SUICIDAL BEHAVIOR
It was a Tuesday morning and Marie was checking her e-mail. She knew her twenty-four-year-old son Michael was struggling hard with daily life. He was a bright, anxious, and socially withdrawn young man. After high school graduation, Michael chose to attend college far from his hometown. Overwhelmed at this large school, Michael never quite fit in. After graduation, a scholarship to a prestigious master’s program boosted his confidence—for a while. Then he met a girl, his first real relationship, and Michael felt everything was progressing well. But within a month, his girlfriend started postponing dates and failing to return his texts. Michael felt blindsided and was distraught about the breakup.
As Marie read a new e-mail from Michael, she was shocked. It said, “Mom—I can’t take this anymore. I can’t stay happy and I hate being lonely. I can’t go on.” Before she read the entire note, Marie called Michael in a panic. As the phone rang and rang, then going to voice mail, she wondered, “Can I reach him in time?”
Another high stakes drama was playing out in the same city, where Nancy had received a call from Michelle, her son Cole’s wife. Cole was angry and upset and yet again was threatening suicide. “You deal with him,” Michelle had said. “I can’t handle it anymore.”
Nancy had adopted Cole, now twenty-eight, as an infant. Cole was provided with lots of love, but never seemed to find his place in life. Cole had ADHD and a severe learning disability and school was a negative experience for him. As a teenager, he found validation working in his father’s scrap metal business. Around that time, Cole also told his parents he was gay, but never was willing to discuss the issue further. His father’s sudden death left him without a confidant or a protected place to work
During the next few years, Cole knocked about, took a few courses, and had a few jobs. When he was twenty-six, Cole suddenly married Michelle, a thirty-four-year-old mother of two teenage children. Nancy wondered but didn’t ask Cole about his earlier declaration of being gay. Nancy was supportive of her son’s new family, and gratified Cole had found someone important in his life. But Nancy’s enthusiasm had waned in the past year when she began receiving desperate phone calls from Michelle. Cole was constantly provoking fights with Michelle and her sons. Worse, every few weeks he threatened to harm himself, and Nancy and Michelle together had taken him to the emergency room twice. After this newest call from Michelle, Nancy desperately wondered what to do. Should she initiate another psychiatric hospitalization? Was Cole’s threat of suicide even real?
When you are parenting your child as a baby, young child, or even during the tumultuous teenage years, you could never imagine that your child could become so very unhappy as an adult that he would attempt and perhaps succeed at ending his life. In those more innocent times, it is inconceivable that he might reject the most precious gift you have given him—his life. Yet all too often, parents of troubled adult children grapple with this unthinkable possibility.
The questions that Marie and Nancy asked themselves at the beginning of this chapter are difficult issues for even experienced mental health professionals to answer. The risk of suicide is vivid for those in the midst of emotional turmoil, and many times parents are forced to make life and death decisions for their children in crisis. In the aftermath, parents must wrestle with the emotional impact of having a child who has so little self-regard that he would attempt to end his own life. The consequences of a completed suicide are far greater.
Suicide attempts compel parents to realize that they have only finite control over their adult children. They realize that the forces of self-destruction that lie within a suicidal adult are powerful and often unsuppressible. These forces are often driven by strong elements such as mental illness, substance abuse, rage, and humiliation. Of course, not all suicidal behaviors are driven by the same elements, most suicide attempts do not end in death, and every event requires a separate analysis.
Michael and Cole from the beginning of this chapter had different outcomes, which are described later in this chapter. They represent examples of two families facing their son’s self-imposed mortal danger. This chapter covers the complexities of suicidal behaviors and the key risk factors for suicide. It also offers suggestions for ways parents can intervene when their child is at the brink. The chapter ends with a discussion of the impossible task of coping with a child’s death that has occurred at his own hands.
