Children, although devastated and permanently marked by the suicide of a parent, for the most part survive the death without severe or enduring pathology. Like adults in the wake of suicide, however, many children experience profound grief, guilt, and anxiety that can persist for many months, if not years. In some instances, particularly if the child has a history of psychiatric disturbance, the reaction may be severe and long-lasting. An eleven-year-old boy, for instance, was evaluated at a clinic approximately one year after his father’s suicide: “This thin, wan, passive boy appeared withdrawn, apathetic, lifeless,” the admitting doctor wrote. “He hung his head, staring at the floor out of unseeing eyes. Greatly preoccupied, he rarely initiated any remark, was painfully slow to respond. His gestures were of utter resignation and defeat, although occasionally he picked at his arm and lip. When he spoke it was of his immense loneliness, his guilt regarding his father’s suicide, his inability to be of help to his family following the suicide, and his own worthlessness.”
The initial communication, or lack of communication, about the circumstances of a parent’s death can be critical to a child’s ability to accept and deal with suicide. The range in sensitivity of the surviving parent may be great, as a study conducted in Britain points out: on the one hand, a father told his sons, “Mummy was very depressed, unhappy and tired and so took her own life by taking too many tablets”; at the other extreme, one mother said to her three-year-old, “The silly fool’s gone and put his head in the gas oven.” Josephine Pesaresi, the social worker whose husband, a psychiatrist, shot himself, told her children, within minutes of his death, “He had a sickness that was like a cancer which could not be cured.”
It is important that children be told the truth as completely and quickly as they are able to take it in. Efforts to “protect” or “shield” a child almost invariably come back to haunt him or her by creating a web of distortions and misperceptions and a “conspiracy of silence.” The true circumstances of death, if hidden, may in any event be quickly revealed by conversations with other children or overheard remarks between adults. Learning the truth later rather than sooner can be an additional and unnecessary damage, and one that prevents the child from understanding the reality of his own or his parent’s experience. Television writer and director Christopher Lukas, whose mother, grandmother, uncle, aunt, and brother (the writer Anthony Lukas) committed suicide, discusses the conspiracy of silence and dishonesty surrounding his mother’s death in his book Silent Grief, written with psychologist Henry Seiden:
On a hot August afternoon in 1941, when I was six years old, and she was thirty-three, my mother walked out of her psychiatrist’s house in Connecticut, stepped into the garden, and cut her throat. My father, a successful lawyer—though an unhappy man—was summoned from his New York office to deal with the death. Also at the psychiatrist’s house that day was my grandmother. She had been taking my mother to the psychiatrist that summer; the visits were the culmination of years of manic-depressive bouts. There was some disagreement between my mother’s mother and my father on what to tell the children—me at home, and my eight-year-old brother, away at camp. My father won the argument: For ten years the nature of my mother’s death was kept a secret from us, though all our relatives and most of their friends knew that she had committed suicide.
When I was finally told the truth, at the age of sixteen, my father and I were sitting in a railroad station on another hot August day. I was about to catch a train, and I have always believed that my father chose that moment to tell me because he could not bear to hold a prolonged conversation on the subject. “Why?” I querulously inquired. “She was sick,” my father replied, making it clear that was all he had to say on the subject. We didn’t talk about it again for many years.
Joshua Logan, director and writer of the films Mister Roberts, Picnic, South Pacific, Bus Stop, and Sayonara, suffered from manic-depressive illness much of his adult life. Following one of his hospitalizations, he made an appointment to see a new psychiatrist and started to recite his childhood history:
In discussing my childhood I heard myself saying, almost as if by rote, “My father died of pneumonia in a hospital in Chicago when I was three years old.”
After a slight pause, Dr. Moore said quietly, “Your father cut his throat with a pocket knife in a sanatorium in Chicago. I think it’s about time you knew that, Mr. Logan.”
I was so astounded that I asked him to repeat the statement three or four times, and then demanded to know how he could know facts I had never heard of in my life.…
I couldn’t wait to leave Dr. Moore’s office and took a taxi to my apartment, where I rushed to call my Uncle Will in Louisiana.
“Yes, Josh,” said Will, “it’s true.”
“But,” I said, “they always told me he died of pneumonia.”
“He did die of pneumonia. It was the blood from his throat that went into his lungs.”
“But why didn’t anyone tell me? Why didn’t my mother tell me?”
“She never wanted you to know, Josh. I can’t tell you why, except I imagine she thought it would be too painful for you.”
“It’s not painful, Will, it’s a relief, because at last I know the truth. The boil has been lanced and the sore is clean. In fact, I’m feeling better than I have in a very long time. Now I know my father, and for the first time in my life. I feel close to him for the first time. He must have been very much like me.”
“He was,” said Will. “Very much. And I hope you won’t tell your mother you know.”
