Worldwide, more people die by suicide than homicide and war.
From Private Pain to Public Action: It’s Not a Choice
P. Bonny Ball
"Friends are the angels who hold us up when we've forgotten how to fly."
A business analyst by profession, Bonny found herself thrust onto a new path when her treasured 21 year old son died by suicide. Thanks to support from friends, family and a huge number of mentors, Bonny has had the opportunity to become involved in many facets of suicide prevention. She was presented the University of British Columbia Department of Psychiatry “Unsung Hero Award” in the volunteer category, and was one of the “faces” for Mental Illness Awareness Week in 2008. She is past chair of the Survivor Division of the Canadian Association for Suicide Prevention, and is currently on the organizing committee for the CASP conference to be held in Vancouver in October, 2011.
Dear Friends, we bring you sad news:
Reed, that sunshine in our lives who mastered climbing the tree‑house rope at age 2, gleefully beat us at Monopoly at age 3, and who grew into a young adult with an adventurous mind, caring spirit, and a circle of close friends, died quietly of sleeping pill induced suicide with his kitten, Solis, by his side and his computer still on. He was 21 years old.
Reed relished his independence. He was determined to be his own person. He loved his solitude, yet he was also aware of how very important relationships were to his life and spent much time and energy nurturing those relationships and helping friends work through their troubles.
Unfortunately Reed found it difficult to let others care for him in the ways that he needed. No one saw the deep war raging within his soul, tearing his very being apart. With a few of us, he would risk academic discussions on the meaning of "life, the universe, and everything" .... telling us about his "other reality", his personal ethics, his approach to life based on perceptions so different than ours. We heard the words, but didn't begin to understand the pain they represented. Nor, when family and friends did see his pain, were we able to reach his rising tide of despair, self-recrimination and self-abandonment that developed into a continuous loop from which he could not escape. It's only now, reading his various personal notes left for us on his computer and going back through his school papers that we're starting to understand how long he carried that load and how heavy it was.
For us his death was not a complete surprise, though it brings us great sadness. Reed had attempted suicide previously, so we had already gone through the feelings of terror, helplessness, grieving, and struggling to let go and allow him to make his own choices. Although Reed's last two years were apparently a time of increasing mental pain, they were also filled with abundant joy. He loved living in downtown Calgary, having his very own apartment, and being fully in charge of his own life.
But the complex puzzle wouldn't come together, so we are left with the paradox of suicide. We remember his times of joy, for no one could soar like Reed, and the hope for the future that now cannot be explored. On the other hand, to ask Reed to live many more decades with what might have been irreconcilable pain would be cruel. And, to not accept his decision, when so much of his inner pain was due to feeling not acceptable, would be doubly cruel.
I vividly remember the weeks immediately after Reed’s suicide. I remember being wrapped in a cozy blanket of non-judgemental caring by friends, family, church, co-workers and the agencies working with us. I remember the compassion of RCMP Victim Services in North Vancouver as they told us of Reed’s suicide in Calgary. I remember those first long-distance phone calls to tell friends and family that Reed had died by suicide—and realizing that I needed to care for them as much they needed to care for me. I appreciated the Calgary police and the Alberta medical examiner for their gentle questioning and patience with my tears.
Following Reed’s death, a minister of our new church in North Vancouver offered sympathy and guidance, and encouraged us to be open about his suicide. She said there had been two or three suicides over the years in that congregation and she could see how the impact of stigma and silence had rippled down into the third generation. Our being open about Reed’s suicide might, she suggested, help these folks in their healing. At the memorial service in Calgary everyone knew that Reed’s death had been a suicide. The minister spoke tenderly about Reed, giving the assurance that “God would take his hurting child home.”
