All the Things We Never Knew (39 page)

Because Portland, Oregon, is a relatively small city and many people are aware of the circumstances of David's death, I am
stopped every now and then by someone who whispers, “My mother committed suicide,” or “My ex committed suicide.” In our culture, we're much less likely to whisper about the death of a loved one from cancer or heart failure, yet the stigma attached to suicide forces us into the shadows with our grief and our questions—most notably, “WHY?”

Some days, I am content with Chopra's view that David's death was part of his inevitable journey. Other times, I am struck with the emptiness of it all, how permanent an end he chose to his temporary suffering. It was not the answer.

The role of antidepressants in David's suicidal state is a topic large enough for a book of its own. It was just three days after David started on antidepressants (Lexapro) that he had his first suicidal thought. I was concerned that because of his poor liver function, the drugs made him more toxic. Antidepressants, if prescribed alone, rather than with mood stabilizers such as lithium or anticonvulsants, can precipitate the type of mania David experienced for the first time on the drug. His initial diagnosis was bipolar disorder type II, mixed state, with suicidal ideation. David had admitted in his initial interview that he had had recurrent depression but had never experienced a full-blown manic episode until three months before his death. In my opinion, David should never have been placed on Lexapro.

The medical summary I received details the psychiatrist's first attempts at a Self-Administered Battery and Personality Assessment. David was unable to complete the task. The doctor finally learned that he believed he'd been “frozen” for several months, unable to bill his work and confused about why his brain was becoming so muddied. David related several periods in his past in which he'd had a brief inability to work, but never as bad as that particular situation.

He admitted to being hypersexual, and told the psychiatrist, “I think I have lost my mind. I'm a completely different person now than I was. Every day I'm getting more different. I have trouble tolerating this moment, any moment. Everything seems so unreal to me. I don't want this to be real.” David told the doctor he believed
his life was done, even though he was still alive. He said, “The life I had before was a good life, a zillion times better than this one, due to my own actions. I let it go. It is completely my fault.”

There is one fact that is particularly potent that I believe should be shared with every loved one of someone who is hospitalized with bipolar disorder: people with manic depression are most likely to kill themselves following their release from a psychiatric hospital.

The transition out of hopelessness, lethargy, and despair is commonly mixed with rapidly swinging mood states. When patients are released, a resurgence of vitality makes it possible for them to act out previously frozen suicidal thoughts and desires. According to Dr. Kay Redfield Jamison, one of the leading experts in the field, psychiatrists are often baffled by the suicides of those patients who appear calmer and in “better spirits” than those who do not. The period during and immediately after a patient's first hospitalization is, at best, a gamble. The family members of the mentally ill should be aware of this and be trained to deal with the dangerous period of uncertainty following their loved one's psychiatric hospitalization.

Of all the authors who brought me closer to understanding David's illness, I'd like to offer a special thanks to one who never treated him: Dr. Jamison. Her ongoing battle with manic-depressive illness, and the numerous books she's written on the topic, had a profound effect on me.

Jamison, too, has attempted suicide, and her vivid writing about the terror of battling a mood disorder allowed me to frame David's decision in the context of his illness, not as a selfish act or a defiant one. Jamison keeps the last line of a poem on her desk that draws her in when things go dark and she is exhausted by the futile attempts to pull meaning from life. It is from Douglas Dunn's “Disenchantments,” and I have copied the line to help me through my darkest hours.

“Look to the living, love them, and hold on.”

RESOURCE ORGANIZATIONS

American Association for Marriage and Family Therapy (AAMFT)

The professional association for the field of marriage and family therapy that represents the professional interests of more than 50,000 marriage and family therapists in the United States, Canada, and abroad. Founded in 1942, AAMFT aims to increase understanding, research, and education in the field of marriage and family therapy. The organization conducts a national exam for marriage and family therapists used for licensure in most states.
www.aamft.org
.

American Psychiatric Association

Founded in 1844, the American Psychiatric Association is the world's largest psychiatric organization. It represents over 36,000 psychiatric physicians from the United States and around the world. Members specialize in the diagnosis and treatment of mental and emotional illnesses and substance use disorders.
www.psych.org
.

American Psychological Association (APA)

A scientific and professional organization that represents psychology in the United States. With nearly 130,000 members, it is the largest association of psychologists worldwide. Founded in 1892, it aims to advance psychology as a science and profession and as a means of promoting human welfare by promoting research, establishing and maintaining standards, and diffusing knowledge. In 1992, APA established the Disaster Response Network (DRN) to work collaboratively with the American Red Cross and other relief organizations to provide licensed psychologists onsite to aid disaster victims and relief workers. More than 2,000 psychologists have received required disaster response training and are DRN members.
www.apa.org
.

