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Originally published January 14, 2007 at 12:00 AM | Page modified May 3, 2013 at 11:26 AM

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Needless goodbye: A young widow wants you to know about suicide prevention

Ten years after my husband killed himself, I still remember certain moments from his last days that make me ache for another chance. Like many suicide survivors...


Seattle Times staff reporter

Ten years after my husband killed himself, I still remember certain moments from his last days that make me ache for another chance.

Like many suicide survivors, I struggle with feelings of guilt. I also have a growing understanding for what people can do to prevent suicide — warning signs we should know and steps we can take to help someone through a suicidal crisis. I learned these things too late, largely because the stigma surrounding suicide prevents us from talking about it. I'm sharing the story of Stu's death, along with advice from experts, as a way of breaching that silence. I want you to know more about suicide than I did before my husband died.

How we met

I met Stu at Ohio State, where we were part of a large, loosely connected group of friends. I thought he was the best-looking, funniest, most brilliant person I'd ever known. He was two years older but the same year in school as me, because just before we met he had dropped out of the optometry program and planned to go for his Ph.D. in microbiology.

When someone seems suicidal:


Be aware. Learn the warning signs.

Get involved. Become available. Show interest and support.

Ask if he/she is thinking about suicide.

Be direct. Talk openly and freely about suicide.

Be willing to listen. Allow for expression of feelings. Accept the feelings.

Be nonjudgmental. Don't debate whether suicide is right or wrong, or feelings are good or bad. Don't lecture on the value of life.

Don't dare him/her to do it.

Don't give advice: This includes making decisions for the person or telling him/her to behave differently.

Don't ask "why?" This encourages defensiveness.

Offer empathy, not sympathy.

Don't act shocked. This creates distance.

Don't be sworn to secrecy. Seek support.

Offer hope that alternatives are available. Do not offer glib reassurance; it only proves you don't understand.

Take action! Remove means! Get help from individuals or agencies specializing in crisis intervention and suicide prevention.

Source: American Association of Suicidology at www.suicidology.org

We graduated with our bachelor's degrees at the same time and married a couple of months later. For almost five years, we were a typical young couple — visiting family on weekends, adopting cats from the Humane Society and taking vacations out West. We had difficult times, but nothing to foreshadow how our relationship would end.

Just before our fifth anniversary, Stu began to have earaches that devolved into unrelenting pain and ringing in his ears. The eventual diagnosis was an unusual and extreme form of tinnitus. After about six months without successful treatment, Stu began to say that he didn't know how much longer he could take it. When his family and friends asked whether he thought about suicide, he said yes, but that he would never do it.

Stu was particularly disheartened by doctors' warnings that he might never fully recover. He continued to work despite little sleep and a host of prescription drugs for pain, insomnia, swelling and other things. He remained good-natured but was quieter. He completed his dissertation in great pain, often laying his head on his desk between sentences.

Sometimes, Stu gave me a desperate look and pointed his index fingers toward his ears to show how much it hurt — like needles.

No one knew what to do for him, and early on, I occasionally wondered if he was exaggerating about the pain.

Eventually, I realized that Stu might be in danger. Some members of his family worried, too, and asked him for reassurances that he would not kill himself. Finally, despite his objections, I made an appointment for him to see a psychiatrist.

Don't tiptoe around it

Last year, I talked to Don Kuch, clinical director of the nonprofit Crisis Clinic in Seattle, about what to do if you think someone might be thinking about suicide.

Never tiptoe around the issue, he said. "If you see a few signs and the question pops into your mind, why worry about counting up the signs?"

Just ask the question: Are you thinking about killing yourself?

It might feel uncomfortable, but it's a no-lose proposition, he said. It's a myth that asking about suicide will give someone the idea.

Too many suicides


More than 30,000 people kill themselves in the United States every year. For each suicide, eight to 25 more attempts are made, according to the National Institute of Mental Health.

Suicide is the second-leading cause of death for people ages 25 to 34 and the eighth-leading cause among men of all ages in this country.

Suicide rates are lowest in winter and highest in spring, according to the federal Centers for Disease Control and Prevention.

"People don't make those kinds of decisions around somebody's questions," he said. "The chances of changing someone's mind toward committing suicide by simply asking them if they're suicidal is, I believe, infinitesimally small, whereas the benefit of asking the question directly could save a life."

Suicide experts believe it is possible to save someone right up to the last moment.

