Eighty per cent of people thinking about suicide send out a warning, and about 80 per cent of lethal suicides follow an earlier attempt. There are about 20-40 suicide attempts for every completed suicide. A suicide attempt is the strongest predictor of future death by suicide.
MEN’S EXPERIENCE OF GRIEF
In 1994 I attended my first suicide prevention conference with my wife, a noted psychologist with considerable expertise in suicide prevention and bereavement programs. Traveling to Canada’s artic, we visited Iqaluit in Nunavut, a community of 3,000 people, the only city in a vast region.
Organized by the Canadian Association for Suicide Prevention, there were keynote addresses, workshops, seminars and meetings with speakers from around the world. I volunteered to help out and immersed myself in the conference. I experienced first hand the anguish and grief of the local community which has been ravaged by suicide deaths for the past twenty years. Knowing next to nothing about suicide, prevention and bereavement, there was much to learn, absorb and take to heart.
This first conference experience for me started an educational process that quickly accelerated in 1996 when I became Executive Director of a national Lawyers’ Assistance Program in Canada. While I had helped found the program in 1990, I was now responsible for developing Health, Wellness and Recovery materials for 70,000 lawyers and judges across Canada. To me, it had become natural to include suicide prevention in the new materials I was creating.
Our interest in suicide prevention and bereavement services accelerated when LPAC received an urgent call for help from the Province of Nova Scotia after a series of lawyer suicides in the city of Halifax. The Barristers’ Society, the Nova Scotia Branch of the Canadian Bar Association, and the entire legal community were in distress. The economic downturn of the 1990’s seemed to have triggered an epidemic of suicide deaths among older lawyers in particular. No one knew what to do or what to expect next.
Having an entrepreneur’s approach to problem solving, I initiated what I hoped would be a comprehensive and integrated response to the situation. First, I undertook research, which included an attempt to research and to understand the scope of the problem. The LPAC 1997 Lawyer Suicide Study identified suicide as the third leading cause of death and established an approximate suicide rate of 69.3 suicide deaths per 100,000 population, nearly six times the general population.
The original LPAC 1997 Lawyer Suicide Study was the first reported investigation of lawyer suicide in Canada and the data has been widely reported and quoted in research papers and in professional articles around the world. It appears to be the first time anywhere that lawyer suicide had been studied.
THE LPAC SUICIDE PREVENTION PROGRAM
In response to the situation in Nova Scotia, LPAC began a nation-wide suicide prevention and bereavement support training program for lawyers and judges and for Lawyer Assistance Programs in 1997. LPAC consulted with Dr. Brian Taney and Dr. Roger Tierney of the Canadian Association for Suicide Prevention (CASP) and with Dr. Lanny Berman and Dr. Morton Silverman of the American Association of Suicidology (AAS) for ideas and direction. We accessed information, data and materials from the Suicide Information and Education Centre in Calgary, the leading suicide library facility in the world. We enlisted the support and expertise of my spouse Dr. Heather Fiske, a clinical psychologist with expertise in hospital and community-based suicide prevention programs and strategies whose innovations have enjoyed strong peer support and approval within both CASP and AAS.
LPAC presented a half-day suicide prevention program at the 1997 National Workshop for the American Bar Association Commission on Lawyer Assistance Programs (CoLAP) in Washington, D.C. featuring Dr. Fiske and Dr. Berman, Executive Director of AAS. This was the first time that suicide prevention was addressed at any CoLAP Workshop and it appears to have been the first such program in the world. This was a remarkable accomplishment for a fledgling program.
LPAC presented a second suicide prevention program the following year at the joint LPAC/CoLAP 1998 International Workshop in Montreal. This program featuring Dr. Taney and Dr. Fiske focused on suicide bereavement and support training.
LPAC and Dr. Fiske created the Suicide Prevention Education Manual with teacher and student materials for LPAC’s Health, Wellness, and Recovery Education Series in 1999, the most comprehensive lawyer wellness materials available anywhere.
Awareness of suicide risk in the legal profession has been greatly improved by the CBA and its LPAC programs. Suicide prevention is now an accepted part of the mandates of assistance programs for law students and lawyers and judges. A cluster of lawyer suicides has not occurred again in Canada, but if it should occur, a program has been left in place to offer support.
