Close up photo of a young boy with blonde hair

Losing a Patient Through Suicide: A Therapist's Experience


Written with permission of Ethen’s mother, who has asked that her son’s story be shared to help others.

Most therapists will tell you that one of their greatest professional fears is losing a patient through suicide. This goes far beyond the fears of professional liability
and the terrible anxiety that arises around potentially litigious events; rather, the suicide of a person we are treating and trying to help appears to go to the very core of why we entered this field at all. The subsequent grief, pain and feelings of helplessness closely mimics that of close family members; yet, there is very little written or presented on the topic of experiencing trauma like this as a professional… only on preventing it. This is the
story of my former patient, Ethen, who was lost to this world by suicide on
February 3, 2013. He was 10 years old.

Ethen had been my patient for more than a year when his family had moved too far away for me to see him anymore. When I was told Ethen had killed himself, I could not, in any way, wrap my mind around it. He made up his mind and told no one. Ethen didn’t ask for help because he wanted his pain to end. He didn’t want to be stopped.

I went to see Ethen’s mother the day after I knew. I could not create the combination of words that would bring comfort, could not wave my psychological, esoteric wand that would bring healing… I could do nothing. I could bear witness; that I could do. With her and for her, for Ethen, and for the surviving children, I stayed with her so she could tell me her story. I sat with this boy’s mother for hours and could not begin to make my mind go the place where I knew she was, though I tried. Even fathoming this type of pain and loss went beyond anything I could begin to understand.

I was traumatized by the suicide of my little patient. I could not stop my mind from thinking about all of the things I might have done differently, despite having not seen
him for a year, that might have changed the outcome. You see, I adored Ethen, his smile, his sense of humor and the ease in talking to and being with him. He wanted things to be better, wanted to do his part… he was a joy, and I always looked forward to seeing him. I knew he was bullied at school, had few friends and had some family problems that made his life difficult, and I took his pain seriously enough to hospitalize him at 8. But at 10, he took his life, and I never even got to say “goodbye.”

I did not return to work for weeks. I wasn’t sure I wanted to. Eventually, I borrowed from the courage of Ethen’s mother and moved forward. I knew I would need to change the way I did things — to be much more forthright about depression and ask the right questions, despite the age of the child I was seeing. Adults have a way of thinking we’ve cornered the market on psychological pain, but this is not the case. Children feel as deeply as adults, love as deeply and certainly suffer as deeply, but often do not have the cognitive ability to think through problems alone. Their own parents are afraid to ask their children if they are thinking of killing themselves and, as much as we might like to believe it isn’t so, therapists are often also afraid to ask that question. Everyone is afraid of knowing what to do if the answer to our question is “yes” — or even of then convincing the powers that be to take seriously the feelings and intent of our youngest charges.

It doesn’t matter how young our patients are, we must pay attention and confront our fears. No one knew anything was wrong with Ethen. He seemed happy and nothing seemed “off” to those who knew and loved him. Of course, Ethen knew; he had already decided when, where and how the pain would end. He saw no other option.

Not a day goes by that I do not think about Ethen, or his mother, or his surviving brothers. Not one.

We must reach out to one another as therapists, ask that parents reach out to us and the children to reach out to them. That is the parallel process. When it is working
as it should, it could very well save a life.

If you or someone you know needs help, see our suicide prevention resources.

If you need support right now, call the Suicide Prevention Lifeline at 1-800-273-8255.

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When You're in the Gray Area of Being Suicidal


To Whom It May Concern:

I’m suicidal. And no, it’s not what you think. I am safe. I am not harming myself. I do not have a plan, and I do not plan on doing anything. But I’m suicidal. And I can’t remember a time when I wasn’t.

People think of things like suicide in such black or white terms. But much like everything else we are so quick to place into categories, being suicidal falls into a gray area for me. Sometimes, I wonder if it does for anybody else. See I can be in a really great mood, right? I could be having the best day of my life. Still, suicidal thoughts will linger. I don’t have to be in a bad mood to be suicidal. I will still have those thoughts if I’m surrounded by the people I love, or if I’m doing something I’m passionate about.

