SUICIDE

I am writing the title of this post in all caps for a reason, which I hope is about to become apparent.

All bold and red highlighting in this post is my own:

Yesterday's anonymous commenter supplied this link to a very short article in Forbes, which quoted a previous article in part as follows:

Roughly 35,000 Americans commit suicide each year–more than die from prostate cancer or Parkinson’s disease. Another 1.1 million people make attempts, while 8 million have suicidal thoughts. Among those aged 15 to 25 it is the third leading cause of death. Yet researchers know astonishingly little about how to treat people who contemplate killing themselves. The subject has been so roundly ignored that the 900-page bible of psychiatry, the Diagnostic and Statistical Manual of Mental Disorders IV, offers no advice for doctors on how to assess suicide risk.

Fear, logistics, low research funding and more risk than reward for drug companies all conspire to make suicide the neglected disease. The National Institutes of Health is spending a paltry $40 million in 2010 studying suicide, versus $3.1 billion for research on aids, which kills half the number of Americans. (Another government agency spends $48 million on hotlines and prevention.) Therapists often don’t want to treat suicidal patients, and university clinical study review boards are skittish about studying them, says the University of Washington’s Linehan.

2010 NCI spending on breast cancer research alone was $631 million, according to this site.

Estimated breast cancer deaths (all ages) in 2009 was 49,170, according to this report.

Excuse me for a moment while I go and throw up.

A few days ago, Evelyn Lauder, a major breast cancer activist, died of ovarian cancer. I believe that she was in her mid-70s.  Lauder?  Think Estee Lauder cosmetics.  Daughter-in-law of Estee.

I am not a New York socialite and cosmetics tycoon. 

I am the pastor of Tiny Church in Tiny Town, a town so tiny almost no one has heard of it.

I'm guessing that Mrs. Lauder had her some pretty nice digs in New York City, and that she knew "all the right people."

We just painted our living room after 27 years of living here, and I know my friends and and congregants. 

I absolutely do not have an activist personality.  I'm a spiritual director, for heaven's sake (literally).  I like quiet conversation and prayer with one other person more than just about anything else in the world.  But I do have a few other skills in my pocket, mostly research and communication skills.  There is that lawyer side of me, lying latent.

And I am sensing a swell of outrage welling up inside me. Perhaps that is how these things get started.

My approach to my own health care could be described as casual at best.  And yet (much as I hate it), I am being treated for a cancer at a stage so early that I can barely believe that I have to endure major surgery and its consequences to address it.  Were this a generation ago, the cancer would not have been detected for years (if at all, which is another whole issue with DCIS, some of which turns into Something and some of which does not, but no one yet knows how to predict which is which, so we all get treated, and that's a whole other and disconcerting story). By the time it was discovered, it most likely would have been invasive and resulted in even more disfiguring and disabling surgery than  what I am about to undergo. Two generations ago, that surgery would have been done in the dark -- no one could predict who would survive and who would not, because testing and treatment for metastatic breast cancer was in its infancy.

All that has changed because of all that pink money and all those activists, women and men alike, who said: No more BS about this.

Suicide and depression?  I know something about those matters now.  And one of the things I know is that we don't routinely screen people for depression.  We don't plaster pink-ness, or some other color, all over the place with posters and brochures telling us risk factors and what to look for, in ourselves and in those we love.  I have posted very little about my son because I try to protect the privacy of my family in my online life, but I will say this (and perhaps someday, much more):  Like many suicide survivors, I look in retrospect at the evidence, including journals I did not have access to until after his death, and it all screams: Depression!  High risk of suicide!  And we had no idea at all.

So.  This is not the week.  I have other things to do this week, things that are possible because the massive Komen and ACS and NCI machines and money have been at work, with the result that there are TWO state-of-the-art breast cancer teams and facilities down the road.  

But when this week is over, I am going to join every damn suicide prevention organization out there and I am going to volunteer everything that I have to offer and if I have to make something up from scratch I will because ~ my son, with his brilliant and creative mind, with one of the finest educations in the world, living in one of the greatest cities of the world, with a great job that provided him with excellent medical insurance, should have been able to put all that together to get for his illness the excellent care and support that is so easily available to me.

