Talking with Karen Bufford Bogue

This week, I spoke by phone with Karen Bufford Bogue, who runs a pro-recovery website at 4peersupport.com. She responded to a request on the MindFreedom International listserv for people interested in speaking up. Each of us admitted after the call that we had felt a bit nervous, being new at this, but it turned out well. Questions are in bold.

Tell me about your experience.

I had a diagnosis of DID _ it used to be called multiple-personality disorder _ with a lot of acute PTSD. I had been trying to find help for it and had not been successful. I just was in a lot of emotional pain, feeling like I had let everyone down and that I couldn’t be the working person that I needed to be. And it kind of got worse and worse and I felt kind of guilty for being alive. I had a brother who actually killed himself, shot himself a few years before. I knew the kind of impact it had on my family, but somewhere in my psyche I still believed that it would be better for everybody. I started collecting medications, did research online. They have suicide sites. And what happened for me is that at some point during the overdose everything felt horribly wrong. It was almost kind of like watching myself from above. And that my not being not alive was not the right choice at that point. I’ve described it to people like, in science you explain why a spaceship has to go through the atmosphere at a certain tilt or it explodes. I felt like I was at the wrong tilt, hitting the atmosphere. I made a call to the emergency assistance people to my house. I kind of crawled to the door because I was in really bad shape by then, then passed out. And I ended up in triage for a very long time with charcoal and people monitoring me because I had ingested a really toxic medication. I was in the hospital for at least a week, I think. Afterwards, of course, I was in shock from everything that had happened, I think. But I started to have to make a lot of medical appointments because I had done a lot of damage to my esophagus and stomach and everything.

I did read your blog about suicide being so glamorized, kind of a peaceful exit, a noble exit. But it causes a lot of personal problems. I know it took a long time for my partner at that time _ now we’re married _ to trust me that I was going to be OK.

When was this?

About five years ago.

How long did it take you to physically recover?

As far as reflux and everything, it took me four years, I think, to stop taking really high doses of reflux medication and nausea medication, prescription strength. I just did a number on my stomach.

Now how are you?

Good. I think I’ve pretty much been past the physical part of it. That was kind of my lowest low and kind of what happened before I found good help. I continue to be in therapy to deal with the things that made me feel that I couldn’t be alive.

Is there any way to estimate how much all of this has cost?

My gosh, I do. Because we pay out of pocket for all my care. So just out of pocket we probably paid at least $150,000, and hospitals and stuff like that probably another 100. So a quarter of a million?

Then you’re financially recovering as well. How are you doing?

The things we wanted to do financially we had to put off, like putting another level on the house or whatever. I feel a lot of guilt about having to use our resources for me. But we’ve done OK. I think initially I had to go through a bankruptcy because of all my medical bills. So I’ve recovered from that. It’s just really hard to have to do that.

I think it’s a good question because it’s very expensive. I have a foundation that I run and stuff, but it’s not bringing in the kind of income I was prior to that. It probably won’t for a year or two.

How has your wife taken this? How has she changed as well?

She has been great. She’s just totally believing in me as far as my recovery when I was not all that convinced that I could lead a really happy life. It’s been hard on her, of course. She’s worried about me. But she’s also one of those people who does a whole lot independently to take care of herself, so she’s kind of able to hold my process at an arms’ length when she needs to. There was a while there that she was really worried I’d be OK. There wasn’t any warning with my attempt. I didn’t tell anyone. So we had to go through some feeling around that terrible surprise that day.

Why was it such a surprise?

A good question. I think for me my intentions were so serious that I didn’t want to to alert anyone because they would stop me. I had planned it out so thoroughly that I hid a razor in a book binding so if I didn’t succeed and they put me in a hospital, I’d have someone bring me this book. That’s what happened. And while I was an inpatient, and they were supposed to be watching me. I don’t really remember it, but I severely cut my arms on both sides all over.

Why? You had called 911.

Yeah, it was weird. Maybe afterwards I had some doubts that I had made the right choice bey calling. I was so _ my mind was so messed up by the drugs that my thinking was not very clear. I was miserable and felt like somehow I deserved it.

You did research. How?

There’s a lot of it out there now. There’s tons of drug use and abuse forums, suicide forums, assisted suicide forums. The problem with it is, it’s a lot harder than people think to die. You just end up with a lot of things to deal with in addition to the problems you started with.

How do you know these forums are reliable, trusted, giving the right information?