I wake up most mornings thinking I’d be better off dead. But I’m quickly distracted by my husband and son, who are sound asleep next to me. I still feel it, but I try not to give power to it. Throughout the day I am faced with challenges that directly affect my subconscious. Either the suicidal thoughts get louder, or they remain just a feeling.

I should explain better; sometimes being suicidal is different than suicidal thoughts. It’s an actual feeling. The feeling that you have an itch you can’t scratch, that a dark cloud is shrouding you. It’s anxiety and depression, it’s mixed state. You’re drowning, there’s no air, and coming down from that feeling takes so long you think it’s impossible. You have blinders on and you don’t know what’s going to happen next. You just have to push through. And while this feeling is happening, you go through your day, as normal as you can, without feeding the feeling.

Some days are harder than others, and today happens to be one of those days. I know I’m not feeling good, and I’ve taken that into account. But I woke up thinking my family is better off without me. Then I started thinking about finances and my heart sunk a little more. I started thinking about my parents and my depression got worse. And I started thinking about everything my husband does so I can test a career in writing, and God, he can do better than me. It’s not fair to him. If I can’t impress the people surrounding me now, can I face how my son will inevitably feel about me? And I just start crying, because it’s all too much, and I’m just a joke. I feel like I’m drowning, over and over and over again. It would be so much easier to end things, and my family could finally get away from how terrible I am.

The way I feel isn’t a reflection of reality though. I know I have things to live for, I know things will get better. I know my family loves me, and the people who don’t like me don’t matter. In fact, they probably don’t give a shit. I know this feeling will pass. I just wish my mind and my body would work towards getting better.

I’m not bad yet. I haven’t made any attempts in almost two years, and I’m really proud of that. Every attempt I’ve made to take my own life ends the same way; I fade into a sleep, and I do regret my actions. I think I used to romanticize my own death back when I had nothing to lose. Now everything is on the line, and I’m terrified of the day my thoughts will become louder than my voice. But I know realistically it may not always be this way, and I may need to admit myself to the hospital again someday.

I have great plans for my future and for my family. So please don’t worry. I don’t intend to end my life and I’m not self-harming. And if I was, I’d go to the hospital. I wanted to write this so people better understood feeling suicidal. It’s so much more than just one day someone decided to end it. It goes deeper than that. It’s years of torment, even on good days. It mostly doesn’t happen randomly — it’s a build up. I don’t want to die; my subconscious and my illness may disagree, but today my voice is louder, and I will not succumb to the evils of my mind.

People with mental illness live in dark places and gray areas. It’s not something that shuts off and on — it comes in waves, it peaks and it fades. But these feelings are never gone. And I wish more than anything in this world they would disappear. I am a warrior of my own mind, and I will continue defending my inner peace. Every day may be hard; but it makes me stronger every day.

If you or someone you know needs help, please visit the National Suicide Prevention Lifeline. You can also reach the Crisis Text Line by texting “START” to 741-741. Head here for a list of crisis centers around the world.

The Crisis Text Line is looking for volunteers! If you’re interesting in becoming a Crisis Counselor, you can learn more information here.

Follow this journey on Taylor’s site.

The Mighty is asking the following: What’s one thing people might not know about your experience with disability, disease or mental illness, and what would you say to teach them? Check out our Submit a Story page for more about our submission guidelines.

My 5 Biggest Frustrations With the Mental Health System


I have been to 14 funerals since turning 17 years old. Fourteen people who were friends, co-workers, crushes, debate partners, school mates and amazing members of the world’s community. Fourteen people whose families and friends I sat next to at funeral services who I heard whisper, “If I would have known,” “How could I miss the signs?” and the awful, “How could they do this to us?”

Fourteen.

