Facing suicide, p.6
Facing Suicide, page 6
Gary Door was one of the muscular canoe-carvers at the powwow. A member of the Nez Perce Tribe, he had been separated from his family at age four, adopted by a white family, and sent to a white boarding school. He never saw his parents or siblings again. By his late twenties, he was an alcoholic, a sergeant in the army, and a suicide survivor who was brimming with hatred. Adopting a Lakota motto, I really want to live, Door embarked on a fifteen-year spiritual journey comprised of learning Native crafts and languages, taking part in sacred ceremonies, and spending long hours communing with elders. About his innumerable physical ordeals and soul searching, he said, “I was changing and becoming who I’m supposed to be.”
At a final ceremony in 2019 he cast off his white name and took the name given to him by the elders. As he explained it, “The bear will tear you apart limb from limb, insides out. Throw you all over the ground. But with bear medicine, the bear puts you back together the way you’re supposed to be. And so that’s who I’ve become. I’m not the child taken from his people who held himself in shame. I am this man you see today. Standing Red Bear.”
At the powwow, Standing Red Bear put hours into shaving out the inside of a cedar canoe made from a single tree. He had become a master of making and piloting the venerable craft and had accomplished several “firsts” down western rivers thought to be too challenging for the heavy vessels. Standing Red Bear was under contract with Patagonia, Inc., to pilot a dugout canoe down the Flathead River for a photo shoot.
* * *
* * *
For people in a suicidal crisis, the biggest hurdle to getting help is the reluctance to ask for it. The majority of those who take their lives don’t share their intentions beforehand. They have never seen a mental health professional or been diagnosed with a mental illness. Why don’t they seek help? A major factor is stigma—the shame and disgrace associated with mental health conditions. SAVE’s Dan Reidenberg believes that stigma comes from fear. He says, “Stigma prevents people from getting help because they’re afraid that if somebody finds out, they’re going to be in trouble. This can happen at work, it can happen in a personal relationship, it can happen in a community, it can happen in the military. Stigma keeps people from help seeking.”
Epidemiologist Madelyn Gould, PhD, believes American self-reliance, often a boon, can be a barrier to seeking help. “People want to handle their problems on their own. But if you have a heart problem, you’re not gonna handle it on your own. If you break your foot, you’re not gonna handle it on your own. Why should we think we can handle psychic pain, depression, serious anxiety on our own? It’s putting too much of a burden on ourselves. We’re expecting too much of ourselves.”
Christine Moutier concurs. “Mental health conditions are health conditions. The same way physical health conditions are. And there is a way to approach them in a proactive manner with self-care strategies. Just like heart disease or blood pressure problems or diabetes. You have to manage it over time and your doctor will adjust the treatment accordingly.”
Still, experts do not want to remove all the stigma from suicide. Recall that in suicide clusters, there is a danger that suicide can become seen as a “normal” behavior, especially among young people. It’s important not to make suicide normal. As Reidenberg told me, “We actually need some level of stigma against suicide. We don’t want the stigma about seeking mental health but we do want the stigma about the behavior of suicide. We don’t want suicide to be seen as in any way good or positive or noble or heroic or anything like that.”
* * *
* * *
After the worst of the suicide cluster in 2016 and 2017, Anna Whiting Sorrell resigned from the Confederated Salish and Kootenai Tribes’ Tribal Health Department. She thought she had seen the worst, but the worst was still to come. “In November of 2018, I had a sister die of an opioid overdose. And it devastated me. I just couldn’t believe that I couldn’t help my own sister, in all that career that I had. So I was ready to move on. I took a couple months off, and applied for a position with Kaufman and Associates (a Native-owned behavioral health consultancy) and I’ve worked there since. I remember the day I submitted my resignation. I was told there had just been a death by suicide. And I can say I felt a relief in every part of my body that I didn’t have to do anything.”
Sorrell also felt something else—that she herself had become dangerously vulnerable. “It’s an option for me, yes. Suicide is an option for me,” she said. And suddenly she was the one who had to ask for help. “All of us have trouble reaching out and asking for help. But I also think for Native people, it’s deeper.”
She showed me an old black-and-white photograph. Her grandmother, at about twenty-five years old, gazed down at her daughter, a girl of about seven, reminiscent of child star Shirley Temple. Both beamed in matching polka-dot dresses. Sorrell pointed to her glamorous grandmother.
“My grandma had polio when she was young. I loved her. She died when I was five years old. And we have no idea if she died of an intentional drug overdose or not. She was forty-two.” Sorrell’s finger moved to the little girl, her mother. “My mom died at fifty-seven from cancer. She had been recovering from her own substance abuse for maybe ten years. And I bring that up because I don’t think that people really understand the deep historical trauma that Native people have gone through.”
