Mental Illness and Suicide
To understand Josh's death one must understand his life. It is too simplistic to only say that Josh took his own life, for by doing so, we can never understand, nor have great compassion for those who suffer mental distress in this life. Equally important, we can never know another's heart, and thus, we are so unqualified to judge the intents and feelings of another. Personally, I believe God has compassion for all those who suffer, in body and spirit, and thus, I know that God heals the wounded souls, whether in this life or the next.
My thoughts here reflect my own experiences. Although my comments are often echoed by others, I do not speak as a medical professional, nor pretend to be. I'm a parent. Also, it isn't my intent to write an academic paper on the subject; I'll leave that to the medical professions. For those seeking help, I strongly urge concerned caregivers and friends to consult with medical professionals about any challenges you might be facing and do your own research to become well informed on the subject.
Rather, I speak as a father whose son suffered a debilitating mental health condition. I speak to families and friends who are struggling to find some comfort or understanding on how to help their loved ones. I do provide some citations that provide reference points to the discussion, but again, I share my personal experiences with Josh on this subject.
I should say that Josh never wanted to be defined by his mental illness; he truly wanted to live a full life, but without understanding his illness, you can never understand his life.
Mental Illness and Suicide
All too often, the word suicide conjures up images that are misunderstood without reflection on the causes and reasons associated with it. It is not my aim to address all aspects of suicide nor to try to provide a comprehensive overview of why people end their lives. Rather, I hope to provide better awareness and greater empathy to those whose lives are affected by it. Unfortunately, society tends to paint broad generalizations about the topic and mental illness in general that provide little understanding and comfort to families.
In Josh's case, he had suffered for about 10 years with mental illness and a myriad of physical ailments, some of which he had had since birth. However, to all who knew him, Josh was well-known for his compassion, charity, and good nature. Few people knew the extent to which he suffered because he wanted to be remembered for his efforts to live a meaningful life, and not for the problems with which he struggled. Unfortunately, people often lack a profound awareness of the issues surrounding mental illness and sometimes cannot understand, nor accept, that someone with such great qualities and belief could end their own lives.
Mental Illness: Myths and Realities
Over the years, a number of widely-held myths on mental illness have often been perpetuated with unfortunate results, but some have sought to dispel these myths to bring about more compassionate understanding ( Grohol, 2008; Morrison, 2005). I would like to briefly mention some of them as they relate to people in general, but also to our son and our experiences.
Mental illness affects people in different ways. Unfortunately, you can't simply take a blood test and determine the causes of why people suffer from different mental disorders, and mental health experts aren't sure as to the exact causes.
A simple definition of mental illness is "any of various conditions characterized by impairment of an individual's normal cognitive, emotional, or behavioral functioning, and caused by social, psychological, biochemical, genetic, or other factors . . ." (The American Heritage Dictionary of the English Language, 2009). In addition, the National Alliance of Mental Illness (2011, para 1) further expounds on this definition by stating that "just as diabetes is a disorder of the pancreas, mental illnesses are medical conditions that often result in a diminished capacity for coping with the ordinary demands of life." With this definition in mind, we wouldn't say to someone suffering from other debilitating medical conditions that all he or she needed to do was to "get over it and get a life." In the same way, those dealing with mental disorders can't just "suck it up" and get over it.
When Josh began to manifest symptoms of mental illness, I was at a loss as to how define his behavior, and it was difficult to wrap my mind around or identify the reasons/causes. (You can't simply take an x-ray and see that something is broken.) As time passed, his condition was better diagnosed, which provide some context of what he was experiencing. Just as certain physical ailments can drain your life away, so can mental illness.
Over time, the medical field, and slowly the general public, has become more aware of the wide spectrum of mental illnesses and cognitive disorders. For example, when we think of the word, "autism," our limited knowledge tends to focus on the very narrow definition or image of a relatively non-functioning child with limited cognitive, social, and verbal skills.
