It’s Okay Not To Be Okay

After the American counselor finished a lecture on “The American Way of Death” at one of China’s most prestigious medical schools, he asked a simple question: “As doctors and nurses, how do you tell a patient that he or she has a terminal illness and there is nothing more you can do for him?”

Silence. A profound silence.

Finally, an anonymous, almost apologetic voice answered, “We would never tell a patient that.”

“What? Then what do you do? What do you say? How do you help him prepare himself and his family?”

“We just tell him he can ‘go home and eat whatever you want.’”

It sounded much like my Irish ancestors who never spoke of cancer – “She has ‘the C’ you know” – and would never, never speak of suicide.

With the COVID-19 pandemic still months, perhaps a year away from being “conquered,” thank God for those who dare to speak truths my Irish grandmothers never could. 

Thank God for the greatest Olympic athlete of all time, who dares to admit – repeatedly – that he hasn’t simply battled depression. “There are days where I want to curl up into a ball and sit in a corner,” and, in 2014, his second DUI left him contemplating whether he should “just end it all,” Michael Phelps told the global news publication Insider in January 2021.

“I’ll be the first to admit my mental health has been scarier than it’s ever been throughout all of this [pandemic], so I can’t even imagine what other people are going through,” said the 35-year-old winner of 28 Olympic medals. “For those who are struggling with mental health, know you’re not alone: There are days where I want to curl up into a ball and sit in the corner. But it’s just taking a little step forward, taking a deep breath from time to time. It really helps.”

In January 2018, at the annual conference of the Kennedy Forum, a behavioral health advocacy group, Phelps described his “hardest fall” - after the 2012 Olympics: “I didn’t want to be in the sport anymore… I didn’t want to live anymore.” He described sitting alone for “three to five days” in his bedroom, not eating, barely sleeping and “just not wanting to be alive.”

The demi-god of the Olympic pool isn’t the only major public figure to call attention to the issues of suicidal ideations and risks and deaths. 

Just over three years after the King of Olympic Gold addressed the Kennedy Forum, a prince and his bride spoke to the Queen of Television Talk about their own battles with suicidal thoughts. The Duke and Duchess of Sussex – Prince Harry and Meghan Markle - described the demands and struggles, the expectations and restrictions of life in the House of Windsor and the suicidal ideations she experienced. She also reflected the shame too many associate with even the mention of suicide: “I was ashamed….”  

Writing in America: The Jesuit Review, Maggi Van Dorn offers an enlightened response: 

Meghan said of her suicidal thoughts, “I was really ashamed to say it at the time and ashamed to have to admit it to Harry especially, because I know how much loss he has suffered, but I knew that if I didn’t say it, then I would do it.”

No matter who we are or what we face, we need to be able to name that which ails us. It is the first step toward breaking the spell darkness holds over us… Regardless of what you think of the British monarchy and its place in the world, and regardless of what you think about duty or what she naïvely signed up for, we must all take a moment to listen. Because while Meghan’s life circumstances may have been exceptional, her suffering is not. After over a year in quarantine, living and working and breathing in isolation from one another, we have got to give voice to all that is inside us. And we need to show reverence when someone is brave enough to do the same.

As we struggle through – hopefully to an end of – the isolation, fear, loneliness, grief and mourning of this pandemic, let’s dare to be different than my Irish forebearers, let’s speak honestly about suicide. 

Frighteningly, in the United States one in 100,000 children aged 10 to 14 and seven in 100,000 ages 15 to 19 die by suicide each year, according to the National Institute for Mental Health; and suicide is the second leading cause of death for 15- to 24-year-old Americans, according to the Centers for Disease Control (CDC). Suicide rates for females are highest among those aged 45 to 54 (9 per 100,000) and for males 75 years old and older – 36 per 100,000.

Accurate data on suicides and other deaths generally lag two years and, in the midst of a pandemic and quarantines, it is impossible be precise. However, the most recent figures from the CDC indicate that approximately 123 Americans die by suicide every day – one every twelve minutes; suicide is the tenth leading cause of death in the US for all ages. 

According to the CDC, depression affects 20-25% of Americans 18 years old and older. Lesbian, gay and bisexual kids are three times more likely than straight kids to attempt suicide at some time in their lives and medically serious attempts at suicide are four times more likely among youths in these groups. In addition, 41 percent of transexual adults report having attempted suicide in one study, which also found that 61 percent of transexuals who were victims of physical assault had attempted suicide.

