Tuesday, June 26, 2018

What I Want To Offer

Our deepest wounds surround our greatest gifts.
― Ken Page

This is what I remember about October of 2013. I remember waking up, and then falling back asleep. Over and over again. But neither was soft or easy. The only easy part, I imagine, was the darkness in between.

Every so often, pain would tap me on the shoulder and pull me out of that easy darkness and back to something excruciating in my throat. I don't know how long the duration was between the darkness and the wakings. Time meant nothing. I remember fighting through a fog of sedation and trying to reach up and pull something that was hurting me out of my mouth, but I couldn't. My hands were in restraints. Maybe a minute would go by. Maybe less. I would give up and everything would be dark again. I was slowly waking up from a coma, and this was the first time I'd experienced respiratory intubation. The physical feeling was unfamiliar and frightening. Emotionally though, the feeling wasn't so different than what I'd experienced before. Being stuck in a cycle of waking up in pain and then giving in to darkness. At times, this was a perfect metaphor for my life. Not always, but sometimes.

One time too many, I suppose.

Let's start with this. I am alive because of the miracle of a few of minutes. That's the truth. For me to tell you more about that though, I have to begin by telling you about the two times that I tried to die.

The fact that I'm a suicide attempt survivor is not a secret. Occasionally, I refer to those attempts in my writing. One look at this blog though, and it is easy to see that I'm much more comfortable talking about the tragedy of having lost others to suicide, than I am talking about my own attempts. Here is why. It is because I am a product of the very stigma I rail against. When I talk about having been in such a desperate place, the embarrassment and guilt I feel can be completely overwhelming.

But I am a suicide prevention advocate and I know that I must speak up whenever I can.

And I am a writer. I do not let shame dictate what I write. 

I regularly advocate on behalf of those who endure the incomprehensible pain of having lost someone to suicide. I talk to survivors of suicide loss nearly every day. I attend an in-person suicide loss grief group, and I belong to online suicide loss grief groups with members that number in the thousands. 

I have found that there are two constants for those who have lost someone to suicide. First, a grief that is so profound, at times it is surreal. And second, the agonizing need to ask the question why. Why did the person we love die in this way? Why didn't our loved one hold on, reach out, get help? Why?

But questioning why someone chose to die by suicide often leads us toward more pain. Even the wording of the question is rife with misconception And very often the question is accompanied by the inquiries 'How could they do this to me? Our children? Our life together? Our dreams?'  In short, when a person dies by suicide, those left behind often feel betrayed, intentionally abandoned, and as if their love were worthless to the person who died. Many ask themselves if the person who died by suicide had ever loved them at all.

I know these things because I am in the unique position of being both a survivor of suicide loss, and a suicide attempt survivor. I know the agony of this line of questioning, because I have asked the questions not just of those I've lost, I've asked the questions of myself as well. Why weren't my family members enough for me to stay alive? How could I be so unappreciative of a life where all of my material needs were met? How could I leave my son in this way? How could I?

What I can tell you is that for years, my loyalty to my loved ones kept me alive. My appreciation for my circumstances gave me just enough light to endure the darkness of constant sadness.

For years these things were enough.

And then one day, they weren't anymore.

I know that there is no one answer as to why a person dies by suicide. I know that. And I know that my story isn't everyone's story. But I can tell you this - parts of my story are the same or very similar to the stories of many people who are mentally ill and suicidal. And, it is estimated that 90% of all people who die by suicide are mentally ill.

So, I'm speaking for a lot of us. If you want to know why or how we get to the point where death becomes more important than life, I will try to put it into words. In so many ways, the emotional desperation that goes into deciding to end your own life defies explanation. Still, I will offer what I can.

As a suicide attempt survivor, this is my story.

October of 2013 wasn't the first time I'd tried to take my life, it was the second. The first time was close to three decades earlier. And so, that is where I'll begin.

My first severe depression hit when I was 14 years old. This is not so uncommon for girls who struggle with mental illness. Often, we first experience symptoms during early to mid adolescence.

In 1985, treatment for mental illness was spotty at best. The first medication I was prescribed for my depression was Valium. This was particularly incongruous because Valium itself is a significant depressant.

By the time I was 18 years old I was a mess and my life was only getting messier. I was depressed, drinking heavily, and regularly using drugs. I was also suffering from PTSD that was related to traumatic childhood events, and there wasn't yet effective treatment for the condition.