In every year since 1999, we provided suicide prevention programs for the Canadian Bar Association, and for many provincial and state Lawyer Assistance Programs and Bar Associations in Canada and the United States. In 2001, LPAC presented its course materials for peer review at a major medical conference for addiction physicians.
In 2002, our website was expanded to include all of the 25 courses in the Health, Wellness and Recovery Education Series. These courses can now be read, downloaded and printed without charge by anyone in the world. They have been translated into four languages for use by Bar Associations in Canada, the United States, Europe, New Zealand and Australia.
MENS’ EXPERIENCE OF GRIEF
In 2003, my wife and I again traveled to Iqaluit, Nunavut for the annual CASP suicide prevention conference. She was to Chair a panel of men speaking on our experience of grief and the panelists included me and two of our friends, Hugh and David. The panel presentation was dramatic, emotional, and very revealing.
Heather addressed 7 questions to each of us:
We learned that both Hugh and David had been stuck in their grief and confusion for nearly ten years. Each had lost a son in his twenties and the loss had been devastating.
Hugh told us that he had been angry, frustrated, confused and bewildered. While his wife investigated survivor groups and then busied herself in starting bereavement support groups and teaching at conferences, Hugh had been on the sidelines. His pain was so deep and so repressed that he had no means of understanding or accepting his loss, much less letting go or moving on. In addition to anger, Hugh left overwhelming guilt and remorse, even though he fully understood that there was nothing further he could have done to prevent his son’s death by suicide.
Slowly, over a period of more than ten years, little by little, cracks began to appear in Hugh’s impervious shell. As Leonard Cohen wrote, cracks are how the light begins to get in. Hugh met other men and this allowed for quiet and private sharing so that little by little, Hugh began to experience progress.
The culmination of Hugh’s growing understanding and acceptance was his participation on the panel in Iqaluit. For the first time in his life, he shared openly and publicly in a room full of suicide survivors. Tears flowed, anguish was evident and they were joined by love, support and acceptance. At the end of the session, every man and woman in the room lined up to hug Hugh.
For Hugh, his healing was finally well under way.
David’s story was remarkably similar but his approach had been very different. Rather than accompany his wife to suicide prevention and bereavement events and stand in the background as Hugh had done, David had stayed away all together. On his own, he had searched and researched with an engineer’s zeal to find out and to understand why his son had died by suicide. He believed that if he could understand the reasons, he could come to understand and accept his son’s death.
While telling no one about his search and his research, he studied the investigative file respecting his son’s death, including the autopsy report and the coroner’s report, difficult, even dreadful reading for anyone. David maintained a dispassionate and professional approach as a coping mechanism. His research led him to studies and to reports, which added to his general knowledge but gave him little insight into his son’s death.
Like Hugh, cracks slowly began to appear in David’s thick skin and slowly and gradually the light filtered through.
It now appears likely, these many years later, that both of these young men had died by suicide as a result as an undiagnosed and untreated bi-polar disorder. While both had been treated for clinical depression, the medications they were prescribed would be useless or even harmful to someone who’s true or correct diagnosis is bipolar disorder. This appears to be plainly established by research done in Canada by leading psychiatrists and psychologists and it is confirmed by similar research done elsewhere.
Hugh and David teach us that men can find the pain of a death by suicide, especially the loss of a child, overwhelmingly painful. It may be that our skills as men are limited in this area and that our ability to seek help is limited as well, perhaps by custom, training or habit. While Hugh and David’s respective wives had turned their bereavement and suffering into a loving involvement in suicide prevention and bereavement support, Hugh and David’s inability to step outside their intolerable pain left them locked in isolation.
For those of us who work in suicide prevention and bereavement support, the experience of Hugh and David is not unusual. For many men, the stereotype appears to fit.
Now, some of you may have noticed that I have neatly avoided my own participation in the panel. It’s time to fill in my story.
As you now know, I became seriously involved in suicide prevention work in the mid 90s and by 1999 I was the author of a major study, the creator of a national program and I was someone who came to and presented at suicide prevention and bereavement support conferences. I helped set up chairs, take registrations, moderate educational programs and I attended the bereavement services with my friends. Every now and then, a stranger would cry on my shoulder and I would provide the natural support we learn in our role as parents and as friends. I thought I understood.