As the first of my friends took their lives and I attended their funerals, I felt an overwhelming sense of guilt. I wondered what I was missing, what I wasn’t doing right. Was it because I didn’t answer that 4 a.m. Facebook message? Was it because I wasn’t open with them about my own struggle? Was it because I didn’t try hard enough somehow? Didn’t love enough? Wasn’t there enough? I beat myself up for a while. I blamed myself and tortured myself. I sought to better understand mental health, suicide and what resources existed to support people feeling suicidal. I made it my mission to take action, and I read, spoke, researched, met, supported and loved the best I could. I learned about hospitals, communities, education systems, treatments, interventions and technology. I found people with the word “doctor” in front of their name and talked their ears off for hours. I thought if I somehow understood the world that the professionals worked in, I could help my friends get treatment within it. I enrolled in and attended all the suicide prevention and mental health training I could find. I wanted to make sure if people talked to me about suicide, I would feel ready to help them.

Fast-forward to today: I still find myself standing at the crossroads in people’s lives, as the more I’ve become involved in this mission, the more people I see at the crux of their struggle. I find myself encouraging them to seek help and try for a happier life. That is my goal, and what I truly wish for them to find. I do my best to help them find the resources to get there, or direct them to where they can find this information. But while I am directing people towards this goal, at the same time, I find myself scared of, concerned about and oftentimes angry about the system and the resources I am leading them towards.

What am I scared of, concerned about, and oftentimes angry about? There are a few things.

1. The mental health system is basically inaccessible.

Despite the fact that the people who were lost to suicide in my life knew about the services and that many of them even worked in the mental health system, accessing services when they (or anyone else) need them is nearly impossible. Appropriate services have wait lists, and emergency services are not trained to properly deal with suicidal people. I’ve heard of people who are suicidal being sent away from emergency departments due to lack of resources or beds. When they are admitted, oftentimes I hear from people their time in hospitals was more traumatic. I have not heard any word or progress on a solution to this.

2. The people who were supposed to help me still don’t think suicide is a real issue (e.g. hospitals and schools).

“You are just seeking attention,” “You did this to yourself, why should I help you?” “I think suicide is such a selfish thing.” “You just need to pick yourself up and be happy.” “You know how much other students suffer? Get over yourself” These quotes (and many more) represent all the things doctors and nurses have said to me while I was suicidal. My friends and schoolmates used to make fun of the crisis lines and mental health talks we had at school. As someone who was suffering and asking for help, hearing these things just made me more suicidal, and it is still happening in our system despite more research and more education. People who hold these beliefs are still talking to our at-risk youth.

3. Young people around me keep dying, despite the progress that has been made.

One of the scariest things about this journey is to learn we still have a long way to go to understanding and preventing suicide. Even with all the discussion of mental health and suicide over the last few years, the suicide rate has increased by 60 percent worldwide in the last 45 years. Rates among young people have been increasing to such an extent that they are now the group at highest risk in a third of all countries. While research is ongoing, there is clearly something we are missing, and it scares me this will continue until we figure out what that missing piece is and how we can help. And then I worry if our system is too broken to even adjust itself in a real way to new information that comes in.

4. We put all our eggs in one basket.

Where resources do exist, I’ve noticed we tend to put the most resources behind one model or solution. The truth is that people who live with mental health issues are as diverse as the rest of the population. One answer does not work for everyone. We need to have multiple therapy types, models and solutions funded to better accommodate people’s needs. One solution will not fit all, and this tendency to try to find that “one solution” worries me.

5. We don’t have money to solve this problem.

Worldwide, mental health only gets an average of 11 percent of the health care budget in Canada, and 6 percent in the United States. That’s not enough resources to go around to make an impact.