The stigma, silence and mis-cues associated with suicide did rear their ugly heads in a few places. The funeral home would not let us include that Reed had died by suicide in the obituary and only very reluctantly included “donations to the Reed J. Ball Memorial Fund for Suicide Prevention.” The minister in Calgary where the memorial service was held absolutely insisted that the service had to start with a “Prayer of Confession” confessing our sins – not what any of us needed at the time, we were already blaming ourselves enough! Every minister I’ve talked to since then has been appalled at that minister’s poor judgement – assuring me that a Prayer of Confession was NOT required. Fortunately, the minister who had helped us after Reed’s earlier suicide attempt was our main support and did the eulogy at the Memorial Service
Later, as I struggled with the “why question”, every book seemed to lay guilt on the family as the problem. But other than these few challenges we were wrapped in this incredible gift of care and support. This gift of non-judgemental support continued as my husband and I returned to work. Our co-workers, the typical Vancouver jumble of ethnicities and faiths, compassionately supported us no matter what their particular background taught about suicide. In short, in the midst of trauma, we were blessed, spared the secondary trauma of stigma and allowed to grieve appropriately.
We were also not completely shocked at Reed’s suicide, because he had attempted suicide before. Now, that incident had been totally traumatic! My husband had just left for a new job in Vancouver after being unemployed for 21 months. I stayed behind in Calgary to sell our house, enjoying Reed’s company while he was home on a university work term. Then, one morning after Reed left for work all happy and cheery as I was tidying up the house, I found a suicide note!
Fortunately, I was able to quickly figure out that the suicide attempt had happened about six weeks previously when I was at out for the evening. I now realize that Reed had taken an overdose of over-the-counter-medication – but just enough so that when he woke in the morning he was extra groggy and spent the day in our water bed curled up with a book (his favourite spot anyway). Thus there had been no frantic rush to the hospital and subsequent referral for medication and counselling. This was also 1992, two years before Prozac hit the front pages of Newsweek.
Unfortunately when I did discover the suicide note and phoned the suicide crisis line, they listened but were unconcerned since the attempt had occurred weeks ago and Reed seemed “fine” now. They offered to send brochures – not much help. What I needed was someone to guide us when we talked with Reed. All I could think of was “one wrong word and he’ll clam up” – or, worse yet, that we would inadvertently push him over edge.
A trusted minister came to our rescue. Reed confessed he had been attempting suicide “for years”, and there had been a suicide incident at university. Campus security had even been involved. I still can’t believe they didn’t call us.
Reed agreed to talk to the employee assistance counsellor where he worked. The counsellor noted how black and white Reed’s perceptions were, but was unconcerned, stating “Reed has his act together better than most kids.”
I was told it was Reed’s choice to follow up on the referral he’d been given (he didn’t); to choose life or death. My job was to “take care of myself” and not let Reed’s suicide attempt become the focus of my life. Yea, right, you try it!
Add to that the stigma of suicide which kept me doing any real research further than “suicide warning signs” (or realizing there even was any) and from reaching out to family and friends for support and informal education. We thus remained clueless.
Ultimately when we moved to North Vancouver we left Reed behind in Calgary. He seemed fine, we certainly hadn’t been counselled otherwise and he’d wanted to be on his own since he was two!. About a year later my mother’s intuition said things were deteriorating. I called the suicide prevention counselling service in our new city. No, they didn’t provide counselling to family members of suicidal people. No, they couldn’t recommend a private counsellor. I talked to one of the staff at our new church. I was told I was being too controlling.
We only began to untangle the situation when I was diagnosed with a clinical depression (funniest thing!) and started medication and therapy. For the first time, someone took our concerns seriously. The therapist reviewed our file of Reed’s school and medical records, his writings, and our notes over the years. She looked beyond the behaviours to the broader picture.
Although she hadn’t met Reed, her analysis was that he had been struggling with bouts of depression since the grade two move to Calgary and there were indications of a bi-polar disorder. But it was too late. While we were trying to set the stage so Reed would be open to medication and therapy, Reed implemented his own plan.
So, the paradox is that while I certainly appreciated the formal and informal services that so compassionately supported us after Reed died, another part of me was furious – why wasn’t this information and support available BEFORE Reed died, when it might have actually made a difference! Coming from the “fight” part of the “fight/flight” spectrum, I was determined to do something!
So in the flurry of planning the memorial service we arranged with the church to be the temporary holding place for the Reed J. Ball Memorial Fund. I’d track down suicide’s equivalent of the Cancer Society after the dust settled.
