Is This Mic on?

Why I went an entire year without posting to my blog

Well, I mean, no one reads your blog anyway, right?

A year ago today in 2018, I was fidgeting on the examination table at my ob/gyn’s office, a paper drape wrapped awkwardly around my legs. I take these women ‘s health things pretty seriously; in 2012, I was diagnosed with Stage 0 cervical cancer (or carcinoma in situ), which really isn’t as serious as it sounds, but when you’ve just lost your job and your health insurance like I had, anything with the word “cancer” can seem pretty darn scary. I had avoided the dreaded pap smear for six years, too busy trying to balance work and four young children as a single mother, and who had time for self-care, let alone self-health-care?

(Planned Parenthood saved my life. The outpatient surgery was a fraction of the cost at their non-abortion performing clinic compared with other local providers, and they told me to pay “whatever you can, whenever you can.” Just a few weeks later, I had another, better job and health insurance).

Back to 2018. The perky medical assistant wheeled up the EMR cart and said, “I’m going to ask you a few questions about your health.” Sure. Standard stuff.

Then she asked, “Have you noticed a reduced interest in doing things that you normally enjoy?”

The question took me aback. This was a gynecological exam. The etymological history of the word hysteria aside, what did my mood have to do with my uterus?

“Yes,” I responded honestly.

“Are you feeling down, depressed, or hopeless? Have you felt that way for more than two weeks?”

“Yes,” I replied, “But it’s situational.”

And that situational depression—its causes and effects—is the reason I haven’t posted to my blog for a year. The situation involves a loved one, and that loved one has a medical condition for which the main treatment method involves the word “anonymous.” We don’t talk about it. We certainly don’t write about it.

After I continued to respond “yes” to each question on a nine-item depression screening instrument, the medical assistant stepped out to consult with my nurse practitioner who came into the room with a concerned smile.

“It’s situational,” I told her.

“I get that,” she said. “How long has this situation been affecting you?”

When did I stop hearing birdsong?

Was it in October, as the leaves changed colors and fell to the earth, as I grieved my dead father?

Certainly, the “situation” was serious by November, when I was a keynote speaker for the National Federation of Families for Children’s Mental Health annual conference. It took everything I had to pull on nylons, slip into my red power dress and navy blue jacket, step on a stage in Houston in front of hundreds of passionate, powerful mental health advocates, and share my family’s story. All I wanted to do then was to sleep—permanently. I felt like a fraud.

Everywhere I went in Houston during that trip, I saw ghosts. In the tunnels, my father, who worked at One Shell Plaza. In the public library, my teenage self, poring over microfiche news clippings about T.E. Lawrence’s death (my first published article, in Brigham Young University’s Insight Magazine, was about Lawrence of Arabia and the problem of modern heroism). In the theater district, my first love, turning to me with bright eyes at the fountains beside the Wortham Center after we saw Prokofiev’s Cinderella on my 18^th birthday.

No, if I was being honest, the “situation” and my inability to function at normal levels was probably earlier than that—September 2018, the start of a new term, when I was eligible to apply for promotion but simply could not see how I deserved it. What was the point of gathering student evaluations? How could I possibly write a narrative highlighting my accomplishments in the classroom when I myself could not see them? Wasn’t I just a burden to everyone?

In hindsight, I think that at least subconsciously, I sensed some of the warning signs that summer, and I tried to take proactive measures. I stopped drinking in early 2018 and will never go back. I resumed my regular yoga practice, lying in corpse pose after a strenuous daily vinyasa flow.

In hindsight, it wasn’t enough.

I was first diagnosed with depression in my senior year of college, and the illness nearly derailed me. With medication, therapy, and incredibly supportive friends and family, I was able to persevere and recover, graduating on time.

When depression struck again during my third pregnancy, I was forced to confront the fact that my mental health condition might be chronic. Once again, medication—a risk during pregnancy but a necessary one—stabilized me.

Before my divorce in 2008, as my marriage was ending, I reached a crisis point (I talked about this turning point and stepping away from suicidal ideation in a 2018 Story Story Night performance about semicolons). Yet once I was on my own, despite the challenges, I felt tremendous gratitude for my life, for second chances, for my beautiful children. During the years that my son was sick, I focused my energy on caring for him, and I am so proud of the man he is becoming today. I was grateful for the opportunities that both Eric and I had to share our stories of hope and recovery. Eric's awesome TEDx Boise talk has way more views than mine (I call that a definite mom win!).

