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The Unique Grief of SuicideQuestions and Hope
By Tom Smith
iUniverse, Inc.Copyright © 2013 Tom Smith
All right reserved.
Chapter OneThose Who Died and Those They Left Behind
The Who Question
Of the nearly one million suicides worldwide during 2003, including the 31,484 in the United States, the 476 in Oklahoma, and the seventy in Tulsa, the suicide of my daughter, Karla, is the one tragedy that ripped apart my heart and my life. She was twenty-six at the time, seven years after the first onslaught of her bipolar disorder. Even though she had three years of mental stability between the beginning of her illness and her death by mental illness, she ended her desperate pain on Monday, January 13. Simultaneously, she slammed us into the swirling world of suicide survivor grief. In 2003, there were literally a million similar experiences. And 2003 happens every year.
Karla fit a high-risk profile for suicide. She had bipolar disorder, had attempted suicide three times previously, and was released three days earlier from a behavioral health care center where she spent ten days being treated for depression. All of those conditions increase the possibility of suicide. A week before she entered the center, she told us how worthless she thought she was; how much of a burden she was, not only on us but on the universe; and how she couldn't stop thinking of killing herself.
When the policeman came to our door in Shiloh, Illinois, and told us that the Tulsa police department informed him that "Karla Smith has died," it was devastating. He had no details on how she died, but I knew immediately that she took her own life. It was an overwhelming shock, but it was not a surprise. It is clearly the worst thing that has ever happened to me.
Karla is a twin, born, along with her brother, Kevin, on August 7, 1976, in Ottumwa, Iowa. They are our only children, and Fran and I have enjoyed being their parents. When they were two years old, we moved to Broken Arrow, Oklahoma, a middle-class suburb of Tulsa. Their childhood and adolescence were normal enough, and they both did well in school and socially.
Since infancy, Karla was adventuresome, curious, and attracted to performing arts: acting, dancing, speech, and drama. In high school, she was a star performer in school plays, a successful member of the speech team, winning state honors in a variety of categories. She also was elected treasurer of the school's student council, which had to do more with her popularity and an appealing campaign ("Karla's the Key") than with her money management skills.
Kevin's interests and personality developed in very different directions. While he too excelled in the classroom, with a special ability in math, his extracurricular energy focused on sports. He played basketball until his sophomore year and then focused on tennis, earning All-Conference Player of the Year honors his senior year, when his team placed second in state.
Predictably, they had different groups of friends, but it was a delight for us to get to know their friends as they progressed through high school. There were some typical adolescent issues we had to deal with, but it was generally a good time in the busy Smith household during those years. Despite their differences, Kevin and Karla remained their own best friends.
They chose different colleges; Kevin went to St. Louis University, and Karla to Incarnate Word in San Antonio. She transferred to Oklahoma State University in Stillwater, Oklahoma, for her sophomore year, primarily because she wanted to spend a year in a European student exchange program, and in order to expand the number of courses available to her in her major study area, English literature. She loved learning and was a bright, enthusiastic student (although she had trouble learning Latin and Spanish, and math was always a problem, mainly because she didn't see the point), and an active member of various clubs, including the poetry group and Amnesty International.
But we were not prepared for the beginning of the second semester of her sophomore year (1996), when she suddenly became seriously depressed. We were grateful that one of her favorite professors called us to say that she had dropped out of everything. She came home, and we got her a counselor and a psychiatrist who prescribed for her the first of many antidepressants. She attempted suicide during this period, but eventually she did well enough to attend the fall semester in Utrecht, the Netherlands, where she once again became depressed. She came home without completing any classes and ended up in a treatment center in Tulsa.
Her mania emerged in 1998, which was followed in 1999 with three years of stability, when she returned to Oklahoma State University. She was three classes away from graduating with a 4.0 GPA when, unknown to us, she took herself off her lithium. Five months later she was in a major, extended manic phase that led to psychotic thinking and behavior. By Thanksgiving of 2002, she was back on her meds but moving into another depression. On New Year's Eve, 2002, Fran took her, in a catatonic state and with a suicide note in hand, to the Tulsa Behavioral Health Center, where she stayed for ten days. They released her on a Friday, against our wishes, and she shot herself the following Monday. She lives in our hearts but not in our lives.
