September is Suicide Prevention Month. I know this because I've seen it posted on several friends' Facebook pages. It's likely your family has been touched by this insidious killer–it's the 10th leading cause of death in the U.S.–I know mine has. Stigma keeps many people from talking about it, but it is past time we stopped avoiding uncomfortable conversations which could offer support and solace to families and to their loved ones dealing with depression, anxiety, and other forms of mental illness.

Nearly 15 years ago we lost my sister-in-law, Christine. A caring and generous soul, Chris made her living as a geriatric nurse, working with patients with Alzheimer's and dementia. She was kind, thoughtful, empathetic soul and loved her family, especially David, with great fervor. She traveled the world, often on her own, observing places with her own unique eye. She returned from those trips to Portugal or Belize or New Orleans with memories and photos and artwork, filling her home with the souvenirs from these trips. She was smart, confident, and strong. Until she wasn't...

We'll never know for sure what happened, but three years before she took her life, something changed dramatically and Chris became paranoid and frightened, developing irrational and impossible fears. David spent a great deal of time with her, convincing her that these fears were not real, coaching her, restoring her to her former self-assurance, only to find to she had regressed the next week or day. We sought medical help, support from family and friends, read articles and books, but nothing provided the relief she sought. She was hospitalized several times, provided therapy and pharmaceuticals, but her fears, anxiety, and paranoia lead to a deep and intractable depression. Still she had moments–she loved our girls and enjoyed time with them, allowing Megan to dump the contents of her purse and explore them, holding baby Ally in her arms, joining us for quiet dinners and family celebrations. And opening her home to us, inviting the girls into her quiet back yard to explore and play. It was clear that she knew she was loved and that she truly loved us. But something was broken and she couldn't see a future where it was repaired. For months leading up to her death we were visited by an ominous premonition that had us lying awake at night, concerned for her life.

On a cold night in early November David drove the mile and a half to Chris' home to check on her–it was a Monday night and we hadn't heard from her all weekend. I asked him to call if he was going to stay as he often spent hours with her bolstering her mood. Nothing prepared me for the raw, violent pain in his voice over the phone, "She's dead, oh God, she's dead." 

And then we were survivors...for David, again. His family has been scarred by suicide four times...aunt, cousin, mother, now sister. If there are miracles in this world, one is that this man has created a happy life out of the wreckage wrought by others. Chris' death was no different. In its wake he lost the company and care of his remaining siblings–it's hard to define why, but a family fraught with mental illness creates its own defenses and survivors find their own way through the darkness. There are always questions, there are rarely answers.

A friend recently spoke about her own dark time with anxiety, telling me she no longer saw suicide as a selfish act, that in the throes of a deep depression you could not see another way out.

I don't know what momentary or menacing process lead Chris to take her life, or what would have kept her from doing so–that is the biggest challenge to friends and family...what could we have done?

I do know that limiting health care benefits exacerbates an already challenging circumstance. In an age when we still know so very little about how our brains operate, it is confounding that insurance companies can still limit access to good therapies that work, given time. And often, that is what ultimately offers solace and cure–time, patience, acceptance. So suicide prevention is really about better mental health care.

But is is also speaking openly about the wreckage that comes in the wake of suicide–scars and questions, blame and abandonment. These are hard conversations to have, but an important part of prevention and critical to healing for survivors. It is a long road to forgiveness, finding mercy and absolution for ourselves and Chris. The knowledge that we did what we could and were there for her, listening and supporting, helps. As is our certainty in her love for our family. Though I do believe rationally that suicide is preventable, I worry about the message we send to families of victims when we make that statement. We still question, could we have done more? If we had called on Friday or Saturday, would she still be with us? Suicide attempts, while not purely an impulse, are transient. One out of every twenty-five attempts are successful, so it can be an issue of timing.

We will never know. And we remain immutably transformed by her loss.

 

"Teen"

“September 11
and I remember another day
not quite a year earlier. It is how I track time
A day the world took notice, and the day 10 months earlier when our private universe collapsed
They are linked for me, a way of marking anniversaries, how long has it been?
15 years nearly
years filled with unattended birthdays, anniversaries, graduations,
a hundred missed celebrations
more marking of time
I see you, head bent over a baby, a child (not your own, but so adored)
I catch glimpses,
there you are in the supermarket or walking on the street or sitting on that bench
moments glance off my memory, your voice, a slight smile,
my ears strain to hear your laugh
anxious for that sweet melody, crowded out by pain, uncertainty
I cannot hear it, though I know it, imagine it, your voice is silent.
Wounded.
You are not here.
You left.
Too soon to see that baby grown tall and elegant, to see that child strike off on her own
Your choice and yet somehow not
Forgiveness is absolution, pain has a short reach but a long memory.
Regret and gratitude walk hand in hand
Though you are not here, you are present.
Your spirit in the home you made for us.
It is not enough.”

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