I had a boyfriend at the time. One night when I was drunk and frustrated with the pains of young love, I did something that hurt him. It wasn't particularly horrible, but it did lead to our break up. Because I'd hurt him, the guilt I felt was overwhelming. And because I was dealing with depression and PTSD, I found the overwhelming guilt to be unbearable. I did not understand mental illness, I did not understand alcoholism or trauma, and I certainly didn't understand young love. All I knew was that I hated myself and could not find relief.

For years I'd struggled with insomnia. In the days after my boyfriend and I broke up, one sleepless night turned into two and then three. The exhaustion combined with the guilt and self hatred exacerbated my mental illness, and I had a psychotic break.

It's not easy to write that. I wish there were some way I could put it into softer, prettier, words. The word psychotic feels dirty and shameful. Just writing it down triggers a sense of inadequacy on my part. Later, I would learn that brief psychosis can be a symptom of PTSD, but I didn't know that at the time. Plus, the complicated thing about psychosis is that for the sufferer, what we are thinking seems very real. We don't spend a lot of time questioning whether our irrational thoughts are true.

My psychotic break looked like this: I became convinced that I was evil. I believed that I was the devil and that everything I touched would end up hurting and in pain. I couldn't understand why this was true about myself, but I certainly didn't want to be me anymore.

So, those were the circumstances of my first attempt at suicide.

These are the important elements, and the parts that I have in common with innumerable people who suffer from mental illness and suicidality:

I was in extreme emotional pain, and had been for several years.

I believed that the pain would never end.

I hated myself.

And unequivocally, I believed that the world and everyone I loved would be better off without me.

Hand in hand with my psychotic break and believing I was evil, I also believed that dying would be the only way to stop myself from hurting the people I loved. I was unable to comprehend that the people who loved me would suffer immensely if they lost me to suicide.

For those of you who have lost someone you love to suicide - what I want to offer you is that there are many reasons why a suicidal person is in unbearable pain and there are many reasons why a suicidal person believes that the world and their loved ones would be better off without them. Usually though, the reason a person has for choosing to die, is not because of a lack of love or concern for the people they care about. 

For me, the symptoms of mental illness eclipsed my ability to see my value in the world. And, the symptoms of my mental illness included emotional pain that is not easy to comprehend if you are not mentally ill.

My depression, my psychotic break, and the lack of effective treatment for mental illness were all reasons for my first suicide attempt. I genuinely loved and cared about other people, but that love did not address or heal the factors that led to my feeling like I wanted to die. How much others loved me did not effectively treat my mental illness.

Often, those left behind after a suicide are tormented by their belief that their loved one who died should have surmounted their mental illness in order to protect them from suffering. But it just doesn't work that way. It is not a decision making process. Mental illness is not a choice. 

We are not choosing our illness over our love for others.

I want to say this, too. For the most part, I did not talk to the people I loved about what was going on inside me. I felt broken and weak and did not want others to know how I felt. I look back and I know that anyone watching closely would have noticed that I was troubled, but most did not see. And even for those who did, I doubt that the possibility of suicide entered their mind. I have always had a sense of humor. I have always had friends. I was industrious and capable. Even at 18 years old, I had a job and was able to support myself. I did not appear hopeless.

If I had died that time, I know that people would have asked themselves what they missed. Many people would have said they never saw the signs. Others would have said that they were confounded as to why someone who laughed so often and was loved by so many would not have reached out for help.

The thing that makes me sad is that many people would have pointed to one external circumstance and blamed it for my despair. That would have been the breakup with my boyfriend.

In no small part, one of the reasons I am grateful I did not succeed at that attempt is because I did not leave my boyfriend behind to sort out the extraordinary guilt and confusion that comes along with having lost a partner to suicide.

The truth is, fights and breakups are often a part of the story of a person's suicide. Just as the loss of a job might be. Or a certain melancholy song. Or a movie. Someone I know lost a childhood friend to suicide, and her friend's parents blamed the book Catcher In the Rye. If we are to live in this world, then triggers will be abundant. But they are not the cause of the mental illness. It is the other way around. Mental illness is the cause of a person not being able to process or tolerate a trigger. 

For those of you who have lost a partner, what I want to offer you is this: Your fights and conflicts were not the reason for the suicide. External pain and circumstances are often a part of the story of our loved one's death. But it is the mental illness that has killed our loved one, and our conflicts with the person we loved are not the reason for the mental illness.