But as a mental health advocate, I hate to admit that I grew complacent during that ten-year reprieve about my own mental health.

When did I stop hearing birdsong? All that I know is this: by the time I took the stage in Houston, I was moving slowly through muffled, suffocating silence. The air pressed on my skin, creeping, crawling. I could not escape. What if the worst thing happens? I thought. What is the worst thing?

I survived. Then December 2018 came. The second week of December, when I lost hope, again, forever.

I have to be vague because if there’s one thing I’ve learned in my years of advocacy, it’s that our stories have boundaries. Where does my story end and where does yours begin? If you want to remain anonymous, do I need to remain silent too? What am I allowed to say? 

I’ve decided after a year of silence that I can talk about myself—my own experiences. I can say that in the second week of December 2018, I felt numb, grey, beyond hopeless, because being hopeless would require a knowledge of its opposite, hope, and those were just four letters on a page to me, like love, like self. These words had lost their meaning. In my experience with depression, everything is spoken and heard through thick cotton. Colors fade. Sleep disappears. Food has no taste. If there are birds, they do not sing.

I can say that this depressive episode was situational, but I cannot talk about the situation because stories have boundaries, and words have consequences. I know this more than most people.

I hate December. In my case, the consequences of sharing stories have involved my worst fears: the loss of my children.

In the second week of December 2018, I had 48 hours to find a new place to live. Thanks to white privilege and a good credit score, I was able to do this. And so there I was in my ob-gyn’s office on the last day of December, flunking a nine-question depression screening.

In 2014, after my book The Price of Silence: A Mom’sPerspective on Mental Illness was published, I had the extraordinary opportunity to meet with David Pate, then CEO of St. Luke’s, the largest healthcare provider in Idaho. He asked me, “If you could make one change to our current healthcare model that would promote mental health, what would you do?” 

I answered without hesitation. “Work mental health screenings into all physical wellness check-ups, from pediatrics on up,” I said. Of course, there are numerous other things we can do—more hospital beds for psychiatric care, integrated models of mental and physical health care, etc. But access to care all starts with knowledge and normalization.

And here I was, four years later, at a St. Luke’s women’s health clinic, experiencing the integration of a mental health screening in my own physical wellness check-up.

“It’s situational,” I told my nurse practitioner. “It will pass.”

“But you don’t have to live like this right now,” she replied. She touched my arm gently and I burst into tears. Not because I was sad—my depression is not sadness. Touch—any touch—was painfully intrusive.

She prescribed antidepressant medication, the same one I had taken during my two previous episodes. The medication worked—I could function again—but I didn’t feel like myself. I was productive but still emotionless, an automaton. I could sleep and eat again, but I still couldn’t hear the songs of birds.

“Let’s try something different,” she said.

We did. And the second medication worked. Everywhere I went, I felt like I was discovering a new language—the language of the birds. They were singing to me, warbling the forgotten words: hope, love, self, okay. I was okay.

I have become acutely attenuated to birdsong.

I have almost completed my promotion packet. Reflecting on my Fall 2018 semester has instilled me with a sense of humility and gratitude that makes me a better teacher.

I have accepted that the nameless heartbreak of December 2018 has become a part of me. 

The past can’t be fixed, but the future is interesting to me again. I want to try.

The "situation" is still a major part of my life, and it’s still anonymous, but I am trying to find ways to reclaim my own voice. And I’m trying to appreciate this opportunity to practice radical compassion. I’ve realized that these efforts will be the work of a lifetime and that as long as some mental health conditions continue to require silence and shame, our work as advocates must continue.

Mental health is physical health. In 2020, we have work to do.  

To be fair, I did write a lot in 2019, just not for my personal blog. I continue to blog regularly for One in Five Minds.org, an amazing organization dedicated to children's mental health, and I still write occasionally for Eagle Magazine and  Greenbelt Magazine. I also had my first short story, "Jesus, Take the Wheel," accepted for publication in the 2019 Writers in the Attic "Fuel" anthology from the Cabin. 

Lost in Transition

The author in Budapest, 2007

I performed three Bartok folk songs yesterday. With the performance came this memory.

One rainy evening in early October 2007, on a winding residential street in Budapest, Hungary, I got lost. I pulled out my notebook, squinting at the greying street signs as I tried to decipher something about my location. “Utca,” I mumbled, looking at the hastily written glossary I had begun building the day before: “Alma=apple. Gyorgy=health. Ut=street.” So “utca” must mean lane or little street.