My story continues in 1999. In addition to running my federal Lawyer Assistance Program, I was still practicing law and everything was moving along nicely. In fact, I was having a great year professionally and personally. My law practice was going very, very well and I felt honored to be chosen to represent a regional police service at a Public Inquiry. My wife Heather and my two children were doing well in their chosen fields. As an alcoholic in recovery, I had been sober more than 10 years and I felt great.
Nonetheless, as the year developed, events began to overtake me. In September, a very close family friend died in my arms and taught me, for the first time in my life, to truly grieve. As it turned out, this was a new skill I would soon need in quantity.
The Public Inquiry turned ugly and threats by terrorists meant I was going to work in body armor, protected by an armed tactical police team. As an aside, I must tell you that it is difficult to express the shame a man feels at bringing the risk of terrorism into his home and to his wife and children. As you can sense, things were beginning to get more than a little difficult.
In my recovery program, we have a tradition of mentoring called a sponsor, and my sponsor was an elderly man who I love dearly. A survivor of lung cancer some 15 years earlier, he learned that fall that his remaining lung was cancerous and he quickly became seriously ill. So in this setting and at this time, in late October I received a telephone call telling me that my mother had died by suicide in her retirement home in the South of England. My parents, immigrants to Canada in 1948, had retired to England in 1988. Using a combination of pills and alcohol, my mother had suffocated herself with a plastic bag after carefully researching the most lethal and reliable methods. She had sent my father out of town so that he could not be implicated in her death.
My mother, Francis, had been unable to walk, using a wheelchair for more than a dozen years. A fiercely independent woman, she had died by suicide rather than face the fear of being institutionalized with the loss of autonomy and dignity she believed that would bring. She had planned her death very carefully and packages were sent by courier with her suicide note.
I had no idea how to feel. I carried on with my work feeling numb and little else. I spoke with my father by overseas telephone, and he appeared to be frightened, confused and uncertain. As is often the case in families when there is a death by suicide, people can act poorly. The results were hard to bear.
The funeral planning was delayed for a time as the police made their inquiries and the county coroner conducted a full investigative autopsy. I was asked not to come to England until those enquiries were completed. So, I waited for word and tried to keep in touch.
The funeral was finally scheduled for two weeks later but I was not notified of the arrangements until just hours beforehand. My father and two of our brothers had avoided telling me and another of my brothers about the arrangements for our mother’s funeral so that with us in Canada, and my dad in the South of England we were effectively kept away.
Many of our friends asked me why my father and brothers would do such a thing. I have no idea but I now suspect that fear and anger were the cause. In truth, I cannot explain further.
I was deeply hurt, confused and even shocked. I felt stuck. When I confronted my father about his conduct, he blamed the situation on me. He soon became ill and he too died not long after. This is often the case when a couple has been married more than 50 years. When one spouse dies, the other often follows not long after.
With both my parents dead, I was even more confused and stuck. But I was lucky. Things happened that brought me progress and peace.
First, I attended a suicide prevention conference in Los Angeles. While I had planned to go to the conference anyway, what I discovered when I arrived was a revelation. For me, everything was different. Every poster, every bulletin and book, every presentation, speech and seminar, every face-to-face contact. I was pretty well known at the event and had dozens of friends and several hundred acquaintances in attendance. I had a good reputation as a hard worker, a friendly individual and a kindly man. Word spread quickly and I was to receive hundreds of pats and hugs and words of comfort. During the survivors’ portion of the conference, we had the usual candle light ceremony. The organizers asked me to light the candle during the service as a survivor who lost a parent. As a trial lawyer, I had 30 years experience in performing in public, even when I felt poorly. I walked to the front with my candle, lit it and confidently placed it in the holder. My task complete, I turned to walk the twenty paces back to my seat in front of the crowded auditorium. It was the longest walk of my life. Safely seated, I cried on the shoulder of a stranger.
That stranger is now a good friend and colleague and earlier this year, he and I were on a new panel, describing the experience of men’s grief.
So, I should now fill in the answers to the questions that were posed to me in these panels.