But of course, first there is this incredible grief, and the exhaustion from the grief, and finishing up the estate tasks from Reed’s death and just working hard to get the fundamentals going again – eat, sleep, work. Then the normal compulsion to try to understand “why” and the initial exploration to try to discover the equivalent of the Cancer Society, where I could donate the memorial funds received at Reed’s memorial service and perhaps volunteer in some way, all the while living a combination of too hyper and too flattened by grief to do anything other than go in a circle. The other inhibitor was that in 1995, the Web was still in its infancy, so there wasn’t really the option to “Google” the web and easily explore the world of suicide prevention.
After about 6 months I decided to take advantage of the free 1 on 1 bereavement counselling offered by SAFER, a mental health agency focused on suicide issues that has survived over 35 years of the ups and downs, budget cuts and reorganizations of what is now the Vancouver Coastal Health Authority. I’m sure the bereavement counselling was helpful, although I must say I don’t remember much of it. I do recall that in addition to the weekly 1 on 1 counselling there was a workshop for survivors that ran over two Saturdays. There I finally got to meet other survivors, which was nice, but the workshop wasn’t really enough time to develop a longer term connection with anyone and it wasn’t really organized to facilitate longer term connection with other survivors.
I do remember that my SAFER therapist didn’t know quite what to do with my passion to become involved. Apparently, getting involved was something that “survivors just don’t do”. Stigma, again? Ah well, I am continually reminded that as a “leading edge” baby boomer (I was born in 1944), all my life I’ve been just a little ahead of the curve in terms of frustration with the status quo, etc. Compounding that, when I have a bee in my bonnet, I can’t stop myself from rushing in where angels fear to tread.
So I persevered. On the “fight/flight” spectrum I am definitely a “fight” type, and I was totally focused on making a difference, so I had a huge amount of energy in that direction. On the other hand, I really didn’t want to do the “15 minutes of fame” sensationalistic thing. I also didn’t want to be “out there” alone. I also had the sense that because of the nature of suicide, it’s just too easy to put in a program that “looks good and tastes good”, but like potato chips – have no real substance, and may actually do more harm than good. While I disagreed with a lot of what I read, I also knew I knew very little about suicide let alone suicide prevention. I had to be sure that what I did would be “well grounded” in research, and connected/supported by whatever the respected resources were out there.
An analyst by both nature and nurture, my first step was to explore the “current situation”. It was more of a challenge than I expected. It turns out that there wasn’t any major nationwide suicide prevention organization to link into, similar to the Cancer Society, that had research and professionals, and a strong volunteer wing doing a variety of things from in-kind donation of professional expertise, to supporting other folks going through what they had, to fundraising – in short, the whole spectrum. I also had absolutely no background in psychology or mental health, so there was a whole new language to untangle.
I now realize that, along with many other survivors focused on action, I struggle with this “must do/can’t do” conundrum. I’d be absolutely focused on “making a difference” in some way, but when a resource was suggested I could never seem to “find the time” to follow up. I recall just feeling overwhelmed, too many directions to go in all at once, too many technical terms and organizational structures I didn’t understand. But now I wonder if the disorganization and not being able to get around to it wasn’t just part of the exhaustion and fuzzy brain that goes with deep grief. I was also working full time, so, in reality, didn’t have all that much available time.
January, 1995 – 6 ½ months after Reed died.
Many thanks to each of you who contributed memorials in Reed's name. We are still exploring the options for the money being held in trust. Ideally we would like to donate the money to an existing organization interested in supporting families where someone has attempted, but not died by, suicide. Surprisingly, the existing programs we have contacted seem restricted to helping the suicidal person (but not the family) or providing grief support for family after a suicide death.
In many ways the trauma during the year and a half after we learned of Reed's suicide attempts was more debilitating than dealing with the grief from his death. However, the point is that during that time we did still have hope for our son's future, we just did not know what to do or where to go for help. That is that support that we wish to enhance for other families through this memorial fund.
If that doesn't work out, our fallback is to donate the money to research and education about depression and related disorders in children. Based on a long list of otherwise unrelated clues, Reed was probably living with a high level of depression stemming back to age eight or ten. We sometimes wonder how many other labels we all may have mistakenly used for Reed's behaviour when he was exhibiting his depression: introvert, moody, hormones, short of sleep, the current flu bug, or that's typical Reed. Researchers are only now identifying that children can be clinically depressed and that some of the effects are caused by imbalances in body chemistry.
In addition to the items in the letter to our friends, intuitively I also felt that the fact that Reed had been gifted had somehow put him at risk for suicide, and I wanted to explore that.
