Reading about the U.S. research agenda on suicide

I’m no expert in bureaucracy, but when the U.S. Centers for Disease Control and Prevention lays out its research priorities for the years ahead, I assume that action follows. It’s good to see that its top research priority on suicide is finding more information on both fatal and nonfatal suicidal behavior. “Because the number of suicides reflects only a limited portion of suicidal behavior (i e , substantially more persons are hospitalized as a result of nonfatal suicidal behavior than are fatally injured), collected information should include data related to suicidal behaviors that result in death, hospitalization, or outpatient medical treatment, as well as those where no medical care is sought.” (Emphasis mine.)

I’m not saying that nonfatal suicidal behavior _ suicide attempts, in other words _ is somehow more significant than fatal suicidal behavior. I’m pointing out that the CDC recognizes all of the risks involved.

“Fatal and nonfatal suicidal behaviors result in considerable medical, economic, and social costs, including lost wages, pain, and reduced quality of life for victims, and trauma for family members and friends,” the report says.

How many victims? Maybe that will become more clear, and soon.

The CDC report calls for more information on suicides and suicide attempts from the state and local level, pointing out that even information at the national level is limited. It also wants more information about the suicide methods and circumstances involved.

Does this mean more suicides will be openly recorded as suicides, instead of being fudged and classified under less stigmatized causes of death?

Reading about “Suicide Movies: Social Patterns 1900-2009”

One of these days, the Lincoln Center branch of the New York Public Library will cough up its copy of the new book “Suicide Movies; Social Patterns 1900-2009.” (The library website says it’s in there somewhere.) The book calls itself the first comprehensive analysis of film suicides, more than 1,500 of them from the U.S. and Britain.

“One striking finding is that while the research literature generally attributes suicide to individual psychiatric or mental health issues, cinema and film solidly endorse more social causes,” the book’s website says.

The preface is┬áless of an introduction to that finding than an overly detailed description of one of the 1,500 movies, the 2008 film “The Wrestler,” complete with screen grabs of star Mickey Rourke looking anguished. Only the last two paragraphs start to pick up a bigger thread, pointing out that the loss of the ability to work is a common theme in movie suicides, such as in the better “Million Dollar Baby.”

I’ll find out more. After posting here earlier about “The Apartment” and its treatment of suicide, I watched a few other Billy Wilder and/or Jack Lemmon films _ “Sunset Boulevard,” “The Front Page” and “The Odd Couple” _ and was surprised to see suicide come up in each one. And not just in passing. What was going on back then?

Some results of talking about suicide

Since this blog is about talking openly about suicide, I should offer this update.

I applied to a few law schools last fall, and my personal essay mentioned my suicide attempt experience. It helped to explain why I would consider leaving a career I’ve loved _ including reporting in China, which the essay discussed as well _ and why I would be interested in exploring mental health law. I ran the essay by a couple of well-respected lawyers in New York who had either studied or worked at law schools that rank in the U.S. top five, and they liked it. They also took it well. “Do I need to worry about you?” one asked, and left it at that. Then he suggested applying to an Ivy League school I hadn’t considered.

I applied to three Ivy League schools and a top “public Ivy” with a well-known liberal background. As of this week, they’ve all said no.

Some might say I shouldn’t have mentioned suicide. But when it’s addressed in a calm, matter-of-fact way, and the person intends to use the experience to help others, and the other factors in the application are strong …

I wonder why law schools with the standing and the resources to take a chance on sensitive rights issues would back off on this one. The subject needs to be explored, and having the support of such a prominent school could bring weight and attention to what remains a very limited conversation.

If the schools just didn’t want to deal with it, that would be disappointing. A lot of people don’t want to deal with it. That’s how stigma, misunderstandings and rights abuses can happen.

(Just sour grapes? Pissiness? I hope not. I think it’s worth considering.)

It hasn’t been a solid wall of “No.” I’ve been accepted to a law school here in New York that’s special for its focus on public interest _ it was one of my two favorite schools _ and it even invited me to interview for one of its full-tuition fellowships. The interview got a bit awkward when we discussed my essay, and they asked whether law school would be some kind of trigger, but can that be a surprise? Even I’m not going to tell you that talking about suicide comes smoothly, especially with strangers.

“I’ll get used to talking about it as needed,” I wrote to them later, in a thank-you note. “I’m sure more people will.”

