Frequently Asked Questions
Throughout the years, Josh experienced great accomplishments and success in the many activities he did, and he found great happiness and joy in pursuing his own interests and doing things for others. I emphasize this because we don't want the discussion on mental illness to overshadow those important events, and we want people to know that you can live a happy and productive life despite mental health issues. With Josh, his mental illness is part of the narrative, and I hope these experiences can be of benefit to others.
First of all, we want to remember and honor Josh's life, for he had such an impact on our lives and those with whom he had contact. He exhuded some many admirable qualities worthy of emulation, and we are very proud of that.
Second, we want to provide hope and encouragement to those who are affected, in one way or another, by mental illness and/or suicide. Josh struggled for many years in dealing with the issues of mental illness, and we know of many people who often suffer in silence because they don't know where to turn for help.
With this in mind, I want to share my experience so that it might be of some help to others. I fully realize that each situation is different, so I only speak in terms of our own experience.
Everyone will deal differently with life and death. As his father, it isn't that hard to talk about Josh because I know him, I am very acquainted with his illness and his decade-long struggle to treat it, and his admirable character that focused on others.
I have been asked candidly if I feel ashamed or embarrassed about Josh and his life, specifically in reference to the manner of his death. My answer, no, may surprise people, particularly to those who didn't personally know him on a daily basis. Let me point out that I do not condone or support suicide. I simply think we need to understand the reasons and factors that can lead people to make that decision, especially in cases of mental illness or acute distress. With this knowledge, we are then in a better position to provide positive support to those in need.
First of all, there exists a stigma regarding mental illness and suicide, but when people become intimately acquainted with the reality of mental illness and the overwhelming despair that individuals face on a daily basis (in some cases, for years), they often develop a greater understanding and deeper empathy towards mental illness and suicide in a similar way as they would respond to those suffering from other debilitating medical conditions.
Second, the mental anguish that Josh felt and his inability to stabilize his moods were just as real and devastating as other medical conditions.To people who knew him, he was a very likeable, honest, and cordial person. What they didn't really know was that his illness wasn't a simple, fleeting sadness or disappointment for a single day, week, or month like we all feel from time to time when life's temporary setbacks get us down. Rather, his illness lasted for a decade. Thus, I wouldn't feel shame if a family member died due to medical circumstances that ravaged his or her life, often beyond a person's control. I don't expect people to fully understand or accept this, but having dealt with Josh's illness and extensive treatment for years, I can simply say that his pain and anguish were real and devastating.
Finally, I grieve like everyone else, and I feel a tremendous loss without Josh and the fact that he couldn't overcome his constant hopelessness in spite of ongoing medical treatment to the end; however, if you were touched with the goodness and life that Josh lived, then you wouldn't feel any shame or embarrassment about sharing his life with others.
All too often, family and friends beat themselves up with guilt and shame; however, a better awareness of mental illness--its causes and effects---along with greater compassion from others, can bring some peace and consolation.
In Josh's case, I'm just proud to have been given the privilege to be his father.
First of all, if you or a family member are in immediate danger, call your local emergency number. The hardest lesson is to learn to intervene and get help.
For general information, the first step is to become informed, and these Web sites can help you get started. It is very easy to become overwhelmed because of the emotional, physical, and financial toll it can have on the patient and family.
If you need professional counseling, we have found that each therapist has his or her own style of interacting with patients and addressing treatment, so you have to determine who you can work with best. Depending on the nature of the problems, a weekly visit with a therapist might be sufficient to address certain mental health concerns. However, if the patient isn't responding to out-patient care, long-term residential treatment may be needed, and such care often isn't covered by insurance.
Although there can be common indicators that a person is considering suicide, each situation is very different because of so many coexisting variables taking place in a person's life. In some cases, a person might be going through traumatic emotional turmoil, but he or she tries to hide its severity because of embarrassment or anxiety. Some of the links above can give you some general principles of suicide awareness and prevention.
Because of these complexities and the private nature of emotional distress and illness, it is very possible that close family and friends are privy to the exact details of what has been done on behalf of the person. However, what unfortunately can happen when there is a suicide is that people unacquainted with the situation can become judgemental (e.g., How could the parents not have known? or Why didn't they take action and intervene?). This can lead to blame-shifting even within families, causing great family and marital conflict and additional grief. Marriages can fall apart. Fortunately, this didn't happen in our family.
