Nov. 12, 2008

Suicide Prevention Presentation  

That beautiful, vibrant and happy looking young woman, could have been anyone’s friend, or sister, daughter, or grandchild--a laughing, well-loved, accomplished college student. She is my daughter, Dominique.

Eighteen months ago, at age 19, Dominique committed suicide. 

She ended her life, and left ours profoundly and forever altered.

Dominique embraced much that life offered her- she had wonderful friends and an adoring family, she sang beautifully, she wrote moving poetry, she took amazing photographs, she loved to travel and she was crazy about dogs. But another activity also consumed my daughter’s time, and that was fighting an insidious disease. It wasn’t a disease that was visible to all, or even, at times, visible at all. It was not a disease whose symptoms were constantly overwhelming or always present—though it was a disease that was always there. My daughter had a mental illness—she suffered from bi-polar disorder and an eating disorder; her depression, especially, became unremitting.

Suicide feels to those left behind like a huge accusation—an accusation made only worse by the ignorance surrounding it. In fact, many people are so anxious to avoid the stigma that surrounds death by suicide that they will admit only that a loved one was lost in a car accident, or to an accidental overdose, or of choking or heart failure. The humiliation is only intensified by the kinds of things that people say when they hear about a suicide, like “How could she do that do her family? It must have been a drug and alcohol problem. Where was the family, anyway? Weren’t they paying attention? What an incredibly selfish act. How could she have done that when there are so many other people fighting for their lives? Or, I’ve been told—there isn’t much that anyone can do to help someone who wants to kill themselves—heartbreaking resignation by those convinced that suicide is often an unavoidable result of severe depression and that there is nothing we can do to change this.

I joined Suicide Prevention International not only because I believe it offers a strategy for saving lives, which I‘ll get to, but also because I believe, as I know my daughter would have, that silence about suicide only worsens the hopelessness of those who obsess about killing themselves. This is why I must stand in front of you today and discuss what many think should remain a personal and private family matter. Let me give you some idea of the dimension of the problem of suicide and the lack of funding for research on ways to prevent it…. In the US alone, in 2005, the number of deaths due to breast cancer was about 40K,  AIDs 13K.  Suicide 33K. The National Institute of Health spent approximately $700M for breast cancer research, and close to $3B for HIV/AIDs—and thank goodness for that. Now contrast that spent for suicide…a mere $34M, despite the fact that there almost as many deaths as by breast cancer, and over twice the death rate of HIV/AIDS. These are only two of the many examples. Research spending against understanding and preventing suicide is appallingly low, despite the magnitude of the problem.  

Dr. Hendin highlighted the rising number of youth suicide. Our teenagers are especially prone to impulsive acts. Suicide is the second major cause of death among high school and college students—the first being car accidents. According to the CDC, in 2005, 17% of US high school students reported that they had seriously considered attempting suicide during the 12 months preceding the survey—8.5% of students reported that they had actually attempted suicide one or more times during the same period. These are alarming statistics, and they are rising.

My daughter killed herself while she was at one of the most respected psychiatric institutions in the country, having been hospitalized after a serious suicide attempt. I believed that the medical staff there would be fully equipped to identify signs of suicidal behavior, as they had seen so much of it among their patients. On the night of her death Dominique was interviewed by a nurse—because one of her friends was concerned about the way she was behaving, and had asked for help. The nurse assessed the risk of her taking her life by asking questions that I have since found out are standard operating procedure. Questions that allow a patient to easily deny their suicidal intent because the so-called “correct” answers are so obvious… Questions like “are you going to be safe?”, “Are you going to harm yourself?” Questions that rely on the patient’s candor— and the patient’s ability to assess themselves rationally.

Dominique was asked the usual questions. Dominique said she would be fine. Dominique lied—or, in the moment, perhaps she hoped she could be okay if she answered the right way—which was easy enough to do. We will never know. All we know is that later that night Dominique abandoned all hope. 

When I spoke to Dr. Hendin, I learned that this line of questioning, which completely misses the danger, was all too common. When directly asked, patients often withhold their suicide plans from their doctors and deny any intent to kill themselves. SPI has developed a very simple protocol that would significantly improve a caregiver’s ability to identify acute risk for suicide. It is a questionnaire that does not rely on having a suicidal patient admit their intention. Instead it measures, by asking more subtle and wide-ranging questions, the intensiveness of several key indicators that accompany suicidal thinking like desperation, hopelessness, feelings of abandonment, self-hatred, rage, anxiety, loneliness, and guilt. 

The initial research results from the hospitals in which this protocol is being used are exciting. Widespread implementation of this valuable tool is something tangible that could save lives. SPI is unique in taking concrete steps towards preventative measures. This is why we established Dominique’s Fund as part of SPI.