Reading about Virginia Eddy and Li Mou

Here are two interesting stories about women who decided they had had enough of their lives. I point out this one from China as a reminder that the issue of suicide is debated fiercely pretty much everywhere, and increasingly online.

The other story is one I came across in a new book by Jane Gross called “A Bittersweet Season: Caring for our Aging Parents _ and Ourselves.” Gross founded a popular blog called “The New Old Age” for The New York Times, and her book tells the story of her mother’s decision to die by voluntarily stopping eating and drinking. “For someone of her nature, that long, humiliating decline _ mentally or physically _ was unacceptable,” Gross writes. As she does her own research into the issue, she comes across the often-referenced article “A Conversation with My Mother” by Dr. David Eddy, published years ago in the Journal of the American Medical Association. (I’ve linked to an abridged version above, which isn’t behind a paywall.)

Both the story of Gross’ mother and of Eddy’s mother are important because they show how people who want to die and a very nervous medical establishment are finding a way around the touchy issue of assisted suicide. Even in the few states that have made steps to make assisted suicide legal, a person wishing for that assistance must be terminally ill. In the cases of these two elderly women, there was no terminal illness. “Her heart and lungs were strong. She didn’t have cancer. She wasn’t even dying, using a disease-based definition. So here we were, my mother and I, wishing she were terminally ill and feeling a bit creepy about it,” Gross writes.

Eddy’s mother was also facing a future of no longer being able to care for herself alone. “Let me put this in terms you should understand, David,” she said. “My ‘quality of life’ _ isn’t that what you call it _ has dropped below zero. I know there is nothing fatally wrong with me and that I could live on for many more years. With some luck I might even be able to recover a bit of my former lifestyle, for a while. But do we have to do that just because it’s possible? Is the meaning of life defined by its duration?”

Both women chose to stop eating and drinking, which is considered to be neither suicide nor assisted suicide. “Even the ethicists, who are queasy about medical professionals having even tangential involvement in what could be considered suicide, agree that forcing liquids down someone’s throat is an ‘unwarranted bodily intrusion,'” Gross writes.

So while the medical world had not judged either woman to be terminally ill, each was allowed to make the decision to end her life while in the company of caregivers and with access to medication to handle any discomfort. It was not a blind guessing game, it was not shameful, and it was not alone.

Both women had doctors who respected their decisions and their decision-making. What makes the story of Gross’s mother even more interesting is her mother’s past of depression and episodes of psychiatric hospitalization. Mental capacity and frame of mind are big issues around end-of-life decisions and surely are a source of a lot of hesitation by doctors. I’d like to know more about Gross’ mother and whether she faced additional challenges or doubt from doctors while making her decision. The key, perhaps, was making her plans loud and clear far ahead of time.

“We’d laid out my mother’s long-standing end-of-life philosophy so nursing home staff would see this deliberate decision for what it was, not as a depressed impulse,” Gross writes.

How far in advance should each of us start thinking about this and making our own preferences clear?

What should we say?

Time to look ahead. A few of us will be speaking in April at the national conference of the American Association of Suicidology, and as far as I know, we will be the only voice of suicide attempt survivors. The others there will be researchers, clinicians, therapists, crisis line workers, other prevention workers and people who have lost friends or family to suicide.

I wonder whether they, having listened to many suicidal people in the course of their work, will expect to hear anything new from us. Well, what can we tell them, even at the risk of startling or offending them? What do they need to know? What are the things we might feel uncomfortable discussing one-on-one in our personal dealings with therapists and others? What, if anything, do we need to point out to shake up what might be established thinking about people with suicidal experiences?

Speak up. Thoughts and suggestions welcome. And thanks.

Talking with Heidi Bryan

When I saw that Heidi Bryan had managed to write a book with the words “suicide” and “irreverent” in the title, I wanted to know more.

I first reached out to her a year ago when I was looking for support groups for suicide attempt survivors and found, to my surprise, that just a handful exist across the U.S. _ if that many. (Why?) Heidi created one of them. She also has lost family members to suicide and has been active in those survivor groups, which are far more common. Her book is “Must be the witches in the mountains: An irreverent guide for knowing what to say after someone dies by suicide.”

Heidi makes a great point about the silence around suicide. “When I was young, people didn’t talk about cancer, either,” she told me. “They whispered it. And look at where we are now.”

You can see more about her book and what she does here and read her own account of her experiences here.

How did your book project start?