The story of her life and our attempts to cope with her illness and death can be found in my previous book, The Tattered Tapestry: A Family's Search for Peace with Bipolar Disorder.
A Few More Statistics
Karla is much more than a statistic. But she is also a statistic. And the numbers are significant as we try to understand and cope with the reality of so many people taking their own lives. The figures show us trends and suggest a profile of who is vulnerable to suicide. We may then create strategies to intervene and prevent future premature deaths.
There are many mysteries surrounding self-inflicted death: Why? What could I have done to prevent it? Who's to blame? And back again to why did the person do it? While the statistics don't solve the mysteries, the numbers do provide a context for trying to understand who those who complete suicides are and why they take their own lives. We need this general context as we address the puzzling and heart-wrenching questions generated by a suicide.
Officially, there were 38,364 reported suicides in the United States in 2010, the most recent figures that are available as I write this book. This number means that there is a suicide about every fourteen minutes, and a suicide attempt about every minute. That is a huge number! Most of us were not aware of this epidemic until we experienced it personally, and even then many of us thought that our loved one was an unfortunate part of a smaller number. Knowing that there are so many suicides can be both comforting and discouraging. In terms of our personal grief, it does suggest that, along with the question of why did our loved one die by suicide, there is another question: Why do all these people take their lives?
Almost four males complete suicide for every female. Women, however, attempt suicide three times more often than men. The obvious conclusion is that men are much more successful at taking their lives, which means that fewer suicidal men get a second chance to stay alive. The difference between men and women in their suicide rate is significant information for suicide prevention efforts. On the other hand, once a person attempts suicide, whether male or female, the likelihood that this person will attempt it again increases. It may be that women make several attempts at suicide before they are successful while men complete the suicide in the first attempt. How does your loved one fit this profile? Is that knowledge comforting or discouraging?
The most common method for completing suicide is firearms. More than half of the people who die by suicide use this method. Men use it more often than women while the women use pills as their most common method. The greater use of firearms by men may account for their higher success rate on the first attempt. Karla's three unsuccessful attempts were all overdoses of prescription pills but her final, successful attempt was with a firearm. Did she avoid the method of overdose this last time because she wasn't successful the previous times? Did she seek another method that would be more definite in its outcome? Or did she simply find the hidden rifle and decide then to use it? All these remain unanswered questions.
Whether the suicide of your loved one fits the statistical profile or not, how does the method of death impact you? Does it really matter to you how they died? For many survivors, it does seem to make a difference. Our concern is that we didn't want them to suffer physically too much. Their emotional pain was excruciating enough. My wish for Karla was that she would use a method that would not be immediately fatal, and give her another chance to reconsider. The rifle all but took away that option. Reality, of course, destroyed my wish and became another part of my suicide grief.
Suicide rates are lowest among people who are married when compared to people who are divorced, separated, or widowed. That makes sense probably because married people have someone to talk with as well as someone who can monitor a potential suicide and try to keep the person safe. It may be too that people who are divorced, separated, or widowed more likely live alone after they had the experience of living with others. That lifestyle change may contribute to a depression that may lead to suicide. Do any of these factors enter into the suicide of your loved one? While this situation alone does not account for the death, it may be a circumstance that helps you get some understanding of why your loved one died.
Mental illness is associated with suicide in over 90 percent of completed suicides. Psychological autopsy studies verify this figure over and over again. The relationship between depression and suicide is particularly strong in that a clinically depressed person is over 50 percent more likely to attempt suicide than someone without this depression. These statistics are not surprising; they verify common sense and the usual belief that someone who takes her own life is "not in her right mind." This was clearly the case with Karla. How does this statistic fit with your experience?
This next statistic is difficult for those of us who are grieving the suicide of a loved one. The research finding maintains that the large majority of people who died by suicide left cues and warnings about their intention to kill themselves. Many of us saw some of the warnings, and yet we could not prevent the death. We will address this terrible feeling of guilt in chapter 2, but for now it is enough to state that researchers have identified some of these cues. With Karla, we saw the signs many times and took whatever action we could, but at the end we did not think she was as vulnerable as she was. Often we look back and see things that we didn't recognize at the time. It is not fair to judge ourselves by what we know now and transfer that knowledge back in time and hold ourselves accountable for what we see today but did not see before the suicide.