What I hope for those of you who are blaming yourself or others for a suicide, is that you be able to lay down some of that blame. The heaviness of guilt is so profound. We often wield blame as if it were a weapon. Always though, we are the ones who end up further injured. 

Thirty years ago, I survived because after I made the attempt - but before I died - I changed my mind.

I am not alone in this experience. There are many suicide attempt survivors who change their mind in the first moments after they have made an attempt. Kevin Hines, who is part of the one percent of people who have survived a jump from the Golden Gate Bridge, recounts the same thing. He says that he changed his mind the moment his hands left the railing. He points out that others who also survived a jump from the bridge say the same, as well. 

Kevin Hines says that he thought of his family and his potential and his future, only after he was already falling. For 99% of those who've attempted suicide in the same way as he did, this would have been too late. Hines though, was given a second chance at life because of a miracle that many will tell you defies explanation.

I did not attempt suicide by jumping off a bridge, but the method I used in my first attempt was not 100% foolproof and so it did afford me the opportunity to take action when I changed my mind. 

Ironically though, the thing that facilitated my wanting to live again was the ocean. Something made me think of the ocean, and in that one brief moment - I felt connected to something bigger than me. Suddenly, I felt connected to the world. I felt connected to the possibility of a life that was larger than the small world I lived in when I was in pain.

Sometimes, even just a momentary sense of connection to anything is enough to save a life.

While the sense that I was connected to something larger than myself saved my life, there were other things that happened that were not as empowering. I began to understand that because I was a survivor of a suicide attempt, many people thought I had a lack of courage and integrity. And the messages were immediate.

In the emergency room, my doctor was rude and hurried. I couldn't understand it and I asked him directly if he were angry at me.

I was a teenager, alone, and only just an hour past my attempt. I was scared and confused and in both physical and emotional pain. The doctor who was treating my injury barely spoke, and when he did he sounded irritated. He was being aggressive and too rough while he was treating me. Here was his reply when I asked him if he was angry:

"I have a room full of people in that waiting room out there. They have real problems and are in real pain, but I have to be in here dealing with you, because you are too selfish to think about other people. Yes. I am angry. Think about that the next time you decide to do something so stupid."

A few days later a close friend was equally hurtful.

"You know, it's really hard to care about you, after you do something like this," he said. "No one wants to care about someone who is just going to die. Besides, did you care about anyone else when you did this?"

I took those messages in. They became perilously intertwined with my feelings about my depression and suicidality. I believed that when I was depressed, it meant that I was stupid and selfish. I believed my mental illness meant that I did not deserve to be cared about.

I didn't make those things up. I didn't pull them out of thin air. Every bit of shame I carried around about my depression was wrapped in words that other people had spoken. 

People told me that my struggles were shameful and that they lessened my value as a human being. I believed them.

Please remember this. Every single time someone else dies by suicide and you call them selfish, that message is reaffirmed for the rest of us who struggle with suicidality. Every time someone who dies by suicide is called insensitive, we hear it. We take it in. Every time someone who dies by suicide is called ungrateful, we hear it. We take it in. But there is so little that is accurate about those statements. It took me a long time to realize that when a person suffering from severe depression dies by suicide, they lost their lives to a disease - not a character flaw.

Can I put this more simply? We take in what is being said about us whether it is said when we are still alive, or it is said about someone who has lost their life. Lashing out at someone who has died by suicide can be cruel to those who are still living.

And cruelty has never healed a person.


Over the next few years, the best I could do to deflect that messaging was to pretend that I wasn't a person that this had happened too. I tried to be worthy of being loved by not talking about my sadness and my fear. Over and over again, I reminded myself that some part of me wanted to live. I tried to remember that I was always connected to something bigger than myself.

I tried. 

And it was almost enough. It was so close to enough. 

In fact, I experienced a lot of joy throughout my twenties. I got married. I was doing well in my career. My husband I bought a home, and we had a son together. When my son was born, I learned more about unconditional love than I ever had before. I hadn't known I was capable of loving someone so much. I hadn't known that I could be loved by someone else so much.

For years, everything was enough to keep me trying. Everything was enough to keep the worst of my desolation at bay. Everything was enough.

And then one day, it wasn't anymore.

In my mid-twenties I quit drinking. Then when I was 29, my marriage began to fall apart. I started drinking again. 

