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My Aunt Sue Who Died by Suicide Was Just Like Me

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When I heard my Aunt Sue died, I felt cold. The feeling spread from the base of my spine, over the top of my head, sank into my chest and pushed out my breath. I felt like I was falling.

Sue was in pain. She was drinking. She did what she felt she needed to do. She took her life. I understand how it feels: the crushing panic, the feelings that can only be described as darkness, not being able to find any space to be calm. The fact that I understand how it felt scared me.

I try to be as honest as I can with my children about the history of mental health issues and substance abuse in our family. My family history remained largely hidden from me as a child struggling with depression. My children need to know these tendencies could be lurking inside them.

More than 41,000 people die by suicide each year in the United States. On a global scale, suicide claims more than 800,000 lives every year. That’s about the entire population of Ft. Worth, Texas. Imagine every man, woman and child choosing to end their lives en masse. People who have lost a family member or friend to suicide are more likely to attempt or die by suicide.

The National Institutes of Health sponsored a study that revealed clear genetic risks associated with mental illness, something long suspected by the medical community and those who live with the disorders. The genes you are born with strongly influence the way your body responds to stress. In other words, your genes aren’t the only factor that controls if you will end up with depression, schizophrenia or any other number of mental illness. Life experiences and how you deal with stress can all influence whether you end up with a mental illness.

My youngest daughter asked, “If Aunt Sue was so sad, why didn’t she come to us?”

“I don’t know,” I said. The words felt like cotton in my mouth.

When I was in my late teens and seeking treatment for my depression, Aunt Sue sought me out to reveal our family history of mental illness and substance abuse (a desperate attempt to self-medicate the pain away) and her struggles. I had no idea about any of this. She saved me. She made me feel like I wasn’t alone, that we were both a part of the same tribe.

Sue was 22 years older than me, but it never felt that way at all. My aunt and I were very close, and we naturally fell in together. We bonded over our shared interest in making pretty things. While the rest of the family went hunting, we armed ourselves with glue guns instead of rifles. Sue was my dad’s younger sister. Their father left when my dad was 4 and Sue was an infant. The rumor amongst family members was my biological grandfather has schizophrenia. My dad and his little sister didn’t have a good childhood.

People would always say Sue and I looked alike: the same thin light brown hair, doe eyes and sharp nose. I loved my aunt, but I was afraid of becoming her. Every so often when she became convinced her depression was untreatable, she’d stop all medication and therapy and hole up somewhere. No one would be able to reach her for months at a time. Then, she’d show up again and act like no time had passed at all. It was shocking to outsiders, but this was her normal.

When I got married, she insisted on taking care of all the decorations. Sue was incredibly talented. She arrived hours before anyone else and set up the entire reception. She transformed an empty banquet hall into a twinkling forest complete with “dead trees.” She had gathered branches from the woods, spray painted them white and then covered them in silver glass glitter. She also gilded hundreds of silk flowers with silver foil and wove them into arches. At the actual party, she disappeared.

Genes don’t necessarily determine a person’s destiny. Certain triggers can alter the expression of those genes. The environment we are raised in has an effect as well. This is why the study of these diseases is so complicated and difficult. How do you identify who might be contemplating suicide?

One of the problems with treating mental illness and suicidal thoughts is researchers only know what the patient is willing to share with them, and they can’t talk to someone who has died by suicide. This has led researchers to study the survivors, the family members of those who have died and those who have attempted suicide and survived, to advance research on the subject.

One of these researchers is Matthew K. Nock, who directs Harvard University’s Laboratory for Clinical and Developmental Research. His hope is to develop a series of computerized tests that can calculate a “risk score” for suicidal behavior in real-time.

One of the tests determines if a patient is associating themselves with living or with dying through word association. The researchers observed that people who are contemplating suicide hesitated a few fractions of a second longer when the word on the screen related to dying. A word like “funeral” caused hesitation while a neutral word like “ice cream” would be dealt with immediately.

Another test measures a subject’s eye movement in response to certain photos that appear on the screen. Nock’s group follows up with questions to measure the reliability of the tests like: Are the test takers more depressed? Have they attempted suicide? What no one can really agree on is what to do with the patients who are determined to be high-risk.

In another study published in the Journal of Psychiatric Research suggested that the healthy relatives of people who have died by suicide often have poor decision-making and impulse control. If this is an inherited trait of suicidal tendencies, what keeps the rest of the family members from suicide? The research showed that these living “risky decision makers” were able to identify alternative solutions to problems.

In another study that focused on how life experience affects gene function found that childhood abuse could cause changes in the body’s ability to regulate cortisol, the stress hormone. The change leaves the brain in a constant state of alertness, causing a person to overreact to stress. The combination of these two factors: impulsive genes and a tendency to overact could lead a person to see suicide as an immediate solution.

Every depression and attempted suicide is different. Because every case presents differently, one would assume all the treatments should be different. However, the treatments are not very distinct at all, and the global suicide rates are not declining.

Marsha Linehan, a psychology professor at the University of Washington, and a person who lives with mental illness herself, developed dialectical behavior therapy (DBT). This therapy combines behavioral science with concepts like acceptance and mindfulness. This therapy is designed to change thought patterns, and subsequently, behaviors. DBT gives patients a skill set and requires work on the part of the patient, weekly meetings, one-on-one counseling sessions and workbooks. It is a huge time commitment, and because of that, it seems to have been relegated to the most severe cases.

Most people attempting to navigate the mental health system are not getting this type of therapy and don’t know where to begin to look for help. My aunt would check herself into the local behavioral health center from time to time. Yet, she never got the help she truly needed.

When my youngest daughter was 2, Sue showed back up. Her house had a small electrical fire, so she stayed with us for a month. My kids grew close to her. She would read to them, build forts and do crafts. I remember her smoking on the back porch. The smoke swirled around her head as she exhaled, standing wrapped in a sweater and sweatpants with bare feet and her left leg bent and foot resting on her other knee. I called it her flamingo pose. She stood like that all the time.

On September 4, 2015, about four hours before Sue killed herself, she sent me a message on Facebook:

It has been a while since we have spoken. Just want to send my love and say how proud I am of you. You are a star in my world! Think of you often. Keep plugging away and it will all make sense in the end! Give the kids a hug and tell them Aunt Sue loves them with abandonment!       

I can pick that message apart for the rest of my life, and I likely will. I’ll analyze her word choices, and I have no idea if she intended to say goodbye. Just what the hell does “abandonment” mean in this context? I have no idea if she planned her death or if she got drunk and made an impulsive decision. I imagine in the moment, just before she did it, she felt like I often do, alone and drowning in her own thoughts.

I want my kids to know they aren’t alone and no one would be “better off” without them. I want them to know even the most impossible situation might not be so daunting if they ask for help. I want them not to struggle like Sue did and like I do.

Depression makes you feel isolated. The only thing you can do is go against what your body and mind are telling you and reach out to people for help and support. At a certain point, even that becomes too difficult. Sue desperately wanted to feel needed, to be caring for someone and I see that in myself. In quiet moments, I find myself thinking of the sound of her voice. I don’t want to forget.

Image via Thinkstock.

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

If you need support right now, call the Suicide Prevention Lifeline at 1-800-273-8255. You can reach the Crisis Text Line by texting “START” to 741-741.

Originally published: September 22, 2016
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