When you look at all the above concerns, there doesn’t seem to be a viable solution in sight, and it keeps me up at night thinking about when the real support will come. Each of these concerns together makes me understand why so many young people are still dying, and it leaves me really mad. I know that people living with mental health issues often struggle so much before asking for help. They see asking for help as the end of a long battle, but in reality, it ends up being the start of a much bigger and sometimes even more painful struggle working through the system, trying to get support when mental health concerns don’t wait around for the system to meet an individual’s needs. Mental health and suicidal thoughts — the same as many physical illnesses — need immediate and appropriate care, and this kind of care is becoming harder and more complicated to access as the years go by. Here is the thing: Things will only get better if we talk about suicide, if we demand more innovation from our mental health experts and governments, if we properly and appropriately fund it and if we let people know we care about it. Innovation is stagnating and while the politics play out, people are still dying.

I’ve been to 14 funerals. Don’t you think that’s enough?

(Thanks to my awesome friend Cheryl for helping me create this piece after I had been hitting my head against it for weeks. Check her out here .)

If you or someone you know needs help, see our suicide prevention resources.

If you need support right now, call the Suicide Prevention Lifeline at 1-800-273-8255.

To Those Who Call Me Brave for Sharing About Surviving Suicide Loss


People tell me that I am brave. I’m really not. They tell me that it takes courage to share my story, my loss with others. I don’t know. For me, there is no other way to wear this new aspect of self that is forever ingrained in me. I am a survivor of suicide loss. I didn’t ask for any of this and in truth, I would go back in an instant to the me that I was before: before my father’s suicide, before I became a survivor, before life as I knew it was forever altered. But I can’t.

Being a survivor feels like trying to fit into shoes that are two sizes too small or clothes that are 10 sizes too big. It’s uncomfortable. It doesn’t fit, and it most certainly doesn’t feel right. I don’t yet recognize this part of myself. Most days I don’t really want to. But I know that I must slowly grow into this new moniker, because it is my truth.

Eleven months ago, my father took his life. I know he was ashamed of battling anxiety and depression and that he couldn’t simply pull himself up and out of the depths of his despair. It made him feel weak. It made him afraid. And knowing that he died feeling this way is what breaks my heart the most, because he wasn’t weak. He was fighting an illness. Only his illness carried with it the added weight of stigma, judgement and shame. And that weight only brought him deeper into that dark place from which he saw no escape.

No, I’m not brave. I’m just trying to figure out how to live with my loss. And I know that I can’t wear it, I can’t truly own this truth, if I try to hide it. Where it fits into my world and sense of self, I am still trying to figure out. But I know I will not layer it with shame. And I know I will not allow others to judge my father. And more than anything, I know I want this tragic imprint that is now a part of my family story, to matter. I won’t cloak it in silence. I want to use it to shine a light on the issues of suicide and mental illness. I want it to humanize this loss so that people can see we were an ordinary family, and it happened to us. I want them to know my father in life, not to simply allow him to be defined by his death.

I am a survivor of suicide loss. I never thought that would be a part of my identity. But if I must wear it, I choose to do it honestly and without shame. I choose to wear my heart upon my sleeve, in all of its brokenness. I choose to be a truth-teller, even if some days I have only the strength to speak in a whisper. I choose to let my tears melt down the barriers that keep us from saying the word suicide. I choose not to let that word relegate me to grieve in isolation. I choose to give meaning to my father’s death. Does that make me brave? I don’t know. But whatever it makes me, I will own it with all of the courage I can muster.

If you or someone you know needs help, see our suicide prevention resources.

If you need support right now, call the Suicide Prevention Lifeline at 1-800-273-8255.

The Mighty is asking the following: Share a conversation you’ve had that changed the way you think about disability, disease or mental illness. If you’d like to participate, please send a blog post to [email protected] Please include a photo for the piece, a photo of yourself and 1-2 sentence bio. Check out our Submit a Story page for more about our submission guidelines.

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Think Before You Say, 'I'm So Bored I Could Kill Myself'


Editor’s note: If you struggle with self-harm or thoughts of suicide, the following post could be potentially triggering. You can contact the Crisis Text Line by texting “START” to 741-741.