I was illiterate, surrounded on all sides by new construction, hastily built stucco and plaster mansions for the nouveau riche who were coming to the formerly Soviet country in droves. I had a sudden vision of my body, violated and strangled and tossed by Russian gangsters in one of the many blue dumpsters that held construction-site waste. The gruesome vision quickened my pace as the rain stung my face and bare arms in the fast encroaching dusk.

I was afraid and alone. I felt in that moment that if I disappeared, no one would miss me.

My then-husband and I were in Budapest so he could compete in the Rubik’s Cube World Championships. We had taken a romantic Danube cruise earlier that afternoon, admiring the soaring span of the rebuilt Elizabeth Bridge, the reconstructed Parliament building, the bleached white Fisherman’s lookout.

“I want to go for a walk,” I told him after the cruise. I hoped—how foolish!—he would offer to come with me.

“Fine,” he said. “I’ll meet you back at the hotel.” I was too proud to ask for help, too proud to admit how lonely I felt. So I walked away.

Now, cold and unprepared, I shivered, seeing the spider cracks in our foundation, spreading and threatening to destroy the entire edifice of our marriage. Our perfect marriage.

My cheeks were wet, though I couldn’t tell the tears from the rain. I thought of Thomas Wolfe: “A stone, a leaf, an unfound door, of a stone, a leaf, a door.” Where was the door that would set me free?

Then I heard the violin music. It was Bartok, a simple folk song, with words I had learned as a child to sing in English: “Give to me the roses red, two I said! One alone would die forlorn, e’er the morn. Oh, no no! Off you go! Both of them are mine.”

I had stumbled in my peripatetic folly upon a music academy, and I listened in delight to the clean, crisp, rhythmically surprising songs of the Hungarian composer I’d studied when I was young. The music filled me with the joy of childhood discovery, the sense that things were possible.

I climbed the nearest hill, the music receding into the twilight. Searching for the lights that glittered along the Danube, I saw my way back.

When I entered the hotel lobby, drenched, shivering, my husband did not look up from his varicolored cube. I stumbled to our room and collapsed into a merciful, dreamless sleep. When he told me the next day, “You don’t love me like you used to,” I looked away, remembered Bartok’s roses.

Dear Claire Dunphy

From one soccer mom to another, here’s why your Halloween Insane Asylum of Horror was anything but awesome

I'm going with Awesomeland.

You may remember seeing me at the soccer field, the grocery store, the PTA meetings. Like you, I’m pretty Type A when it comes to raising my kids; for many years, I viewed birthday party goody bags as a competitive sport. But then something happened to my family that I wouldn’t wish on anyone: my second son began to show symptoms of a serious chronic illness.

By the time he was in preschool, we knew something was not right. At first, they said maybe it was autism. Later, they would tell us it was Oppositional Defiant Disorder, or Intermittent Explosive Disorder, or Attention Deficit Hyperactivity Disorder. There were so many labels and different medications! We took parenting classes, got on wait lists for specialists, and restructured our entire family’s life around the child who had an illness, as many families in our situation do. We also became increasingly isolated from our friends and community, as it became harder and harder to manage our son’s behavioral symptoms.

In the midst of the struggles to find an answer, my marriage disintegrated. It was not my son’s fault. But the stress of raising a child with a serious illness can prove overwhelming sometimes. And suddenly, like many other single moms, I was doing it alone. I remember one time at the soccer field, when my son’s shoe came off, and he couldn’t fix it, and he collapsed, wailing and screaming. I will never forget the look of absolute disgust on your face and the faces of other parents that day, the look that said, “What’s wrong with that mom? Why can’t she control her kid?”

Or the time in the grocery store when my son was screaming “Child abuser! Child abuser!” at me and you threatened to call the police and took down my license plate number. Fortunately, the store manager protected me. “I understand,” he whispered to me. “My nephew has autism.”

Or the time you stood at your front window and gawked when I called the police on my own son, because in America, that’s what we have to do when our children have an uncontrolled brain attack. You stared as three policemen put my son in handcuffs and carried him twisting and screaming to the back of their car. You didn’t hear the policeman say to me, “You’re a good mom, ma’am. Never forget that. We know your son needs help, and we will help him to get it.” (God bless our crisis intervention team-trained police department!).