Eve Meyer is executive director of San Francisco Suicide Prevention. "If you can get someone through an episode of pain," she said, "then they go on living, sometimes without even remembering why they wanted to destroy themselves so much."

Even many doctors lack the necessary training to recognize suicidal warning signs, said Paul Quinnett, who runs The QPR Institute in Spokane, which trains people to recognize when someone is suicidal and to find help for them. QPR stands for Question, Persuade and Refer, and the idea is that gatekeepers of all sorts — doctors, teachers, police officers, ministers, parents — should learn the techniques of suicide prevention just as they would CPR, so more people will live.

Resources


Local Crisis Clinic: 206-461-3222 and 866-427-4747 and TTY/TDD 206-461-3219 or

www.crisisclinic.org. Web site provides advice and resources.

National Suicide Prevention Lifeline: 800-273-TALK (8255).

National Alliance on Mental Illness: www.nami.org — resources for people with serious mental illnesses and their families.

Families for Depression Awareness: www.familyaware.org — helps families recognize and cope with depressive disorders. Includes messages of hope, including a question-and-answer with the late author William Styron, who wrote "Darkness Visible, A Memoir of Madness" (96 pages, Vintage, $11.95), a book about his own suicidal depression.

Suicide Prevention Resource Center: www.sprc.org — part of the National Strategy for Suicide Prevention, a federal initiative of the U.S. Department of Health and Human Services.

The American Association of Suicidology: www.suicidology.org — clearinghouse for information on suicide and suicide prevention.

American Foundation for Suicide Prevention: www.afsp.org — a nonprofit dedicated to understanding and preventing suicide.

Suicide Prevention Action Network USA: www.spanusa.org — founded by a couple who survived their daughter's suicide, this nonprofit is dedicated to preventing suicide through public education and awareness, community action and advocacy.

The QPR Institute: www.qprinstitute.com — Spokane-based organization offering suicide-prevention educational services and materials, including training programs for companies, hospitals and others. Has a free downloadable book, "Suicide: The Forever Decision," with a chapter on getting help, including ideas for finding a good therapist.

Books

"How I Stayed Alive When My Brain Was Trying To Kill Me: One Person's Guide to Suicide Prevention," by Susan Rose Blauner (352 pages, Harper Paperbacks, $13.95).

"My Kind of Sad: What It's Like to Be Young and Depressed," by Kate Scowen (168 pages, Annick Press, $10.95).

"Night Falls Fast: Understanding Suicide" (448 pages, Vintage, $14.95) and "An Unquiet Mind: A Memoir of Moods and Madness" (240 pages, Vintage, $13.95), both by Kay Redfield Jamison.

"No Time to Say Goodbye: Surviving the Suicide of a Loved One," by Carla Fine (272 pages, Main Street Books, $14.95).

"Touched by Suicide: Hope and Healing After Loss," by Michael F. Myers and Carla Fine (320 pages, Gotham, $15).

My experience supports Quinnett's concern about the medical profession. One doctor who knew about Stu's suicidal thoughts, and who had lost other tinnitus patients to suicide, suggested Stu go to church more often, which was no help at all. And doctors who were not mental-health experts prescribed antidepressants but never suggested Stu see a psychiatrist.

Such carelessness is part of a broader problem.

"Mental-health services in America are a disaster right now," Quinnett said. "Basically, we're saying we don't want to fund mental health and are willing to live with the suicide rate."

Emergency-room visit

About two weeks before Stu's psychiatric appointment, I took him to the emergency room.

He said he was afraid of what he might do. He wasn't specific, and when I asked if he meant killing himself, he nodded but didn't answer. I persuaded him to go to the hospital by promising we wouldn't admit him unless he thought they could help.

I did not know how hard I needed to push to get that help.

The emergency-room personnel told us to come back later. No psychiatric doctors were available. When I refused to leave, they sent someone from the psychiatric ward, but not a doctor.

Stu told her about his ears. I interrupted and said we had come because he was thinking about killing himself. She asked Stu if he felt suicidal, and he gave his stock answer: "People who are in chronic pain often think about killing themselves, but I would never do that to my wife and parents."

Turning to me, she said, "He says he's fine," as if that were the end of it.

I asked what the hospital could do for him if he were admitted.

"Not much, really," she said. "We would keep an eye on him until he said he didn't feel suicidal. But he's saying that now."

Outside the hospital, Stu seemed happier than he had in months. He stopped alluding to his suicidal thoughts.

Three days later, he was dead.