There’s not any surefire way of knowing. I’m fairly knowledgeable in the area of pharmacology. I’d go back and read, do research myself. You really you don’t know if you’re online.

How do you feel about more people speaking openly about their experience?

There are always going to be disorders bringing about suicidal thoughts. And people are resourceful to think of ways. I wish it weren’t so taboo to talk about it. I would like to feel I could talk about it openly with my family. That would actually be a relief.

You haven’t done so?

Not necessarily about the attempt. But there’s more we talk about now, my diagnosis, my treatment.

Does that help?

Yes, it did.

What’s the best way to talk more openly about this topic?

The biggest fear is of the punitive stigma. That people may think you’re totally unstable if you had a suicide attempt. People wonder about their livelihood or social standing being impacted. I’m not really sure how to go about changing that other than people just trying to be as honest as they can.

Why did you e-mail me?

Actually when I got your e-mail, I was working on my site, a peer support network online. That’s when your request came through on MFI (MindFreedom International), and because I was kind of doing the same thing, I was like, “I’m gonna answer this.”

What are you doing? Tell me about it.

I run a trauma-sensitive peer support site. I’ve created a chat place, live chat 24 hours around the world, support groups and things like that. There was really a need for one sensitive to people with PTSD, and there wasn’t anything really good out there.

It’s operational?

Yeah, it has been for, let’s see, 16 months. It’s been a neat project.

How does it work?

You just come in and register, there are different rooms people hang out in. They can one minute just talk about their dog, one minute talk about medications. The special groups we have are like PTSD support. It speaks to people who may be disabled and may not have transport. They can literally hang out on the site if they’re feeling they want to hurt themselves as long as they can and talk to people.

I just watched a couple of people come in, actually. We also have people help me as administrators that have diagnoses. It’s peer-run.

How many people use the site, any idea?

Now I probably have around 100 who regularly come through. Usually 5 or 6 people are there in one room at any given time.

I keep saying people should talk openly. What’s the benefit to talking anonymously? How does it help?

When it comes to my site, for example, people can come in and share without people finding out who they are, where they are. It gives them a chance to not be self-conscious. It’s kind of funny because things are becoming less and less anonymous because Facebook is incorporating everything.

So, aside from all of this, who are you?

I’m an artist. I do art, I write. I’m just kind of a regular person with too many dogs. Five dogs. And I’m working with a company to invent health products for dogs. Yeah, that’s a regular person. You know, I’m a spiritually involved person. If anything, I hope that that would define me.

What does spiritually involved mean?

I have an active belief in a guru, I practice Siddha yoga. Gosh, these are hard questions. A lot of who I am is about trying to leave things in a better state than when I left them.

How’s that going so far?

It’s going very well. I had kind of an overnight site success, and that is something that I’m really, really happy I was able to provide. My wife and I fund the site and I volunteer my time, and that is something I always dreamed I would be able to do. and I’m doing it.

Do you have any other grand plan or dream?

I’m working on writing about my recovery experience. I write quite a bit. I’m still in the middle of the process. I’m getting good feedback. I hope if I can kind of chronicle the healing process then someone else might not feel so helpless at the point that I did attempts.

When you publish it, will you use your name?

Yes.

Is there anything else you’d like to say?

I’m trying to think to summarize things. Part of what I do is to reassure people that there is healing out there, and not any one situation is hopeless.

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Talking with Terry Wise

Today I talked by phone with Terry Wise, who was one of the first attempt survivors to speak publicly and often about her experience. She’s a former trial attorney who now writes and speaks full time and has served on the boards of a number of national organizations on this issue. She’s at terrywise.com.

Here’s quite an interesting development as more people choose to talk openly about their experience: The major national suicide prevention groups and others are putting together guidelines to help people decide whether they’re ready to tell their stories publicly. There are concerns about people speaking too soon. The details are near the end of this post.

We started off chatting, then I started taking notes. Questions are in bold.

Terry: I was extremely, extremely fortunate. After my talks, I meet people who walk with a cane or such who took far less than I did.

Did you know the risks you were taking?

I’m an overpreparer. I had researched it. Sadly, there is a lot of information out there. It’s relatively easy to find what is a lethal dose. I had an arsenal of narcotics from my husband. I calculated it out, counted it out. I put it all together so it would be enough to end my life. I was convinced it would be a fatal dose. Many people don’t take enough, or change their minds and call the hospital, or wake up in a puddle of vomit after throwing up the fatal dose, or someone finds them in time.