My son was was two years old at the time, and once again I was experiencing episodes of extreme depression and suicidality. I was acutely aware that I wasn't supposed to feel the way that I did.

After all, I had a son.

When he was three years old, I voluntarily admitted myself into a psychiatric hospital. I was deeply ashamed, but those feelings were outweighed by my desolation and more importantly, my fear of what I might do to myself. This was the second time I'd been hospitalized. Years earlier, I'd been hospitalized directly following my first suicide attempt. This time around, I was in the hospital for a week, and then, bored and frustrated with their ineffective treatment, I decided to go home.

I was home for less than a month when my fear of what I might do, once again became unbearable. I went into the hospital again.

Then, I came home.

Perhaps a few months went by. I went into the hospital again. That fourth time, my son's father came to see me.

He isn't a cruel man. Our marriage did not fall apart for that reason. It also did not fall apart because of a lack of love. There were different irreconcilable issues, but I was still happy that he came to visit me. We sat on the couch in the hospital's visiting room. He told me that he loved me. That he always would. He asked me why I was having such a hard time.

I told him the truth. I told him I wanted to die, and that I was scared.

"It's really selfish, Chelise," he said. He wasn't trying to be mean. He was saying what he thought was true.

"Think of our son," he said. "Think of how he would feel."

"I do think about him," I said, looking at the floor. I still remember what that linoleum floor looked like. It's white color had yellowed and the square tiles were chipped and peeling at the edges.

"I think about him all the time," I repeated. "It's why I'm here."

After that fourth hospitalization, I tried to regroup. I tried counseling. I tried medication again. The counseling helped a little. The medication was not the right one for me. It did not help. But I made it through a year. My son was on the heels of turning five years old.

And then, my mother died. And she died by suicide.

I didn't know how to feel that grief. I was so busy avoiding all the rest of my feelings, already.  When she died, everything in me went numb and everything I felt was magnified at the very same time. How that was possible, I don't know. But that is the best description I have. 

I wanted out. 

My mother and I had been estranged for several years at that point, and I wanted a chance to make that right. I wanted to be with her again. I suppose some part of me wanted to be her.

And I was terrified. Thoughts of my dying in the same way were suddenly made real again. I was afraid of every feeling I had.

Perhaps some of that fear was healthy too. Perhaps it was what got me through the next two years. I left my career and went back to school. When my son was six years old, I remarried. Once again, I owned a home. I was loved. I had everything I needed.  

But it was always there. That fear. And at my core, a pain that I couldn't name and didn't want.

When my son was seven years old, I was hospitalized for the fifth time. When he was nine, I was hospitalized for the sixth. And the seventh. And the eighth. By the time he was eleven years old, I'd lost count of how many times I'd been in a psychiatric hospital.

I lost count somewhere after fifteen hospitalizations. This entire time, I went to counseling. I saw psychiatrists. I had periods of sobriety. My relapses always involved abusing the prescription meds that were being prescribed to me for my anxiety and depression.

I tried every medication that was prescribed for me. My memory was always dull. My laughter and wit was less quick. I gained weight. And gained weight. And gained weight, until I was morbidly obese.

I didn't care. I just desperately wanted to stop hurting. All I wanted was to find a way to live. I didn't want to live for me, or for my future. I hated myself, after all. I was selfish, I was weak, I was stupid, I knew. My depression and suicidality were exhausting to everyone. I knew that too.

For the first few years, whenever I was admitted into a hospital, the staff would ask me how I'd managed to stay alive so far. It's a standard a question. They are looking for what motivates a person to get help. They want to know what to tell a person to focus on, when that person is at their lowest. Every single time, I answered the question the same way. "My son." I'd say. I'd managed to stay alive for my son.

It was true. I loved him more than anything in the world. That never lessened. I can not emphasize that enough. My love for my son was immense and it never lessened.

By the time that I'd lost count of my admissions to the hospital, the staff stopped asking me what was keeping me alive. I'd been there so many times and for so many years, the staff all knew me well. Instead of asking me why I was trying so hard to stay alive, they'd just ask me how my son was doing.

One day though, I could no longer tell the staff that my son was doing ok.

I don't know exactly when it started to happen. I don't know when he started to show the signs of being impacted by the trauma of repeatedly losing me to mental illness. Did it happen when he was four? When he was seven? Did it begin when I was hospitalized for the fifth time? The tenth? Perhaps it was around the same time that I lost count of those hospitalizations. I don't know.