During the difficult times, Josh openly talked and struggled with suicidal ideation (i.e., thoughts) and the pains of mental illness on and off for years. He believed that being completely honest was a trait that people of good character just did. He was very transparent, and in a way, so was his illness. He discussed his feelings with us and the mental health professionals with whom he worked. When he needed acute care at very difficult times, he was hospitalized at a specialized neuropsychiatric institute. There were times during hospitalizations where he emotionally collapsed and couldn't process his feelings and shut down, but he tried to work through them.
In addition, we had countless individual and family therapy sessions with psychologists, psychiatrists, therapists, social workers, and other medical staff, which did a great deal help him become a better person and learn to cope with his mental health issues. (It also helped me recognize what I could do to be a better father.) And just like with other chronic and debilitating diseases, families will exhaust every possible treatment to provide comfort and relief from the pains of an illness.
So, from the point of awareness, his situation was before our eyes every day, but we realized that it was impossible to protect him completely from every case scenario. There were times when he left the house in a very confused state, and fearing for his safety, we called the police to help us find him. This was an obvious sign that he could be in danger. After he turned 18, we continued to exhaust treatment option after option to seek relief from the mental anguish he was going through. Whenever we saw signs that his anxiety levels and depression were increasing, we intervened. In many cases, he knew he needed help and was compliant to his treatment; at other times when he wasn't able to think clearly, we intervened again, and he was hospitalized involuntarily.
That said, although not always so apparent to family and friends, one possible warning sign of suicide is when the individual stops talking about suicide. In such cases, rather than assume people are over their immediate crisis because they seem in a calm state of mind, we should realize that they might be feeling at peace because they have already made the decision to end their life. Don't be afraid to ask how they are feeling.
In our last conversation with Josh, he had a thoughtful, calm demeanor about him. He was compliant and polite; however, the calm that he might have been feeling may have come from the knowledge that the pain that he had been feeling for so long would soon be over. Hence, as in this case, while there might be overt signs that a person is at risk for suicide (statements such as, "I want to die."), remember that suicide can be proceeded by many types of behavior, including an absence of discussion on suicide when it had been present before. All this said, so many people like Josh who die by suicide really WANT to live; they simply want the pain to go away.
In short, when you hear of a suicide, suspend judgement on what might have happened to the individual and what was done on the person's behalf. It can be a heavy burden to carry the loss of a loved one, especially when the eyes of the world are watching.
So, going back to the original question, there are often warning signs regarding suicide, but the individual may try to hide their suicidal ideation from you. Seek out advice from medical professionals in your area that are specifically trained to provide assistance, and never hesitate to call a local emergency number for immediate assistance.
No, that wasn't a factor at this point in his life; however, when he was younger, he sometimes experienced intense bullying in school, in part because he didn't always fit it. He had unique social quirks and difficulty in social situations, and the bullying contributed to his anxiety and depression. As he got older, things improved through the help of friends, family, and teachers.
However, bullying can be a significant factor for other children, and bullies often can't see or don't care about the impact that their actions have on others.
Probably the best thing to do is to call your local emergency number to get immediate assistance. Making statements such as, "You'll regret it" or "You're just being selfish, and you're only going to hurt your family," might sound like rationale statements, but they do little to support the person contemplating suicide and can simply aggravate the situation.
Keep in mind that one of the hardest aspects that families often don't anticipate is how inaccessible urgent care can be, depending on whether the individual is a minor or an adult. Local laws and personal freedoms can limit what you can and cannot do. Thus, if you suspect the possibility of suicide, what you are able to do can depend on the relationship and age of the person for whom you are seeking help. When you are dealing with children, you generally have the parental and legal right to intervene, require treatment, and if needed, seek hospitalization.
However, when you are trying to get help for an adult family member or a friend over 18 years, you may have fewer options depending on local laws because, unless the person is an immediate danger to themselves or others, an adult often has to grant consent to medical treatment. In other words, an adult generally cannot be forced against his or her will to get medical treatment unless you can verify the person is in imminent danger, which can be hard to prove if the person appears to be of sound mind when interviewed, let's say, by local law enforcement.
Moreover, even if your adult child gives consent to get medical help, you might find yourself completely shut out of treatment decisions and consultations with medical professionals because the child is now legally considered an adult. Parents in such situations can feel completely helpless and frustrated that even though they might pay the complete bill for hospitalization and medical expenses, the child can decide whether or not to include you in his or her care. The law is designed to prevent abuse of power and authority of parents and government over an individual, but a parent can feel powerless to help.