It was after a suicide loss. I was talking to people, and people just said these stupid things. The one thing my family taught me was a sense of humor. I just make fun of things, use humor as a tool. Also, I get annoyed. I get annoyed when a woman said, “You have to change your name (of your group). Suicide in your name is not good.” I said, “But that’s the point. I want people to talk about it.” And when we setting up the event, people were saying, “Oh, this is gonna be a fun group.” Yes, there’s life after suicide, after an attempt, after loss. And you know what? We get to be normal people. We’re not these morose beings who walk around through life and say, “Oh me,” you know?

Humor can be so healing and so free. We do laugh again, and that’s the whole point. We’re choosing life, we have dealt with life, we’re learning how to enjoy life. But … Sorry, I got on my soapbox. But it’s still pissing me off. I mean, what do they think about us? People say, “Oh, I wanted to hold a survivor support group but couldn’t because of liability issues.” What, do they think we sit around and pass around razor blades? What are they thinking? So.

Do you have other examples?

My personal favorite that happened to me was, an addiction counselor was sitting next to me, and it was the day after my brother died. She turned to me and said, “Don’t feel guilty.” I kind of wanted to say, “Thanks, I never thought of that!” I just thought, “What a stupid thing to say!”

Did you say that?

No. I just said, “Thanks.”

And the title of the book. Someone, she lost her son to suicide, met with women from her church. They said they were talking and decided that it must have been the witches in the mountains who put a spell on him.

Where was this?

I forget, down south somewhere.

The book is for friends and family. Not for those who have attempted suicide.

Right. But I do a lot of presentations and trainings around suicide. I always do throw humor in them. I’ve gotten a lot of comments about them: “I didn’t think this could be fun.”

What do you do?

I make fun. I once read that one of the warning signs is hoarding pills. I share in my trainings/presentations that I started hoarding pills when I was young, and I did it throughout life. No one ever knew that. And I said it’s kind of funny, because it’s kind of like an alcoholic who gets sober and finds bottles all over the place. I’ll clean and I’ll find these bottles of pills. So I say I’m glad I didn’t do it, because it’s sure as shit I wouldn’t remember where I put them all. I don’t say it that way, but I just joke about it. I just poke fun at mostly myself.

And I tell them, “I don’t know about you, but my first impulse when someone tells me ‘I want to kill myself,’ my first impulse is, ‘Oh crap.'” I think it’s human nature to automatically panic. But take a deep breath.

And people connect with this.

Yeah.

What do people’s faces look like? Is it an odd environment? How do you break the ice?

It depends. The worst environment was a prison. I had to give a presentation for prison workers. And they didn’t want to be there. And you could tell. It was mandatory. It was hard. They were sitting there and had their arms crossed. I just start talking to them about me, why I got in this. I got in because my brother killed himself, and I tried, but his death saved my life. In a way, my opening myself up to them kind of softens them or something. And sometimes it falls flat. The hardest thing is to get that first person to ask a question. Once that happens, they start relaxing. They’re usually dour and quiet until then. I want them to get rid of this perception they have that we’re so serious. You can tell sometimes they’re shocked. You can see their face.

How do experts respond?

I think usually when I’ve told my story, then they come up and say, you know, they’ll thank me.

Do you know anyone else who takes this approach?

To be honest, not off the top of my head.

Do you feel there are things that ought to be said or addressed but aren’t?

I don’t know. I have to think about that. I think what frustrates me is, it seems to me a lot of times the clinicians and researchers think it’s a choice. And I don’t know about you, but I don’t see being suicidal a choice. I don’t want to feel this way. I don’t want to be this way. And I don’t think I have chosen to be this way. It’s the way I’m wired, really. And I still don’t think for the most part they get it.

But they’ve been studying it for so long.

Not really. If you look in the field, the medical history, they really haven’t. I honestly believe it’s a disease and should be categorized as its own diagnosis.

What should?

Suicidality. I think there’s a lot we don’t understand. And I think we should talk about it.

How to talk about it?

You just do it.

It’s not easy to bring up.

Right. I know. Another thing I can joke about is, I can clear the room in 10 seconds flat: “Gotta go!” But I’m not gonna apologize for it. I remember my father-in-law’s funeral, and a relative asked me, “What do you do?” I said, “You don’t want to know.” Finally, I said, “I started a suicide prevention council, but I don’t like to talk about it because everyone gets all silent.” And they all got silent. And I said, “See?” and they started laughing. It broke the ice.

