The takeaways below are my personal lessons as a grieving father. I am not writing in a professional capacity, nor in any way offering professional advice. Each child is different, and each case needs to be assessed by mental health professionals. In telling my particular story, I owe a debt of gratitude to B’shvil Ha’Haim (an NGO dedicated to preventing suicide and to providing emotional support to those who have lost loved ones to suicide), whose devoted staff have given me the tools to share my insights in a compelling and responsible manner. But the story and takeaways are mine alone.
Over the years, some have expressed concern that I would be emotionally overwhelmed by talking about suicide prevention, that I would drown in a morass of guilt. This, thankfully, has not been the case. I have lived my life with a healthy mix (for me) of joy and sadness, an appreciation of my blessings accompanied by an assumption of responsibility for my mistakes. “Takeaways” can save lives – and that is why I talk with soldiers, educators, and members of local city councils as a B’shvil Ha’Haim volunteer, and why I post on Facebook and write blogs for the Times of Israel. If sharing my experience can save even one life and prevent even one father or mother from living with the myriad of “what if?” questions that I do – “dayenu,” – the reward will have been well worth the effort.
Another reaction to my involvement with suicide prevention has been: “If someone is determined to end their lives by suicide, they will.” That is true – but should we therefore not even try to reduce the number of suicides? People die of cancer, car accidents and terrorist attacks. Should society simply accept these calamities? A staggering 69 billion dollars were invested in cancer research during the past decade because a just and caring society takes the moral high ground and endeavors to reduce cancer, suffering and death – even in the knowledge that not all types of cancer (or illness in general) can be cured.
According to the World Health Organization, some 720,000 people worldwide end their lives every year by suicide, and approximately 10-20 times that number attempt suicide. (It is widely accepted that these statistics are markedly understated due to the stigma associated with suicide.) It is incumbent upon us as a community to work to drastically reduce this scourge. In this vein, the name B’shvil Ha’Haim is a beautiful and instructive play on words. On the one hand, “b’shvil” means “for” – conveying the sense that the NGO provides services – “for the living.” But the word “shvil” also means “path,” thus adding another layer of meaning to the phrase, which can now be read as: “the path of life”. Losing a loved one to suicide is overwhelming – and is why people need help to stay on the path of life – to ride through.
After the episode of tears I mentioned above, Ariel began to see a psychologist on a weekly basis, which initially seemed to help. But soon, aggression, depression and anxiety appeared. Ariel would wake up in the middle of the night screaming and crying. I would hop into bed with him to comfort him, but to no avail. Over time, the outbursts became more frequent and more intense, and I became less patient. I was tired, and concerned about Ariel waking up our other children and our neighbors. In reality, I was scared and in denial. My wife immediately realized what Ariel was going through and said, “Our son is mentally ill.” Not me. Not my son. I was convinced that the anxiety was just a case of teenage hormones and the pressure of winning the judo championship a few months before. I just wished Ariel would be quiet and let me sleep so we could continue with the normal and ideal life we had – the happy and handsome family that we outwardly projected.
In truth, we were all bewildered and scared, and my wishful thinking was, in hindsight, tragically unfounded. The family continued to suffer, and most of all, Ariel, who was afflicted by a classic case of clinical depression.
SUICIDE PREVENTION – MY SIX TAKEAWAYS
Takeaway # 1. UNDERSTANDING THE LINK BETWEEN DEPRESSION AND SUICIDE
The concise definition of generic clinical depression as explicated in B’shvil Ha’Haim’s literature is critical to understanding its specific elements.
“A dramatic decrease in mood, over time, that causes an inability to function ,and leads to a sharp decrease in enjoyment and a sharp increase in sadness.” Most importantly, if someone is diagnosed as clinically depressed according to the abovementioned criteria, they are, a priori, at risk of ending their lives by suicide.
Our son’s behavior fit the criteria on every level. Ariel would wake up in the middle of the night screaming “Life sucks – I want to die!”; often didn’t get up to go to high school; dropped from five units to three in math; and stopped doing what he loved most – competing in judo. By definition, he was at risk of suicide. But I never grasped this basic definition and never understood that he was at risk. Over the course of 10 years the mental health professionals – his psychologist and 4 different psychiatrists – were of little help, and never broached the subject of suicide, for reasons which to this day remain to me unexplained. It is incumbent upon parents to take responsibility for the mental health of their child and not unquestioningly rely on the mental health profession. Do not let fear, shame or stigma prevent you from openly discussing the issue of suicide with your child. And know that depression comes in waves, and that you need to identify where your child is at any given moment on that wave.
