By Nancy Rappaport, M.D.
Some 34,000 people die by suicide every year in the United States, which means that every 15 minutes, there is another devastated family faced with the challenge of how to make sense of a tragic loss.
While there is so much that we have come to understand about suicide and how to protect people from self-destructive impulses, last week’s sad news about the suicide of Junior Seau reinforces the complexity of every suicide death and illustrates the heartbreak and trauma that results. Initial news coverage suggested that Seau’s final act may have been influenced by the ravages of playing in the NFL for so many years. The problem goes deeper than that; in most cases, there are multiple causes that drive a young man like Seau to shoot himself tragically in the chest.
I write this as a mother of three healthy children who can understand the unbearable anguish at the thought of something harming one of them. I lost my mother to suicide when I was just four years old. I can imagine the sorrow and the bewilderment of Seau’s three children, because I felt it myself so many years ago. I am also a child psychiatrist who knows that mental illness is the underlying cause of the majority of suicides.
I have devoted my professional life to preventing this devastating outcome, so that families will not wrestle with the exhausting, haunting impenetrable question of why. My hope is that those who are suffering with suicidal thoughts or mental illness don’t worry alone. Call someone.
The early recognition and treatment of depression and other psychiatric illness is one of the best ways to prevent suicide. If someone can get the appropriate treatment –including psychotherapy, medication, or a combination of both — and stay with it, the prognosis is actually quite good; over eighty percent of people feel better with combined treatment. It’s true that some antidepressants can slightly raise the risk of suicidal thoughts and behaviors in adolescents and young adults, but suicide is far more common in people whose depression goes untreated.
If a family member is increasingly isolated, crying, irritable, and giving away prized belongings or engaging in high risk behavior (like increased alcohol and drug use or seeking access to pills), don’t be afraid to ask directly if he is suicidal. Try to break the isolation and let him know that you are on his side and willing to help and encourage them to allow himself to have a chance to get help. If you have a family member — particularly a teenager — in the house who is angry and impulsive, remove guns from your home. Guns are involved with one percent of suicide attempts, yet they are the cause of 50 percent of deaths by suicide.
Families often struggle with how to carry on following a suicide loss and are tortured by feelings of guilt and shame. Silent grief can be overwhelming, and blaming can occur as a way to avoid sadness. It is pivotal to communicate constructively and find comforting rituals to share, such as participating in religious observations, lighting candles, or creating and keeping a memory box. When there’s been a suicide in the family, parents often think it’s best to hide that knowledge from their children. But studies have shown that being direct is the better approach. Avoid euphemisms, which can be confusing to children. Often families need to revisit the conversation many times as the child grows up and his level of understanding and ability to ask questions grows.
This year, I ran the Boston Marathon to raise money for the Samaritans, a suicide prevention organization that offers education and outreach, including help lines and programs for those impacted by the tragedy of suicide. A fellow Samaritan runner reminded me that the physical challenge of Heartbreak Hill – the long uphill climb that comes in the final stage of the 26-mile trek – is nothing compared with the unbearable pain that her brother must have been in when he hanged himself.
As a professional who works with depressed patients every day and as a daughter who knows the grief and the energy it took to heal after my own mother’s death, I ask that anyone who is feeling desperate hold on in the darkness. Get help. Remember the words of Emily Dickinson: “Not knowing when dawn will come, I open every door.”
Nancy Rappaport is the author of In Her Wake: A Child Psychiatrist Explores the Mystery of Her Mother’s Suicide (2009), an attending child and adolescent psychiatrist at Cambridge Health Alliance, and an assistant professor of psychiatry at Harvard Medical School.