Now, we see autism on a spectrum which includes Asperger Syndrome, and Pervasive Developmental Disorder, Not Otherwise Specified (PDD-NOS). In addition to other mental disorders, Josh also had high-functioning autism that few people knew because they had little understanding on the characteristics of this brain disorder (See High-Functioning Autism and Asperger's Syndrome, 2012). Unfortunately, without a knowledge of this disorder, we sometimes as humans make broad generalizations about a person that often formulate false and negative impressions about others.
While behavior issues can be the result of poor parenting skills, there is far more at play here. At times, my wife and I beat ourselves up because we felt that many of the problems that Josh was experiencing when he was younger were due to our complete ineptness to be good parents. How often have any one of us made a judgemental comment about a parent wrestling to control their children? "Boy, they can't keep their kids still? They must let their kids run around the house like animals while they are watching TV."
Certainly, we had much to learn (and still do), but the causes of behavioral issues are often much broader in scope than poor or inadequate parenting skills.
In suggesting an explanation for mental health conditions, Dr. John Grohol (2008, para. 3) explains that "many mental health experts believe in the bio-psycho-social model of mental disorders. That is, there are multiple, connected components of most people's mental illness that include three distinct, yet connected, spheres: (1) the biological and our genetics; (2) the psychological and our personalities; and (3) the social and our environment. All three seem to play an important role in most people's development of a mental disorder." However, there is still great debate on these issues because no specific biological markers have been discovered to actual prove the genetic connection. Careful future research should provide us with more answers before a definitive answer is reached.
With these considerations in mind, our family began to see the broader picture of mental illness, and we began to distinguish what things were in our control to work on as well as other factors over which we had less control. Over time, the first thing I lost was, in a way, my vanity in that I became less concerned with people knowing that Josh was in the hospital for the fourth, eighth, or twelfth time, and more interested in trying to learn more how to handle things better. I just knew I had no control of what people thought about our family.
Once I realized that his condition could be due to a combination of factors, I slowly learned to focus on the elements of which I had control, and we worked with medical professionals to handle other aspects of his treatment.
Research also shows that people who deal with certain mental disorders including autism may have other co-existing mental health issues including depression and biopolar disorder (Ghaziuddin, Tsai, & Ghaziuddin, 1992; Ghaziuddin, Ghaziuddin, & Greden, 2002; Lugnegå, Hallerbäck, & Gillberg, 2011; Leyfer, Folstein, Bacalman, Davis, Dinh, Morgan, Tager-Flusberg, & Lainhart, 2006; Munesue, Ono, Mutoh, Simoda, Nakatani, & Kikuchi, 2008), and thus, these disorders that manifest themselves can be due to interlacing bio-chemical factors of the human body, and not bad parenting.
Unless you have experienced chronic and clinical depression, extreme anxiety, or any other mental illness, you may make the unfounded assumption that those suffering from these conditions lack the drive to succeed, and just need to get up and get moving. The same could be said of suicide. Making statements that a person who commits suicide is simply being selfish denies the reality that people who are dealing with mental illness are often not thinking clearly at times to be able to process what they are doing. You simply can't lump all people into the same mold.
As for Josh, he made many goals in life, accomplishing some of them, and he wanted to be happy. Unfortunately, his mental illness made it difficult to overcome the very deep depression he experienced. No one who knew him would question his desire to get better, evidenced by the years of treatment he underwent and even enduring the stigma that went with it. (Fortunately, we had many family, friends, and medical professionals who had great empathy and understanding of his condition, so he was able to recover well between hospitalizations.)
Personally, I might have melted from the stress of having to be hospitalized so many times; however, Josh kept trying in spite of the intensity of the disease, and one of his accomplishments was to graduate from high school a month before he died. The high school he was attending required him to complete packets for certain courses. Instead of simply ripping through a packet as quickly as possible, he felt education was important, and he should give great care to his work, usually going well beyond the minimum requirements. The high GPA in the classes he took during the last part of his coursework was evidence of his determination to get things done and do them well.
And just as you wouldn't say that someone who died of heart disease or cancer lacked character to stay alive, the same could be said of many suffering from mental illness.
