Iris had an appointment to see Dr. C that afternoon. Since Iris refused to let us accompany her, I e-mailed Brett that he should take Iris to see the doctor and tell Dr. C that Iris intended to buy a gun. I was glad when Brett told me later that he’d made an appointment to see Dr. C that afternoon. It turned out, however, that the meeting with Dr. C was quite short and Brett did not have a chance to mention the gun to him. In September, Brett had criticized me for worrying too much about Iris. Now he apologized to me because he realized that Iris indeed had suicidal tendencies.
After October 28, the day I found out she had gone to a gun shop, Iris avoided me. On Sunday, October 31, I went to a farmer’s market in the early morning and bought some fresh flowers. I made a flower arrangement to send to her, plus some healthful food I’d bought from the farmer’s market. In the evening, I invited Brett and Iris to have dinner with us. This was the last evening we were ever with Iris. It was Halloween night, but it did not have the flavor of Halloween; I might have totally forgotten that that night was supposed to be a holiday. The four of us ate the meal quietly. No one seemed to want to talk. It was strange, but Iris was very calm and peaceful. She told me “thanks” and “the dishes were delicious.” I had the illusion that we were at our Urbana home. She was a little girl and was happy and content. When she finished the meal and told me how delicious the dishes I’d cooked had been, suddenly I felt very comforted and relaxed, a feeling I had not had for a long time. I was overjoyed.
After dinner, I asked them whether they wanted to watch the tape of the “Three Tenors” I’d recorded from PBS TV programs years ago. Iris loved opera, so we watched it. Again, it seemed that we had returned to the time that was twenty-some years ago—we were in our Urbana family room, in front of the fireplace, watching a TV program. I hoped that moment would stay forever.
Tuesday, November 2, was the presidential election. The day before, Iris had told us that someone had e-mailed her and predicted that John Kerry would win. She felt relief when she heard the prediction. The next day, as we know, Kerry lost to Bush. We knew that Iris was against Bush’s foreign policy at the time and supported Kerry strongly. Besides, she’d written several articles which were highly critical of the Bush administration. The prospect of enduring four more years of the Bush administration was too much for her. The election results could make her even more depressed.
Iris began to feel hopeless, I later realized. She wanted to carry out her plan, and she did not want us to find out. In the last week of her life, she prohibited me from visiting her. She did not even want me to call her, and did not return my calls or my e-mails. In that final week, Shau-Jin and I took a walk ourselves to ease our worries. I went to a Palo Alto support group on Wednesday, November 3. Shau-Jin and I went to another support group in San Jose on Friday, November 5. We tried to gather information on how to deal with depression in loved ones who were possibly suicidal. For all this time, she was actively planning her final exit, while we tried to find a way to rescue her. We raced against each other, and we did not realize that she would carry out her plan so quickly. One week later, on November 9, she was gone.
It was an untimely death. Over the years, Iris had always commented that life was too short for her to finish the things she wanted to accomplish. She said many times that she wanted to write more books, to make films, and to record more oral histories. It was so painful to realize that many of her dreams were not fulfilled. Yet, it is not how she died, but rather how she lived that will be her legacy. Whenever I think of Iris, the memories of a loving daughter and a beautiful soul always remain with me. In her short thirty-six years, she had inspired many, many people in the world with her noble spirit—her passion, dedication, sincerity, and determination—in preserving historical truth and in pursuing justice for the voiceless victims. Iris was a woman whose heart beat passionately for those who suffered. She was a woman who could not forget—she could not forget their agony, and she refused to let their stories go untold.
Iris’s life was short but brilliant, like a splendid rainbow across the sky, one that the goddess she was named after would be proud of. Iris’s rainbow was magnificent, vanishing quickly. What she left behind is a legacy of a life full of courage and conviction, and a life’s work that will continue to illuminate and inspire.
