. I provided myself with the real-life equivalent of that virtual paddle in the summer of 1995—a .32 caliber revolver. No one knows of its existence nor will until I paddle ashore.”

On the back of the note, he added a picture of himself waving to the camera and a final remark about his sense of duty: “For those who will receive this but do not know me really well, I should add that I am a widower with no dependents and no debts. Otherwise, I wouldn’t think of doing this now.”

And finally: “No nursing home for me! Adios!”

Shortly after writing those words, he joined the more than 5000 elderly people who die by suicide each year in the United States, the majority of them men. (Jordan and McIntosh, Grief After Suicide, p.66)

According to the American Association of Suicidology, the elderly die for more than one reason, usually. Risk factors include the recent death of a loved one, physical illness, uncontrollable pain or the fear of a prolonged illness, perceived poor health, social isolation and loneliness, and major changes in social roles such as retirement (www.suicidology.org).

What hope might have been offered the gentleman of these posts?

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The previous post concerns an elderly gentleman who sent my husband a suicide note in 2009. The man wrote that while he had no fear of death, he was “particular” about how he might die and that he was planning to quit while he was “ahead.”

Far from being “defeated,” “disabled,” or “discouraged,” (among several negative adjectives he provided), he said that positive words best represented his mental state.

He then employed a metaphor to show how biological life–“the route from birth to death”–can be distinguished from the “real” life of  “experiences, hardships, education, hope, love, joy, sorrow, etc.”  To him, biological life is a “stream on which I ride in a canoe. There is a paddle, but I don’t use it. I am carried down the stream of life with no effort on my part. This is a very personal stream: each person has his own and is alone on it. I have drifted along on mine for going on 88 years. Keep that in mind: it affects one’s perspective.”

The metaphor is perplexing:  1) In what sense could it possibly be true that our biological life–our “route from birth to death”–is distinguishable from “real” life?  2) How can biological life symbolized as a “stream on which I ride in a canoe”  capture the fullness–variety, color, mystery, transcendence–of his or anyone’s life?  3) If he means “I am carried down the stream of life with no effort on my part” to argue that, like everyone, he’s growing older, the idea makes sense. But to say he is alone on his stream (and apparently thinks he always has been) makes no sense to me. Reading it, I imagine his grown children found the comment jarring and wrongheaded.

There’s still more to say about this good man.

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With the Christmas cards in 2009 came a newsletter from one of my husband’s elderly medical patients. Printed five times along the top of the newsletter were the words FINAL ISSUE. “The moment of culmination of years of planning has arrived,” it begins. “When you read this, I will have left for my next post.”

He goes on to explain that from time to time he had “inflicted upon some of you these egocentric declarations: 1) I have absolutely no fear of death but am damn particular about how I get there!  2)  I plan to quit while I’m ahead. 3) I intend to choose the time, the place, and the manner of my departure. (And how many people get to do that? Or want to?)”

It was not that he was in a “really lousy mental state,” as he thought some might conclude. Only months before, in fact, he had sat down with a dictionary and gone through words beginning with “de” and “dis” to find those that did not describe him. That is, he was not to be considered  “debased, decadent, decayed, deceived, decrepit, defeated . . . disabled, disappointed, or discouraged.” 

“There are a lot more words than this on the positive side,” he added, “but they aren’t conveniently grouped for easy listing!”

The tone throughout the writing is most reasonable and considerate.  At the end of the suicide note are the names of immediate family members, three of them married children who likely received the FINAL ISSUE around the same time as–maybe even a little later than–my husband.

I’ve wondered for years how reasonable and considerate they felt their father’s suicide to be. Feelings of rejection–not to mention shame and stigmatization–are prominent among adult children bereaved by the suicide of an elderly parent (John Jordan  and John McIntosh. Grief After Suicide: Understanding the Consequences and Caring for the Survivors. New York: Taylor &  Francis  Group, 2011, p. 67).

More to follow.