By the time my son was fourteen years old, the same age that my first depression hit, he wasn't doing much better than me. He was drinking. He was using drugs. He was hospitalized for overdoses. And we were regularly being called by the police. 

Sometimes I was home from the hospital when these things happened. Sometimes I wasn't.  

Self hatred is another thing that is difficult to put into words. Hatred is not a big enough word for what I felt.

I was staying alive for my son. But I now knew he was devastated by the impact of my mental illness, too. I began to believe that my efforts at staying alive were killing my son, or at the very least - causing him unbearable pain. I couldn't figure out how to reconcile all those things.

By the time he was in his teens and I was in my early forties, my mental illness included an eating disorder that was raging out of control. It was the latest iteration of my PTSD. I didn't throw up or do anything like that, I just stopped being able to eat. I was losing weight at an alarming rate. I didn't care. I was relieved. It was what I wanted.

Finally, I was disappearing.

I may not be able to tell you what it's like to live with that kind of unhappiness and that kind of self hatred, but what I can tell you is that the entire time that my desolation and self hatred grew - I also loved people tremendously. I never stopped loving them, and I never stopped caring about them.

The thing is, caring about how my mental illness was impacting other people made me more depressed and not less so.

I did everything I could to try to find a way out of my pain. I did everything the doctors told me. Desperately I began to rely on self medicating. My second marriage didn't survive under the pressure of  my erratic behavior and my frequent feelings of despair. I made terrible choices in relationships after that marriage, and I began to abuse my anxiety medicine more and more heavily. 

Doing what doctors asked of me didn't help. Self medicating didn't help. Disappearing didn't  happen fast enough.

Nothing helped.

I tried and tried and tried.

Some days holding on was easier than others. Another thing that is hard for people to understand is that often from the outside, I looked fine. And the truth is, there was a lot of happiness in between the hospitalizations and breakdowns.

I had incredible bursts of creativity and I was at the helm of an online art group for a number of years. That consistently brought me happiness. I traveled and spent time with family and friends. I continued to laugh often. I wrote, I took classes, I volunteered at my son's school.

And I never stopped telling my son I loved him. He always told me he loved me back. I had that. I will forever know that if nothing else, my son knew I loved him during those years. And in many ways, that is all I could ever ask, anyway.

After that first attempt at suicide when I was a teenager, I held on for 26 more years. I held on for a lot of reasons. I fell apart, but held on at the same time. The last decade that I was holding on, it was almost entirely because of my love for my son. I did my best and I tried so hard.

This is what I want to offer to those who have lost someone with mental illness to suicide. Not all stories look the same as mine. The details may differ. But what most of us have is common is that we do not decide to take our lives because we don't love you. Instead, it is because of our love for you that we lived as long as we did. If you can reverse the way you've interpreted that piece, you will likely see things more accurately. And perhaps, you can begin to forgive the person you lost, and stop tormenting yourself over how they could do something so horrible to you, or agonizing about why it was your love wasn't enough to keep them alive.

Sometimes, mental illness kills people. And heartbreakingly, love is not a cure.

My love for others was never enough to keep my illness at bay.

Eventually, I no longer had anything better or stronger or smarter in me that could save my life. I really did do my best to stay alive for years. I did everything I could.

And then one day - I had nothing left.

I was 44 years old the second time I tried to kill myself. And for all intents and purposes, I was successful. I am only alive because my 16 year old son found me and called 911. I wasn't conscious when the ambulance arrived. I only know the rest of these details because doctors and nurses shared them with me afterwards.

On the way to the hospital, my heart stopped beating and I stopped breathing. But I was with people who knew how to bring me back to life. They intubated me and I was revived. My hands weren't restrained though, so I reached up and pulled the intubation tube out. Again, my body gave up its efforts at life. I was intubated a second time. The effort was so hurried and aggressive, significant damage was done to my trachea and larynx. This is why days later when I began to wake up from a coma, my throat was in so much pain. The people in that ambulance worked hard to keep me alive. A few years later, I would get an x-ray that showed that my ribs had been broken when the paramedics performed CPR that day. Sometimes that happens. The effort to keep a heart beating supersedes efforts to avoid breaking ribs. Good paramedics operate by that rule.

I died in that ambulance, but there was also a miracle doled out. Because my son called 911 when I was still alive, and because of when the ambulance arrived, they were able to save my life. Had even five or ten more minutes gone by, this would have been far less likely.