I have been writing for three years about how my grief and sadness have been exacerbated by the many times people have avoided the topic of my son's death, and by how much I have been helped by those who were not afraid of it.  But ~ and this is true, pathetic as it may sound ~ it took breast cancer and the universal willingness of people to get down and dirty with me for me in this new challenge for me to understand how much of a taboo suicide still is.

BS that MUST STOP.



Image: A Joyous Josh, Sleeping Bear Dunes, 2001.  

What a Journey This Life Is!

I am actually feeling much graced tonight.

Ignatian stuff ~ In the "everything is connected" category: I emailed my summer retreat director and asked him how his best friend, who died last summer, had lived fully in the context of all the demands that a serious illness forces upon you.  He responded in part that his friend was a person of deep prayer who focused upon living and serving, and not upon his illness.  He did not seem to think that that approach is beyond me.

Then another Jesuit posted a homily today in which he talks about using all that God gives us. I posted a comment to the effect that one of the messages in my Ignatian retreat of six years ago was  that I should "use yourself up. Make use of everything you've been given until you've exhausted it all." 

My regular life ~ I have said more than once that it is quite some privilege, to have to contend with breast cancer in the context of having just been ordained into ministry.  In part, I really don't have  a lot of time for moping around ~ an activity at which I am sure I could become quite expert, given the chance.   But more importantly, I have a seemingly endless stream of opportunities in which to provide care and hope to other people, who seem to welcome the presence of someone who has needs of her own.  I suppose that there is no possible way, given the circumstances, that I could come across as overly self-confident, which may be a great blessing.

Suicide ~ I have noticed something really interesting over the past two months.  People TALK about breast cancer.  People talk about it freely and openly, ways in which people DON'T talk about suicide. 

The Lovely Daughter was astonished, at first.  "People don't usually even say the word 'breast!' " she exclaimed.  "And yet you keep meeting women who were strangers only moments earlier, and next thing you know, they're pulling up their shirts to show you their reconstructed breasts!"  

But I have noticed quite a difference between conversations about breast cancer, even where older and more reticent women are involved, and conversations about suicide, which tend to stop even the most voluble folks in their tracks.

And so I've been thinking about that quite a bit.  I haven't seen myself as a suicide prevention activist at all.  But now I wonder.  There are thousands ~ millions ~ of people willing to talk openly about breast cancer.  There are very few of us who have been forced to become fearless in our discussions of suicide.  And we all know that it is by bringing evil into the light that you destroy it.

In my personal life, the evil of depression has taken a lot more territory than that of cancer.  Maybe, when this acute phase is over, I am being called to turn some of my attention to that most insidious of killers, clinical depression.

It would be odd, wouldn't it, if having breast cancer turned me into a noisy and irritating voice aimed at the eradication of suicide?

Intergration, Not Military Mobilization

One ~ 

I definitely spoke too soon yesterday.  By evening I was in a state of complete disarray, and my most wonderful family sat with me at the kitchen table for hours, reviewing all possible options and consequences and associated feelings.

Two things in particular came up.  The Lovely Daughter asked me point-blank whether I trust my doctors, and I responded immediately with an emphatic "NO."

This has nothing whatever to do with the doctors. They are outstanding physicians at a university medical center; they are progressive, up-to-date, articulate, compassionate, and skilled educators.  

This has to do with events in my childhood. 

When I was seven and lying in a hospital bed with major injuries and begging to see my mother, I was told that she was asleep down the hall.  The truth, that she was dead, came out pretty quickly, but the impact of that outright lie on my subsequent management of my health care has been profound.  In both good and bad ways.  I look at a medical building and I am filled with suspicion and distrust.  Those feelings, along with my natural inclination to leave no stone unturned, have gotten me, and my children, excellent medical care and a lot of information and support.  They are also, in these weeks in which major decisions are required and little time is available, something of an obstruction.

Two ~

The second thing that came up for me, and I'm not sure that we even got to it in our hours of conversation last night, is that it is sinking in that this process that has already gone on for two months will not be complete until at least three, and quite possibly six, more months have passed.  You don 't just pop an implant in.  For me, the person whose blood pressure rises into the stratosphere at the sight of a hospital, there will be weekly visits and one or two or more surgeries after the big one before everything is complete.  All of which means that this is not just a burst of a crisis that will subside.  This is months of living my regular life with the need to plan and show up for medical care as a new constant.

