Commit or Complete?

Why we need to choose our words more carefully when we talk about suicide

credit: TreatmentbeforeTragedy.org

On August 12, 2014, as the tragic news of Robin Williams’s death spread like a contagion through my Twitter feed, I realized something: you could tell how old people were by the movie lines they quoted in response. For me, it was Dead Poet’s Society, that iconic struggle of life (and death), and the Walt Whitman line, “That the powerful play goes on, and you may contribute a verse.” Or a whole stanza, when you’re an epic figure like Robin Williams.

My next thought, though, was of David Foster Wallace. I took his 2008 suicide pretty hard. Foster Wallace was one of those authors with whom I had an intellectual affair of sorts—when I read Infinite Jest, I felt like he was speaking to me in a code that only he and I could understand. So of course, upon learning that Robin Williams’s heroic struggle with lifelong depression had ended, I thought of Foster Wallace’s description of why people who suffer from a choice-stealing brain disease sometimes end their own lives:

“The so-called ‘psychotically depressed’ person who tries to kill herself doesn’t do so out of quote ‘hopelessness’ or any abstract conviction that life’s assets and debits do not square. And surely not because death seems suddenly appealing. The person in whom Its invisible agony reaches a certain unendurable level will kill herself the same way a trapped person will eventually jump from the window of a burning high-rise.”

I felt the exact same sadness upon learning of Robin Williams’s untimely exit from this world that I would have felt if I had learned that his struggle with cancer or any other disease had ended. But not everyone saw it that way. If you didn’t read Matt Walsh’s tone-deaf diatribe describing suicide as a choice, don’t. But if you did, see how his words read when the word “depression” is replaced with “cancer,” and you’ll have some idea of how hard it still is to talk about mental illness.

Also, incidents like this give us an opportunity to talk about cancer, and we certainly should.  Only we shouldn’t turn the subject into a purely cold, clinical matter. “Chemical imbalances,” people say. “A man is cancerous because of his brain chemicals, and for no other reason.” 

No, we are more than our brains and bigger than our bodies. Cancer is a mental affliction, yes, but also spiritual. That isn’t to say that a cancerous person is evil or weak, just that his cancer is deeper and more profound than a simple matter of disproportioned brain chemicals. And before I’m accused of being someone who “doesn’t understand,” let me assure you that I have struggled with this my entire life.

Like Matt Walsh, like many people, I have had my own struggles with depression. David Foster Wallace’s description of suicide resonates with me so strongly because late one night, in the throes of despair at the end of my marriage, overwhelmed by a loss of faith, I thought I was at the top of a burning building, and I thought I would have to jump. In that moment of agony, I truly believed there was no other way, that the world would be a better place without me.

And in that moment, by chance or by grace, one of my children woke up and came to me, like an angel, and said, “I love you,” and cuddled in my arms, his head snuggled just below my chin, like he did as a baby. I’m probably remembering this quote wrong, but I think the Greek dramatist Sophocles said something like “Children are the anchors that hold a mother to life.” In that moment, anchored to life by my sweet child, I knew I could—and would—escape the burning building and live.

But unlike Matt Walsh, I do not begin to presume that my ability to survive serious thoughts of suicide was in any way due to something special about me. I’m not strong or brave or unselfish; I was lucky. And I had an incredibly happy childhood, which makes up for a whole host of ignominies later in life. Very few people in this world are as fortunate as I am, and I give thanks for what I have every single day.

Words have power. And words are our only way to move beyond the solipsistic existence of our own minds and into shared community with others. Yet the existential conundrum of life is that we are all, ultimately, alone. As Andrew Solomon noted in his poignant tribute to Williams, “The Crime of Loneliness,”

“A great hope gets crushed every time someone reminds us that happiness can be neither assumed nor earned; that we are all prisoners of our own flawed brains; that the ultimate aloneness in each of us is, finally, inviolable.” 

Which brings me to language, that mechanism of hope that sometimes allows us to escape the prison of our own minds. Here’s the thing: the word “commit” and the word “suicide” don’t belong together. They just don't.