Historical trauma is the physical and psychological harm inflicted upon individuals and even whole cultures by harrowing experiences like slavery, the Holocaust, and violent colonization. The University of Nevada’s Michelle Sotero, PhD, MPH, describes how, for Natives, historical trauma began when whites committed mass trauma upon Indigenous peoples through colonialism, slavery, war, and genocide. As a result, the affected peoples displayed physical and psychological symptoms. This population passed on those symptoms to subsequent generations, who now show similar symptoms. They consist of elevated risks for alcohol and drug addiction, diabetes, tuberculosis, and a variety of mental health complications, including depression and suicide. Historical trauma contributes to why Natives have a suicide rate up to ten times the national average.
Donald Warne, MD, MPH, of the Johns Hopkins Center for Indigenous Health, calls historical trauma “the collective emotional wounding across generations that results from massive cataclysmic events.” Trauma, Dr. Warne contends, is “held personally and transmitted over generations. Thus, even family members who have not directly experienced the trauma can feel the effects of the event generations later.”
Trauma’s destructive forces can last generations. This is a bold idea that’s gaining increasing attention in the scientific community. The mechanism for intergenerational trauma is epigenetics, the way gene activity is changed by behavior and environment. Gene sequences, or DNA segments, are not changed, but environmental and psychological factors can alter the expression of genes by switching some genes on and switching others off. Epigenetic changes are also tied to prenatal and postnatal stress, which can program a child’s brain for later health issues. Especially catastrophic for Natives was the Federal Indian Boarding School Initiative. Between 1819 and the 1970s, the United States government established 408 federal schools across thirty-seven states. Their goal was to culturally assimilate Natives by removing them from their families and tribes and by preventing them from practicing their languages, religions, beliefs, and customs. Native child removal also demoralized Indigenous peoples during an era of territorial expansion. At the boarding schools, children were forced to perform hard labor. Child abuse was rife. At fifty-three schools and counting, investigators have discovered marked and unmarked burial sites.
Sorrell affirmed the horror of the Boarding School Initiative. “If you can’t teach your own kids your own language, think about the trauma in that. If you can’t teach them your religion. If you can’t teach them your songs or the music that you love, that’s our most intrinsic belief system, right?”
She searched my face for answers.
She said, “I would say that returning to our cultural ways is our only way out, to get to the health and healing that we need. And that is really what will prevent the next suicide.”
* * *
* * *
Counting both indoor and outdoor basketball courts belonging to the school system and to public parks, the small village of Arlee boasts twenty courts in all. Greg Whitesell and Darshan Bolen played one-on-one behind the high school on a weather-worn apron of concrete from which there was a clear view of the Lolo National Forest to the west. On the Arlee Warriors team, Darshan played defense, so Greg had a hard time charging the basket without having the ball slapped away. He opted for two- and three-point jump shots, swishes all. But then Dar met him shot for shot, earning grimaces, and compliments, from Greg.
They took a break for water. Dar wandered off to make a call. I asked Greg about the night he almost killed himself. How exactly had he felt? He backs it up a little. He mentions his concussions and the one that preceded his depression. Then he gets to the cluster of suicides.
“I was already kind of in a bad space, you know? I was already going through some things. I knew about ten people who killed themselves. It was just a really hard time going on in my life.”
And in everyone else’s lives too. But I had heard that there’d been a girlfriend and a breakup as well. I knew that Greg had been close to Roberta Hayes, the foster mother and “auntie” whose suicide had shaken so many. The net effect on Greg was pain and isolation.
Greg insisted the text he sent his friends wasn’t a call for help, as some had suggested, but a goodbye note. He had written, I don’t want to be here anymore, then turned off his phone. And even though a blizzard raged that night, it was funny to him how fast his friends appeared at his house.
“You know, two seconds after I sent that text it felt like my two friends were right there. It’s crazy to think about it because I wouldn’t be here if they hadn’t come through, if they hadn’t knocked on my front door.”
One of those friends was Darshan Bolen.
That fact that friends came to Greg’s rescue would not surprise Christine Moutier of the American Foundation for Suicide Prevention. She says that most young people will talk with their friends about tough issues in their lives, even suicide, before they’ll talk with their parents or other adults.
“Peer-to-peer communication can play a really important role in youth mental health and suicide prevention,” says Moutier. “Because among youth who are experiencing suicidal thoughts, about half of them are not telling anyone. Among those who do, two thirds of them are only telling a peer. They have a gut feeling about it. Their friends are telling them about the hard stuff going on in their lives.”
Often, friends are concerned but unsure how to help. Fortunately, Greg’s friends knew they needed to reach him, fast. They woke Greg’s mother, Raelena, who wanted to take him to the emergency room, another smart move recommended by experts. Greg resisted, saying again and again, “I don’t want to be here!” In other words, leave me to die.
But his friends and mother weren’t having it, knowing instinctively another piece of expert advice: you should never, ever leave someone in suicidal crisis alone. Accompany them to an emergency department or to a medical or psychological professional.