Defining the Problem
About 38,000 Americans ended their lives through suicide in 2010, according to the Centers for Disease Control and Prevention (CDC), and suicide is the tenth leading cause of death in the United States. In addition, an estimated one million people reported making a suicide attempt within the past year, and nearly four times that percentage thought about committing suicide. The CDC reports that for every one suicide, there are an attempted twenty-five suicides.
Men have a significantly greater risk of dying from suicide than women, and men represent nearly 80 percent of all completed suicides in the United States. Men and women also differ with respect to the means that they use to commit suicide; the CDC reports that 56 percent of men who commit suicide use firearms, while suicidal women are most likely to poison themselves by overdose.
In considering the age of a person and the risk for suicide, the CDC reports that young adults ages eighteen to twenty-nine years have a significantly higher rate of suicidal thoughts, suicide planning, and suicide attempts when compared to adults thirty years and older. Ironically, those individuals who are in what should be the sweetest part of their lives are thinking about ending their journey. The presence of mental illness and substance abuse often accounts for these alarming figures.
Mental health professionals designate different types of self-harmful behaviors. The least lethal form of suicidal behavior is referred to as passive suicidal thoughts, followed in terms of risk by those with active suicidal thoughts, then those who have made suicidal gestures or unsuccessful attempts. The completed suicide is the most severe form of suicidal behavior.
Passive Suicidal Thoughts
These depressed patients relate that they have thoughts about “not waking up” or “just not being here.” When pressed, they deny that they have an active suicide plan and dismiss the possibility that they would ever harm themselves. These are unsettling thoughts to hear, but they usually do not represent an imminent risk.
Active Suicidal Thoughts
Individuals with active suicidal thoughts do ponder their own deaths, even if they never act on these thoughts. A person with active suicidal thoughts is burdened by disturbing images and thoughts, and may make statements such as, “I drive by the railroad every morning and think about driving my car on to the tracks and staying there, but I have never done it.”
Surprisingly, for many people these recurrent troubling thoughts never go any further. However, concern grows if and when these individuals develop an actual plan for their own self-destruction, such as, “I plan to hang myself after my parents leave for work next week.” If such thoughts are expressed to relatives or friends, they demand serious attention.
Suicidal Gestures, Unsuccessful Attempts, and Completed Suicides
Suicidal thoughts that evolve into behaviors are of great concern. Suicidal acts are subdivided into gestures, unsuccessful attempts, or completed suicides, in which the person self-harms and dies.
Suicidal gestures include such acts as swallowing three or four sleeping pills or superficially cutting one’s wrists. Hospital emergency rooms are filled with patients with these mild injuries, and the generally accepted belief is that these are impulsive acts rather than well-planned acts. These individuals need psychological help but do not plan to die from their injuries.
Every hospital has what some refer to as “frequent flyers,” or notorious patients who make repeated suicidal gestures. These patients carry the scars of healed lacerations, and their medical charts are stuffed with information on past medical encounters. Each episode is disruptive to the family and costly for the hospital. Suicidal gestures are often considered manipulative or attention-seeking behaviors intended to provoke a sympathetic response. As the gestures become more frequent, sympathy inevitably morphs into resentment. However, it is a serious mistake for anyone to turn a cold shoulder to this behavior. Suicidal gestures always represent underlying emotional distress. Even the most benign self-harmful gestures can go wrong and result in an unintentional death.
Suicidal behaviors that do not end in death have the ironic designation of an “unsuccessful attempt.” These patients intend to die from their actions, but instead they survived because they miscalculated the number of pills needed to die or some heroic medical effort was made to save them. Survivors are at great risk for subsequent attempts. But the outcome is not always bad.
Eileen was a fifty-five-year-old patient with bipolar disorder who survived a massive drug overdose years earlier. In Hebrew, the number eighteen is called chai, and it also represents life. I was surprised one day to find an invitation to Eileen’s “Chai party.” The invitation read: “On this eighteenth anniversary of my survival, I wish to celebrate my life.”