Sometime during the summer of 1995 my SAFER therapist must have decided I wasn’t going to give up on this idea of “making a difference” and mentioned the annual conference of the Canadian Association for Suicide Prevention (CASP). It was basically a professional conference, and it was still pretty early in my grief journey, but if I really insisted she’d write a letter saying I was a SAFER volunteer so I could get the agency discount.
She also suggested I contact Jennifer White, who was director of a suicide prevention project at UBC. Jennifer listened and responded to me at an intellectual level rather than at therapy level. She was certainly compassionate and caring, but she didn’t put me off, she didn’t play the “expert” card, she didn’t dismiss me when I talked about something that needed to be done or what was going wrong. It was just magical.
The other thing that Jennifer (and other professionals I have since worked with) did was to allow me to vent my anger that would bubble up in otherwise analytical conversations and not take that anger personally. Jennifer not only heard through the anger to what I was trying to say, she actually took the trouble to learn from me and incorporate it into her perspective. She didn’t discount what I was saying as “just survivor grief/anger” She didn’t protect/defend the system and/or her professional colleagues by patting me on the head with “you had a bad call”. Instead, she’d say “yes, you are right” or we’d engage in mutual discussion and learning.
I did have the “benefit” that the suicide happened in Calgary, so I when I vented my anger, I wasn’t talking to the very people who let us down in the first place or to their colleagues or managers. I could truly say I was talking about trying to improve the system rather than getting someone fired. Little did Jennifer and I realize that that two hour coffee meeting would evolve into a partnership that continues today – fourteen years later.
In October 1995, sixteen months after Reed’s death, I attended my first CASP conference. My therapist was right, it was brutal – but along with meeting Jennifer, going to the conference was the starting point in my involvement in suicide prevention. I remember being exhausted. I remember feeling ignored by all the professionals at the conference. The therapists had come to the conference to meet with their peers, not support a basket case like me! On the other hand, when I did have the opportunity to talk to them one-on-one, they were unfailingly gracious and respected what I had to offer as a survivor.
I learned a huge amount. It was frustrating that there were no presentations on my “hot buttons” of the relationship between giftedness and suicide and living with someone who is suicidal, but on the other hand, that conference was key in starting to expand my horizons about suicide.
There were only a few survivors at that conference (stigma again? professional exclusion?), but I remember meeting Ann Edmunds, the first survivor to attend CASP conferences regularly and the first survivor on the CASP board taking me under her wing and giving me endless hugs and making me promise I’d come to the conference in 1996. So while I came home from that 1995 CASP conference emotionally exhausted, as it turns out, I had met the core of the people who have been my mentors ever since.
By this time, email was coming of age (although the Web as we know it today was still in its infancy) so I could stay connected with the people I had met at the CASP conference. With SAFER’s support, I began working on what eventually became a brochure called “Living with Someone Who is Suicidal”. SIEC1 helped me confirm that there wasn’t any brochure like it out there. Amazing! It would strike me as intuitively obvious that when someone attempts suicide, the family feels like it has been thrown into a living nightmare. Much as families of newly diagnosed Cancer, AIDS or Alzheimer’s patients, the families have had their “assumptive world” shattered, and need support on their grief and loss journey. Families also need information about suicide beyond the much touted “warning signs” and how to provide a “positive framework” for the suicidal person. There are now a few programs across Canada2, but at the time there was nothing, and amazingly no comprehension that there needed to be anything.
Thanks to the magic of email, I was able to forward drafts to my newly adopted mentors – my team - and they took time out of their busy lives to review them. What a gift! Jennifer was fabulous at rephrasing my often bitter and angry wording to something that took the barbs out, but still got my point across.
My “team” provided statistics and appropriate language for what I felt needed to be said, or when the research was different, gently said “well, actually, the research says this…” I had fabulous discussions with my various mentors. I learned a huge amount about suicide and I think they learned much from my “lived wisdom”.