Greg was frightened by the ER, where nurses put him in a room with no bed, no table, no fixtures of any kind with which he could hurt himself. He spoke alone with a doctor while his parents learned there were no psychiatric patient rooms available in Arlee, Missoula, or the surrounding area. They had no choice but to take him home. This frightened Raelena.
Her eyes widened as she told me, “I was scared. I was scared because we went home and I think like for a month I could not sleep because I would check up on him. Every night I would look into his room, make sure he’s okay. I would set my alarm like every hour so I could go check on him and I would call him, ‘Are you okay?’ I would ask him every day, ‘Are you okay, are you okay?’ And then finally he says, ‘Mom, quit asking are you okay.’ I said, ‘I will never, ever stop asking are you okay because I don’t want there to be a moment if something happens and I’m not there for you, son.’ ”
Soon, Greg began regular therapy sessions, which he continues today. It was expensive, but Greg’s parents had good health insurance. And now he’s grateful for the interventions that saved his life, and happy he did not kill himself as some twenty others on the Flathead Indian Reservation did.
But a question about Greg’s good fortune stuck with me. Why had Greg survived when twenty others had not? Why did farmer Chris Dykshorn take his life after four days of treatment, when Greg seemed to begin his rebound after a single conversation with a doctor and a visit to a scary holding room?
There are no easy answers. As suicidologists have repeatedly told me, every suicide and suicide attempt is different, and so are the causes behind them. In the midst of a cluster of suicides, Greg was probably susceptible to suicide contagion. His depression was almost certainly linked to the latest concussion of many he had suffered. But somehow an outpouring of love stabilized him during his most vulnerable days.
Chris Dykshorn had endured extreme anxiety and depression for months before he killed himself, perhaps a more entrenched depression than Greg’s. And the source of his pain—the farm, with its endless chores and financial minefield—was waiting for him when he was discharged after just four days of treatment. He never had a true respite from worry, which, according to Mike Rosmann, is what kills farmers. He never found his “safe place,” as farmer David Boettger had.
I left Greg at the house he shared with his mother. She had made a lunch of sandwiches and iced tea and they had it on a picnic table on the back porch. They laughed at something and talked about nothing. They had not run out of time.
Greg had told me, “In my head I was only worried about myself, but my mom would be living the rest of her life without me. My pain would just be ending, but everybody else’s around me would just be starting.
“If you’re thinking about killing yourself, just know that you’re loved, know that you’re cared for. Today might be hard but tomorrow’s a new day. You never know what’s going to happen tomorrow.”
CHAPTER FIVE
FIRE IN THE BRAIN
Greg Whitesell’s and David Boettger’s stories, and many like them, show that family and professionals can sometimes identify signs of suicidal behavior and prevent suicides. Scientists hope they can point the way to helping people earlier, before they’re in a crisis. It’s a complicated challenge because the detectable signs can be subtle, or even hidden by someone who plans to kill themselves. And tragically, few people bent on suicide tell anyone beforehand. Researchers investigate the causes of suicide from different angles—probing human behavior, trauma, and the role of drugs and alcohol. For neuroscientists, there’s only one place to start: in the human brain.
Columbia University’s Dr. John Mann trained in his native Australia and has the unmistakable accent his countrymen are known for. He’s a wry, intellectually exacting scientist, and an aging athlete who has downshifted from running marathons, including six times in Boston, to triathlons. He smiles ruefully as he describes his beef with psychiatrists and psychologists. They think they can understand suicide solely by examining behavior, outward signs, and external stressors in the lives of those who have attempted or carried out suicides. Suicidal thoughts, they claim, can be understood and treated with “talk” therapies like cognitive behavioral therapy and dialectical behavioral therapy.
Mann disagrees. He thinks talk therapies may help people manage their suicidal thoughts, but they take weeks to work and do not get at the basic causes of suicide, which lie inside the brain. He said, “It’s a bit like when you take your car to be repaired, the mechanic doesn’t listen to the sound of the engine. The mechanic actually lifts up the hood and looks at the engine.”
The Molecular Imaging and Neuropathology Division in the Department of Psychiatry at Columbia University occupies a cluster of floors above a vast museum-like lobby of soaring triangular windows and alabaster walls. Mann and his team occupy a warren of rooms whose gleaming stainless steel and glass machinery is designed to store, dissect, and examine human brains. In two rooms, row upon row of freezers contain just that: nearly one thousand brains of people who have died by suicide. What prompted Mann to collect brains?
“We started out a number of years ago by principally examining mood disorders. And in order to understand what was fundamentally wrong with people who suffered from mood disorders, we began collecting brain tissue from suicide decedents at the medical examiner’s office. We did that because we understood that about half those patients suffered from a major depressive episode at the time of death. We began to think about what was wrong with the other half of the folks who died by suicide.”
Mood disorders are specific types of psychiatric illness that primarily affect an individual’s emotional state. Mood disorders include conditions such as depression, bipolar disorder, and symptoms of depression that are caused by drug and alcohol abuse and sometimes medicine or medical conditions.