With a completed suicide, the attempt results in death. Death is delivered by a gunshot wound, overdose, a hanging, or other means. For a doctor, a completed suicide represents the worst possible outcome (short of homicide-suicide). For the surviving family, suicide marks the beginning of the darkest chapter imaginable. The death of a child from suicide places parents in the black hole of depression and some are left contemplating for themselves the very act that took their own child.
Groups at an Elevated Risk for Suicide
Suicide patterns among groups have been carefully studied. A report from the surgeon general reveals that suicide is highly correlated with mental illness and substance abuse. Suicide is also more common among American Indians and Alaska natives. In addition, gay, lesbian, bisexual, and transgender populations are at higher risk for suicide, as are individuals coping with a loved one’s death. Their risk increases if that person’s death was due to suicide. Individuals who engage in self-harmful behaviors such as cutting are more likely than the rest of the population to eventually commit suicide.
Numerous media reports have covered the high rates of suicide among active duty Armed Forces and military veterans. The rates have remained high despite intensive efforts by military medicine and the Veterans Administration (VA) to help these young soldiers. A recent report from the VA indicates that although the percentage of veterans who died from suicide has slightly fallen since 1999, the actual numbers of deaths from suicide has risen since then. The VA has initiated a Veterans Crisis Line (800-273-8255, push 1) for suicidal veterans, or individuals can text 838255 to contact the VA.
Suicide is also a prevalent problem for those incarcerated in jails and prisons and for patients with serious medical conditions, particularly cancer. According to the National Institute of Mental Health (NIMH), having highly conflicted and violent relationships with others also elevates the risk for suicide. Other risk factors include a personal history of physical or sexual abuse and the presence of firearms in the home.
Mental Illness, Substance Abuse, and Suicide
When psychiatrists ponder a patient’s suicidal behavior, they also immediately evaluate whether mental illness is present. High rates of suicide attempts have been identified among those with bipolar disorder, followed by individuals with major depression. In addition, alcoholism, drug addiction, and other mental health diagnoses increase the risk for suicide.
Psychiatric Illness, Alcoholism, and the Risk for Suicide
In a 2011 publication, Leonard Tondo, MD, and Ross J. Baldessarini, MD, analyzed the results of 28 studies involving 21,500 patients with bipolar disorder. Of these patients, 823 died from suicide, a rate of 390 per 100,000 individuals. This rate is 26 times greater than the risk for suicide in a general population, a prevalence that was surprisingly high.
Other psychiatric illnesses are linked to suicide. The results of a landmark Mexican study of nearly 6,000 subjects drawn from the Mexican National Comorbidity Survey was published in the Journal of Affective Disorders in 2010. The researchers found that nearly half of the subjects with suicidal thoughts had previously been diagnosed with a psychiatric disorder. Of those who had attempted suicide, nearly two-thirds had a known psychiatric disorder. The strongest predictors for another suicide attempt were a diagnosis of conduct disorder (a disorder of defying authority and acting out) or alcohol abuse or dependence. The presence of either condition increased the risk for a suicide attempt by six times. The next most serious predictor for suicide was the presence of an anxiety disorder, which increased the risk of another suicide attempt by two to three times greater than among those without anxiety disorders.
Why You Should Intervene and What You Can Do
When they learn of their child’s despair, most parents would do anything to reverse the situation for their adult child. Others are paralyzed by the gravity of the situation or meet their child’s crisis with a sense of resignation. Most families are relieved to learn that doctors and families can decrease the risk of losing an adult child to suicide.
Psychiatric Treatment
Psychiatric treatment is proven to reduce the frequency and intensity of suicidal thinking. This finding is best exemplified by studies concerning lithium carbonate, the standard psychiatric treatment for bipolar disorder. In various studies, treatment with lithium significantly lowered the risk of suicide. Patients taking lithium had nearly a three times lower rate of suicide than patients who were taking other bipolar medications. Another study uncovered that the risk for suicide increased by twenty-fold after the discontinuation of lithium and a rapid discontinuation of the medication rather than a slow tapering of the dose. The studies cemented the belief that lithium has antisuicidal properties.
