Night Falls Fast

by Kay Redfield Jamison

  SUICIDE IS a death like no other, and those who are left behind to struggle with it must confront a pain like no other. They are left with the shock and the unending “what if’s.” They are left with anger and guilt and, now and again, a terrible sense of relief. They are left to a bank of questions from others, both asked and unasked, about Why; they are left to the silence of others, who are horrified, embarrassed, or unable to cobble together a note of condolence, an embrace, or a comment; and they are left with the assumption by others—and themselves—that more could have been done.

  Family members and friends are, most painfully, left to ask of themselves, What will I do without him? How can I live without her? A month after his death, two years ago now, an older woman wrote me a letter that began, “My 21 year old grandson shot and killed himself. We were very close and I loved him more than life itself. He started treatment too late and wouldn’t take his medicine.… His death leaves a hole in my heart that can never be filled.” It is the hole in the heart that is such a terrible thing. Once the shock has abated, the guilt wrestled with, and peace made, it is the hole in the heart, the missing of the person, that stays. This suicide shares with other kinds of death.

  Although it might seem otherwise, most aspects of bereavement after suicide are not notably different from the reactions of those who lose members of their family or friends to death in other ways: to chronic illness, an accident, homicide. All are hit with shock, denial, anger, depression, intense loneliness, and a pervasive sense of loss. But a few things intrinsic to suicide set it apart. Because the death is often sudden and unexpected—though by no means always; perhaps half of suicides are at least somewhat expected (one person told an investigator, for example, “When I got the phone call that he had done it, my first thought was: so this is it.”)—families haven’t the opportunity to become accustomed to the possibility of death, make amends, or say good-bye.

  The initial denial that often accompanies death is frequently compounded by a denial of the nature of the death. Parents who ultimately accept the loss of a child may continue to deny that the death was a suicide. This is particularly true for the parents of young children or adolescents who kill themselves. The medical examiner for the state of Maryland told me that even if an adolescent writes a suicide note and dies by hanging or by a gunshot wound to the head, some parents continue to insist that the death was an accident. (The inevitable ambiguities involved in overdose deaths, drownings, and single-passenger automobile accidents make parental acceptance of suicide in these cases even harder.)

  Other matters compound the nightmare: suicide is often violent, which means that family members either discover or must identify severely mutilated or damaged bodies; police need to be involved in the death scene, which adds an additional criminal-like and disquieting element; and insurance investigators, in whose hands financial futures are held, often make matters worse by intrusive and offensive questioning. Friends and neighbors may or may not respond to a suicide death with the same level of consolation and community support that most other deaths command, and in fact, one-third of family members report they felt stigmatized by suicide.

  Guilt is a usual and corrosive presence after suicide: parents, siblings, children, husbands, wives, friends, colleagues, and the most casual of acquaintances remember and ruminate on all things done and left undone: the arguments, the slights, the unreturned telephone calls, the doctor not notified, the guns or drugs not removed from the house, the psychiatric hospitalization postponed or resisted. Many suicides occur in an already highly stressed and fragile personal world, a world fraught with anxiety, frayed tempers, overdrawn bank accounts, and ill will. Persistent psychiatric illness is not kind to those who have it, nor is it kind to those who must live with those who have it. Anger, mistrust, and agitation are part and parcel of manic-depression, depression, schizophrenia, and alcohol and drug abuse. However great the love may have been for the person who commits suicide, it is likely that the most sustaining relationships were, at the time of death, frazzled, drained, or severed entirely. The absolute hopelessness of suicidal depression is, by its nature, contagious, and it renders those who would help impotent to do so. By the time suicide occurs, those who kill themselves may resemble only slightly children or spouses once greatly loved and enjoyed for their company. It is a chilling, but not surprising, reality that one in ten family members admits relief that suicide has brought to an end the agony for all concerned. In one study, parents whose children had died in accidents were compared with parents whose children had killed themselves. Both groups of parents were asked, among other things, if the children’s deaths had brought any unexpected benefits to the family:

  An equal number of parents from both the suicide and accident groups said that the death did have a positive impact on their families. Those from the accident group felt that the suffering had brought the family closer together. Parents in the suicide group believed that the positive effect was due to the calm that came back into their lives from not having to worry all the time. This was mostly the experience of families who had a son, suffering from mental illness or substance abuse, which had caused great stress and tension within the family. The suicide, as painful as it might be for all the family members, was perceived as a relief from all the difficulties and suffering for themselves and their son.