Center for Mental Health Services (CMHS)

A component of the Substance Abuse and Mental Health Services Administration (SAMHSA), Public Health Service (PHS), and Department of Health and Human Services (DHHS), CMHS is charged
with leading the national system that delivers mental health services and administers programs and funding for assisting people with mental illness with treatment, employment, housing, and transportation. CMHS was established under the 1992
ADAMHA Reorganization Act
. The Emergency Mental Health and Traumatic Stress Services Branch (defined below) is housed within CMHS.
http://samhsa.gov/about-us/who-we-are/offices-centers/cmhs
.

Children's Advocacy Centers

Established by the Office of Juvenile Justice and Delinquency Prevention within the U.S. Department of Justice to assist communities in improving their response to child abuse, the centers provide information, consultation, training, and technical assistance; help to establish child-focused programs; and support coordination among agencies responding to child abuse.
www.ojjdp.gov
.

Department of Health and Human Services (DHHS)

The U.S. government's principal agency for protecting the health of all Americans and providing essential human services, especially for those who are least able to help themselves. The department's 300 programs cover a wide spectrum of activities and purposes, from medical and social science research, disease prevention, and food and drug safety to health insurance for elderly, disabled, and low-income Americans and maternal and infant health. In the Federal Response Plan (FRP), DHHS is the lead agency responsible for carrying out Emergency Support Function number 8 (health and medical care) and plays a supporting role in mass care and information and planning.
www.hhs.gov
.

Department of Veterans Affairs (VA)

The VA is the U.S. government agency charged with providing benefits and services to veterans and their dependents. Its health care system provides a broad spectrum of medical, surgical, and rehabilitative care and also houses the National Center for Post-Traumatic Stress Disorder, Readjustment Counseling Service, and the Emergency
Mental Strategic Health Care Group. In the Federal Response Plan, the VA plays a supporting role for four emergency functions: public works, mass care, resource support, and health and medical services.
www.va.gov/about_va/history
.

Emergency Mental Health and Traumatic Stress Services Branch

A branch of the Center for Mental Health Services that is responsible for meeting the mental health needs of disaster survivors and responders, the EMHTSSB works in collaboration with FEMA to implement the Crisis Counseling Assistance and Training Program when a state has applied for a Citizen Corps Program (CCP) grant after a federally declared disaster. The grants may be for immediate services, which support services for sixty days past the declaration date, or for regular services, which support services for nine to fifteen months past the declaration date.
www.fema.gov/additional-assistance#0
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International Critical Incident Stress Foundation

A nonprofit foundation dedicated to preventing and mitigating disabling stress through the provision of education, training, and support services for all emergency services professions, including continuing education and training in emergency mental health services for psychologists, psychiatrists, social workers, and licensed professional counselors, and consultation in the establishment of crisis and disaster response programs for varied organizations and communities worldwide.
www.icisf.org
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National Association of Social Workers (NASW)

A membership organization that promotes, develops, and protects the practice of social work and social workers, NASW also seeks to enhance the effective functioning and well-being of individuals, families, and communities through its work and its advocacy.
www.naswdc.org
.

National Center for Post-Traumatic Stress Disorder (NCPTSD)

A seven-site consortium created by public law and housed within
the Department of Veterans Affairs. The mission of the NCPTSD is to advance the clinical care and social welfare of America's veterans through research, education, and training in the science, diagnosis, and treatment of PTSD and stress-related disorders. As a leading authority on PTSD, NCPTSD serves and collaborates with many different agencies and constituencies, including veterans and their families, government policymakers, scientists and researchers, doctors and psychiatrists, journalists, and the lay public.
www.ptsd.va.gov
.

National Institute of Mental Health (NIMH)

A part of the U.S. government's National Institutes of Health, PHS, and DHHS, the NIMH is responsible for research on mental health and mental disorders, including research on the mental health consequences of and interventions after disasters and acts of mass violence.
www.nimh.nih.gov
.

National Organization for Victim Assistance (NOVA)

NOVA is a private, nonprofit organization of victim and witness assistance programs and practitioners, criminal justice agencies and professionals, mental health professionals, researchers, former victims and survivors, and others committed to the recognition and implementation of victim rights and services. Its mission is to promote the rights of and services for victims of crime and crisis.
www.try-nova.org
.

Office for Victims of Crime (OVC)

A federal agency established by the 1984
Victims of Crime Act
to oversee diverse programs that benefit victims of crime. OVC provides substantial funding to state victim assistance and compensation programs, the lifeline services that help victims to heal. The agency supports training designed to educate criminal justice and allied professionals regarding the rights and needs of crime victims. OVC is one of five bureaus and four offices with grant-making authority within the Office of Justice Programs, at the U.S. Department of Justice.
www.ojp.usdoj.gov/ovc
.

Public Health Service (PHS)

A major division of the Department of Health and Human Services, PHS is the principal health agency of the U.S. government. PHS is responsible for promoting and ensuring the nation's health through research into the causes, treatment, and prevention of disease.
www.os.dhhs.gov/phs/phs.html
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Substance Abuse and Mental Health Services Administration (SAMHSA)