Schizophrenia, as with bipolar disorder, carries a high risk of suicide. People with schizophrenia have an 8.5 times greater risk of suicide compared to the risk among the general population. Yet treatment with the antipsychotic clozapine has demonstrated significantly reduced rates of suicide to the extent that the FDA approved the medication for this specific indication.
Treatment for drug and alcohol dependency also lowers the risk for suicide. Rates of suicide decline during periods of sobriety from alcohol or drugs. Not all who suffer from these conditions will welcome treatment, but if they are treated, they lessen the chance of death at their own hands.
Family Intervention
If your adult child describes suicidal thoughts to you, it is essential to reach out to her and to encourage her that hope still exists. For example, help your child make contact with a doctor. Offer to drive them to their appointments. Usually suicidal thoughts pass quickly, and cushioning your loved one who is in the depths of the crisis can help to avert disaster.
Suicide is often an impulsive act, and if you can get your child past the immediate danger zone, you might outrun the threat. Paul S. F. Yipp and colleagues report that suicide attempts are often spur of the moment decisions. If a lethal means of committing suicide is unavailable, then the suicide attempt may be delayed, and hopefully the suicidal impulse will not recur. This reasoning holds for individuals in crisis and those who have recurrent suicidal thoughts.
The best way to protect homes with suicidal family members is to remove guns and other weapons. By placing obstacles in their adult child’s way, families may have given him a second chance, and it also gives the family one more opportunity to get him treatment. The goal is to postpone and avert a crisis. You can never assume that the problem is totally over, of course, nor should you believe that suicide and death are inevitable for your child. Instead take an adversarial stance against the forces bringing your child down.
Maintain a Proactive Attitude
For those with chronic depression, suicidal thoughts are ongoing and exhausting. When the thoughts become more intense, hopelessness may set in, and your child may assert that medications or therapy are both futile actions. The truth is that anyone who contemplates suicide once, particularly if their treatment is disrupted, is likely to find herself in that bad, dark place again. It is important for you not to adopt the same sense of hopelessness.
You might agree with your child that some past treatments have been disappointing. In the tension of the moment, however, it is best not to engage in this discussion. At those moments, families need to physically separate their child from guns, pills, and other dangers. This might require voluntary hospitalization and it is always best to do this with your child’s consent. However, without their consent, an involuntary hospitalization, committing your child to a psychiatric facility against his will because he is a danger to himself, may need to be a consideration. This difficult process of involuntary hospitalization will be discussed later in the chapter.
Take Suicide Threats Seriously
Always take suicide threats seriously. If your adult child says she has a plan or is going to kill herself now, it may be a real threat or just another means to manipulate you to do something. However, never assume that the threat is not real. This could be a fatal mistake.
Predictors for Recurrent Suicidal Behavior
If a person like Audrey (see She Lives with Her Suicidal Daughter) tries to commit suicide once, will she try it again? This section covers the risk factors that have been shown to predict the likelihood of suicide attempts. Factors that guard against suicidal behavior are also explored.
A 2012 report from the surgeon general has identified a number of known behaviors that are associated with a future risk for suicide. The greater the number of these signs that are present in a person, then the higher the risk is for suicide in that individual.
The Person Has a Specific Suicide Plan
The presence of a specific suicide plan signals danger. Talking about wanting to die or developing a plan detailing when or how the act will occur increases the concern that a person may act on her suicidal ideas.
The Person Has Attempted Suicide in the Past
Unfortunately, the past is often prologue to the future. When a person has attempted suicide in the past, he is at an increased risk for a future attempt. Several factors contribute to this finding, but the most likely is that suicidal behavior occurs during periods of depression. Under the best circumstances, it is hard to live with a mood disorder. If your child loses his job or relationship during an episode of depression, the risk of suicide increases.