How could you trust the information you found online?

To be able to trust a recipe to end your life, that’s sort of a misuse of the word “trust.” You never know what’s reliable information and that isn’t. You take your best guess. When you’re depressed, your judgment is skewed anyway. But it would be great if none of that information was out there. A lot of people would hang on and get help. Suicide prevention organizations I work with do work with social media sites if there’s something life-threatening out there.

What do you think of the way suicide issues are portrayed in films, TV, the media at large?

I’m very disappointed in the lack of awareness. As an example, I was invited to a very well-known talk show. I asked who else was on, and when I found out, I didn’t want to do it. They were trying to get ratings for shock value. They had someone missing half a face from a gunshot, someone missing their legs. Media and TV, they reveal too much detail, which is also shown to increase suicide contagion. It’s better to avoid those highly detailed descriptions. Or it’s especially true when a celebrity dies by suicide. People start to glamorize them. The bottom line is, I wish more people who portray attempts would read the suicide reporting guidelines and understand the safe messaging.

(The guidelines are posted here: reportingonsuicide.org)

I think that some, not all, personal stories are crucial to hear. For example, for that talk show, they could have a mix, not just those who were physically maimed. No experts in suicide prevention were asked to appear. It was imbalanced. It should be accompanied by some professional input as well. What have you learned? What would have prevented you from doing what you did? I use myself as an example. I started to give away personal belongings, I started to drink more, I made new estate plans, I started to lose a lot of weight. Educating people. There has to be some incorporation of a positive image.

Would the images of shock value have stopped your attempt?

It certainly is a deterrent, but I didn’t see any before my attempt. I probably would have avoided looking at those because I wanted to avoid anything that would interfere. I would’ve thought none would apply to me.

How you we ease the tension when talking about the topic of suicide?

I think there will always be some sort of stigma to silence people, some myths, unfortunately. They’re not eradicated. Unfortunately, we’re always going to be battling stigma and myths. But absolutely there’s a way to keep a balance between not talking and talking about it to save people’s lives. Back when I started in 2004, I was pretty much the only person who had attempted who was giving speeches. Over time, I’ve seen the growth of public speakers out there. It’s actually evolved significantly. I can only imagine 10 years from now.

What is the worst stigma?

One leading component is the belief that depression is a sign of weakness, a character flaw. In fact, recognizing depression and reaching out for help is a sign of personal strength. A lot of people are silenced by the belief that by talking out, people think they have a character flaw.

How do you think this will change in the future?

Every time someone comes out when talking openly about depression and recovery, it reduces the silencing power of stigma. That’s why it’s important when celebrities do it. When you come forward and say, “I suffered, I got help, I’m better now,” I think that drastically reduces the power of stigma.

The stories I see about people who have survived suicide attempts usually end with the people saying they got help and feel better. What about the people who haven’t reached that point and are still struggling? Should we be hearing their stories as well?

I hope they’re hearing from me. Everybody, everybody has the possibility of recovery. I can’t imagine a situation where I’d say to myself, “This person doesn’t have, shouldn’t have any hope.” Recovery, it doesn’t happen overnight, and not on the first try. Don’t give up. There’s hope for everyone. I hear from a lot of those people. Hundreds, maybe thousands. Think of it, they are in the middle of the night online, researching, and they find my site and write to me. They think they just can’t go on another day. It’s the perfect example of people who think they’ve tried it all. But if they’re writing to me, it means they haven’t lost hope. And I point that out. There’s a small piece of you who hasn’t lost hope. The one thing I get the most thanks for is, thank you for making me feel less alone. Being alone and suicidal is a lethal combination. It’s something very liberating to find someone else. That can be a lifesaver.

Is there any value in people hearing their stories?

There is value in certain settings, like support groups, where they’re trying to overcome some challenges. Would I recommend that someone go up and give a keynote speech if they were depressed? No. It’s not healthy for them or their audience.

I’m on a committee to draft regulations for people who want to tell their stories. There’s nothing out there like a formalized document to help people decide whether or not they’re ready to tell their story, to deliver a safe message to their audience. There are a lot of people out there who are not ready. The guidelines can be very helpful for speakers and audiences. Hopefully, they’ll be done within a couple of months.

A lot of people who have lost children to suicide, they want immediately to go to the high school and talk about their child’s death. They’re still grieving. You should ask: How will their family be affected? Does that matter to you? Did you talk to them?