While women are three times more likely to attempt suicide with poisoning as the most common method and experience depression at roughly twice the rate of men, suicide among men is four times higher than among women and male deaths represent 79 percent of all US suicides, with firearms the most commonly used method (51 percent) among males. 

Because firearms are the most commonly used and highly lethal method of suicide and suicide accounts for most firearm deaths nationwide and 68 percent of veteran suicides in 2018, many states have passed or are considering legislation that establishes a process for issuing an Extreme Risk Protection Order (ERPO) to ensure individuals at risk for harming themselves or others are temporarily prohibited from purchasing or possessing a firearm. 

Law enforcement or family/household members of a person at risk for harming themselves or others can petition the court to issue an ERPO, which – if granted – temporarily prohibits the purchase and possession of a firearm by the person at risk. After an ERPO has been granted and a warrant issued, law enforcement will temporarily remove all firearms from the person’s possession or control if the person does not do so voluntarily.

In 2018, veterans made up about 14 percent of the total suicides in the United States. Importantly, however, Veterans Administration officials have emphasized that mental health challenges and suicidal thoughts are not a problem specific to the veterans and military communities. Findings documented in the 2020 National Veteran Suicide Prevention Annual Report of the Department of Veterans Affairs highlight the continuing and increasing problem of suicide among U.S. adults and among veterans, and the need for ongoing efforts to improve methods of suicide risk mitigation. In 2018, the rate of suicide among veterans was 17.6 a day and approximately 20 a day when active-duty troops, guardsmen and reservists are included in Veteran Affairs Administration data. 

Statistics from 2017-2018 show slight decreases in the rate of suicide among veterans who recently received some type of care and an increase of 2.5 percent among those with no connection to the VA. Significantly, the report also included the statement “while suicide is preventable, suicide and suicide prevention are extremely complex.”

From 2005 to 2018 the overall suicide rate among veterans remained largely unchanged – between 17 and 18 veterans a day. After making adjustments for sex and age, veteran suicide was roughly 27.5 per 100,000 individuals in 2018 – compared to 18.3 per 100,000 for all U.S. adults. In November 2020, Military Times noted that veteran suicides comprise about 14 percent of the total suicides in America. “In raw numbers,… the number of veterans who died by suicide in 2018 was 6,435, up less than half a percent as the total veterans population fell by about 1.5 percent. By comparison… there have been 7,032 troop deaths in conflict zones since 9/11, according to Defense Department statistics.”

Unlike my Irish ancestors, it is critical to speak openly about suicide. The American Foundation for Suicide Prevention recommends that, if you suspect someone may be suicidal:

• Don’t leave the person alone.

• Remove firearms, alcohol, drugs, or sharp objects that could be used in suicide attempts.

• Call the U.S. National Suicide Prevention Lifeline at 800-273-TALK (8255).

• Take the person to an emergency room or seek help from a medical or mental health professional

Unhappily, many people of faith still believe the terrible theology spouted on television and in the movies that suicide is such an all-powerful “sin” – “a mortal  sin” -that individuals who have died by suicide cannot receive a Christian funeral or be buried in “hallowed ground.”  

In a recent episode of the CBS program Blue Bloods, a family’s attempt to hide a suicide was explained with ungodly – or certainly not-God-like - 1950s theology: If it is known that he died by suicide, he can’t be buried from the Church. 

While The Catechism of the Catholic Church addresses suicide in “Church speak” and the context of life as a gift from God, happily it also acknowledges “Grave psychological disturbances, anguish, or grave fear of hardship, suffering, or torture can diminish the responsibility of the one committing suicide… The Church prays for persons who have taken their own lives.” 

The story – probably apocryphal – is that, upon learning of the suicide of her missionary brother in the New World, a 16th Century cloistered nun in Spain wrote to God. In summary, she told him “My brother was sick and in pain. If you would cut him off from your love because he was sick, I want nothing to do with you.”

Hurray for her! 

Now is the time to extend a hand and the gift of presence to the suffering. Now is the time to speak openly and honestly about suicide and suicide prevention. 

Now is the time to understand that a loving Lord welcomes those whose physical and/or emotional pain has driven them to suicide with the words “Come, blessed of my Father, inherit the kingdom prepared for you….” (Matthew 25:34)