And then the shadow of cancer will follow me all the days of my life.  As does the shadow of suicide.

Three ~

I know that this part will be controversial, and I welcome all comments and insights.  But here's where I am at the moment:  I hate the military terminology that we use with respect to disease and loss.  The fight battle victory defeat wage war terminology.  (All of those, I might add, are words that I use, because God forbid that I should ever view consistency as a virtue.)

But I just don't find it all that helpful to view my body, or my family, as a war zone.  I am going to have to live with the realities of cancer, just as we have to live with the realities of Josh's death.   So the word that I am beginning to play around with is the word integration.

I have no idea what that means, in a practical or physical or spiritual or intellectual sense.  I do know that, while there have definitely been times in the past few years in which I have felt as if I were fighting to survive, I have been better off, whatever that means, which I have been able to meld the complexity of the whole in some kind of metaphorical architecture that makes room for both the horrors and the goodness of Josh's death and, more importantly, life.

Integrate, it turns out, comes from Latin for to make whole.

Feelin' Upbeat Today

This is probably a bit premature, but my outlook today is pretty positive.

I think I have done about as much research and preparation and dealing with my, uh, stuff, as a person could.  My father called today and asked if I were at peace with my decision, and I was able to say, with complete equanimity, that mine is not a set of options likely to produce peace.  In other words, I'm not at peace ~ but why should I be?  That's not a requirement.

I'm glad that I didn't rush into surgery two months ago.  Even though I am doing exactly what the first surgeon originally recommended, I am doing it  in a knowledgeable and well prepared manner.  I know about options, I know statistics, I know what the procedures are (SO not appealing).  I have things to wear, I have a place to hang out, we have a new tv, and my work life is somewhat in order.  I could not have pulled all that off in less than two months. 

I have come to terms, sort of, with the reality that I can't predict anything about my recovery.  I've read some real horror stories and I've read some by women who came through all this fairly easily.  I can't choose, and I don't believe that optimism is the controlling factor here, but I'm ok with that.  Most of the time.

I have recovered my sense of perspective.  I want Josh to be here, I always want Josh to be here, and I can't believe that he isn't flying home from Chicago this week to be with me, where he belongs.  But that's no different from every other week.  And I do know that this ~ this is just a breast.  It is not a child.  

I am extremely clear about the difference.

This past week I ran into an acquaintance who has had cancer.  She's been fine for several years.  And while I know that she has other significant challenges in her life, I realized as we talked that: I am not a fragile person at all.  Her story?  Not mine.  I have my moments, and my days, when I am puddled all over the floor, but on the whole I am a pretty tough babe.  And I'm good with that.

Best of all: I am imagining the future.  You can travel all over the world with a fake boob.  You can preach and take photographs and do spiritual direction and hike and canoe.  And you still can't sing or cook if you never could.  So, basically: I will still be myself, just with some new and gory scars and some silicone inside.

This whole thing really and totally sucks.  But: OK ~ I will come out the other side and I will be fine.  

Although I will probably have even less patience with certain people and their idiotic remarks than I do now!

Ask; Don't Instruct

As Jody says in the last set of comments, some moments jump out at us as examples of "the wisdom of silence and the comfort of just being there."

Oh, I hope I remember that.

When someone whom I know to be a person of faith (any faith) is in turmoil, I try to ask, "Does your faith help you?"  Or, "What has been your experience of God in this?"  Sometimes people are surprised ~ they expect me, the pastor, to TELL them how their faith helps them, or how they should be experiencing God.  And then, sometimes, they venture a quiet response along the lines of "Not always," or "Not so much."  And then they look even more surprised: Is it ok to acknowledge that?  Is lightning about to strike?

Of course, sometimes the opposite happens.  Sometimes a person preaches an entire sermon in response to one of those questions.  And that's ok, too.  It might not be my sermon, but it's that person's moment, not mine.