Can people find the guidelines online?

No. The group is me, a couple of psychologists, suicidologists, etc. Probably a dozen of us. All the national organizations for suicide prevention have a representative involved. (UPDATE: The guidelines are now available here.)

A how-to?

Some of you have started writing in, and I appreciate it. Here’s a comment from Corinna West, who is a motivational speaker, poet, former member of the 1996 Olympic judo team and more. She’s also been open about her suicide attempts. 

“My thought is that when I was trying to exit the planet, I would have just used this blog as a how to,” Corinna says. 

“I would have thought, well, now I know better than to do this or that. Lots of people tried to scare me, and that always went nowhere. Also, lots of prevention research shows that health education about many topics such as drinking, HIV, pregnancy, smoking, etc. is not very effective with scare tactics. Better effects have been found with social norming, like, ‘67% of students drink three or less drinks when they go out’ or ‘78% of students use condoms when they have sex.'”

Here is her site: corinnawest.com

I went to the national conference of the American Association of Suicidology this spring to meet other attempt survivors and speak up in some sessions. When I brought up the idea of warning suicidal people about the risks they were taking in their attempts, a few people who work in counseling and crisis lines responded immediately. We don’t talk about methods, they said. It’s too dangerous.

That’s a different idea from Corinna’s, but the common concern is giving people the details they can use to refine their methods.

What do you think? For my part, this blog isn’t going to dissect specific methods and their chances. Some people out there, notably and graphically the author Geo Stone, are doing this. (Others are anonymous. Why?) I recall one of Kay Redfield Jamison’s books listing what seemed like dozens of desperately creative, and often unsuccessful, ways in which people have tried to kill themselves.

As a survivor and as no expert in medicine or otherwise, I’m more for the broad but firm statement: Nothing is foolproof. Our bodies can be so much more resilient than we think. And that goes even more for the young. 

Picking apart various methods or even showing images of what people have done to themselves and survived would take this blog off course, I think. 

This is a place to talk without drama from any direction, without scare tactics or the swell of sentimental music or the hush of talking about something Very Formal and Important. 

This is for exploring where we are and where we’ve been, and for reminding people that surviving a suicide attempt is just one of plenty of experiences that have defined and shaped our lives.

By the way, if you write in, feel free to share more about yourself than your experience alone. Who are you and who are we at large?

The theory

This blog came about because I have a theory, and I’d like to know if the thinking is right or wrong.

I worry that some people, young and old, are going into suicide attempts with serious misconceptions. Maybe they’ve been influenced by romanticized images in films, books or elsewhere and assume that killing themselves will be easy. As if a collection of random pills will do it, and they’ll drift away. (Emma in “Madame Bovary:” “I shall fall asleep and all will be over.”) Or they assume that harsher methods _ a gunshot, a jump _ are so violent that they’re foolproof. 

Nothing is foolproof. I now know people who have shot themselves and survived. The New Yorker wrote about people who jumped off the Golden Gate Bridge and survived. I know people who have taken pills, attacked themselves with knives and razors. The media have reported on people who jump from high buildings and live.

“When it comes to death by suicide, the body is not going to cooperate _ it is not designed to,” the suicidologist Thomas Joiner and colleagues has written.

Some people _ and how many are out there in all? _ go into their suicide attempt assuming it will work and instead emerge with a body that is long or permanently damaged. People have been paralyzed. They have damaged their livers with the pills. They have faced months or years of reconstructive surgery or physical rehabilitation. Hospital bills alone have reshaped their lives.

Julie Holland, who wrote “Weekends at Bellevue” about her time in the psychiatric emergency room there, put it bluntly: “These are the most pathetic things that I deal with, bar none _ the botched suicides. … It’s tougher than you think to end it all, take my word. And after a failed attempt? You thought your life sucked before, just wait.”

From the 2010 article in The Atlantic, “Death Becomes Him,” about one assisted suicide group in Europe: “Luley described some of the people who, having failed in their own suicide attempts, had contacted Dignitas to finish the job. ‘One lady jumped eight stories down to a paved parking lot. Now she is in a wheelchair. Then there was a man who shot himself in the face, but survived. Another leapt in front of a train and lost both his legs.’” 

For another perspective, you can read Dorothy Parker’s poem “Resume.”

Or Lewis Wolpert: “Though I am a biologist, I did not know of a fail-safe way to kill myself. … I hoarded my sleeping pills and heart pills but was not sure they would work, and I did not want to end up even worse off, if such a thing were possible.”