  Death by suicide is not a gentle deathbed gathering: it rips apart lives and beliefs, and it sets its survivors on a prolonged and devastating journey. The core of this journey has been described as an agonizing questioning, a tendency to ask repeatedly why the suicide occurred and what its meaning should be for those who are left. One parent explained to a researcher, “I’d wake up at night envisioning it—him sitting there with a gun to his head. And then I’d wake up a lot trying to get an answer or figure out what was going through his head when he was doing this.” Another said simply, “The thoughts are always there, you know. You wake up and wonder ‘why?’ ”

  Parents of children who commit suicide are left particularly devastated. For months, if not years, they are overwhelmed not only by the loss of a child but by guilt as well: a sense of having failed the child at the most critical time of his life, of being insensitive to the extent of his pain, or of overlooking final cues. Many fathers and mothers repeatedly question their competence as parents and experience a deep sense of shame, as well as anger and guilt. Unbridled terror that another child might also commit suicide is common, as is overprotectiveness of the surviving children. Iris Bolton, director of a counseling center in Atlanta and author of a book about her son’s suicide, writes that after her twenty-year-old son died of a self-inflicted gunshot wound she was haunted by “Why? Why wasn’t I home? Why my son?” and felt as though her car had a huge sign on it reading “My son committed suicide. I am a failure.” She worried, as many parents do, about the impact of the suicide on her remaining sons and observed that her husband dealt with his grief far more privately than she did. With a minister, she started a support group for parents and found in it the beginning of a life without her son, as well as an acceptance of the fact that she and all parents of children who kill themselves are “mortally and irrevocably wounded.” (Mothers in particular are vulnerable to depression after a child’s suicide. One in five becomes significantly depressed within six months of the death.) She also observed that mothers and fathers tend to respond to suicide differently:

  During the past ten years I have met many mothers and fathers who have experienced suicide. Most have similar feelings. One difference between the sexes is that fathers more often talk about the lost future with the child, while mothers feel that they have lost their present time. Nancy Hogan, a nurse and grief educator from Illinois, explains this by saying that, since the father spends much of his time working away from the home and providing for the future of his children, his loss comes partly from the fact that he has no future with this child. He had planned for the child’s graduation or perhaps walking his daughter down the aisl
e at her wedding. His work may now have lost its meaning. The mother may be involved with the day-to-day activities of the child, such as carpools, organizing clothes, school, basketball practice, etc. She has lost her “present time” with the deceased child. The losses are equally painful, but they are different.

  In the preface to her book My Son … My Son, Bolton laid out the dilemma that she and all parents who lose a child to suicide face:

  I don’t know why.

  I’ll never know why.

  I don’t have to know why

  I don’t like it.

  What I have to do is make a choice

  about my living.

  Before they get to that point, however, parents go through acute disbelief, suffering, and bewilderment describable only by them. I am still haunted by the words of a colleague and friend whose nineteen-year-old son died of a self-inflicted gunshot wound. An extraordinarily warm, lively, and caring mother and clinician, she said, still in shock after her son’s death, “I feel like a mother animal. I keep searching for my baby.”

  The impact of a suicide on the lives of brothers and sisters has been almost entirely ignored in the clinical research literature, an omission made the more remarkable by the closeness of emotional ties between siblings and the possibility that they may be more likely to kill themselves because of shared genes and environment. The surviving children also now share the suffering and heightened anxieties of devastated parents. Clinically, siblings experience not only the enormous loss that the death of a brother or sister brings but guilt and a sense of responsibility as well. The nature of the death lends itself to unkind speculation and stigmatization by other children and feelings of vulnerability that this might happen to them as well.

  A three-year follow-up study of the siblings of twenty adolescents who died by suicide found, however, that in general there appeared to be relatively few long-term adverse psychological consequences to the surviving children. But in the first six months after the death, depression was common; one in four of the siblings, in fact, became clinically depressed. Not surprisingly, siblings who had a family or personal history of a psychiatric disorder were far more likely to become depressed than those who did not. Younger children—perhaps because they were more influenced by the life of an older child or perhaps because they spent more time at home—were more obviously affected than older siblings. Adolescents, when asked about the impact of a sibling’s suicide, often say they feel they “grew up quickly” or “matured more rapidly” as the result of the death.

  The suicide of an adolescent is often considered to be a newsworthy event, and when handled in an insensitive or sensationalist manner by the media it can be a further source of pain and embarrassment to the siblings and parents. Karen Dunne-Maxim, now the project director for the New Jersey Central Region Youth Suicide Prevention Project, recalls the horror that she and the rest of her family felt when the local newspaper reported simply that her sixteen-year-old brother, Tim, “dove” in front of a commuter train. No information was given about the rest of his life, which made the manner of his death more important than the loss of his life. The family asked Newsday, a Long Island newspaper, if it would include a description of Tim as they had known him, and it did:

  He never missed a year on the honor roll. He was editor of the Junior High yearbook and produced his own antiwar film that was presented at the Rockville Center Library. He received awards for playing the cello and had recently been mountain climbing with the Boy Scouts in Switzerland. He was brilliant and sensitive and the question will always remain with those who loved him—Why did he die?

  Surprisingly little is known not only about the impact of suicide on siblings but also about its impact on friends. There is next to nothing written about how close friends and colleagues make sense of or deal with the suicide of someone they know well or have worked with. Anecdotal and clinical experience suggests that guilt—How could I have not noticed how depressed he was?; If only I had called (or written, or dropped by her house); If only I had let his wife or doctor know—is common, as is denial that suicide was the real cause of death. Most people know little about suicide or the psychiatric illnesses most closely associated with it and therefore flail about, trying to make sense of an often senseless act. They inevitably focus on the events of life—broken or difficult relationships, financial concerns, job-related stress—as the reasons for suicide. In some instances, employers use the occasion to educate the surviving staff about the most common causes of suicide and provide information about depression and how to obtain help if it is necessary, but this, unfortunately, is unusual. More commonly, the cause of death is skirted around or not discussed, and speculation outstrips accurate information and compassion.

