In "How a Family Copes with Schizophrenia and Suicide," NPR's All Things Considered tackles the difficult subject of suicide not always being preventable. As psychiatrist Harold Schwartz puts it:
"It's important for everyone to know that for some people, suicidal ideation and suicidal intent is a terminal illness. There are many things that we can do to prevent an individual from committing suicide, but we can't always do it. We can't always be successful."The NPR report tells the story of Homer Bell's family in the aftermath of the 54-year-old man's suicide in April. By the time Homer died, the family had been worn down by three decades of trying to help manage what seemed to them to be an unmanageable disease. Shortly before Homer's suicide, he showed up at his mother's house, but she had for a long time been unable to allow him to stay there because of the seriousness of his illness:
"He was frightened. I saw that fear. Nobody understands what I'm trying to say. It's not the idea I feel guilty because he passed away. Maybe I couldn't have helped that. But what bothered me is no matter what nobody does, I'm still his mother. I was supposed to let him in that house to help him because I saw the fear, but I didn't know what to do. And then I went to the window, and I heard him say, 'I'm waiting for Mommy.' I heard him. I'm looking at him. I walked away from the window. I said, 'God, what do I do?' I said, 'Jeez, I don't know what' -- I didn't know what I was going to do. I went back to the window, he was gone. That's the last time I saw my son. I just didn't open up the door. I didn't know what to do, maybe because I was tired ...This heartbreaking story points to the downside of statements depicting suicide as universally preventable, such as those of U.S. Surgeon General Regina M. Benjamin last fall, during her announcement of a new National Strategy for Suicide Prevention:
"The latest research shows that suicide is preventable, suicidal behaviors are treatable, and the support of families, friends, and colleagues are critical protective factors. Suicide prevention needs to be addressed in the comprehensive, coordinated way outlined in the national strategy."The readers' comments to the NPR story demonstrate the range of perspectives and opinions regarding whether and how suicide can be prevented.
One reader writes about his brother's treatment, which has protected him from suicide but has come with serious side effects from the medication he is taking:
My brother has suffered from bipolar with psychotic features since his mid-twenties, and there were times when I was very certain that I would get a phone call informing me that he was dead. While he is now on medication, and not experiencing the wild swings of his disease, his life is not a happy one. The medications are so powerful that he can do little more than sleep. A once active man now can't hold a job and lives at home with my parents.Another reader focuses on the need for more assistance for homeless people who have a mental illness:
So sad. The mother can't blame herself. It must be so exhausting to deal with this and not get adequate help. I am not America bashing, but all my friends from abroad are shocked that there are so many homeless Americans on the street who have obvious mental issues and don't get the help they -- or their families -- need.But one reader -- who has had years of experience successfully helping a family member of his or her own -- does blame Homer's family:
I understand their situation because I too have a mentally ill family member, and I have been down a similar road ... It makes me sad to say, but I think Homer's family gave up on him.More than one reader comments on the complexity of the problem and points out that there are no simple or easy answers:
Freedom is the Catch 22. You cannot force an individual on medication without a court order. The court order typically only comes when imminent danger is shown to either be evident toward the individual or others. You also cannot force people to live in a shelter or place of living. Even if free shelter is offered, it very well may be refused.And yet another reader reminds us that Homer's story is repeated over and over again:
My son, Alex, died at age 24. So many of the emotions and challenges of dealing with a child with mental illness described in the story were so close to home. The mother seems to carry the largest burden. Dealing with the inability to move your son away from the street, toward anything resembling a normal life, is so hard. Then they come knocking on the door. We've walked that walk. This story let me cry once more for my son.Of course, suicide is preventable and, of course, it is important to communicate to the public that suicide is preventable, but framing that as an absolute statement neglects emphasizing all of the conditions necessary to make suicide preventable. Making such a universal declaration minimizes or ignores the complexity and recalcitrance of individual situations. Namely, suicides like the one that took the life of Homer Bell are preventable ...
• if families of suicidal people like Homer Bell receive adequate support in their efforts to care for their loved ones;
• if suicidal people like Homer Bell have viable options for housing -- or residential treatment -- that provide them with shelter not only from the elements but also from the acute symptoms of their disease; and
• if there is adequate support available to integrate people with severe mental illness into the mainstream culture and activities of the communities where they live.
And in the end, characterizing suicide as universally preventable often means that someone must be blamed when a suicide fatality occurs, and all too often, the blame falls on the victim (the person who died by suicide) or on the victim's family.