The Person Has the Means to Commit Suicide
Most suicides involve guns or an overdose of pills. Restrict these means, whenever possible. Suicide is often an impulsive act, and at-risk individuals should not have easy access to the means that are used for suicide. Some families of troubled children avoid housing any firearms, and if they own guns, they are kept offsite. Families who are uncomfortable with this option should ensure that any guns they own at home are kept in a secure locked cabinet that cannot be broken into by their adult child. The key or the safe combination should remain with the owner only, not in an obvious place, and the bullets should be stored separately.
Similarly, many medications are dangerous in overdose and large reserves should not be kept in the homes of loved ones with recurrent depression. Opiate medications are lethal in overdose, and unused prescription painkillers should be locked up or safely discarded. Even over the counter medications like Tylenol should be available only in small amounts.
There are many other methods to perform suicide. Parents lose their children to hanging, drowning, jumping off high sites, and carbon monoxide poisoning. You cannot protect against all these factors, and you can only be vigilant that the threat exists.
The Individual Is Suddenly Cheerful
Doctors have noted that rapid mood swings are common in suicidal patients. There are also reports of severely depressed patients becoming suddenly cheerful, a switch that makes their subsequent suicidal attempt seem even more shocking. Some experts speculate that this shift signifies that the person has now resolved to commit suicide, and that he feels comfortable with the decision.
The Person Was Recently Placed on Antidepressants
A small percentage of depressed individuals taking antidepressant medications may have a brief period of increased suicidal risk soon after starting their medication. It is believed that these medications may give the depressed person the energy to act on their negative feelings. The risk is greater among individuals younger than twenty-five years old. The FDA has mandated that this warning be included in all packaging for antidepressants. Although this paradoxical reaction is uncommon, the black box has had the unfortunate consequence of discouraging many doctors from using antidepressants in younger patients.
The Psychotic Person Hears Voices Telling Her to Commit Suicide
Suicide is associated with both depression and psychosis. Auditory hallucinations (hearing voices) are the hallmark symptom of schizophrenia, a psychotic disorder. An increase in command hallucinations, which refers to internal voices that issue orders to the person, may herald the onset of suicidal behavior. Many patients suffer for years from these terrifying hallucinations, but the overwhelming majority never act on the harsh directions. Command hallucinations are most likely to return after stopping antipsychotic medications.
Protective Factors against Suicide
There are some factors that protect against suicide. Patients do better if they have access to physical and mental health care. Follow-up care after a psychiatric hospitalization is essential, as is a sense of connectedness to family, friends, and the community. Everyone needs self-defined reasons for living. Beyond all this, perhaps nothing protects your adult child from suicide more than the knowledge that their own children need them.
Warning Signs of Suicide
What To Do If You Suspect That Your Adult Child Is Suicidal
Parents can take the following actions if they see troubling signs of a possible suicidal intent within their adult child:
Do Not Leave Your Suicidal Child Alone
Usually suicidal impulses come and go. When your adult child is in the depths of a crisis, stay with him. If you cannot be there, then arrange for another family member or a friend to be present with your child. Of course, no family can stand vigil forever. When a longer-term solution is required, then a hospital stay may be in order. If you think that your child is a risk to himself and/or to others, then contact the police and tell them so. Provide clear examples of what you are concerned about. Be sure to state that your adult child is a danger to himself and needs to be protected from his own suicidal impulses.
Develop a Relationship with Your Child’s Therapist
If your adult child is chronically suicidal, try to develop a working relationship with your child’s therapist. If you have built rapport during periods of relative calm, then you have a partner who can help you in a time of crisis. It is wise to have a release of information agreement signed by your adult child ensuring that you legally can talk to her doctor and that the doctor can answer back freely. Without this release, the doctor cannot provide you with confidential information, although she can act on information that you offer. During periods of crisis the doctor will be able to guide you about appropriate actions to take.