  Denial of suicide by family members can make a bad situation even worse for friends and fellow workers. A colleague of mine, an eminent scientist who suffered from manic-depressive illness, killed himself a few years ago. His wife, understandably distraught, refused to believe that he had committed suicide. She made it clear that suicide was not to be mentioned at his funeral or memorial service and, unknowingly, made it very hard for his fellow professors, graduate students, and laboratory staff to deal with his death and move on with their lives. Even a year later, his students and colleagues found it difficult to discuss the suicide of this intense, imaginative, and charismatic man. One of his students said, “He was larger than life. He gave all of us life and joy in our work; his enthusiasm filled the lab. I’m finally getting back to my experiments, but it all seems grayer now. I still believe I ought to have been able to save him. He would have done as much for me.” The student paused for a long time, trying not to cry, and then said, “But I guess he didn’t, did he?”

  THE SUICIDE of a husband or wife brings with it all the intensity and complexity of marriage, and the loss is inevitably shaded not just by the closeness of the relationship but by whatever arguments, physical violence, financial strains, and emotional withdrawal may have been imposed on it by psychiatric illness or drug or alcohol abuse. Preexisting marital problems or separations generally worsen the already powerful sense of guilt or responsibility the surviving spouse feels. To the person who has shared a suicide’s bed or borne his children, the decision to commit suicide is a particularly personal rejection. And because suicide is usually seen by others as a preventable or avoidable death, spouses often bear the brunt of community gossip and family blame. The inevitable involvements with the police immediately following death, with the not-so-subtle awareness of murder having to be ruled out, do not improve the situation.

  If, as is frequently the case, there has been a prolonged history of severe mental illness in the spouse who commits suicide, the toll it has taken on the marriage—in anger, resentment, sexual infidelity, hopelessness, physical and verbal abuse, or estrangement—will cause some spouses to feel, in addition to their despair, an unnerving sense of relief. One husband’s immediate reaction after the suicide of his wife, who had suffered from recurrent depression for twelve years, reflects this ambivalence: “I had the strange feeling of being three persons,” he said. “One was the person in shock. The second person felt a strange sense of relief: no more psychiatrists, pills, shock therapy and hospitals. A third person witnessed the other two: ‘Look at that fool weeping and yelling, and look at the other fool already experiencing relief after twelve years of sympathetic suffering.’ ”

  Although the spouses of those who commit suicide experience sharper guilt and a stronger sense of being blamed for the death than do spouses whose husbands or wives die in accidents (even though they, too, have been widowed under sudden and unexpected circumstances), most research finds that the long-term psychological outcome is similar for both groups. An ultimately good adjustment is made by the majority of surviving spouses, especially by those who are young. Most go through an initial period of depression after the suicide but then go on to remarry and bring up their children with less difficulty than might be imagined. Less diff
iculty does not mean no difficulty, however, and the healing is exceedingly hard and takes a very long time.

  Josephine Pesaresi, a social worker in New Jersey, was left a widow with three children aged ten, fifteen, and sixteen after her husband, a psychiatrist, died of a self-inflicted gunshot wound during a severe, agitated depression. She describes the days and months that followed:

  From the first moment, people wanted to know why. Why? Why? God, how I came to hate that question. I was somehow expected to be able to explain a happening that had just torn the heart out of me. The stigma, the awful stigma that is associated with suicide, compounded the excruciating pain we were experiencing.…

  As the realization of the loss began to set in, so too did the guilt and blame. I blamed myself for not realizing the depth of my husband’s suffering and for not hospitalizing him. Our children felt guilt about their relationship with him. Our son was in the middle of adolescence and had been arguing with his father. Our older daughter said she had sensed disaster and should have followed her instincts to stay close to her father that day instead of going swimming. Our younger daughter felt she should not have left the room where her father was to listen to a tape in her room.

  The guilt and “if onlys” escalated and seemed to be endless, especially for me. My husband’s parents, who were very close to us before the suicide, blamed me for my husband’s depression and refused to enter our home.…

  After my husband’s death, my children and I had an unspoken contract. If I would crawl out of my hole, put on some clothes, shop for food, and drive them to their activities and school, they, too, would continue with their lives as best they could. However, I had to keep my end of the bargain—no fudging and no substitute mothers. We were all hurting, but if any of us were going to do it, we were going to do it together. They drove a hard bargain with me. It was torture, and they made me furious, but I got in that damned car and they did too. I knew that my husband had left me with the unfinished job of raising three children conceived in love and commitment. Somehow we would get each other through—and we did. Humor even began to creep back into our lives. Our older daughter gave me a plaque to keep by my bed which said, “Shall we call in a consultant or louse it up ourselves?”