When you found out my son was in an acute care psychiatric hospital, you didn’t offer to watch my other children so I could visit him. You did not bring me a casserole. Mental illness is not a casserole disease, I guess. Fortunately for us, after nine years, my son finally got the correct diagnosis. I was relieved when I found out he had bipolar disorder, because I respect and admire my friends and acquaintances who are successfully managing their bipolar disorder and living productive, happy lives. This was the future I had thought my own child could never have. Suddenly, we had hope.

I’m a soccer mom like you, Claire. And what happened to my child could happen to your child. Mental illness is not a choice or a character flaw. This is why your Insane Asylum was so offensive to me and to my son. It’s not funny to ridicule people who are sick. Worse, the image of mental illness you portrayed is not remotely what mental illness really looks like.

You seemed to recognize your cruel mistake when your neighbor Ronnie lied to you and told you his wife had spent six months in the “cuckoo farm” (lovely words, those). But what about all the real people—children included—who could have been harmed by your Halloween “joke”? What message did you send your own children? My son has worn a straitjacket too, but his was during a behavioral episode. And like many children with mental illness, he has been institutionalized, though we don’t really have insane asylums anymore. We have something far worse: prison. My son was in juvenile detention four times before he was 12 years old, not because he's a bad kid, but because he had behavioral symptoms of a brain disease.

Claire, here are some truly scary facts about mental illness:

•  In any given year, only 20 percent of children who need treatment for psychiatric disorders actually get it. 
• Half of all mental illnesses start before the age of 14. 
•   65-75 percent of youth in juvenile detention have at least one mental illness.
• It costs states $5.7 billion per year in the U.S. to incarcerate an average of 93,000 youth. 
•  There is not a single child psychiatric hospital bed in Orange County. Not one. 
• One in five people with bipolar disorder (what my son has) die by suicide. 
• Worldwide, suicide is the cause of death for more than 800,000 people each year. 
• Adolescent males with mental illness are being shot and killed by police in ever increasing numbers. 

Many people have defended your actions, saying “It’s Halloween! She was just having fun!” Others have accused me of focusing too much on political correctness. But I don’t think I’m out of line in asking for some basic respect from you. We talk a lot about the word “stigma” when we talk about mental illness. But what we really mean is “discrimination.” Your unrealistic and negative portrayal of mental illness perpetuates that “us vs. them” mentality that allows those of us who are not living with it to continue thinking mental illness is a choice, or that it is caused by bad parenting.

So Claire, as a fellow soccer mom, I’m officially asking for an apology. Your Insane Asylum of Horror, had you let it stand, would truly have been the most frightening house in the neighborhood. But for different reasons than you think.

P.S. To the writers of Modern Family: one in five children in the U.S. will suffer from a serious and debilitating mental disorder at some point before age 18. You have five children on your show. I challenge you to introduce mental illness for one of those children into next season’s plot line. You could use your platform to change people’s perceptions about mental illness in real and meaningful ways.

The Third Week of October

Some Memories Never Fade

One evening just before sunset in the third week of October 2014, I walked down the hill from my new home to the soccer fields. The Boise foothills glowed rose and gold in autumn sun’s last light, and the manicured emerald fields rang with cheers and groans. My oldest son once played on these fields, in another life, before my divorce. I have since learned that memories can change.

The long lean years of dingy apartments, of rice served at every meal, of every phrase qualified with “if the good Lord’s willing and the creek don’t rise,” those years (God willing!) are over. To walk out of my home—our home—to see those soccer fields, those glowing foothills, to look back at the picture window, the piano, the wall of books (his and mine), was a dispensation, a manifestation of grace.

Twenty years ago, in the third week of October, my father died. He was 50.

I’m still sad about his death. With the removal of the bereavement exclusion in the DSM-5, the fact that I still tear up twenty years after losing my father to cancer might indicate I’m depressed. I’m not—I’m just sad. Sad to think of the grandchildren who never met him, the hikes we could have shared, the conversations about faith and life and books and science—his avocation—that would have kept us up late at night.

That’s one of the challenges facing modern psychiatry. What type of grief is normal? To me, it seems that psychiatry, in attempting to answer this question, has barely moved beyond augury or astrology. As I walked around the soccer field that evening, a bright copper coin stood out in sharp relief against the sidewalk. I stopped to retrieve it, certain (as I always am when I find pennies) that it was a sign. Our silly brains see patterns in the flight of birds, in sheep entrails, in spare change on sidewalks.