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Confounded

When my seventeen-year-old daughter Mary died by suicide in 1995,  one thought confounded me from the first: “She couldn’t take her life another day. The life that God, her father, and I gave her–that precious life–she didn’t want. So she threw it back in our faces. ” 

 Mary’s death was incomprehensible, a rejection of the values she’d grown up with not only at home but also in Catholic classrooms for almost a dozen years. 

In Grief After Suicide: Understanding the Consequences and Caring for the Survivors, researchers John Jordan and John McIntosh highlight the bewilderment of parental guilt following suicide: “It’s bad enough to lose a child . . . but the guilt [that other parents who have lost a child to some other form of death] have over not getting them to a doctor ‘soon enough,’ the guilt over not being able to protect them from cancer or drunk drivers or whatever can’t be as fundamental and soul-searing as knowing they couldn’t endure the life you gave them” (Sue Chance. Stranger than death: When Suicide Touches Your Life. New York: W.W. Norton, 1992, p. 50 as quoted in Jordan and McIntosh)

“Soul-searing” is an apt phrase; it describes the anguish better than most.

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One memorable comment the grief therapist made to my family after my daughter Mary’s suicide  was, “Guilt is a bear you’ll be wrestling for a long time.”

In Grief After Suicide, editors Jordan and McIntosh write that guilt results from what a survivor did, didn’t do, or imagined he or she might have done to prevent the suicide death (p.31).  In my experience, guilt usually showed up in “what-iffing” questions: what if I’d been home that day, what if Mary had seen another doctor, what if I’d gone into her bedroom and read one of her journals?  What if I’d been more attentive?

“What-iffing” questions waned only when, a couple years into the grief, I got tired of asking them. For one thing, I started giving myself credit for doing the best I could do with what I knew about Mary at the time of her death.  Yes, I had fallen tragically short; but whatever I did or failed to do was the best I could do at that time.

Our family grief therapist also said something to my husband and me one day that helped quell the what-iffing: “You’re just not that powerful.” John was lamenting his inability to protect our daughter, and I was admitting how little I had known her when she most needed to be known. We were both frustrated and sad and rattled by failure. “You’re just not that powerful,”  Jane told us.  Far from discouraging me, her words rang with truth.

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Suicide bereavement often includes the following features: a sense of abandonment and rejection, feelings of shame and stigma, a desire to conceal the cause of death, a tendency to blame others, and an increased self-destructiveness or suicidality (John R. Jordan and John L. McIntosh, Eds. Grief After Suicide: Understanding the Consequences and Caring for the Survivors. New York: Taylor and Francis Group, LLC, 2011, pp. 30-31).

In my experience as a survivor of my daughter Mary’s suicide in 1995, I did feel abandoned and rejected by her for several years. I also felt accused. It was as though Mary was telling everyone I hadn’t done enough for her. And really, how was I going to deny the truth in that?

Owing to the immediate support my family received from our Catholic faith community, however, the shame and stigma of my daughter’s death was not a prominent part of my bereavement. In fact, even while members of the rescue squad were trying to revive Mary, I decided not to hide the fact that she had overdosed on her anti-depressant medication. When a neighbor asked, “What happened?” I told him the truth, believing that the truth would bring the help we needed. And it did.   

Mary’s psychiatrist joined my husband and me in the emergency waiting room, lamenting her misjudgment regarding the state of my daughter’s mental health. My husband would not allow the psychiatrist to blame herself, though, and I tried to follow his lead. Inevitably, I did end up blaming the psychiatrist, my husband, and myself for my daughter’ s suicide. Blaming is a normal part of suicide bereavement, I have come to see, but it did eventually fade away.    

As for the increased risk of self-destructiveness following a suicide, I understand a bereaved person’s desire to die. But in my grief, the desire to die was countered by hard-won awareness of the devastation another suicide would inflict. I never considered taking my own life, though I could see that people were concerned I might be thinking about it.   

 

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