Or, finally, Kay Redfield Jamison, who may be the best-known current writer about suicide: “Laypeople … were wildly variable in their understanding of different methods. They overestimated (when compared with the pathologists) the effects of prescription drug overdoses and wrist cutting and underestimated the deadliness of gunshot.” 

I believe that some people who try to kill themselves set out to destroy their suffering, not their bodies. They don’t consider that their lives could end up more limited than they were in the first place. They just want things to be over.

That seems like an awful gamble to me. “Maybe this will work,” people say. I’ve said it myself.

There’s so little we know about this. The issue should be studied and reported. How many people have been affected? How many wish they had known far more about the possible consequences before they tried to kill themselves? 

I’ve found a couple of studies. Russel Ogden in Canada has written about botched suicides there. And law professor Roger Magnusson in Australia has explored the issue: “The fact is that very little is known about the prevalence of ‘botched’ attempts. … Of the 88 firsthand accounts of involvement given by interviewees, 17 (19 percent) involved ‘botches.’ … The rate of botched attempts may well be higher where health care workers are not involved.” 

I think that the more that people know about the risks, the less they’ll look to suicide, especially in impulsive moments. And the more openly we talk about suicide overall, the less people will find themselves isolated and desperate and
trying to “fix” everything themselves based on information from who knows where. (So much is anonymous online.)

Maybe I’m wrong. Maybe others who think about suicide don’t feel this way. But I know that I’m here because I was too scared to take those risks. I researched various methods and ruled out many because of what could happen to me if I failed. (I ruled out others for the risks posed to first responders or others connected to the scene, but that’s another story.) 

That kind of fear can be a deterrent. The message should become a key part of suicide prevention efforts, because the usual and overly simple message _ “Don’t do it” _ doesn’t begin to say enough. 

There. I’ve said what’s most important to me at the moment on the subject of suicide. It’s been pressing at me for months, and I feel better to be putting it out there.

If this makes sense, or if you’ve lived the risk I’ve described here, I’d like to hear from you.

By the way, do people still read blogs?

Welcome

Thanks for stopping by. I’m a journalist and a survivor of suicide attempts, and I’ve decided that it might be healthier to relax and talk openly instead of trying to hide it and feeling ashamed. 

Suicide happens quite often. There are more deaths by suicide than by homicide in the United States. But it’s an uncomfortable subject for most of us. The trouble is, silence risks leading to ignorance, bias and fear. When I worked in China and reported on human rights, I saw some of the dangers and stresses of self-censorship. It didn’t seem right to come home to the U.S. and accept a similar kind of taboo. 

This blog is for talking and sharing information about suicide issues. I’d like to hear your thoughts. I’d especially like to hear from other suicide attempt survivors who are willing to use their names. There are plenty of places online to talk anonymously about suicide. Let’s not do that here. 

It feels kind of unusual as a journalist to start off with opinions, but here’s some of my thinking so far. Keep in mind that I’m still learning:

We should not be afraid to talk openly about suicide and suicidal thinking. And those of us who talk about or emerge from these experiences should not be defined by these thoughts and experiences alone.

The relief people would feel in talking about suicide openly and without shame would outweigh the risk that talking about suicide would inspire people to do it.

We should make clear that much about suicide is unknown, including its causes.

Not talking openly about suicide can be dangerous if people act on inaccurate and romanticized ideas of it without understanding the risks they are taking with their bodies.

The message that no suicide method is foolproof and that all methods carry risks _ sometimes to first responders as well _ should be incorporated into suicide prevention efforts.

People who express the intention of killing themselves should not be detained and treated against their will.

Psychiatrists, therapists, counselors and others who are approached for help should not dismiss or disrepect suicidal thinking. Comments such as “Only a cry for help” or “If you really wanted to kill yourself, why are you still here?” are not helpful.

Suicide and suicidal thinking can have nothing to do with mental illness. 

Adults who have weighed their lives and made a reasoned decision to kill themselves should have the right to access to counseling, guidance and the means to doing it in a safe, peaceful and responsible way.

People who have been diagnosed with a mental illness should not be denied the right mentioned above.

Being more open about suicide will help ease the deep sense of isolation, helplessness, hopelessness and exhausted frustration that contribute to some people’s thinking that suicide is the only option they have.

You may not agree with some of these thoughts. That’s fine. I didn’t say talking openly about suicide would always be easy.