The year my father was diagnosed with cancer, I learned a German word that has stuck with me when all the other German words I learned in college have fled. Unheimlich. This cognate’s meaning can be easily guessed—heimlich for “like home” or “comfortable,” unheimlich for uncanny. It’s the discomfiting sense of being a stranger in a land that should feel familiar.

That’s how I always feel in the third week of October. We can be orphaned at any age: I was orphaned at 22, on the cusp of my adult life, not quite ready to put away childish things or to acknowledge the reality of death. As I thought of my father, the bright penny’s startling appearance banished the ghosts and brought back a sense of comfort, of belonging, of home.

Gazing at the soccer fields, clutching my copper token of the universe’s momentary good will, I was transported suddenly into a present-tense past. I see myself at nine, my daughter’s age, my hair in two braids, standing on the lawn outside our home in Pennsylvania. It’s my birthday, and I’m wearing a leather softball glove, still stiff with newness. My father stands across the way, a white ball in his hands. “Was it okay to get you this?” my father asks. “I wasn’t sure if you would like it. I mean, you’re a girl. I mean, a wonderful girl! You can be anything you want to be!”

My father loves sports—football, baseball, basketball. I’m his oldest child, and already, I’m more of a book girl than a baseball girl, which doesn’t seem to disappoint him in the least. His own father died when he was just seven years old, so he is always trying to make sure that everything is “okay,” that his performance as a father is meeting our needs and expectations, that we know we can give him honest feedback. 

Standing in the yard with him playing catch, I know, even as a child, that my father’s gift—what he himself wanted as a nine year old—is the best possible gift he can give me, even though I’m not particularly athletic. As the ball connects with my mitt, a satisfying thump, I feel the love my father has for me radiate up my arm and all through me.

And that present-tense moment, a father tossing a white softball to his nine-year old daughter years later on the soccer fields in Boise, Idaho, is still happening, and was always happening, and will happen forever.

The Price of Silence

Dear Friends,

This is a humbling day for me. The first time I read a book and realized the power that words can hold over our hearts and minds, I knew that I wanted to write. Today, my dream of publishing a book has come true with The Price of Silence: A Mom's Perspective on Mental Illness, from Hudson Street Press.

But for me, the price of realizing my dream was beyond anything I imagined. I wrote The Price of Silence because like most  of us, after Newtown, I wanted answers. My quest through the complex and often hostile systems that families and children who have mental illness must navigate was personal: I live this experience daily with my dear son.

Kirkus Reviews described my book as "a searing indictment of the lack of affordable care available for the treatment of mentally ill adolescents."

Andrew Solomon, author of Far From the Tree (which everyone should read), wrote: 

In this courageous, determined, radical book, Liza Long exposes the dearth of alternatives for parents of kids with mental illnesses, the shame that attends their perceived failures, and the hope that such families may find their collective voice and demand better options.  I hope her passionate cry is heard far and wide.

I am profoundly grateful to the families, providers, police officers, educators, and advocates who shared their often painful stories with me. It's not easy to talk about mental illness; I know that truth firsthand. And I am especially grateful to my son, whose perspective provides valuable insight into mental illness and how it affects children. His humor, intelligence, and love have made my life immeasurably better. He is not a bad kid--he is an incredibly brave kid (and he just finished writing his first book! At age 14! It's about demigods from outer space).

But today, though I am grateful that so many people are speaking up and sharing their stories. I am also saddened at our inability as a society to act. People who have mental illness, including children, are "treated" in jail or left to die on the streets or by suicide. This is a national tragedy of epic and growing proportions. I feel that we have a moral obligation to care for our children, brothers, sisters, parents, friends, and colleagues who have mental illness.

I hope you will read my book. But more importantly, I hope that you will join me in speaking up for change. Please contact your representatives in  Congress. Join Treatment Before Tragedy. Participate in your local NAMI walks this fall. And share your stories. Their truth is powerful. Together, I know we can make a difference. In the words of one of my favorite poets, Robert Frost:

 

Only when love and need are one, 

And the work is play for mortal stakes

Is the deed every really done

For heaven and the future's sakes.

These are our children, and this is their--and our--future.

Best to you all!

Liza

P.S. If you do want to buy the book, please consider a local bookseller. Here are two of my favorites:

Iconoclast Books
www.iconoclastbooks.com
671 Sun Valley Rd W, Ketchum, ID 83340
(208) 726-1564

Rediscovered Books
www.rdbooks.org
180 N 8th St, Boise, ID 83702
(208) 376-4229

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."