EPILOGUE
From the day Iris died, the question of why she would take her own life has haunted me. I still cannot believe that a person like Iris, who was so enthusiastic about life, would kill herself. Whenever she heard about someone committing suicide, she would tell us that it was unfathomable to her. It seemed that suicide would never, ever be an option to Iris.
The tragedy of her death was so overwhelming at the beginning that I was numb. I was confused. I was not able to comprehend it fully. In the next few years, I started to recall every detail of her life in its last several months. Writing this memoir has helped me sort out many things.
We all felt that the first time we’d seen the change in Iris was when she returned home after her month-long book tour in April 2004. Before the tour, she’d seemed all right. Something must have happened on the tour to make her so afraid.
As most people know, her book The Rape of Nanking had caused a firestorm in Japan. Immediately after her death, people speculated that she might have been murdered by the Japanese right-wing groups. I initially excluded this possibility when news reporters raised the question right after her death. However, with time and a careful recall of the events that happened in the last period of her life, I need to reevaluate the small possibility that such groups played a role in her death. Iris was moody and paranoid after her book tour. If we believe what she told us—that someone on the book tour had threatened her—then her sudden change of behavior after the tour made more sense. We may never know what really happened.
In the last six months of her life, Iris constantly referred to an “evil force of conspiracy” attempting to prosecute her because what she had written. Family members always brushed these claims aside, attributing them to her imagination. However, after I read several political commentaries on Iris’s death—for example, Steven Clemons’s eulogy of Iris (located in the appendix)—the aura of conspiracy will always stay with me no matter how unlikely it may sound.
On top of everything else, Iris started to suspect her son of having autism. Over the ensuing two months, with interview-trip preparations added to her intense investigations about autism, she experienced penultimate physical and mental exhaustion, resulting in her breakdown in Louisville. Treatment with antipsychotic and antidepressant drugs did not improve her condition; instead, it worsened. During that time, I had already suspected that the antipsychotic and antidepressant drugs her doctors were prescribing might exacerbate her condition. I was not so sure about it until 2009, when detailed studies finally emerged to discuss the adverse effects of psychiatric medications.
In 2009, I incidentally saw an on-line comment about Iris’s death. The writer hypothesized that Iris’s death could likely be a case of medication-induced suicide. In the note, the name of a psychiatrist, Dr. Teicher, was mentioned. Later, I realized that Dr. Martin Teicher is a well-established clinical psychiatrist at the Harvard Medical School. I immediately contacted him. In October 2009, I had the chance to meet him in person at McLean Hospital while I was in Boston attending my PhD thesis adviser Professor Eugene P. Kennedy’s ninetieth birthday reunion at Harvard Medical School.
To make a long story short, Teicher gave me several of his published research papers on the emergence of intense suicidal ideation and behavior of patients on the psychiatric drug fluoxetine (such as Prozac, from Eli Lilly). Dr. Teicher’s findings on the antidepression and anti-anxiety drug fluoxetine were alarming and scary. In the 1990 paper [reference 1, see Notes and References section], he and his co-workers found that patients free of recent serious suicidal ideation developed intense, violent suicidal preoccupation after two to seven weeks of fluoxetine treatment. The suicidal ideation state
persisted for as little as three days to as long as three months after discontinuation of fluoxetine. He and his co-workers [1] also found that a number of antidepressants, including SSRIs (of which Celexa is one), could induce and exacerbate suicidal tendencies in some patients. It’s important to note that the antidepressants paradoxically could worsen depression and induce akathisia, anxiety, and mania.
Dr. Teicher also presented me with a paper published in 2004 [2], in which the researchers found that the current suicide rate for schizophrenia and other psychoses was twenty-fold higher than the rate at the time before the advent of psychiatric drugs. Dr. Teicher told me that when he practiced as a young psychiatrist, he had been more optimistic about the benefit of these “new” psychiatric medications. He has since found that these medications seem to have more serious adverse side effects than previously thought.