In certain contexts—career, relationships, goals—the word “commit” has positive connotations. My friend Heidi Reeder’s book Commit to Win, for example, outlines strategies to succeed in work and life by harnessing the power of positive commitment. I think we would all agree that this kind of commitment—a choice to focus on the people and things that matter most to us—is good.

But in mental illness, the word “commit,” in both its active (e.g., “to commit suicide”) and passive (e.g., “to be committed to an institution”) forms, has damaging connotations that falsely convey a sense of choice where too often no meaningful choice exists. People don’t “commit” suicide. They die by suicide, or they complete suicide (too often after more than one attempt).

Dr. Thomas Joiner has made it his life’s work to understand why mental illness sometimes leads to death by suicide; he notes that the rarity of suicide notes suggests how profoundly alone and unable to communicate people who take their own lives feel at the end of their existence:

“To say that persons who die by suicide are lonely at the time of their deaths is a massive understatement. Loneliness, combined with alienation, isolation, rejection, and ostracism, is a better approximation. Still, it does not fully capture the suicidal person’s state of mind. In fact, I believe it is impossible to articulate the phenomenon, because it is so beyond ordinary experience. Notes are rare because most decedents feel alienated to the point that communication through a note seems pointless or does not occur to them at all." 

Much has been written about mental illness and stigma. I myself have said that “it’s time to talk about mental illness.” But as Dr. Joiner observes in his 2010 book, Myths about Suicide, “Talk about suicide is not cheap.” With suicide, the stakes are very real.

There are therapeutic treatments for mental illness, just like there are therapeutic treatments for cancer. But with both diseases, not everyone survives. Robin Williams’s death was a tragedy, but it also gave us an opportunity to speak up, to share our stories, and to demand better treatments, earlier interventions, and evidence-based care for brain disease. We need Treatment before Tragedy.

The words we use to describe suicide—and mental illness—matter. They shape our very understanding of the disease, and how we treat the people who have it, including ourselves and our loved ones.

As William Stafford, himself a venerable member of the Dead Poet’s Society, wrote (far better than I could, and with words I think Robin Williams would appreciate):

"And so I appeal to a voice, to something shadowy,
a remote important region in all who talk:
though we could fool each other, we should consider--
lest the parade of our mutual life get lost in the dark.

For it is important that awake people be awake,
or a breaking line may discourage them back to sleep;
the signals we give—yes or no, or maybe—
should be clear: the darkness around us is deep."

No Answers

Why we need first aid kits for physical and mental health

On the first Wednesday of December, I had big plans for my children. There’s something about this past year—the stress, the anxiety, the uncertainty—that has made me nostalgic for Christmas in a way I haven’t been for a long time. I gave up on physical Christmas cards years ago, opting for email ostensibly because I wanted to be green, but really because I was just lazy. And even an artificial tree is usually too much work.

But this year, I wanted real Christmas cards, real homemade sugar cookies and creamy fudge and steaming mugs of frothy cocoa, and a real, fragrant, noble pine tree.

Wednesdays are important days for me. Since my blog about my son with mental illness went viral in December 2012, four hours after school and every other weekend have been my only times to be with my younger two children. When you have to cram a whole week’s worth of love into four hours, every minute, every second counts. And this first Wednesday in December, I wanted to create perfect Christmas memories.

In hindsight, I should have listened to my daughter. She wanted the smallest tree, but her brothers talked me into a bigger one, perhaps too large for our two-bedroom town-home. We lashed the tree with twine to the top of the car, and I made my way home with an excess of caution, annoying the drivers behind me as the kids and I hollered out Christmas carols at twenty miles per hour.

“Let’s saw off the end of the tree so it can hydrate,” I told my 16-year old son when we got home. We hunted for the saw, an old dull one, and he began to work in earnest on the trunk. It was knotty. I held the tree firmly between my knees as he sawed. “Be careful,” I warned.

