Living through loved one’s suicide involves many layers of hurt

Then I received the heartfelt letter below in reply. My editor has agreed to make an exception in this case for the normal 750-word limit. So, grab a cup of coffee and join the dialogue.

Hello Steven: I read your two articles on suicide. The first was not only wrong but extremely hurtful. I don’t think judging or generalizing about people being in rages will lower the rate (of suicide) or help the relatives. Inadequate medical care for the terminally ill, schizophrenics, bipolar, clinically depressed is a big cause (of suicide). Violence to spouses and children is another reason for it. Bullied gay children also. Victims are in nonsurvival states emotionally and mentally and escape hopelessness, not in rages.

Addiction to legal and illegal medications is also a cause. No work or the parents working too much are causes also. Many different reasons are common. I am a naturalist, not religious, so I don’t judge them and condemn them to hell. I think older people need a more humane death, like in Oregon. I know that they are different from murderers who have more going mentally.

I realize you are probably tired of the sad, depressing topic and need new work. Too long in that area makes people feel angry or depressed. Our society is corrupt and money-hungry, not healthy. Caring and compassion are in short supply. All of the areas need a lot of work. But deciding they die in rages is not truthful, as the relatives know all the problems involved. It’s just a pointless attitude. People all have feelings and are entitled to them except for those who write for newspapers and get more influence and exposure. You should be more careful about generalizing in sad areas. — J.B., Las Vegas

Thank you for your letter, J.B. It was from the heart and deserves a respectful response.

First, I’m writing unaware of a second recent column (you mention reading "two articles") regarding the subject of suicide. For the record, then, I’m responding only to your concerns about the Aug. 16 column of last year.

Next, I know you’re a survivor of suicide. That’s jargon from the American Association of Suicidology, meaning not that you once tried to kill yourself and survived; rather, that you were closely related to someone who did complete suicide. Surviving suicide is fraught with a terrible and almost always complicated grief. I admire the courage and resolve with which you have walked it. Your brother would smile at the way you’re standing up for him.

Finally, in a historical accident of fate, I actually got my start in behavioral health work in suicidology. Prevention, intervention, postvention — suicidology is a particular focus of my training and work as a clinician. The crux of my Aug. 16 column comes from a speech I often give across the country called "A Unique Grief." I am a survivor of suicide, three times over. Lost two cousins and an uncle during a 16-month span. It was like a grass fire ascended from hell. I’m right there with you, J.B. Let’s talk.

You say I’m judging. It is true that I take seriously moral deliberation regarding human behavior. Also true that I sometimes am willing to draw moral conclusions, which I’d agree are, then, judgments. Specifically regarding suicide, I make no apologies for my insistence that suicide is a moral event. That is, it can never be a nonmoral event.

If you’re asking about my personal beliefs, I say that suicide is … wrong.

Yet, I suspect that, by judgment, you mean something more akin to condemnation. And that I don’t do. First, because I’m not God. But second, because condemnation is not something I want to do. If I was to say this theologically, I would say that, in the love of our Maker, the door to hell has been permanently locked open. No one resides there who does not absolutely insist upon it. While you said you were not religious, I just wanted you to know that not everyone who lives by faith needs or wants to condemn your loved one to hell. Though I apologize for the many religious folks who have gleefully insisted suicide is unforgivable. Just saying that’s not me.

Generalizations? The idea of suicide as retroflected anger (rage) is no generalization. More a psychoanalytic observation. Perhaps my favorite Sigmund Freud quote of all time is, "The consequences of our behavior tend to reveal our motivations." Whatever the felt or stated "reasons" of a suicidal patient, a suicide is in the end an act of violence that kills. And this violence is, at minimum, connected to a motive for behaving violently. If not officially rage, it expresses at least a deep antipathy for one’s own life.

You list many "causes" for suicide: mental illness, inadequate care for mental illness, domestic violence, bullying, addiction, joblessness, hopelessness. Yet, in my work, we don’t call these causes; rather, they are risk factors. I’m saying these states of suffering do not explain suicide. All we know is that suicidal patients are commonly experiencing these sufferings. Yet, other patients with these same sufferings don’t kill themselves. So, risk factors point to statistical risk, not to cause.

You say that suicidal patients are different from murderers because murderers "have more going mentally." I must tell you that, in the case of ordinary people (not sociopaths) who commit murders, I don’t know that I know your view to be true. The evidence points to both people having a lot in common in terms of mentality. Both are commonly in crisis. Both are desperate. Hopeless. Both are in tremendous pain.

And both tend to be angry.

Actually, it’s not at all true that I am "tired" of the topic of sadness. Nor does the subject make me the least angry or depressed. Grief is a particular calling of mine. I find a continuous inspiration in working with sad people.

You and I agree that our society is corrupt and money-hungry. That caring and compassion are in short supply.

You say that my linking suicide and anger is "a pointless attitude." I, on the other hand, am keenly aware of my point. Two points, specifically: observing this link will decrease the risk of suicide and help survivors.

When patients present as suicidal, they often are unaware of their anger. The inability to hold anger consciously is consequential. Unconscious anger is, at minimum, exhausting. It saps vitality (depression). But it also can be destructive or even lethal. It follows then, that identifying anger (making it conscious) can give a patient more choices about what can be done with anger. Throughout my career, I have many times noticed that encouraging a suicidal patient to meaningfully engage anger usually decreases suicidal ideation, often rendering these fantasies no longer necessary.

Next, the survivors. Over and over I have watched survivors protect their broken hearts with what I called in the column a poetic narrative. The story is told as tragedy, for which we then mobilize compassion, empathy, understanding, and in some cases, unexamined "explanations." We get the victim off the hook, because our broken hearts very much need for the victim to be exonerated.

Then, several months or even years later, those same survivors often show up in a counselor’s office with malaise, depression, acting-out symptoms — psychic stuckness. They have surrounded their loss with a story that does not permit disappointment, indignation, or as Dr. Sue Chance says (the author of the book I referenced, "Stronger Than Death: When Suicide Touches Your Life,"), being "righteously pissed."

At some point, most survivors need to include a moral accountability laid at the feet of the victim. Suicide is deeply intimate, deeply personal to those left behind. It hurts. Someone has killed my loved one. That someone is my loved one.

Asking the victim to be ultimately responsible for the decision to die, whatever the list of risk factors, is a crucial part of healing for most survivors. I’m committed to helping them find a voice for that outrage. When they are ready, of course. It’s never my practice to tell any patient how to feel about anything. Rather, I push my patients to tell themselves the truth about how they are feeling, or whether some denied feeling is at the root of their symptoms. As you say, "People all have feelings and are entitled to them." I completely agree.

I’m sorry you experienced my column as "extremely hurtful." In my work, I do frequently have to be willing to articulate things that must uncover a great hurt. I take no pleasure in that. But I derive great joy and satisfaction out of watching someone lean into their hurt and thereby find a lighter spirit and more choices for living well.

Which, from the bottom of my heart, is my wish for you.

Steven Kalas is a behavioral health consultant and counselor at Las Vegas Psychiatry and the author of "Human Matters: Wise and Witty Counsel on Relationships, Parenting, Grief and Doing the Right Thing" (Stephens Press). His columns also appear on Sundays in the Las Vegas Review-Journal. Contact him at 227-4165 or skalas@reviewjournal.com.