I asked Dr. Teicher about the possibility of racial and gender differences in reaction to the psychiatric drugs prescribed for Iris. I had speculated that perhaps the psychiatric drugs Iris took had had stronger adverse side effects to her due to her Asian roots and her gender. It is scientifically established that certain variations in genes, called polymorphisms, tend to vary by ethnicity and can affect the safety and effectiveness of drugs by affecting how they are metabolized [3]. In answering my questions about racial and gender differences in response to psychiatric drugs, Dr. Teicher showed me in several papers [4] that indeed there were racial, ethnic, and gender differences. Asians seem to have a lower threshold for both the therapeutic and adverse effects of antipsychotic drugs than Caucasians.
This made me wonder if Iris had been overmedicated because her dosages were calculated based on studies on Caucasian patients. Dr. Teicher explained his usual protocol for starting a patient on a medication such as Risperdal at a starting dose of 0.25 mg. Iris’s initial prescription was 8 times this dose.
In the meeting, I was surprised to learn that although himself a psychiatrist, Dr. Teicher had serious reservations about using psychiatric drugs to treat his patients. He also introduced a book to me: Side Effects: A Prosecutor, a Whistleblower, and a Bestselling Antidepressant on Trial, written by Alison Bass [5], a health reporter for the Boston Globe. When I returned home from Boston, I read Bass’s book and realized that there were a number of other similar books on the subject. It opened my eyes about the lesser-known negative effects of psychiatric medications, especially the associations with suicidal ideations.
From Bass’s book Side Effects, I realized that not only Prozac, but another similar SSRI antidepressant, paroxetine (Paxil), also caused suicides among users. The book revealed that there was no hard proof that Paxil performed any better than sugar pills in children and adolescents. The company that produced Paxil, GlaxoSmithKline, withheld the unfavorable data from the drug trials and the suicide risk of the drug from the public, and misled physicians and consumers about its safety.
I also learned that the medical researchers who conduct drug trials that are submitted to FDA for approval are financially supported by the pharmaceutical companies to test their products. There are no real protections to make sure that the studies are unbiased. Bass’s book forced the government to start protecting its citizens.
Dr. Peter Breggin is another author who has written extensively on the adverse effects of psychiatric medications [6]. Dr. Breggin was one of the early whistle-blowers who promoted extreme caution in the use of psychiatric drugs to treat patients. His work was considered very controversial and was ignored by the medical profession when first published. This was partly due to the lack of disclosure of the pharmaceutical companies and the lack of oversight of federal government agencies and research institutes. Many of Dr. Breggin’s findings are now widely accepted, and the new “atypical antipsychotic” drugs such as Risperdal and Abilify are now known to have most of the same risks as the older drugs they replaced [3]. The FDA and the National Institutes of Mental Health now carry warnings on their Web sites that antidepressant medication can double the risk of suicide, compared to placebo [7]. A very recent study [8] found that risks of suicidal thoughts or committing suicide were similar for patients starting any kind of antidepressant. In addition to the risks assumed by taking these drugs, there are also risks when a patient stops taking them.
In the recent book Anatomy of an Epidemic: Magic Bullets, Psychiatric Drugs, and the Astonishing Rise of Mental Illness in America [9], author Robert Whitaker, a health science investigative reporter, found that taking psychiatric drugs long-term actually did more harm to the brain than good. The drugs often created more mental problems than benefits in patients. The excessive and abusive consumption of psychiatric drugs resulted in a drastic increase of disabled mentally ill in this country to an epidemic level—the number of mentally ill in the U.S. tripled over the past two decades!
I wish I had learned of the risks of antidepressants and antipsychotic drugs sooner, before Iris was treated with them. In 2004, the psychiatrists who treated Iris were unaware of the potential serious toxic side effects of those drugs, and they were also not well educated about racial and ethnic differences in response to those medications. The age affected by these medications is not limited to youth, as the product labels state, but all ages are at risk for the adverse effects, such as suicidal ideation [1].