I was saved by the miracle of a few minutes.

I think about that fact often. This past year, I clung to the responsibility that miracle laid at my feet. When the loss of my beloved John once again brought me face to face with my own desire to die, I remembered that a miracle had brought me this far.

I think about the fact that I live in the middle of that miracle all of the time. A miracle saved my life, and that miracle still keeps me alive.

In October of this year, it will be five years from the day that I tried to take my life.

How it is I finally found my way to a life full of hope and more importantly - purpose, is a long story. But if I am to be rigorously honest, I will say this: finding sobriety and recovering from my addiction issues is nine tenths of that story. My program of recovery from substance abuse is the thing that allowed me to begin to recover in other ways too. Every day that I wake up clean and sober represents another day that I wake up and choose to live.

I lived because people began to tell me that from now on, I could find my value by helping others - and they modeled that truth by helping me.

I lived because my son gave me another chance. I lived because he too got sober, and he gave himself another chance as well.

I lived with the help of strangers who quickly became family, and who showed me how to let the Grace of God keep me sober one day at a time.

All those things are true. And this too. My life is made fuller, more complete, and more beautiful, because of my love for my son and for others, and because of their love for me. But love alone is not the reason I am alive, and love could not save me when I decided to die.

If you have lost someone to suicide, what I want to offer you is that the person you lost did not suffer on purpose, and our desperation was not a reflection of our being selfish. Very few of us intentionally wanted to end our pain by giving it all to you.

I can't finish this particular story without saying something else. This entire blog and all of my suicide prevention and awareness advocacy came about because a little over a year ago, suicide entered my life once again, when I lost my boyfriend John.

I have written about that loss extensively. If you've read any of that writing, you know that John was an incredibly strong, caring, and compassionate man. You know that he was deeply loved by his family and friends and that he was devoted to the ones he loved, as well.

John, like me, had lost a close family member to suicide. Close to two decades ago, John's brother David also died by suicide.

John understood the extraordinary heartbreak that suicide leaves in its wake. Like me, John wanted desperately to find a way to stay alive for his family and friends. And like me, John had many periods of joy and happiness in his life. His fighting to stay alive for the people he loved and the joy and happiness that he did experience, were enough to keep him alive for many years. John suffered from bipolar disease, but he fought that disease with everything he had. And the reason he fought so hard was because of all the people he loved.

John died, unequivocally because of his disease. I was with him when his bipolar became unbearable for him. I was with him when he called his doctor and told him that his medication was no longer working. I was with him when his doctors mishandled that call and neglected to see him for weeks. I was with John when he self admitted to hospitals more than once, in order to try to protect himself from his suicidal thoughts. I was with John when he begged for more intensive treatment, but he was turned down because he was not 'medically compromised.' I was with him when he begged for residential treatment, and his insurance company turned him down because he was deemed too 'functional' to need that kind of help.

When John died, I wanted to carry his ashes to his health insurance company and drop them at their  door. "Is he struggling enough to get some help, now?" I wanted to say.

In the months before John died, the pressures that his illness placed on our relationship often felt unworkable. We'd been fighting and breaking up off and on for a while, and I was constantly pleading with him to somehow fix his mental and emotional deterioration on his own, because no one else was helping him.

No one else was helping him because mental illness is not prioritized as a life threatening condition on par with physiological conditions. In this country, people have had to fight tooth and nail to enact laws requiring insurance companies to pay for mental health treatment.

No one else was helping him because there isn't enough effective treatment, and the treatment that does exist isn't readily available.

No one else was helping him because there is so little funding for critically needed research that can identify effective treatments for mental illness.

No one else was helping him because those with mental illness are constantly constantly constantly being told that they need to cure themselves by getting a job, taking a walk, having a better attitude.

No one was helping him because those with mental illness are regularly called selfish and lazy and ungrateful, even by the people who love them.

No one was helping him because our culture and our society tells us all that those with mental illness are at fault for the symptoms of their disease.

I know all of this because I watched these things impact John, and I know all this, because these things impacted me.

Mental illness can be a fatal disease, and in John's case, it killed him.

When John died, I began to research what was known about mental illness and suicide. It turns out there is far more information out there than I thought. There is a lot of scientific evidence that explains what happens to the brain and the resulting behaviors of people who are suicidal.