Talking about death or mental illness for many people can be hard and awkward, and we, as humans, can inadvertently stumble over our words in expressing our condolences or sorrow, or for some people, they exert great efforts to avoid the topic completely and don't say anything. They seem to be paralyzed by discomfort and unable to bring up the subject. This may stem from the fact that we often don't know all the facts associated with death, or that we just don't know how the family will respond. Unfortunately, not saying anything or staying away can cause more discomfort and pain.
Whatever the case might be, I suggest that people say something. Anything. You don't have to be eloquent to express your sympathies and grief. Furthermore, instead of saying, "Please let us know if there is anything we can do," just do something. Many people in times of grief need the simple things, so instead of volunteering to watch the kids at some future date, just take them out to get some ice cream or watch a movie or any other activity so parents or other family members have time to contemplate and simply make any needed funeral arrangements.
Also, take some simple action to alleviate some of the stress in the days right after someone dies, making sure that you are careful and sensitive to any needs the family might have. Mow their lawn; take out their garbage; make a phone call. Just keep in mind that the degree to which we share words of condolence or acts of kindness shouldn't be based on the manner in which the person died. Hearthache and grief will always be there no matter how you package it.
Even if days, weeks, months, or years have passed without being able to share your condolences, a simple thought or remembrance can provide healing. It is never too late to do so. Sometimes people worry about bringing up the loss of a loved one. "They might get emotional if I say something, so I probably shouldn't say anything." To those who might think this, simply ask how they are doing and provide a compassionate, listening ear. In fact, some people find great comfort in being able to talk about the loss of a loved one, with no expectation of receiving advice. After the first week or so, visits to the family tend to trail off, but the need to provide emotional support is just as great or greater, so even a brief visit, a letter, or a phone call can buoy up a family.
Fortunately, our family has been showered with so much goodness from friends, neighbors, and even from people even half way around the world who have been touched by Josh's story. In fact, the greatest comfort for me has been when people have written a letter or note and have shared a memory they have of Josh. You can even leave a message on this site's Guest Book. I know it is a selfish desire to hear stories about Josh, but such memories are treasures to our family and help sooth the heart.
Finally, there are a number of resources to help suicide survivors code with loss. Some people might find comfort in meeting in a group setting with others. Others might prefer to read resources on their own such as are found on page called Suicide Survivors at the National Alliance of Mental Illness. Pointing your friends and family to such information at an appropriate time can be a great assistance.
No one wants to feel pressured, directly or indirectly, to discuss the particulars of a person's death. Allow the family to express their thoughts in their own way. Validate their feelings when appropriate. Much of what is said will depend on your relationship with the family. If people want to talk, they will. Whatever the case might be, thoughtful expressions of love and support from time to time in the weeks and months afterwards can provide great comfort.
To suicide survivors (those whom have lost a friend or family member to suicide), keep in mind that you may want and need to process your thoughts and feelings with others long after the event, and doing so with a suicide support group might be helpful. The Suicide Aftercare Association has a listing of support groups around the United States.
Every case in losing a friend or family member is unique. Some events we can control, but in other cases, we may be powerless to change the course of events.
From our experience, we know people who have been anguishing over the belief that they could have done or should have done something to have prevented Josh from taking his life. "If I only had visited him more often" or "If I hadn't made that comment to him" have been common expressions of remorse.
Unfortunately, family and friends tend to beat themselves up with the belief that one single event could have changed the outcome; however, Josh knew that everyone had done what they could for him, and only a very small circle of individuals truly understood the length to which he tried and received help. I accept the fact some people will judge him or the efforts made on his behalf simply because they just never were aware of what was happening. Such misperceptions are generally true of most things in life. With Josh, no one should feel that they should have done more because his family and close friends did all they could under the circumstances.
One of the hardest parts to accept is that in spite of all your efforts, you may not be able to stop someone from ending his or her life if they are intent on doing so, particularly when they are adults. When they are children, you have control over their medical treatment; when they turn adults, your legal recourse and treatment options and influence are much more limited.
I have seen other cases in which those not close to the situation question whether the family or friends had done enough to prevent the loss of a loved one, regardless of whether it was due to an unfortunate accident, physical illness, or other cause. Misunderstandings and hurt feelings can result when we don't realize that so much probably had been done that was simply not openly publicized for privacy reasons. I mean, who wants to announce that you had to admit a family member to a psychiatric hospital multiple times or you had to call the police for fear of someone's safety, and several police cars show up at your house?
