mental illness

Suicide and mental illness

Posted on by Adele Ryan McDowell

Suicide is considered a mental health issue. Why would someone want to take their own life? They must be crazy.

And, sometimes, they are. There are people who cannot function on a day-to-day basis, do not bathe for a year, receive messages to kill themselves or others, or believe their fillings are wired to Martian intelligence. There are very real neurological and biochemical influences that place these patients at high risk.

Untreated depression is considered the number one cause of suicide. If you, or someone you love, has experienced the reality of major depression, you know what a devastating, debilitating, and a biochemical illness it is. The depressed person does not see or think clearly. She is locked inside a black, airless box that offers no light or perspective.

Hospitalization and medication have saved many lives. William Styron, in his memoir, Darkness Visible: A Memoir of Madness (1992), eloquently detailed his descent into, and recovery from, depression, which he called, “a howling tempest in the brain . . . dreadful, pouncing seizures of anxiety.” Styron understood the stranglehold of depression: “The pain of severe depression is quite unimaginable to those who have not suffered it, and it kills in many instances because its anguish can no longer be borne.”

Along with major depressive disorder, the psychiatric illnesses that can lead to suicidal actions are bipolar disorder (formerly known as manic depression), borderline personality disorder, post-traumatic stress disorder (PTSD), schizophrenia, and other psychotic disorders.

Did you know that the single greatest risk factor for suicide is a history of suicidal behaviors and attempts? Of course, this makes perfect sense, and if someone you love has these behavior patterns, take them seriously.

If you have lived with a loved one who has suffered from any of these mental illnesses, your life has not been an easy one. Nor has theirs. No one chooses to live with a debilitating psychiatric or psychological disorder that frequently moves in and out of crisis. It is painful, chaotic, exhausting, and terrifying for both the patient and loved ones. Ongoing treatment and meds are usually necessary to help make life more manageable.

A psychiatrist colleague of mine, once shared this with me: The majority of her patients who ended up in the hospital emergency room had stopped taking their medications, which then precipitated the subsequent disintegration.

Whereas, Nancy Kehoe, PhD, RSCJ, a Harvard Medical School professor, clinical psychologist, and nun, offered a new take on psychiatric hospitalizations during a lecture I attended decades ago in Boston. She allowed that for many of her patients, a psychiatric hospital gave them a much-needed sense of community and connection. And, with that sense of community and connection, they were able to heal. And by heal, I mean to find some stability so that they could return to the world as a functioning participant.

This made me think of the African tribes as well as many of the Indigenous people who work as a community and address the soul to help those in pain (of any kind) to find relief. There are many paths to wellness and wholeness.

What if the suicide was not so surprising?

Posted on by Adele Ryan McDowell

contact-treeYears ago, I worked at an urban drug clinic. In my early days, I was assigned a new client—let’s call her Mimi—for my caseload. She was being released from long-term care in a psychiatric hospital, where she had been hospitalized for a near-fatal suicide attempt. It was her seventh attempt; Mimi had lethally drugged her dog, and she had barely survived herself.

At our first meeting, Mimi said she wished she had succeeded in taking her life and could join her German shepherd. At our next two sessions, Mimi talked less about suicide and focused on the possibilities of work or school. At our last session, Mimi uncharacteristically bounced into the clinic. I had never seen her so happy. I was thrilled. We made an appointment for the following week, but that never happened. Mimi had secured another cache of drugs and ended her life at a local motel, hours after our session.

As a young therapist, I did not realize that Mimi’s unusual happiness, given her psychiatric history and prior emotional states, was an indicator that she had decided to take her life again.

Individuals who have been in and out of psychiatric hospitals, have attempted suicide multiple times, and/or have dealt with the extremes of bipolar disorder are at high risk for suicide.

Their families and loved ones have lived through the duress of chronic crisis states and the cycles of hospitalization, new meds, and help. Suicide threats are far too common in their households. These families have witnessed the get-out-of-my-life locked doors and the crashing explosions of fury; they have listened to the refusals to be hospitalized or take meds. They have seen the mind of their mentally unstable loved one unravel with delusions, spiral with grand plans, and crash with tangled emotions and distorted thinking. It is exceedingly difficult, stressful, and heartbreaking for everyone.