I am not a doctor or scientist so I am going to oversimplify it and try to put it into layman's terms. Essentially, in mental illness, they are finding differences in brain structure and brain activity. I'll call these differences an impairment.

The impairment can be physiological in origin. An imbalance in the chemicals in the brain is often what causes the structural impairment.

Occasionally the impairment is physiological, originating from a physical disease. We see this with Alzheimer's, Dementia, Brain Cancer, and other diseases that impact the brain in such a way as to significantly change a person's behavior, moods, and their ability to process information.

Head injuries that cause brain damage also impair brain structure. Traumatic brain injuries often have symptoms, many of which can be permanent, that include marked changes in personality. Football players who sustain repeated concussions are at risk for Chronic Traumatic Encephalopathy (CTE), and two significant symptoms of CTE are depression and suicide.

Let me repeat that, a physiological brain injury is causing personality changes, anxiety, depression, and suicide.

Because of the way our culture has approached suicide for thousands of years, the loved ones of those with CTE at first struggled with the same things most of us who have lost someone to suicide do. Many questioned why the person they lost chose to die by suicide, how that person could have been so selfish as to have done something that left so many people behind to suffer and grieve.

However, there is now scientific proof that the thing that looked like a selfish 'choice' was actually the result of very real physical brain damage.

Perhaps the most interesting note though, is that external circumstances entirely psychological in origin, can also create these structural changes in a person's brain. Most notably, emotional and mental trauma. Studies have shown that brain areas impacted by emotional trauma include the amygdala, hippocampus, and prefrontal cortex. Traumatic stress has been associated with lasting changes in these brain areas.

I once heard someone equate suicide to a heart attack. A brain attack, they called it. When it comes to mental illness and suicide, I think that metaphor is fairly apt. 

No matter how many promises a person makes to never kill themselves, to never leave a loved one in this way, to do things differently, to try harder - no matter how sincere they are - promises do not cure diseases. Sincerity and loyalty are not antidotes to brain structure impairments.

What we need are concrete and effective treatments. What we need is to better understand exactly how brain chemistry works. What we need is to better understand how to repair brain structure and neurotransmitters and the impact of both physical and mental trauma.

There is no excuse for not having done this already. If we can figure out how to split a gene, we can figure out how to repair broken neurotransmitters in the brain.


Meanwhile, those who are mentally ill and the people who love them are not educated about these studies and advances. Instead we spend lifetimes living with shame or rage. 

Survivors of suicide loss spend months, sometimes years, exacerbating their pain by questioning why their loved one would choose to leave them and to let them suffer.

Brain structure impairment is not a choice. 

But it is often the reason for mental illness and suicidality.

Mental illness is often the reason that people can not pull themselves out of extreme depression. 

Mental illness is often the reason why a mentally ill person seems unwilling to get the help they need.

Mental illness is often the reason why people can't tolerate painful situations such as stressful arguments, fights, or life changes.

Mental illness is often the reason why people make life or death decisions that appear to be impulsive. 

Mental illness is why people do not see a light at the end of the tunnel.

Mental illness is why our loved ones have died.

Rage, hurt, and feelings of being abandoned can be normal parts of grief and they have their place. But getting stuck there (as survivors of suicide loss often do) helps no one. And blaming yourself, others, or the person who died, doesn't help either.

Place the blame where it belongs. On a very flawed mental health care system in this country and on the stigma around mental illness that provides an excuse for a lack of funding, research, and effective treatment.

Place your anger, blame, and rage there. It is only with this kind of focus that life saving changes will begin to happen.

When John died, I wasn't angry at him. My heart was broken in a million pieces, but I was not angry at him. I understood how desperately he tried to stay alive, and I understood how desperately he tried to get help.

I understood how much of his own self hatred came from his belief that he was at fault for the symptoms of his mental illness.

And I understood that he'd lived for years because of his love for others. I wasn't angry at John. In many ways, I felt he was a hero.

Close to five years ago I survived my own suicide attempt. But I'd lost my mother. Then, I lost John. I knew that I got to live because I was doled out a miracle. I believe I now bear a responsibility to speak up about suicide.

Today, John and his brother share a headstone. On that headstone is carved this sentiment:

All that love could do was done.

What I want to offer to those of you who have lost someone to suicide - is that those words are true. For so many of our loved ones, all that love could do had been done.

But it is because of love, that we have to do more.

John Macaluso and I. 2016