Thus, the fear of being judged sometimes causes people to carry a silent burden. Viewed another way, seeing athletic events (e.g., a 5K race) organized to raise money for those suffering from cancer is not uncommon and can provide wonderful support to a family; however, how often do you witness such an event to raise money for someone suffering from schizophrenia, debilitating depression, or bipolar disorder? Such events sometimes do happen, but the person suffering and the family often don't want to be identified as people who are dealing with such stigmatized illnesses. It is usually easier to talk about a broken foot, a pulled muscle, cancer, and high blood pressure than a mood disorder.
The lesson in all of this is to pay careful attention to those things which are within your control, accept the things that you have no control over, and forgive yourself and others when mistakes are made. In the end, I feel that once you rub shoulders with such difficult circumstances on a very personal level, you tend to feel a greater spirit of compassion and a less critical attitude towards others. Fortunately, our family has been greatly blessed by family, friends, and neighbors who have poured out loving support that has soothed our souls. Their examples are worthy of emulation by all.
Finally, death tends to either bring families together and strengthens family relationships, or it can tear families apart. The difference often depends on the faith and nature of family relationships before our ships get tossed around in life's caldron of tribulations. Personally, my wife and I have grown together throughout the years, and these experiences have strengthened our commitment to each other and our entire family.
Over the years, there were times when I tried to find the most appropriate words to describe suicide, while not sounding insensitive. Now, having a son who died by suicide, I often find myself in situations where people ask about our family (e.g., "So, how many kids do you have and what do you they do"?). Initially, I wasn't sure of the most appropriate words to say, in part because I didn't want the other person to feel uncomfortable.
The words, "commit suicide," are commonly used in conversation and in the media. However, the terms, "died by suicide" or "death by suicide" may be often more appropriate and less offensive to some individuals.
Our experiences in loving and raising Josh is only a small part of our story, for we had so many other challenging events going in our lives over this same period. At times, I felt completely overwhelmed, hoping that tomorrow would be better. Through all of this, I have found that adversity introduces man to himself, and you quickly learn who you really are in terms of faith and courage.
Learning to cope was and still is important so that our lives didn't/don't unravel. In addition to having great friends, family, and concern health care providers, we had to learn to take care of ourselves, emotionally, physically, and spiritually. You can't help anyone if you are in a state of complete emotional collapse yourself. Immediate and extended family members still struggle with Josh's death, but we try to support one another.
For me personally, the things that have helped a great deal include the following:
Losing someone by suicide is a traumatic event, so family members may need short- or long-term grief counseling or therapy to process their feelings. Our family is no exception. Talking with friends can be helpful, but the emotions and topic on death and suicide can overwhelm friends who are unprepared to process the feeling with you. In such case, professional counseling help you navigate the grieving process.
Some final thoughts . . .
Some things in life are often beyond our control to change, and running around and complaining that life isn't fair never helps. If we feel that life is supposed to be all bliss, we certainly will feel great disappointment every day. Instead, our lives can be enriched and improved because of such trials. They teach us important lessons we can't learn otherwise.
I am just grateful that I have been blessed with my own set of circumstances because I know that other people have much more difficult trials to deal with than my own. I draw great strength from the inspirational stories of those who have survived and thrived in periods of adversity.
For all of us, it's not a matter of if, but when, we will face new, seemingly-insurmountable problems. Anchoring ourselves to something--family, good friends, a good medical support system, and our faith--can help through difficult storms. Josh was a great example of striving to be better; he is my hero.
How do your own personal beliefs and values help you deal with your loss?
People deal with life and death in different ways, and I certainly respect the feelings all individuals, whether they believe in a supreme being or not. Some people draw strength from family and friends; others seek out relief from anguish through counselling or even recreational activities. Personally, I find comfort in all of these activities.
Our capacity to understand the things of the mind and heart are so very limited, sometimes causing us to make unneeded and often harsh judgements about others. We often tend to take a grim view of those who end their lives without trying to fully understand the circumstances.
So, whatever your source of strength might be, try anchoring your hope and faith to something solid and immovable, which may include close family and friends whose core values and support don't waver in the rough seas of life . . . people who still stand by you even when life kicks you in the gut. All of us will pass through difficult times. A lot depends on how we respond to things and whether we allow such events to completely define who we are. Just remember that great sorrow can be turned into joy and comfort as we reach out to comfort others who stand in need of it.