For some, like Joshua Logan, the truth about his father’s suicide came as a relief and helped him make sense of both his father and himself. Others remain haunted by the thought of suicide, obsessed by their parent’s violent end, and fearful of what it means to their own lives. John Berryman, who like his father and his father’s sister killed himself, wrote in his poem “Of Suicide”: “Reflexions on suicide, & on my father possess me / … Of suicide I continually think.” In a poem written after Ernest Hemingway’s suicide he said, “Save us from shotguns & father’s suicides / … Mercy! my father; do not pull the trigger / or all my life I’ll suffer from your anger / killing what you began.” But his most powerful statement on his father’s suicide was in yet another poem from The Dream Songs:
The marker slants, flowerless, day’s almost done,
I stand above my father’s grave with rage,
often, often before
I’ve made this awful pilgrimage to one
who cannot visit me, who tore his page
out: I come back for more,
I spit upon this dreadful banker’s grave
who shot his heart out in a Florida dawn
HOW DO PEOPLE survive such impassable grief and rage? How do they keep from being so destroyed by guilt and sorrow that they sacrifice the remainder of their own lives for the one lost earlier to suicide? There are many ways: the support of family and friends, religious faith, the passage of time, psychotherapy, or counseling, but one of the most effective has been through the establishment of self-help groups for those who have survived another’s suicide. The American Foundation for Suicide Prevention and the American Association of Suicidology are the major national organizations in the United States that offer, in addition to scientific, advocacy, and education programs, a wide network of local support groups. These groups allow those who have been through the suicide of a friend or family member to get together and exchange support, information, and encouragement about carving out a meaningful future. Listening to others who have survived kindred straits and eventually helping newer members to do the same is invaluable in learning to survive and do well with life. Many of the suicide survivors go on to become actively involved in school and church education programs, hoping to raise awareness about suicide and the psychiatric illnesses that can lead to it. Others work at the state and national level to change legislation or to increase funding for suicide prevention programs and related research. All try to redeem s
ome good from the awfulness they have known; and most succeed.
Still, most are left to ask why it happened. Scottish writer Lewis Grassic Gibbon, who himself attempted suicide when he was a young man, writes of this in Sunset Song, the first book in his trilogy A Scots Quair. He describes the struggles of his protagonist, Chris Guthrie, in trying to come to terms with her mother’s suicide:
Just as the last time she’d climbed to the loch: and when had that been? She opened her eyes and thought, and tired from that and closed down her eyes again and gave a queer laugh. The June of last year it had been, the day when mother had poisoned herself and the twins.
So long as that and so near as that, you’d thought of the hours and days as a dark, cold pit you’d never escape. But you’d escaped, the black damp went out of the sunshine and the world went on, the white faces and whispering ceased from the pit, you’d never be the same again, but the world went on and you went with it. It was not mother only that died with the twins, something died in your heart and went down with her to lie in Kinraddie kirkyard—the child in your heart died then, the bairn that believed the hills were made for its play, every road set fair with its warning posts, hands ready to snatch you back from the brink of danger when the play grew over-rough. That died, and the Chris of the books and the dreams died with it, or you folded them up in their paper of tissue and laid them away by the dark, quiet corpse that was your childhood.…
Then Mistress Munro washed down the body that was mother’s and put it in a nightgown, her best, the one with blue ribbons on it that she hadn’t worn for many a year; and fair she made her and sweet to look at, the tears came at last when you saw her so, hot tears wrung from your eyes like drops of blood. But they ended quick, you would die if you wept like that for long, in place of tears a long wail clamoured endless, unanswered inside your head Oh, mother, mother, why did you do it?
EPILOGUE
I was naive to underestimate how disturbing it would be to write this book. I knew, of course, that it would mean interviewing people about the most painful and private moments of their lives, and I also knew that I would inevitably be drawn into my own private dealings with suicide over the years. Neither prospect was an attractive one, but I wanted to do something about the untolled epidemic of suicide and the only thing I knew to do was to write a book about it. I am by temperament an optimist, and I thought from the beginning that there was much to be written about suicide that was strangely heartening.
As a clinician, I believed there were treatments that could save lives; as one surrounded by scientists whose explorations of the brain are elegant and profound, I believed our basic understanding of its biology was radically changing how we think about both mental illness and suicide; and as a teacher of young doctors and graduate students, I felt the future held out great promise for the intelligent and compassionate care of the suicidal mentally ill.
All of these things I still believe. Indeed, I believe them more strongly than I did when I first began doing the background research for this book two years ago. The science is of the first water; it is fast-paced, and it is laying down, pixel by pixel, gene by gene, the dendritic mosaic of the brain. Psychologists are deciphering the motivations for suicide and piecing together the final straws—the circumstances of life—that so dangerously ignite the brain’s vulnerabilities. And throughout the world, from Scandinavia to Australia, public health officials are mapping a clearly reasoned strategy to cut the death rate of suicide.