Salient Lesson of Takeaway # 1
If your child/friend/spouse/sibling is diagnosed with clinical depression, they should be considered at risk for suicide, and precautions must be taken – some of which will be highlighted in the following takeaways.
Takeaway # 2 – LONELINESS AND DEPRESSION
“Loneliness feeds on depression and depression feeds on loneliness.” This powerful statement in B’shvil Ha’Haim’s literature is one I wish I had been aware of during Ariel’s ten-year ordeal. As mentioned, it is imperative to understand that depression comes in waves, and to clearly identify where your child is on the wave at any given moment. If s/he is in the depths of depression and close to the low part of the wave, they must not be left alone. Yes, watching someone 24/7 is impossible and people determined to end their lives can often figure out a way to do so. Nonetheless, it is incumbent upon us to protect them from themselves to the best of our ability with the understanding that there is no failsafe way to do this.
While in the army, both for logistical reasons and because he was considered an excellent candidate, Ariel was the only soldier in his paramedic course who was assigned to an isolated dorm room on an army base after completing his shifts in the MDA ambulance. Alone in his room after seeing death for the first time, his OCD- related anxiety and depression returned with a vengeance. I knew this was happening but failed to respond in a helpful manner. I respected his decision not to share his background of depression lest he be thrown out of the army. To be honest, I was too scared (ashamed?) to confront the reality of our son’s mental illness and did not want to risk revealing this information to his commanders. Looking back, I also believe that because my own 17-year army experience (one and a half in the standing army and 15 years in the reserves) had strengthened me emotionally, I assumed the same would be true for my son.
It was not.
I should have intervened with Ariel’s commander. But I did not, and now live wondering: Had I spoken to his commanders, would Ariel be alive today? Given the severity of Ariel’s depression, he might have ended his life in any case. It really does not matter. I regret not being more aware of my son’s emotional challenges during his time in the paramedic course. I should have protected him more and I should have hugged him more – even if in the end I could not save him from his illness. I am fully cognizant that I cannot fix and control everything – it took a lot of hours in trauma therapy to convince me of this – and I fully understand that I was not responsible for not saving Ariel from himself and his noisy brain.
But I could have and should have done more. I could have and should have been a better father. I’m still learning to live with regret without being overwhelmed by guilt. (In this regard, I highly recommend David Pink’s “The Power of Regret”, as it was most helpful to me.
Salient Lesson of Takeaway #2:
If your son/daughter is depressed and isolated, they are at risk of ending their lives by suicide. It seems so readily evident now – but I was either blind or paralysed at the time. Do not be. It is a tough burden to carry. And, yes, I understand that even if I had intervened, Ariel may have eventually ended his life anyway. It does not matter. I should have and could have acted differently.
Takeaway # 3 – Identifying and Utilizing Community Resources
Before speaking about identifying community resources, I want to describe the process of how Ariel was accepted into the army’s paramedic course and what transpired before he was forced to leave the army. Despite suffering from depression and anxiety for much of high school, Ariel, like many other 17-year-olds, was excited to prove his mettle in the army, but concerned that his history of depression and medication would prevent him from being accepted into a combat unit. With this in mind, Ariel slowly began to reduce his medications and requested letters from both his psychologist and psychiatrist affirming his fitness to serve in a combat unit.
There are numerous questions to which I often return. Why did I encourage Ariel to be in a combat unit after so many years of suffering from depression? Why did the mental health professionals who worked with Ariel also encourage him and categorically state, “You are healthy.” Why is there so much stigma and embarrassment surrounding the entire issue of mental health that Ariel realized that he needed to stop taking his medications in order to get into the army? Why didn’t Ariel’s mental health professional in the paramedics course attempt to treat Ariel and get him back on his medications instead of expediting his removal from the course and the army in general? The answers to these questions are complex. But clearly the army, mental health professionals and I should have been less influenced by the stigma of depression and demonstrated more understanding, empathy, and professionalism.