Iris had never had a serious depressive or a manic episode in her entire life; therefore Shau-Jin and I, as well as Iris, never believed that she had bipolar disorder. And that was why, at the beginning, Iris was the one strongly opposed to taking any of the prescribed drugs. I have to give credit to Iris, who knew herself better than any other member of the family, even at her lowest point. It was the family members who were ignorant about the toxicity and the serious side effects of antipsychotic and antidepressant drugs—our trust in her doctors and our hope that she would become better by taking those medications turned out to have been counterproductive.
Iris was probably much more sensitive to psychiatric drugs than the average person. Dr. Breggin, in his book Medication Madness: The Role of Psychiatric Drugs in Cases of Violence, Suicide, and Crime [6], wrote: “It turned out that the first few days are the greatest time of risk. Perhaps in the same way that the first few sips of alcohol or puffs of a cigarette have such strong effects on the previously uninitiated drinker or smoker, so, too, the first few doses of an antidepressant in the uninitiated can have the most overwhelmingly harmful impact.” This, to me, is an exact description of what happened to Iris.
Iris was neither a drinker nor a smoker. In her whole life she had never taken anything stronger than coffee, let alone any psychiatric drugs. Her first suicide attempt on September 21, 2004 and her attempt to buy a gun on October 28 were both completely out of character for her. Coincidentally, both these incidents occurred several days after she began to take Celexa.
I believe Iris’s suicide was caused by her medications. She represented a classic case in which psychiatric medications change one’s personality. I do not need to repeat the huge number of bizarre cases documented [6, 9], in which an originally ordinary mildly depressed patient becomes violent and destructive after taking antidepressants. The time from Iris’s breakdown to her suicide was incredibly short, less than three months, and coincided exactly with the time she started taking psychiatric drugs. And the tragic, violent way she ended her life was not characteristic of Iris. The rapidity of the downward spiral and the violent manner ending her life were very likely triggered by the medications she took. I admit that I am not a clinical psychologist or psychiatrist. But, as a research biochemist, this is the best conclusion I can draw from my close observation as Iris’s primary caretaker in the last half year of her life and my own independent research.
Observers have argued that other factors might have played a role in her suicide, such as her fertility treatments that might have affected her mood. As far as I know, her fertility treatment length was very limited, only involving several weeks before the egg retrieval in December of 2001. H
er emotional spiral began in 2004.
Others blamed the dark nature of her Nanking book as the cause of her suicide and asserted that perhaps no one should write books on a topic so dark. I know Iris had absolutely no regrets that she had been able to write the Nanking book and expose this tragic chapter of history to the world. Shau-Jin and I also believed that the Nanking book was not a real cause for her suicide; after all, the book was written seven years before her death. It was unfortunate that she was going to write about the American POWs’ horrible experience in the Philippines in the 1940s for her next book. Even though this last research was also on a hideous subject and it certainly was not good for her mental health, I don’t feel it was a major factor in her depression.
Could Iris’s suicide have been prevented? I strongly believe that if she had been given a chance to rest, physically and mentally, without psychiatric medications, she would have recovered and would be with us today. Intensive psychotherapy would have been helpful as well, as we all know there is no magic bullet to snap a patient instantly out of depression. With rest and support, she would have been able to manage her problems, personal or professional, in a systematic and logical way. She had dealt with other obstacles in her life successfully. She was always a strong and passionate person with enthusiasm for life. Tragically, Iris was not given a chance to recover from her physical and mental exhaustion. She was immediately given an antipsychotic drug and then an antidepressant with side effects which could exacerbate her anxiety and mild depression.
I hope this book will help people become aware of the possible danger of psychiatric drugs and to think twice before taking them. Even though the statistics show that the percentage of suicide among patients on antidepressants is low, still it is higher than placebo. Every single life is important and valuable. I don’t want what happened to us to happen again in anyone’s family.
Woman Who Could Not Forget Page 43