Still, the effort seems unhurried. Every seventeen minutes in America, someone commits suicide: Where is the public concern and outrage? I have become more impatient as a result of writing this book and am more acutely aware of the problems that stand in the way of denting the death count. I cannot rid my mind of the desolation, confusion, and guilt I have seen in the parents, children, friends, and colleagues of those who kill themselves. Nor can I shut out the images of the autopsy photographs of twelve-year-old children or the prom photographs of adolescents who within a year’s time will put a pistol in their mouths or jump from the top floor of a university dormitory building. Looking at suicide—the sheer numbers, the pain leading up to it, and the suffering left behind—is harrowing. For every moment of exuberance in the science, or in the success of governments, there is a matching and terrible reality of the deaths themselves: the young deaths, the violent deaths, the unnecessary deaths.
Like many of my colleagues who study suicide, I have seen time and again the limitations of our science, been privileged to see how good some doctors are and appalled by the callousness and incompetence of others. Mostly, I have been impressed by how little value our society puts on saving the lives of those who are in such despair as to want to end them. It is a societal illusion that suicide is rare. It is not. Certainly the mental illnesses most closely tied to suicide are not rare. They are common conditions, and, unlike cancer and heart disease, they disproportionately affect and kill the young.
A FEW WEEKS after I nearly died from a suicide attempt, I went to the Episcopal church across the street from the UCLA campus. I was a parishioner there, however occasional, and in light of being able to walk in through the door instead of being carried in by six, I thought I would see what was left of my relationship with God. To make it easier, I purchased a ticket to a Bach recital that was being performed in the chapel. I went to the church early; my mind was still dull, and everything in it and in my heart was frayed and exhausted. But I knelt anyway, in spite or because of this, and spoke into my hands the only prayer I really know or care very much about. The beginning was rote and easy: “God be in my head, and in my understanding,” I said to myself or God, “God be in mine eyes, and in my looking.” Somehow, despite the thickening of my mind, I got through most of the rest of it. But then I blanked out entirely as I got to the end, struggling to get through what had started as an act of reconciliation with God. The words were nowhere to be found.
I imagined for a while that my forgetting was due to the remnants of the poisonous quantities of lithium I had taken, but suddenly the final lines came up into my consciousness: “God be at mine end, and at my departing.” I felt a convulsive sense of shame and sadness, a kind I had not known before, nor have I known it since. Where had God been? I could not answer the question then, nor can I answer it now. I do know, however, that I should have been dead but was not—and that I was fortunate enough to be given another chance at life, which many others were not.
While writing this book, I kept on my desk a photograph and a fragment of a poem. The photograph is of a young, good-looking cadet at the Air Force Academy, standing next to a jet fighter. Writing about this young man’s suicide was perhaps the most difficult part of writing this book. I started the essay on a clear winter day in the library at the University of St. Andrews in Scotland, where I teach for a few weeks each year. I was able to read his medical records only for brief periods before I had to get up, walk over to the window, and look out at the North Sea in a futile attempt to pull from it a meaning that would make more tolerable the awfulness of it all. I would then return to the medical notes that charted out the inexorable course of the illness that would kill him. The photograph at first haunted, then consoled me; I found great pleasure in knowing Drew Sopirak.
The fragment of the poem I kept on my desk was one that drew me to life. It is the last line from Douglas Dunn’s “Disenchantments”:
Look to the living, love them, and hold on.
Appendix
Notes
Acknowledgments
Appendix
RESOURCES FOR INFORMATION ABOUT SUICIDE,
MENTAL ILLNESS, AND ALCOHOL AND
DRUG ABUSE
American Association of Suicidology
4201 Connecticut Avenue, N.W., Suite 408
Washington, DC 20008
(202) 237-2280
Fax: (202) 237-2282
www.suicidology.org
American Foundation for Suicide Prevention
120
Wall Street, 22nd Floor
New York, NY 10005
(888) 333-2377
Fax: (212) 363-6237
www.afsp.org
Anxiety Disorders Association of America
(301) 231-9350
Fax: (301) 231-7392
www.adaa.org
Centers for Disease Control and Prevention
National Center for Injury Control and Prevention
www.cdc.gov/ncipc
Child and Adolescent Bipolar Foundation
www.cabf.org
Depression and Related Affective Disorders Association
The Johns Hopkins Hospital, Meyer 3-181
600 North Wolfe Street
Baltimore, MD 21287
(410) 955-4647
Fax: (410) 614-3241
www.med.jhu.edu/drada
Health Resources and Services Administration
www.hrsa.dhhs.gov
National Alliance for Research on Schizophrenia and Depression
60 Cutter Mill Road, Suite 404
Great Neck, NY 11021
(516) 829-0091
Fax: (516) 487-6930
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