Unfortunately, this often isn't the case because perceptions are deep-rooted and hard to change. With Josh, we seldom mentioned that he had high-functioning autism (let alone his depression, severe anxiety, and mood disorder) because the word, "autism," was the only word most people heard, and this tended to conjure up broad, and misinformed, images of the disorder. He just didn't want people to treat him differently or think badly of him.
Furthermore, as I mentioned before, people still view mental illnesses such as depression as simply something that can be cured by a pep talk and a moving, motivational speech. Then, when the individual suffering from depression doesn't get out of bed, some people simply attribute this behavior to a simple lack of willpower and desire. Try getting out of bed with a 5,000-pound emotional elephant sitting on your chest, and you will see how hard it can be to move. Unfortunately, many people can't imagine this because the mentally ill don't have a visual sling around their brains.
The method of treatment can best be determined with the help of qualified medical professionals, and I would also encourage those seeking help to consult with different people within the field on the best course of action. Patients and caregivers should educated themselves thoroughly and not be hesitant to question different courses of action. Often times, people can get lost in the sea of medical rehtoric and all too quickly accept the treatment plan of one doctor or therapist. Read the research literature yourself, and like any diagnosis, be prepared to consult with other medical professionals if you feel unsure as to how to proceed.
Although research does show some connections between the two (Robinson, Sareen, Cox, & Bolton, 2009; Vohs, Gable, Ward, Barresi, Martel, R, & Slocumb, 2008), you equally have people who struggle with mental illness and never self-medicate with drugs and alcohol, and you have people with substance abuse problems, yet do not suffer from forms of mental illness (although we could argue that anyone who takes harmful drugs and is willing to inflict harm on their bodies are certainly making poor choices ).
However, we cannot claim that everyone's life disintegrates into drugs because of mental illness. Josh thought carefully about these issues and discussed different medical treatments with family and medical professionals. In the end, his own personal code of ethics helped him make decisions to avoid substance abuse.
From time to time, stories appear in the news regarding the possible correlation between mental health and violent behavior, including mass shootings.
Unfortunately, humans tend to follow the path of least resistance when it comes to drawing valid conclusions, and thus, in our haste to find answers, we often fall short when it comes to showing a definitive connection between A and B. We tend to overgeneralize, leading to bias and potentially-harmful assumptions about certain groups of people. This could cause caregivers, educators, public servants in law enforcement, and the general public undue fear and anxiety.
On the other hand, there are countless, daily examples of people with no mental health diagnosis committing aggressive actions or violence towards others. Road rage, domestic violence, bullying, and what I call "Black Friday Syndrome" (i.e., becoming agressive towards other shoppers) are examples of this. People simply don't know how to control their emotions and carry out socially-appropriate behavior.
In the end, providing accurate information and training to the general public on mental health care in schools and the workplace can increase our awareness of mental health issues, dismantle long-standing stereotypes about specific groups, and encourage us to reach out and show greater empathy to family and friends who deal with autism on a daily basis.
Anyone who is experiencing some emotional stress his or her life might benefit from getting helping from a well-qualified and trained psychologist, therapist, and counselor in the field. Unfortunately, because of the stigma associated with getting help, some people choose not to seek out advice or support for fear of how they might be perceived by others. People want to try to tough it out or rely on family and friends who, unfortunately often don't have the training to deal with difficult emotional issues. Furthermore, at times, there is great benefit in having all members of a family participate in therapy sessions because the problems that seem to deal with a single person often have a significant collateral impact on the rest of the family unit.
Church leaders and close friends can provide invaluable support to someone struggling with mental illness, and we were very fortunate to have had great people around us. However, keep in mind that many people are not specifically trained in the types of treatments needed for the complex nature of emotional disorders. There may be times when a leader, friend, or family tries to "rescue" someone because they feel it is their obligation, but these individuals and even a parent can become overwhelmed by the situation without the real skills to handle mental illness.
The unfortunate result in some cases is that the person trying to help languishes in depression as well, particularly if their friend ends their own life. A feeling of anguish and regret can further be intensified when we launch into the "I-should-have, could-have" statements where guilt overcomes us. I have learned that while friends and family can provide some help in understanding and dealing with emotional distress, medical professionals and therapists specifically trained in this area can often provide a better diagnosis and treatment in conjunction with the support of loving friends and leaders.