If I know, or guess, the person to be someone for whom what I would describe as religion is meaningless, I try to ask, "What helps you deal with this?" or "How are you approaching this in your mind or heart or spirit?"  

People have such powerful stories to tell!

But I guess you have to want to hear theirs more than you want to impose yours.

I can't say that I get an A+ in this endeavor.  Some days, I suppose, a D-.

But you really do have to know that sharing yours is a meaningless gesture, and sometimes one that inflicts damage, until you've heard theirs.

DON'T

Don't tell me not to be afraid.  My son has died and I am not afraid of much, but this week I am afraid of some things.  This week I am afraid of hospitals.  I am fine as a hospital visitor, as a chaplain, as an observer.  I am not squeamish, I have no sense of smell, and I am just generally not bothered when my own self is not the focus of medical care.  But when I am the focus ~ let's just say that I have childhood memories that have worn grooves into my soul, and I get to be afraid.

Don't tell me that they'll manage the pain.  I have never had adequate pain management, so I feel completely undermined when I think you are lying.  You probably aren't lying, at least not intentionally, but I am pretty sure that the reality is not going to be pain-free, or what hospital folks call "uncomfortable."  I'm pretty sure that it's going to be hell.  So let me have the truth of that.

Don't tell me that it's not all that big a deal.  It is, actually, in its own way.  Or not.  I can't tell.  It's more like re-living the events of three years ago than it is its own thing, and that's a very big deal.  

DON'T stand in a store and quote Bible verses in my face.  Just DON'T. DO. THAT.

This Week - Ordination and Cancer

1.  I am in trouble.  I had no idea about ordination gifts.  No expectation or anticipation whatever.  Apparently that was extremely dumb.  I have received such personal, thoughtful, creative presents ~ I am astonished.  And grateful.  And I thank so many of you, and I WILL do so, personally and for real  ~ but it will take a little while. And if  "a little while" is after surgery ~ well, so be it. 

This is nothing like after Josh died ~ when every thank-you note was an exercise in anguish, and I would have to take breaks that lasted for weeks. This time, I look at these wonderful gifts and I am filled with joy and gratitude.  But I'm still pretty slow.

2. This cancer thing?  It's tough, although not in ways you might expect.  I continue to struggle with the reality that it, too, is not Josh ~ and so where do I put it?  The other night, my husband said, "It IS breast cancer, you know."  "Right," I responded.  "Right; I keep forgetting."

All of us in our little family have acknowledged: This is not the death of our son and brother.  But everything for us is about life and death, and for me about mothering and bodies.  So what is this, exactly?  How much mental attention and energy does this warrant?  I guess it gets what it gets.  Some times a lot and sometimes none.

3.  I've been reading a few blogs, trying to retain my equanimity where some of the descriptions of the week after surgery are concerned, and trying to pick up practical information.  Some of them are incredibly helpful, full of tips that are obvious once you read them, but are not things that would have occurred to me on my own.  So I am wondering, in an unimpressed and sarcastic kind of way: Ten days away and I've received nothing from the hospital about what I might need for the day and night I get to spend there and for the days immediately following. Helloooooo?

4.  Best tips worth sharing: Pajamas that open in front (for ~ ahem ~ gross and messy activities) and have a front pocket, for a phone and ipod.  In the hospital, said one woman, I couldn't do much, but when I was vaguely alert, I could send and receive texts.  Second thing, if you want to do something for a friend facing this, or any other major surgery: Target (or whatever; Target is the one closest to us) gift cards.  There are a lot of little unexpected expenses, things you need that you might not usually buy.  Too late for me ~ I now have leggings and socks and men's t-shirts ~ but in case you want to help someone else out and ESPECIALLY if, like me, your cooking skills don't extend beyond grilled cheese, those little cards would be a godsend.

5.  I have some really, really bad moments, and hours, and longer.  But today I was muttering to myself (no, not out loud) that sometimes I really do get sick of how people just do not "get" certain things, like for instance the confluence of the death of a child and breast cancer, and then I thought, "But I do.  I have now become a person who gets it."  I can't say that I consider that to be good news.  But maybe , for someone else one day, it will be at least helpful news.

6.  I could, of course, write thank-you notes if I stopped blogging!