We are at the beginning of a long journey towards recovery—though none of us who loved her will ever be the same. Suicide is said to leave survivors—the word used to refer to those of us who must live on in a devastated limbo.

Imagine the battle of the parents, spouses, family of suicides: a battle where there is never an ending….never an answer…always, and only, terrible questions. I live with an unending struggle to understand: I replay every moment, every decision, everything I wish I had seen with the benefit of hindsight. That is a lot to survive. Imagine the shame I feel. All I ever wanted was to be a good mother. I feel like I failed. My love, which Dominique knew, and felt, and trusted, and wanted and needed, was not enough. That is the worst thing for a parent, to realize that the deepest love possible is not strong enough to save a child’s life. I must now survive my battle with the hopeless despair and horror of having lost a child to suicide.

My obsessive wish is that Dominique could be here instead to call herself a survivor. I am also possessed by the hope that others who are suicidal can be helped past the shoals of such a devastating, often impulsive act. I have come to understand that my daughter committed suicide to end her unbearable pain, not to create pain for others she loved.

The day after Dominique’s death I began searching every piece of her writing—desperate for an answer to why she killed herself. I found an essay, folded into a tiny square, tucked deep within my bedside table. I didn’t recall ever seeing it. It was a piece entitled “dedicated to those who suffer in silence.” It was as if in some mysterious way Dominique was helping me comprehend. She might very well have written this, but I can’t be certain that she didn’t copy it from somewhere. But I know for sure that it had resonated with her. I would like to share part of it with you: “It’s not the dying that’s appealing…I mean, you don’t want to do it, but you feel like you have to. It’s a matter…well, a matter of survival really. Which sounds like one hell of an oxymoron, I guess, to people who don’t know. It’s not really “death” per say, with reaper and shroud and tombstone and decay.… It’s….it’s quiet. Dark. Comforting. See, all life really is is…pain.  Every single damn day.

People say to look toward the future, it will be better tomorrow. What they don’t realize is that you have looked towards the future and it looks like absolute and total agony, which just makes you want to steer clear of next week. People say its selfish and cowardly and the easy way out. Sorry, but there is no ease involved. You’re not killing yourself, really, because…you’re already dead. Suicide’s not insane.  In fact, it’s sometimes the only sensible thing to do. You don’t want to die, you want to be rid of searing hot constant pain. Nothing that you can do to your body will come close to the torture that you live with everyday.”

Dominique suffocated herself—it was probably an extension of the feeling that was already consuming her. Sadly, she is not alone. It is hard to grasp the idea that the person who commits suicide is not really in control of herself. But when the brain is diseased, there is no rational thinking. We must not give up by simply accepting that there is nothing we can do for those who want to die. 

I am so grateful to all of you who have joined us today and have so generously contributed to SPI and Dominique’s Fund. I hope that you embrace our mission and get involved. I hope that you pass on our message and that you find the courage to talk openly about suicide so that it stands among the other causes commanding our attention and resources. And of course, I hope that you dig deep into your wallets and give as generously as you can!

As a token of our appreciation, we are sending you off with a gift … it’s a bracelet—for men and women—that we will be selling for Dominique’s Fund in order to heighten the awareness of the crisis that suicide has become. It is our dream that we see this bracelet on as many wrists as the yellow and pink rubber cancer bracelets. 

We want to tell the world to pay more attention to suicide. We want these bracelets to honor those who have killed themselves—and to symbolize our hope and our work to help prevent further suicides. And of course we want every celebrity prominently sporting these on their wrists, on TV, in magazines, and among their friends—to eradicate the stigma and make it ok the to tackle suicide, like we have tackled cancer, heart disease, HIV/Aids, to name a few. All proceeds from the sales of these bracelets will help fund SPI’s research and development.

The bracelet is similar to a silver one Dominique loved to wear. It is etched with a French braid—a braid with four strands. Dominique loved her French grandmother, and loved the French language. She often asked me to weave her long hair into a French braid. Her sister reminded me that Dominique could French braid her hair in less than 30 seconds, as fast as it took anyone else to put their hair in a ponytail—I suppose this is the kind of thing younger sisters envy! I can still feel my hands on Dominique’s head—where they were from the moment she was born—cradling that tiny, miraculous new life, washing her hair, combing it, braiding it—and, as she got older, stroking it—wanting to comfort her with all the love of a mother’s touch.

I can’t help but think that the four strands represent the four of us in her immediate family—my husband Steve, her twin siblings, Elodie and Hunter—left behind to survive this terrible loss. Dominique once had a bright future. She loved, and knew she was loved. She had hope for all she could be. All of that is gone. I keep a lock of her hair just as I keep in my heart the memory of her smile.

Most of all, the braid is a symbol of the way in which we need to entwine the strands of our Hearts, our Efforts, our Learning, and our Promise—our HELP—in compassion for those who need us—those who suffer in silence. 

Thank you.