Call the Police
The role of the police in urgent situations is not to treat your loved one’s psychiatric condition, but rather to protect him and to help solve the imminent problem. If you think your adult child is in imminent danger of suicide, contact the police and inform them of the emergency situation. The police have both the might and the mobility to come to your home in a crisis. Police are aware of local commitment laws and will be willing and able to take the individual to the emergency room for assessment.
Be very forthcoming with information if the police come to your home. If your child is in a psychotic state and is threatening you, let them know. If you find a suicide note, then provide the police with a copy. Never give up the original note—it may be useful later in the commitment process or as a piece of evidence.
Consider Hospitalization
You may need to consider hospitalization to avert the risk for suicide. The hospital staff can evaluate the situation and provide physical safety temporarily in the emergency department until the short crisis passes, or by admitting your child to a psychiatric unit. Some suicidal behaviors are more ominous than others, but in the crush of the moment, it is very helpful to get the input of an experienced staff with appropriate resources at their disposal.
Once your child is in the hospital, you should seek to partner with the doctors as much as possible. Ask your child’s psychiatrist to contact the hospital doctors to provide them with information. Working together, a good decision about any further steps that need to be taken can be made.
As mentioned elsewhere in the book, doctors may refuse to provide you with information. But they are not prohibited from listening to what you have to say and choosing to act (or not) on it. They will likely not tell you what they have decided because of privacy regulations. But your insights may be very valuable to the doctors.
Most of the time, an individual with suicidal thoughts will voluntarily sign herself into a psychiatric hospital. However, sometimes your child might push back and refuse inpatient treatment. At these times, the option of an involuntarily hospitalization becomes an important consideration.
Involuntary Hospitalization for Suicidal or Aggressive Behavior
Each state has its own particular legal criteria for the circumstances under which an involuntary admission to a psychiatric unit may be made. The general rule for an involuntary commitment is that the individual must be a credible and imminent threat to himself or to others. The process of civil commitment varies by state, but it generally follows a logical pattern. In Michigan, for example, a petition is a legal statement that is completed by people who have witnessed the individual’s suicidal or aggressive behavior.
Petitions to the court detail the concerning behavior and are usually completed by a therapist, family, or friend. A psychiatrist, physician, or licensed psychologist may also sign a civil certification essentially confirming the threat. With these two elements, the patient is confined to the hospital involuntarily for at least seventy-two hours. During this time, the patient may sign in on a voluntary basis or be offered an attorney to challenge the commitment.
When a person is civilly committed, the hospital determines the level of the person’s dangerousness. If experts at the facility do not believe that the person is a threat to himself or others anymore, then he will be discharged. However, if they acknowledge that the person needs hospitalization, and if a longer treatment is deemed necessary, the court has the power to order further treatment until the immediate danger recedes. The patient may be discharged with the stipulation that he receive outpatient psychiatric care.
Surviving Your Adult Child’s Suicide
Probably the most difficult experience imaginable is to survive your own child’s suicide. This act causes an emotional pain that lasts indefinitely, although the most intense pain occurs shortly after the suicide and for about a year afterwards. Parents wonder what they could have done to prevent the suicide and have many “if-onlys.” If only they had called the child on that day or had done something else differently, they think, maybe they could have prevented it. If only they had told him that he was loved, maybe he would have stopped before going through with the suicide. If the last words with the child were words of anger, this is yet another cause for regret.
Stages of Bereavement
Many years ago, Elisabeth Kübler-Ross, a brilliant psychiatrist, described five general stages of grieving that may occur when a person suffers a severe loss. A diagnosis of terminal cancer or the death of a family member may trigger psychological reactions known as denial, anger, bargaining, depression, and acceptance. These stages do not always occur in sequence, and some people experience some stages and not others.
Denial
When a child dies at his own hand, the shock of the experience may be too overwhelming to grasp. It is normal for a mother or father to deny that it possibly could have happened. Denial is not a wrong or bad reaction and it gives a person a chance to process this terrible news.