Instead of trying to handle the emotional rollercoaster all on our own, seeking out professional resources is critical. The first thing to understand is that you are not turning your back on your friend, but rather, putting them in the best position possible to get the help they need, and you then will provide additional support based, in part, of the plan of treatment by trained professionals. Although the person might not realize or accept it, encouraging people to get professional help is not turning our backs on the needs of our family and friends; rather, it is simply supporting their mental health needs beyond what we are capable of doing.
In our own case, our local church leaders provided a great deal of friendship and spiritual guidance, coupled with other resources, that helped our family immensely during our challenges. In addition to this support, we sought out professional psychiatric help to deal with the medical aspects of Josh's treatment.
Perhaps, instead of writing a conclusion, I should pen new beginnings. Throughout Josh's life, we were greatly filled and enriched by his goodness and attempts to bear the emotional burden of his disease. I also feel better prepared to handle other life challenges when, not if, they appear. I feel that great joy can replace tremendous grief as we reach out to others who are suffering from the ills of life, and I feel blessed to have been the father of such a great son who taught me in so many ways what it means to lift the burdens of others and try to comfort them.
Ghaziuddin, M., Ghaziuddin, N., & Greden, J. (2002). Depression in persons with autism: Implications for research and clinical care. Journal of Autism and Developmental Disorders, 32(4), 299-306.
Grohol, J. (2008). Top 10 Myths of Mental Illness. Psych Central. Retrieved on June 28, 2012, from http://psychcentral.com/blog/archives/2008/06/13/10-myths-of-mental-illness/.
High-Functioning Autism and Asperger's Syndrome. (2012). WebMD. Retrieved June 23, 2012, from http://www.webmd.com/brain/autism/high-functioning-autism.
Leyfer, O. T., Folstein, S. E., Bacalman, S., Davis, N. O., Dinh, E., Morgan, J. Tager-Flusberg, H., & Lainhart, J. E. (2006). Comorbid psychiatric disorders in children with autism: Interview development and rates of disorders. Journal of Autism and Developmental Disorders, 36(7), 849-861.
Lugnegå, T., Hallerbäck, M. U., & Gillberg, C. (2011). Psychiatric comorbidity in young adults with a clinical diagnosis of Asperger syndrome. Research in Developmental Disabilities, 32(5), 1910-1917. doi: 10.1016/j.ridd.2011.03.025.
Mental Illness. (2011). National Alliance on Mental Illness. Retrieved on June 23, 2012, from http://www.nami.org/template.cfm?section=about_mental_illness.
Morrison, A. B. (1995). Myths about mental illness. Ensign. Retrieved on June 26, 2012, from http://www.lds.org/ensign/2005/10/myths-about-mental-illness?lang=eng.
Munesue, T., Ono, Y., Mutoh, K., Simoda, K., Nakatani, H., & Kikuchi, M. (2008). High prevalence of bipolar disorder comorbidity in adolescents and young adults with high-functioning autism spectrum disorder: A preliminary study of 44 outpatients. Journal of Affective Disorders, 111(2), 170-175.
Robinson, J., Sareen, J., Cox, B. J., & Bolton, J. (2009). Self-medication of anxiety disorders with alcohol and drugs: Results from a nationally representative sample. Journal of Anxiety Disorders, 23(1), 38-45. doi:10.1016/j.janxdis.2008.03.013.
Teen Suicide. (2008). American Academy of Child and Adolescent Psychiatry. Retrieved June 27, 2012, from http://www.aacap.org/publications/factsfam/suicide.htm.
Vohs, C., Gable, R., Ward, C, Barresi, J., Martel, R., & Slocumb, D. (2008) Anxiety and depression as comorbid factors in drinking behaviors of undergraduate students in an urban private university. NERA Conference Proceedings 2008: Rocky Hill, Connecticut. Retrieved June 30, 2012, from http://digitalcommons.uconn.edu/nera_2008/28.