Maybe you’re too young, but when I was young, people didn’t talk about cancer, either. They whispered it. And look at where we are now.

If you had the means, all the money and resources you needed, to make this topic more open, how would you do it?

If I had unlimited funds, I would love a social media campaign, public announcements on TV. And people would realize it’s everyone. There’s no discrimination. It’s all of us who’ve been affected in one way, shape or form.

There are survivors and attempt survivors. You’re kind of in the middle.

That’s another dream I have. Are you familiar with Compeer? They just kind of help each other, and I think one has more recovery than the other. They kind of mentor each other. I would love to establish a program where attempt survivors are paired up with someone who lost someone to suicide. So the attempt survivor can see the effects on others, and the bereaved could help someone because they couldn’t help the one they loved. I think it would be a wonderful pairing. Maybe not all could do it, but I’d love to see it.

Have you ever proposed it?

I brought it up at a consumer/survivor subcommittee at (National Suicide Prevention) Lifeline, and the idea was well-received but the problem is the usual _ how to get funding.

The other thing I’m never giving up on is to start a peer support group for attempt survivors.

You already started one.

I had. Ken Tullis had started Suicide Anonymous. I want to do a different model. It just didn’t work.

How would you set it up?

I need help with figuring out the format. It would need some structure. I don’t want it to become … I don’t know. You want it to be helpful, offer tools, but also everyone would be able to talk.

Interesting that you use the word “tools,” since people have worried that people in such groups would trade advice on how to kill themselves.

I’m not surprised to hear that. I know that with our Suicide Anonymous it was not like that at all. The one thing everybody always does is, the first thing that helps me when I’m suicidal is being able to talk about it. When you’re with a group of other people, you certainly aren’t going to say … Well, I’m a recovering alcoholic. There was this woman who would come into the meetings drunk, saying, “I drank this and that …” Finally we came up to her and said, “You have to be willing to stop drinking. In the meeting, you can’t really be talking about this and that mixed drink.”

Did you kick her out?

Yeah. We didn’t kick her out, but we questioned her desire to stop drinking. And I think it would have to be something like that, rules and regulations.

So one of the rules would be, you can’t talk about methods. I mean, you can’t elaborate and go on about it.

I kind of want to ask you to get back on your soapbox and say what else frustrates you.

Ha! You mean, like the lack of funding for suicide prevention? There’s so much for money for breast cancer. And so many thousands die of suicide every year, and it hardly gets anything?

Also, the perception that people have of us.

Do you think therapists, etc., should have to talk about their own experiences? So people can know what their point of view on suicide is?

That’s a good question. I don’t know if I could say it should be required, but … I don’t know. I think about my therapist and I think at first he didn’t get it, and I know we went through some tough times, and I feel like in the end I kind of taught him and we learned from each other. I could tell that he had never experienced it, and it did frustrate me. But it didn’t mean that he couldn’t help me. Then I think, but on the other hand, for survivors of suicide loss, it’s almost imperative to have a therapist who has had a suicide loss because otherwise they don’t get it. You can tell. You can tell.

I say that, but then I think of these other therapists who haven’t lost anyone to suicide and ended up very compassionate and did get it. And so it’s a fine line. I don’t know.

It just seems, the idea of being locked up for talking about it …

You’re absolutely right, some therapists don’t have the training, and yet they won’t get the training because they think they don’t need it. Because how many of them do freak out? How many of us don’t tell mental health professionals because they do freak out? And for a while with my therapist, he was going to be the last person I told. There was a point early on where I felt he didn’t get it and I decided, “Well, I won’t tell him.” And I have friends who say the minute they mention it, the therapists pull out a contract to sign and they do it just to shut them up.

Is that contract useful?

No, they stopped using it.

So how do you pick a good therapist?

Yeah. I think, my brother told me, you call them and interview them like with anything else. If you don’t like their answer, call someone else. And I think we do forget that, we have that right. And we have the right if we don’t like them to not go. You have to shop around.

I read the short autobiography you wrote of your experiences. What does it feel like to want to die? And do you still feel that way?

I don’t think it will ever go away, completely, but it has gotten a lot, lot better. I believe for me it’s like an addiction. When I get stressed, my suicidality is a chronic illness. I just have to maintain; I have to work at it all the time. When I don’t take care of myself, when I get stressed, it comes back much more readily than other times. If I’m doing everything right, it’s not nearly so prevalent. When I’m in a bad place, my first thought is, “I hate myself, I want to die.” I just have to challenge it. It’s not constantly, but it won’t ever completely go away.