Anger
Many parents become angry when they learn of their child’s suicide. They may be angry with the child’s doctor for not having prevented the suicide. They may be angry with others who they felt did not take the situation as seriously as it clearly was. They may be irrationally angry at many different people. If they are religious individuals, they may be angry with God for allowing the suicide to occur and not having stopped it at the last moment. They may also be angry with their child for ending his life. When a mother gives birth to her child, she has many hopes and dreams for him. When he ends his life, it may seem like a repudiation of that person’s life.
If the child has not died from suicide but is in clear danger of death because of her suicidal tendencies, the parent may try to bargain with God or the doctor. For example, the parent praying to God to please save her child and she will forever after go to church faithfully unless she can’t because she’s in the hospital, or begging the doctor to save her child and she’ll do volunteer work for his favorite charity. Of the many other types of bargaining, some are verbalized and some are not.
Depression
When you lose someone you love, especially your own child, depression may be inevitable. Throughout the country, support groups such as Compassionate Friends welcome survivors of suicide. Most are survivors themselves. If depression lingers and is debilitating, consultation with a psychiatrist may be needed. Therapy and antidepressants can help considerably with symptoms of grief.
Acceptance
It is hard to fully accept the fate of an adult child who commits suicide. Feelings of emptiness will inevitably be mixed with feelings of anger. Loss may alternate with relief, especially if your child was long troubled. Grief waxes and wanes and abates only with time. It comes back again at certain times, rawness covered by the passage of time.
Parents React Strongly to Their Adult Child’s Suicide
Dr. Kübler-Ross’s famous stages led to empirical research on survivors of suicide. In a large study, James M. Bolton, MD, and colleagues compared adults whose children had died from suicide (1,415 subjects) to parents bereaved by their child’s death from a car crash (1,132 subjects) and to nonbereaved parents (also 1,415 subjects).
The researchers found that suicide bereavement in parents was associated with an elevated rate of depression, anxiety disorders, and marital failure within two years after the suicide had occurred. They also found that suicide bereavement was also associated with an increased risk for mental illness hospitalization among the parents when they were compared to the other groups. The subjects in the suicide bereavement group were also more likely to suffer from physical disorders, such as cancer, hypertension, and diabetes than the subjects in the other groups.
In addition, the parents bereaved by suicide had an increased risk for alcohol use disorders both before and after the death of their child, a risk more than three times greater than found among the nonbereaved group of parents.
Clearly, the loss of a child through suicide has a profound effect on parents, and this subject should be studied further, not only to understand further how suicide affects parents but also to ascertain how mental health professionals, physicians, and the friends and family of bereaved individuals can better help them.
Outcomes of Cases in This Chapter
So what happened in the cases of Cole, Audrey, and Michael, all suicidal, and described in this chapter? Cole had a good outcome. He allowed his mother to get him professional help and he started to see a psychiatric nurse practitioner for therapy. Cole also responded well to an antidepressant medication. Through therapy, Cole began to accept his sexuality, and he recognized that the extreme lengths that he had gone to in order to pretend to be straight, particularly marrying a straight woman, had caused him great internal conflict and depression. Cole and Michelle divorced amicably and his suicidal thoughts did not recur.
Audrey improved over time. A new psychiatrist viewed Audrey’s behavior as impulsive and diagnosed her with ADHD. Treatment with a long-acting stimulant medication muted Audrey’s rapid mood swings. Audrey returned to school, and she also found a part-time job she enjoyed. Her suicidal thoughts and actions became rarer and eventually abated.
Tragically, Marie never made contact with her son Michael in time. After she read his e-mail, Marie frantically called the police and her son’s landlord. The landlord found him first; Michael had hung himself the night before. Years later, Marie’s wounds heal ever so slowly.
It is easy to forget in the midst of crisis, and especially when one crisis seems to closely follow another, but it is also very important to take care of yourself when you have an adult child who has severe issues. That is the subject of Part Three.