I remember one point I wanted to make, to help professionals and families get past their denial, was that once a person has attempted suicide they are at higher lifetime risk for suicide. The emails went around and around. It turns out the professionals were looking “forward” - only 10% or so of people who attempt suicide go on to die by suicide, while I was looking “backward” - of the people who die by suicide, 40-50% have attempted suicide before. 3
The brochure4 was done in time for me to take it to the 1996 CASP conference in Toronto. I recall still being pretty shaky emotionally, but Anne Edmunds was there to hold me up and now included me in her circle of friends. Best of all, psychologist Heather Fiske was presenting a paper on “Including Parents of Suicidal Adolescents in the Treatment Process: A Psychoeducational Program”. I showed her my new brochure. She liked it. She agreed to pass it out at her presentation, and gave it a glowing endorsement when she did. I added another mentor to my team.
Back home in Vancouver, Jennifer continued to offer me opportunities to learn and to participate. She asked me to write Reed’s “Story” for Lifelines, the journal of the Suicide Prevention Program at UBC, and invited me to write other articles over time. When an article on “Blaming the Health Care Professional” by a health care professional came out in March, 1998, followed by “Blame after Suicide: A Cultural Perspective” by the Executive Director of SAFER in September 1998 - and they both made my hair curl, Jennifer first invited me to critique it and then mentored me through writing an article from the survivor perspective.5
In late 1997, Jennifer invited me to be on her Provincial Advisory Board for Suicide Prevention, the only survivor in a room full of bureaucrats. It was quite a challenge as I’d never sat on a committee of this type before, but I got to be one of the reviewers for “Best Practices in Suicide Prevention Manual” and reviewer and contributor to “Practice Principles: A Guide for Mental Health Clinicians Working with Suicidal Children”6.
Somewhere along the way, UBC had volunteered to host the annual CASP conference with Jennifer as Project Manager and in 1998, she asked me to join the planning committee, the rest of whom were various health care professionals. I was beginning to understand the lingo and players at this point, but I often still felt like my voice was dismissed. I did have the thrill of being the primary writer/editor of the Call for Abstracts (and me, a computer jock!).
By this time I was also quite clear that there was a place for survivors and professionals to work together in partnership – similar to any other “cause”, it’s the families who finally get the “cause” on the public and political agenda, raise funds, contribute their professional and volunteer skills, participate in research, provide peer support, raise the issues, find (and often fill) the gaps, provide their “lived wisdom” to researchers, and shape public policy and practise protocols. The professionals, however, didn’t seem to “get it” – the paradigm apparently being that survivors are the “patients” that the professionals are caring for and/or that the survivor’s “role” is to grieve (including anger and attempting to resolve their self-blame by shifting the blaming to others), which overshadows survivor ability to contribute in any effective way. Clearly not true for all survivors, but paradigms are hard to shift.
But with much effort and support from another “survivor in action” Jennifer introduced me to, the CASP conference had its first “Survivor Orientation Day”. The structure was a “psycho-educational/awareness” model rather than an “emotional support model”. We provided good basic information about suicide to provide survivors with a foundation for the conference, explained the common grieving process for survivors of suicide and introduced survivors to the concept of “Survivors in Action”. And, of course, through all of this we provided opportunities for the survivors to get to know each other, so they wouldn’t feel so alone during the main conference.
As the professionals gained confidence and comfort with my understanding of the broader issues in suicide prevention, I was asked to speak from the “survivor perspective” in various media interviews. The relationship worked both ways, as I depended upon them to vet which media to work with, to provide the core statistics and background information, and to help protect me from being exploited.
Meanwhile on the gifted/suicide front, a Christmas card in 1996 from an old friend of my husband mentioned that his psychologist wife counselled gifted youth. I wrote her of my perceptions about the “dark side of giftedness" somehow being a risk factor for suicide and asked for suggestions (SIEC had found little on giftedness, particularly as it related to the issues I’d perceived). She sent me an article by Dr. Tracy Cross of Ball State University in Indiana. For the first time the analysis sounded just like Reed! I emailed Dr. Cross – he emailed back, and another incredible journey began. He agreed to do a psychological autopsy of Reed. It took six years, but ultimately we wrote and co-presented the research paper “A Psychological Autopsy of the Suicide of an Academically Gifted Student: Researchers’ and Parents’ Perspectives “7 I didn’t really get the “answer” as I’d hoped, but I learned a huge amount, including why research into non-quantifiable risk factors like giftedness is so difficult.