Is it words or an actual physical feeling?

Sometimes it’s actual physical feelings. It comes over you and it’s like wrestling with the devil, but that’s rare. It’s only happened once in this past I don’t know how long. Other times it’s like this automatic feeling.

Your husband, can he tell when you’re not so great?

It’s got to the point where I can talk to him about it, tell him I’m having a bad day, feeling suicidal. It can’t be easy for him, and I try not to lay that on him. I just tell him I’m having a bad day. You know. Usually after I talk to him, I feel better. I realize that a couple times when he came home late and couldn’t find me, it must have scared the shit out of him. I asked him and he said yes. I said, “I’m really sorry you had to go through that.”

But you just weren’t there.

Right. I was just doing something else. But for that split second he was thinking, “Oh my god, she did it.”

(I ask about the theory behind this blog and what she thinks of it.)

I know this kid who jumped off a cliff. He’s in a wheelchair, and I think he’s going to be that way for life. And other people who altered their lives so physically. I don’t think that’s hardly ever talked about, and I think that’s another real part of it. No one addresses it. You’re the first person I’ve heard address it. I don’t know. And then other people who survive, and others who could have been saved and aren’t. And that’s why I always say about self-harm, “Don’t think for a minute that they can’t kill themselves. They can misjudge.”

I think not enough attempt survivors come out of the woodwork to talk. I think we need more of that, to say, “It didn’t work, you know, and now it screwed up my life. That’s why we need help.”

There’s also assisted suicide. Are that and suicide two different topics?

Different. A part of me, as I’m getting older … When you have a fatal illness, you know, and you know you won’t survive and have only a few weeks, you have the right to end it and save your family thousands in medical bills and your family pain. But I had a cousin in his 70s and an uncle in his 90s, and both killed themselves. The families were still devastated. It’s still suicide! Maybe if they had said, “I can’t go on anymore, there’s no point,” maybe we can get them help. The point is, it’s still suicide!

How much of the pain of losing someone is the surprise of it?

I think it just adds another dimension to it. My brother, it was a shock but not a surprise. It was with my cousin, that was a shock, because I didn’t know him that well. It just adds another, like, layer to it. It depends on how .. It just adds intensity. But I don’t think it’s the defining thing.

I’ve heard about these new regulations for attempt survivors who publicly tell their stories …

It’s kind of, it’s not like rules, but it’s just helpful. I think first of all some survivors, when they talk, go into gory details. They need to do that, but the audience doesn’t need to hear it. It’s part of their recovery or something. It’s not pleasant, and you’re left with these images. You just don’t want it out there for impressionable people. I think there’s also, when you enter this world and start sharing your story … Leah Harris once said that when she dates, she wonders whether they Google her. When I moved to Wisconsin, I thought about my neighbors, whether they Googled me.

You can have some loose cannons out there. They think they’re being useful, but really not. So they need some help. You don’t really need to go into, “And then I took 20 Xanax and a sip of vodka,” you don’t really need that.

And you need to be prepared. People are going to come up to you with their own stories. Or, “I have a cousin who’s suicidal, can you talk to them?” And you’re like, “No! I can’t!”

Does that happen often?

Not often, but it happens enough. You get e-mails from people. I’ve gotten used to them. I just forward them to Lifeline, and they do it for me. I forgot about it, and I had a volunteer who was checking my e-mails who said, “Oh my god, you got an e-mail from someone who’s suicidal! What do I do? I didn’t see it right away!” You know.

How many people do you hear from?

Since we put everywhere we can that we’re not a crisis center, maybe six a year now. So not so much anymore.

Do you ever get sick of talking about this subject?

Well, I don’t do it as much anymore since I moved to Wisconsin. It’s funny, when I go on vacation, I pick up a book, there’s a suicide in it. I watch TV, there’s a suicide. “Jesus Christ, I can’t get away from it!” I’ve just given up.

Where can we find your book?

On the website. Barnes & Noble. Amazon.

Who else are you, outside this issue?

Well, I’m a wife. And I’m a dog owner. I am … I don’t know! I think about this and have always rebelled _ a suicide survivor, a recovering alcoholic _ but I’m also discovering this side of me, making chocolates, I just painted a chest, made my own stencils … I guess there’s a more creative side of me than I thought.

Chocolate?

It’s really fun. I used to be a chemist. Making chocolate is really chemistry.