When Ariel left the army, despite the disappointment, he was still determined to serve his country, so he applied to volunteer at the Jerusalem Battered Women’s Shelter as part of his national service. Initially, the Shelter would not even consider him as a candidate, as only women volunteers had ever worked there because of the violence they had suffered at the hands of their husbands. When Ariel was not depressed, his intelligence and warmth won people over, and he thus ultimately became the first male volunteer to do his national service at the shelter. Ariel soon developed an excellent rapport with the professional staff, the mothers and, especially, the children. Then, similarly to what had transpired in high school when he left judo and in the army when he left the paramedic course, Ariel left the shelter. His depression and compulsive thoughts had returned with a vengeance, and Ariel crashed on the aforementioned wave.
Ariel saw the same psychologist for 10 years and took a variety of medications for most of that period. In addition, he saw several psychiatrists – but none of them were helpful. My wife took him for an interview at a CBT clinic that specialized in treating OCD, but Ariel refused to enter the program. Later, after he had left the shelter and was spending more time at home, I spoke to him and pleaded that he consider trying CBT. During one conversation he said, “Abba, you do not understand.” (a phrase I heard many times during his 10-year struggle). “OCD is a cognitive disorder, and CBT is a cognitive treatment. With all this stuff in my head I will explode and burn to death.” I tried to reply with sensitivity by saying, “You will not die, but if you get burnt, we will put healing cream on your body – just try something different already, something that might help since the therapy and medications clearly are not helping.”
I think the most important thing I have learned – sadly in hindsight –is that parents are not the best people to offer advice to their child, especially when there has been so much conflict in the house over the child’s aggressive and depressive behavior. Instead, consider asking other family members, friends, teachers or coaches to make suggestions about changes in treatment approaches. Perhaps if others had spoken to Ariel, he might have shown less resistance to trying something different. I will never know. I am aware ultimately it is up to the child to decide. We cannot control or fix everything. But we can try different options and not just give up in frustration or blame our child for being “stubborn”.
Salient Lesson of Takeaway # 3:
If you and your child have trouble communicating, seek out other resources in the community who can engage in a more open and calm conversation. Break down the stigma and talk openly about depression and mental health issues.
Takeaway # 4 TALK OPENLY AND DIRECTLY ABOUT SUICIDE IDEATION
The most dangerous myth surrounding the subject of suicide is that if we broach the subject of suicide, we may put the idea into someone’s head and subsequently cause him/her to end their life by suicide. This myth must be debunked! People yearn to live productive and enjoyable lives. We wish to enjoy our work, families, and hobbies. As Jews, life is a preeminent value, as it says with respect to observing commandments, “We should live by them.” There are many laws concerning the observance of Shabbat, and in the face of even the smallest risk of losing a life, these laws are immediately suspended for the sake of “pikuach nefesh”. It is incumbent upon us to save life.
Why do people choose to end their lives? Because they are in terrible pain and feel alone in their misery and helplessness – not because they heard that someone else did it and said to themselves, “Why don’t I try suicide as well?” This is a tragic misunderstanding of people suffering from depression. For most severely depressed people, not only is there no light at the end of the tunnel, there is no tunnel at all – just total darkness. They feel hopeless, isolated, and misunderstood – and desperately need a way to stop their pain – forever.
On two occasions Ariel spoke to me about the intense pain that his OCD was causing him. He said, “ Abba – you just do not understand me,” (He was right – I did not). “You just decided to have a cup of coffee, made the cup of coffee, drank the coffee, enjoyed the coffee, and then moved on with your life. Take a peek at my world: I also decide to have coffee, but then instead of making and enjoying the coffee, I have a hundreds of thoughts about one silly cup of coffee. Should I have had the coffee earlier so it will not affect my sleep, or maybe I should have decaffeinated coffee? But decaffeinated coffee undergoes a chemical process that is not healthy, so maybe I should have regular coffee with soy milk. But soy milk also undergoes a chemical process so I should probably stay away from it and drink green tea. But green tea also has caffeine which will affect my sleep. So, instead of a hot drink, I think I will have some healthy yogurt. But, lately due to all the stupid meds I take, dairy is causing problems with my irritable bowel syndrome.”