Those of us who lost a loved one to suicide are called suicide survivors. That is not my term, and I discuss this designation a little later in this chapter. Although the number of survivors is difficult to calculate, conservative estimates indicate that there are at least six survivors for every completed suicide. Based on data from 1983 to 2010, we can estimate that the number of survivors in the United States is approximately 4.78 million (one of every sixty-five Americans in 2010.) An estimated 230,184 survivors of suicide were added in 2010. We are clearly not alone in our grief, although it often feels like we are alone. Many people who suffer from this grief do not speak about it because of the stigma attached to suicide, and because friends, coworkers, and sometimes even family members do not know how to process this grief, or even how to talk about it. This book is an effort to help us through this grief.
The statistics, research findings, and conclusions in this section are based on the information found on the website of the American Association of Suicidology. Please check this site and the previous site identified in this section if you want more information about who the people are who die by suicide.
The Language of Suicide
How do we deal with these statistics and research findings? How do we even talk about suicide and suicide survivors in a way that is honest and helpful? We begin by clarifying the language we use when we talk about suicide.
Language is our primary means of communication. Language flows from human experience, and ideally, our language accurately reflects our experience and thoughts. We go through something and then we search our vocabulary to find suitable words to describe that event.
One problem with this natural process is that we inherit language regarding our experience. Fortunately, we don't start from scratch when we try to describe what happens to us. We borrow the language from people who have had the experience before us. We use their language to describe our experience. This process is inevitable and valuable. Otherwise, we would all have to create our own language to express what happens, which would end up in communication chaos. Our common language allows us to communicate more clearly.
A difficulty emerges, however, when we experience something that our inherited language doesn't accurately or completely express. We then try to force our experience into accepted language. Sometimes the language does not adequately reflect the experience, which is one reason why our language adds new words each year and deletes other words that no longer apply. Language lives and grows because human experience transcends the words we use to describe that experience.
The suicide of a loved one is a case in point. There are at least three areas where it might be helpful to explore some new ways to speak about suicide and suicide grief: suicide survivors, suicide veterans, and died by suicide. This verbal exploration may help us describe our experience of the suicide of a loved one more accurately and thereby help us grieve more effectively.
I presume that many of the people who read The Unique Grief of Suicide are suicide survivors like me. As the final item in the research findings above indicates, there are millions of us. While the large number of suicide survivors is somewhat consoling because we are not alone in our loss, it does little to take away the feelings of grief that we endure each day.
Even though I have no substitute phrase, I don't particularly like the term suicide survivors to designate those of us who lost a loved one to suicide. Hearing the term for the first time, most people think that the survivor is someone who attempted suicide but did not succeed. That interpretation is fair enough; it is how we generally use the word survivor. To survive means to stay alive, endure, recover after an accident, live through a war or a hurricane, or, on a lighter note, a final exam or a TV series. We do not normally or immediately think of a survivor as someone who lives after someone else dies.
It is annoying, distracting, and sometimes painful to explain the meaning of the phrase suicide survivor to a friend who wants to comfort you after the suicide of a loved one. It feels like going into teacher mode when all you can do is struggle with your conflicting emotions. I use the term as little as possible because I know that whenever I use it, I have to explain it. The phrase itself becomes an obstacle.
It isn't only that suicide survivor is hard to explain. The purpose of the phrase is to describe the feelings of a person who loses a loved one to suicide. The words insist that we are surviving, barely getting through the ordeal, loss, and pain of trying to cope with the death. The term sometimes seems to be accurate enough to reflect those initial reactions to the loss. For months after Karla's death, surviving emotionally was barely possible, even though at work I was developing and implementing one of the largest projects I ever directed in my life. I'm still not sure how I "survived" and even performed well professionally.
But I simply am not comfortable thinking of myself and being referred to as a survivor. Is it denial? Perhaps, but I don't think so. My best guess is that I always felt, as bad as the immediate aftermath of Karla's death was, that I was doing more than surviving. Surviving what? I was never suicidal myself. Surviving the grief, the loss? I knew I would survive in the sense that life was going to continue in some way and I was going to be a part of it. I was certainly not coping well, or managing, or thriving, but I was not as bad as merely surviving either.
Excerpted from The Unique Grief of Suicide by Tom Smith Copyright © 2013 by Tom Smith. Excerpted by permission of iUniverse, Inc.. All rights reserved. No part of this excerpt may be reproduced or reprinted without permission in writing from the publisher.
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