Since the conference was in Vancouver in 2000, I felt increasingly accepted as part of “the team”. I replaced Anne Edmunds on the CASP board in late 2001, and started the Survivor Advocate Listserve8 in February of 2002, which now has over 300 members. The Listserve, while originally designed so those few of us who are “survivor in action” types wouldn’t feel so totally alone, is now an eclectic mix of survivors, researchers, and service providers of all types sharing what they are doing and what needs to be done. It has turned out to be the tool to win over our professional friends to the concept that we CAN work together and we CAN make a difference.
So what “made the difference” in my becoming a “survivor in action”?
And why do I continue? After 15 years I’m actually able to see that things are changing and I like to think I’ve helped that happen. The suicide rate hasn’t come down appreciably, but the public is more aware. A group of new documents, including two to help professionals working with suicidal adults, include strong sections on understanding the family trauma and supporting them after a loved one has attempted suicide.9
On a separate note, there’s seems to be a bit more acknowledgement that people who are gifted or are “academic overachievers/perfectionists” aren’t immune from struggling with suicide – the finding of the research paper I co-authored, actually!
We don’t yet have a Canadian National Suicide Prevention Strategy, but we now at least have a discussion document – a “Blueprint”. The document is a collaborative effort of a variety of health care professionals, researchers and, importantly, survivors. Various levels of government are showing an interest and it is already a working document for groups doing strategic planning around suicide prevention.
“Veteran” Survivors (i.e. folks who are past the awful raw grief stage) are increasingly respected for both their “lived wisdom” and the volunteer and professional skills they can bring to the table. Survivors are increasingly asked to be active participants in research, advisory committees and editorial review of policy and practise manuals, as well as taking initiative themselves.
At an individual level, I talk to more and more new survivors who have chosen to be open about the suicide, and have been met with care and compassion from family, friends and faith community. In short, more and more Survivors are feeling comfortable “breaking the silence” and as the silence is broken, more are feeling comfortable coming forward to “make a difference”.
What is probably equally important is emerging research that talks about “instrumental grievers" – people who process their grief by “doing” rather than going to support groups. So maybe in the near future grief therapists and service practitioners will be trained in how to appropriately support us “Survivors in Action”.
The other good news is that there are now discussions within psychiatry acknowledging the phenomenon of “Post-traumatic Growth”. This is the age old concept that when something traumatic – a house fire, horrific car accident or the suicide of a loved one – happens that shatters our very being and our understanding of the world, the ensuing struggle to make “meaning of the madness” can ultimately lead us to a new resiliency, deeper relationships, and an overall better handle on our lives.
And so, though it is bittersweet, the last fifteen years have been an incredible journey through both pain and joy. Perhaps that is the final stigma of suicide that needs to be tackled. Similar to other journeys we never expected or wanted to be on, survivors of suicide need to be able to say that while our lives will never, ever be the same after a suicide, eventually – if we are willing to engage in the struggle – there can be life and hope and even growth.
1. Suicide Information and Education Centre, which has now evolved into the Centre for Suicide Prevention, http://www.suicideinfo.ca/ The SIEC Library and Database contains the largest collection of English language information on suicide and suicidal behaviours in the world.
3. "…one previous attempt multiplies suicide risk by 38-40 times" NIMH Director Thomas Insel, M.D., COGNITIVE THERAPY REDUCES REPEAT SUICIDE ATTEMPTS BY 50 PERCENT, August 3, 2005 "Journal of the American Medical Association (JAMA)".
5. http://www.turtleisland.org/news/news-youth.pdf page 13.
7. Cross, T., Gust-Brey, K., Ball, P.B. A Psychological Autopsy of the Suicide of an Academically Gifted Student: Researchers’ and Parents’ Perspectives, Gifted Child Quarterly 46 (Fall 2002): 247-264.
http://www.davidsongifted.org/db/Articles_id_10337.aspx (2004 NAGC Gifted Child Quarterly Paper of the Year Award winner)
9. See: http://www.carmha.ca/publications/index.cfm?topic=13 The documents include: Working with a Client Who is Suicidal: A tool for Adult Mental Health and Addiction Services, Working with a Suicidal Patient: A Guide for Health Care Professionals; Coping with Suicidal Thoughts, and Hope and Healing: A Practical Guide for Survivors of Suicide