This is OCD at its worst! This obsessive, compulsive, repetitive way of thinking wreaked havoc on Ariel’s brain and soul. It paralysed him and made him crazy – literally.
On another occasion, when I asked him why he could not simply leave me a roll of toilet paper after he left the bathroom, he said, “Abba! – You do not understand!” (He was right again). “You sit down in the bathroom with your cell phone and read your Facebook, emails and ESPN sports news and then continue with your day. When I go to the bathroom, I cannot sit without hundreds of thoughts spiraling in my brain. You relax; I get anxious. You are productive; I am paralysed by compulsive thinking. Trust me, I wait for the day when I will feel better about myself and can plan to mess with you by purposely leaving you without toilet paper. But, for now, you do not even exist. I am so emotionally and physically drained by my endless thoughts that I barely have enough strength to get up and return to my room.”
These examples perhaps provide an inkling of why Ariel and so many others end their lives by suicide. We do not put thoughts in their heads – thoughts inundate them from within! But, if we talk openly and honestly and encourage them to share their pain, frustrations, and loneliness there is a chance – even if only a slim one – that they will choose to live and ride through.
I did ask Ariel on two separate occasions if he intended to hurt himself, but I did not explicitly say the word “suicide.” This sent a message to my son that I was scared and tiptoeing around and avoiding the real issue at hand. Even worse was that I asked a yes or no question. That was a huge mistake – please learn from me. Ariel, of course, answered “no” on both occasions, and I was so relieved that I quickly left the room. What I should have done is engage in a conversation with him by first giving him my assessment and then asking for feedback. I should have said, “Ariel – you have been fighting depression for 10 years of which the last two you have been terribly isolated in our home. You seem more depressed and anxious than ever. Eema and I are genuinely concerned that you are considering ending your life by suicide – do our concerns resonate with you? Do they have any basis in reality? Please share your thoughts with us honestly, and based on your answers we can make decisions about whether we can leave you alone in the house. We love you and want to help you.”
Salient Lesson of Takeaway # 4
I did not engage our son in an open discussion about suicide, and I so wish I could have a “do over”, as in pick-up baseball games when I was a kid. So, have the conversation. I understand people lie and that even if I had said the right things with more honesty and empathy, our son still may have decided to end his life. But we will never know, and I live with the angst that something I had taught my social work students hundreds of times – to create a trusting relationship and invite clients to talk – I did not do with my own son. I own this angst and share it with you so you can act differently. Take my mistake and learn from it. By doing so, you will help your child, yourself and, just perhaps, avert a tragedy.
Takeaway # 5 Be alert for warning signs
There are countless warning signs that your child may be contemplating suicide that one can easily find on the Internet. Seek them out. Ask mental health professionals. Each person exhibits different behavior. I can only share the warning signs that I missed with my son.
• Ariel closed his Facebook account.
• He closed his WhatsApp group with his Mechina (gap year program).
• He disconnected from friends.
• He stopped running and exercising.
• He barely left the house and created his own self-imposed quarantine: staying home, watching TV, and researching subjects on the Internet
Salient Lesson of Takeaway # 5:
There is rarely one reason why a person takes their life by suicide, and there is rarely one salient thing you have to watch out for. So, pay attention to major changes in your child’s behavior, as these may be signs that your child is spiraling downward to the low end of the wave. Sharpen your eyesight and your hearing – and be aware.
Takeaway # 6 Keep Dangerous Objects Away
For the last two years of Ariel’s life there was often a gun in the house due to army service. We didn’t think about the ramifications of this for many reasons: we did not understand the basic definition of depression, did not see that Ariel felt terribly isolated, and were not aware that he was on the low end of the depression wave and thus at risk. And, as mentioned above, we never had an open discussion with him about the possibility of his ending his life by suicide.
It is imperative to reduce opportunities for suicide by blocking access to dangerous objects such as drugs, ropes, and guns. To reiterate, if a person is determined to end his/her life it is extremely hard, if not impossible, to stop them. But as it says in the Torah – “Don’t put a stumbling block before a blind person” – do not put people in a situation which may cause them to fall.
Salient Lesson of Takeaway # 6: I should have had been more aware of the risks of having a gun in the house even if the gun itself was disassembled and locked up. I was not, and I have to live with this mistake. Protect the people you love who are suffering from depression by keeping dangerous objects away from them.