What I've learned

Things I wish I'd known before Stu died:

It is the nature of severe depression to believe that life will not improve, and convincing a depressed person that there is hope can be life-saving.

People who are suicidal need to be reassured that their conditions are treatable, even if they have tried and not yet found the right kind of help.

Such people need a loved one to help them negotiate the health-care system until they are properly treated, an endeavor that in some cases includes the turmoil of failed treatments and suicide attempts.

"The person who needs help can sometimes barely put one foot in front of the other, and they don't have the psychic energy to keep trying over and over, which is why when someone reaches out, they really need the person they reached out to to advocate for them, to bring some of that energy that they don't have," said Anara Guard, associate director of the Suicide Prevention Resource Center, formed in 2002 to advance a government initiative called the National Strategy for Suicide Prevention.

People need to be allowed to talk about suicidal thoughts.

Warning signs


These are listed on the local Crisis Clinic's Web site, which stresses that they are intended to educate and should not be used as a substitute for professional care.

Potential emotional indicators

Hopelessness/

helplessness

Panic/anxiety

Feelings of guilt and/or shame

Depression

Moodiness

Irritability/anger

Increased crying

Persistently sad or "empty" mood

Sudden euphoria or happy/calm mood

Feelings of worthlessness

Potential behavioral indicators

• Talking about suicide, making a plan or preoccupation with death

• Giving prized possessions away

• Change in weight/appetite

• Increase or decrease in sleep

• Dangerous or impulsive behavior

• Self-injurious behavior (i.e. cutting or burning oneself)

• Drug or alcohol abuse

• Previous suicide attempts

• Family history of suicide attempts

• Withdrawal from family/friends, isolating

• Preparation for death (i.e. setting one's affairs in order)

• Loss of interest in things that one normally cares about

Source: www.crisisclinic.org

Anyone who suggests she is considering suicide — even with the seemingly casual "I'm going to shoot myself" — should be taken seriously and never told things like, "I don't want to hear you talk that way."

People planning to kill themselves often want to be stopped and will divulge details about their plans if someone appears able to handle the information. That means conversations should remain calm and nonjudgmental, a harrowing task for someone worried that a loved one wants to die.

"When we're at the point of panic, we have to remember they've trusted us with their inner thoughts, and continue to provide that place of safety and trust," said P. Bonny Ball, survivor of her 21-year-old son's 1994 suicide and chairwoman of the survivor division of the Canadian Association for Suicide Prevention.

It is absolutely essential to make an appointment with a psychiatrist when you suspect someone is suicidal. Make sure the doctor has experience dealing with suicidal patients, and attend at least the first session, if your friend or family member will let you. (Some suicide-prevention advocates say that clergy and other counselors can be helpful, but there is less chance they will be trained in treating suicidal patients.)

After the appointment, send a letter to everyone who attended, reminding them of what was said and the plan for treatment.

If the threat of suicide is immediate , take the person to the emergency room of a hospital with psychiatric doctors and make sure your concerns are heard by people who are trained to assess and treat suicidal patients.

Talking about suicide

At times, Stu probably meant it when he promised not to kill himself. In retrospect, I think he would have opened up more with gentle questioning.

I wish I had maintained a conversation with him about his intentions. Instead, I was relieved when he said he wouldn't take his life and for months, I mostly ignored the fact that he was thinking about it.

If I had asked more questions — gone beyond my fearful "Are you sure you won't do it?" — I might have learned that a few days before we went to the emergency room, Stu had bought a gun. It would have been difficult for me, or anyone at the hospital, to ignore that warning sign.

Sometimes I wonder if I would have been better equipped to help Stu if my family had talked more openly about suicide when I was growing up. I didn't know until I was 11 that my mother had killed herself, and I was grown before I learned that postpartum depression led to her suicide.

There's much to explore about suicide beyond the recitation of warning signs. On my personal list: Too many people with tinnitus kill themselves. Too many women with severe postpartum mood disorders die by suicide. Too many hospitals are not adequately funded and staffed to treat suicidal patients, and too many medical professionals do not take mental health seriously.

As long as we shy away from such topics, our society will neglect its duty to help the 30,000 people who kill themselves each year in this country. On a personal level, we will not know how to recognize when someone is in a suicidal crisis or know how to help him.

Trying to save a life can be a heavy burden, but expert advice and other support are out there.

I can tell you firsthand that it is infinitely preferable to the alternative.

Please send comments to suicideprevention@seattletimes.com.



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