And, if the unstable one ends his or her life, it is often not a total surprise. Suicide has been percolating on the back burner as a possibility for some time. It doesn’t lessen the impact of suicide or the heaviness of grief. Sometimes, however, there is relief that their loved one is no longer in agony. Their loved one is now free from the internal torment and, hopefully, has found a place of peace.

The choice by Janie Brown

Posted on by Adele Ryan McDowell

images (18)This is Janie Brown’s beautifully compassionate and loving response to a friend’s struggle with mental illness and later, suicide. The original piece was featured on Krista Tibbett’s “On Being” blog, where Janie Brown was a guest contributor.

Dearest you,

The phone message you left yesterday from an unidentified B&B somewhere on Vancouver Island said I would know by morning whether you had chosen to live or die. You said the pills were lined up, counted, on the dresser.

A month before when you were unraveling again, you asked us, your closest friends, what we thought about you choosing to end your life, and we all said the same thing: “You must be tired of it all after so many cycles of mental illness in your sixty-two years, but with medication and therapy you always get better.” We always had a “but,” a reason we wanted you to keep choosing life. We hadn’t accepted you had a terminal illness then, a terminal mental illness. If you had advanced cancer, we might not have tried so hard to encourage you to keep going, if you hadn’t wanted to.

Today, I know what I want. I want you to live so we’ll carry on being friends, as we have for twenty-five years. I want you to continue to sharpen my knives and bring me organic beef for the freezer when you come to town. I want to call and hear your business voice on the answering machine. I want to look across the room and feel your heart as wide as the universe as you play your ukulele with abandon, your voice belting out Bob Marley’s “No Woman, No Cry.” I want to feel your love for me, your deep caring that my life matters to you.

Most of all I want you to be happy.

But I know it’s not about what I want.

If you choose to live maybe you’ll find a sweet little home here in Vancouver just around the corner from us, and we can have dinners, and music nights, walks, and late-night conversations. We can work together, cook together, and drink good wine together. Ultimately, we would see each other through and out of this life.

If you choose to die tonight, I will carry no judgment, just a huge ache in my heart of missing you. You have lived a beautiful life, and a tough one. You have had to encompass more internally than anyone I have ever known, and I have nothing but admiration and respect for the way you have conducted your life. You are a good person. You have tried. You have succeeded on so many levels. I hope that if you choose to leave, you will truly know what a life of devoted service you’ve lived, and that you have loved, and that you have been loved in return.

Whether you choose to live or die today, I will always love you.

She chose to live that night. She said she was too scared to be alone, as she died.

A week later her psychiatrist and her closest friends encouraged her to go to a hospital where she would be kept safe from harming herself, and hopefully receive the treatment she needed to heal.

Even though she persuaded the occupational therapist to take her grocery shopping so she could make mulligatawny soup for the other in-patients (being a nutritionist, she worried the hospital food wouldn’t help them to get well); even though we snuck her out to a restaurant for a big salad, and a hearty glass of Cabernet Sauvignon against hospital regulations.

Even though we took a guitar and songbooks to the common room of the acute psychiatric unit, and sang together, and doors opened and patients peeked out, slowly sidling up to join the sing-a-long until an anxious nurse shut us down for fear of over-stimulating the patients.

Even though she did her best to maintain her dignity as her body survived the cycle of acute illness — her soul withered, slowly and quietly, over those months committed to a psychiatric unit.

Six months after she returned home, she told me she was unraveling again. She didn’t ask her friends what she should do, or tell them what she intended to do. One year ago this month, she didn’t wait until she was too ill to make the choice to die.

The day someone you love chooses to die must always feel too soon. September 5, 2014 was too soon for me, but I know it was likely not a moment too soon for my beloved friend. That day ended a lifetime of living with the enormous challenge of mental illness, a lifetime of immense loving and whole-hearted living, and a lifetime that impacted me more than I can possibly comprehend yet.

 

Janie Brown is the executive director of the Callanish Society, a nonprofit organization she co-founded in 1995 for people who are irrevocably changed by cancer, and who want to heal, whether it be into life, or death. An oncology nurse and therapist for almost thirty years, Janie explores her ideas through stories on her blog www.lifeindeath.org and is working on her first book.