I was bewildered, sad, confused and angry. At the same time, I felt a peacefulness in my relationship with my mother who is no longer in pain and distress. This leads me to an observation I feel compelled to make. While the experts will tell us that we should not compare our losses, I am most firmly of the view that there is a huge difference between the loss of an aged parent, disabled or otherwise, and the loss of a spouse or the unspeakable suffering of the loss of a child. While my mother’s death by suicide opened my mind, my heart and my eyes in a way I had never anticipated or expected, I have been spared the profound and complex grief that you and many of my friends have experienced. Quite frankly, your loss and pain to me appears intolerable.
From numbness, to hurt and loss, to anger and to peaceful resolution. I remember each of these stages with clarity.
I was so lucky in three different ways. Firstly, my wife and two children held me, comforted me and loved me. This made all the difference. Secondly, I put the word out to my friends, colleagues and associates and the results were truly astonishing. I received notes, cards, e-mails, flowers and phone calls from over 200 people and I was completely overwhelmed with this support. From the janitor and the security guard in my office building, to friends and professional colleagues, to a former president of the United States. They all took time to get in touch. This outpouring of support was as humbling as it was healing. Finally, I had your help. I was already a part of the suicide prevention and bereavement support world and you all came to my rescue. At conferences and at meetings; from that day until this day, you have all had your hand in keeping me safe.
Clearly, my family and our dysfunctional history. I needed a chance to grieve at my mother’s funeral and I needed an opportunity to comfort my father and be comforted by him. None of this was possible.
Strangely, the stereotypes all apply. As a man, I was quick to shut down and shut off. On the other hand, I had the support of my family and my friends and I took their advice to reach out for help. They were smarter than I could be at that time and I was lucky to have their advice and even luckier to be able to take it. As I have told you, the support I received was truly astonishing.
I’ll answer these two questions together in a minute, but first I have to give you the final chapter of my story.
After my father died, I felt trapped in an issue I could never resolve. With my sister and brothers, I did attend his funeral and for me it was a ceremony for both of my parents. I taped letters from me and from my children to my dad’s coffin with the goal of burying my hurt and anger with him. It only helped a little. One last event came to pass that made me whole again.
You remember my sponsor Clive and the reoccurrence of his cancer. As time went by, he grew more and more ill. He was in and out of hospital and I visited him often, sometimes with my security detail in tow. One Sunday morning in February I realized that it had been several weeks since I had called Clive and when I did telephone I learned that he was back in hospital and very, very ill. I drove to the hospital that day and learned that it was his 75th birthday. He wanted pizza for lunch and this became my birthday gift to him. He entertained his family, including his grandchild and had a wonderful day. Yet, it was clear to me that his hours were numbered. With his family’s permission, I let a number of our joint friends know and quite a few of them dropped by to see him the next morning. That evening I went back to the hospital to attend a meeting of Alcoholics Anonymous with my three closest friends and our plan was to drop by and see Clive, go to the AA meeting, then say goodnight to Clive. If he was well enough, we’d take him to the meeting as well.
When we arrived at the hospital, Clive’s daughters were in great distress. Clearly, he was dying and he was very, very uncomfortable. We stayed for a few minutes and then went to the meeting as planned. We left the meeting early, going back to his room before visiting hours closed. The scene in Clive’s room was awful. He was semi-conscious and in great agitation and picking at his skin. His daughters were very upset. I looked at Clive closely and realized that his oxygen tube was behind his head and I replaced it in its proper place, with the canula into his nose. This is rather a personal thing to do for another man but as soon as I did it, Clive calmed right down and became relaxed. I realized that he had been suffocating without the oxygen, causing the behaviour and symptoms we had seen.
With their father relaxed and comfortable, his daughters calmed down and together we watched Clive slip off into death.
For me, this experience with Clive healed the loss I had felt from my absence at the deaths of my own parents. While I truly regret that my mother died alone and at her own hand, I am now at peace with it. While I still regret my father’s conduct at the time of her death and after, I am at peace with it. By being able to care for Clive and to comfort his widow and his daughters and to stand as his pallbearer, I found peace and serenity. In dieing, Clive gave me what I needed to move on. There is a saying in AA, Doing for us what we cannot do for ourselves.
To answer question 6 and 7, let me say this.
If there was one thing by way of experience or advice I would want to pass on to you all here today, it is this: Men need your support, love and experience every bit as much as women and children. For many of us, we also need your guidance and your ability to reach out even when we as men do not have the common sense to reach back and take your hand. We are teachable, if a little slow. Have patience. We too have much to offer.