Here’s a question you’ve probably never asked yourself before: Am I being flippant about suicide?

“None of my friends are around to hang out today, I just want to kill myself.”
“When he didn’t text back I totally had a panic attack!”
“I’m so depressed. This class is so dull, I just want to cut myself…”

Any of these sound familiar? I think at some point we have all said something similar. In fact, I hold my hand up as guilty. But do we really realize exactly what we are saying? Let’s take a look at these.

“Your hair looks like you have cancer.”
“I didn’t want to get up today, I was like totally paraplegic.”
“Two periods of math class is like having chemotherapy!”

So what makes other major health condition comparisons offensive and mental health comparisons OK? Point is, neither are acceptable. Mental health is a legitimate illness. True, pretty much anything you say will offend someone somewhere; this isn’t about squashing the freedom to express yourself. The point is just taking a moment to realize that if you do use phrases associated with mental health in a flippant way, chances are you’re hurting a lot more people than you may realize.

Why is it offensive? Using a diagnosable clinical condition as an exaggeration of an everyday feeling trivializes the word and gives it less integrity. In other words, the more you use it flippantly, the less serious it becomes. As a result, everyone has their own meanings and links attached to words such as “depressed” or “suicidal,”  often times nothing close to accurate to describing the genuine condition. Consequently an appearance of a genuine case of depression, for example, is taken with a pinch of salt. This can be terribly frustrating for the one suffering from the condition and in some cases can even make their disease worse. Some can ultimately start doubting the legitimacy of their own illness. Language is an extremely powerful tool, and often people are unaware of its impact on physical and mental outcomes.

In some more extreme cases, a flippant comment can be turned into a triggering experience for an individual. According to pyschcentral.com, a trigger is “something that sets off a memory tape or flashback transporting the person back to the event of her/his original trauma. Triggers are very personal; different things trigger different people. The survivor may begin to avoid situations and stimuli that she/he thinks triggered the flashback.”  Triggers are more commonly associated with post-traumatic stress disorder but can actually be applied to anybody with a mental health condition.

When I was a teenager I was at a local music gig and a band came on and started to play a rather somber song. A friend of mine started to sway along in time to the first verse and repeated the words “Cut yourself, cut yourself!” Many people around her laughed at the joke. But looking back, it was a terrible thing for her to say. Someone trying to stop self-harming, for example, can be triggered easily by the mere mention of it, let alone a comedic jape towards the act. The Internet in particular is a cesspool for this kind of language; you need only glance at the comment section on YouTube to read some pretty horrendous things. The same goes for people considering suicide. Turning their struggles into a joke both offends and trivializes a terrible experience. As a result, the person suffering often is less likely to open up about their pain.

But when someone utters a phrase similar to those mentioned at the start, remember not to judge them too harshly. Chances are they have no idea of the impact of what they are saying. This is because most of the time they are oblivious to how their language can affect people with mental illnesses. Most of the time, it’s not that they’re being malicious, it’s just they simply don’t understand. Of course there are some exceptions to this rule, but I always like to give people the benefit of the doubt!

When phrases like those are used, those who do know better should not feel obligated to let the comments wash over and dismiss that person as an a**hole. Educate them. Let them know why what they said was offensive. Mental illness is often invisible, there’s no neon flashing arrow saying “I have depression,” so people tend not to hold back on flippant statements. This is why it’s even more critical to interject offhand comments from unaware individuals. Most will probably thank you in the long run for being honest and letting them know their comment wasn’t well-received.

So next time you’re in a dreadfully boring class or meeting and feel like expressing just how “depressed” this makes you feel or want to let everyone know how the new Coldplay song just makes you want to cut yourself, please stop. Consider that at least one in four of the people sitting with you will have clinical depression within the next few years of their life. Don’t make it less valid for them.

If you or someone you know needs help, see our suicide prevention resources.

If you need support right now, call the Suicide Prevention Lifeline at 1-800-273-8255.

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