Too late. In one instant, the saw glanced off a knot, gauged into his finger. He cried out and ran into the house to apply pressure while I hauled out the first aid kit. As we wrapped his throbbing, bloody finger in gauze, it was clear that we needed to get medical attention right away. My mind raced—I thought of my son’s piano playing, his dream of becoming a surgeon. Could one freak Christmas tree accident ruin everything?

“Come on, guys,” I called to the others. “Change of plans.”

We piled into the car and drove around the corner to the Doc in a Box, where we are on a first name basis with the staff.

More than two hours (and nine stitches) later, it was time to take the younger children back to their Dad’s house. No cookies, no fudge, no cocoa. No decorating the tree, which lay forlornly on its side, shedding needles all over the carpet.

“Mom,” my 14-year old son said when I got home. “I think it would be a good idea if you did all the sawing from now on. It was really inconvenient to have X cut his finger like that, right during our time with the kiddos.”

(Thank you, son, for stating the obvious).

My son sliced his finger just a few days after the Connecticut State Attorney released the report about what happened at Sandy Hook Elementary School last year. And that report has been on my mind. The verdict? No answers. Lots of legally purchased guns. And a young man with a long history of mental illness.

From the report:

"The obvious question that remains is: “Why did the shooter murder twenty-seven people, including twenty children?” Unfortunately, that question may never be answered conclusively, despite the collection of extensive background information on the shooter through a multitude of interviews and other sources…. It is known that the shooter had significant mental health issues that affected his ability to live a normal life and to interact with others, even those to whom he should have been close. As an adult he did not recognize or help himself deal with those issues."

No answers. It’s the hardest thing about life, isn’t it? When something bad, worse, or truly horrible happens, we want answers. We want accountability. Maybe we even want revenge.

At the very least, we crave simple cause and effect. We want fairness, and we want life to make sense.

But it doesn’t. It just doesn’t.

After my son cut his finger, my friends tried to make light of it. “Anyone can have cookies and cocoa,” one joked. “How many people get stitches for Christmas? That’s the way to make lasting memories!”

I'd still prefer the other, more conventional memories. For me, the accident was a reminder that sometimes bad things happen, and those things are beyond our control. In fact, all too often, all we can control is our reaction to the event.  We can choose to hate. Or we can choose to forgive.

What have we, as a society, done since Sandy Hook to help people with “significant mental health issues,” people like Adam Lanza, Jared Loughner, Seung Hui Cho, James Holmes, Aaron Alexis, Gus Deeds? In my essay last year, I said that it was time to talk about mental illness, and it was.

It’s still time to talk. And it’s definitely past time to stop blaming the mothers, a memo I’d like to send to Emily Miller, senior opinion editor of the Washington Post, who apparently still thinks that’s the solution: 

"In the end, we can’t blame lax gun-control laws, access to mental health treatment, prescription drugs or video games for Lanza’s terrible killing spree. We can point to a mother who should have been more aware of how sick her son had become and forced treatment.”

But Adam Lanza was 20 years old. Even if his mother had recognized that his insistence on communicating solely through email was a little off, Nancy Lanza would have had a potentially uphill fight to force treatment for her adult son, as Pete Earley and others have noted. The fact is that the whole system is broken, and tragedies like Newtown are inevitable until we start to make real changes in how we view and treat mental illness.

In a pointed call for action nearly one year after the Newtown tragedy, Linda Rosenburg, CEO of the National Council for Behavioral Health, recommended a practical, real-world solution: Mental Health First Aid training for everyone, so that we all can recognize the early signs and symptoms of mental illness and intervene before it’s too late. 

“Mental Health First Aid makes it OK to have the difficult conversations — it helps people open up and talk with family, friends, and coworkers. It ends the isolation and offers a path out of the despair,” Rosenburg wrote. 

Mental health first aid might be just what we need. When my son cut his finger, we grabbed the first aid kit. Then we called the doctor and got him the care that he needed. In a few more days, he will play Christmas carols with a healthy finger.

It’s about time we had the same solutions for mental health. Enough talk. It’s time to act.