Suicide prevention: Talk! It can save lives.

The takeaways below are my personal lessons as a grieving father who lost his son to suicide eight years ago. I am not writing in any professional capacity (not as a social worker, although I have an MSW, nor in any way offering professional advice). Each child/situation is different, and each case needs to be assessed by professional mental health professionals. I have integrated my personal story with information that I acquired in training provided by the B’shvil Ha’Haim NGO about how to share my personal story in a compelling, honest and responsible manner. But the story is mine only.

PERSONAL TAKEAWAYS & LESSONS LEARNED

LESSON 1: Understand the ramifications of your loved one’s diagnosis of clinical depression

Background to Lesson 1: The concise definition of generic clinical depression as explicated in the B’shvil HaHaim PowerPoint presentation 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.

My son fit the criteria on every level. He would wake up in the middle of the night screaming “Life sucks — I want to die!” He often didn’t get up or go to school throughout high school. He dropped from five units of studying (highest level) to three units (lowest level) in math, and he 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.

The mental health professionals — his psychologist and four different psychiatrists, over the course of 10 years — never broached the subject of suicide. They were either incompetent, afraid of overwhelming us, or, like most of society, too afraid to tackle the subject directly with Ariel z”l and/or with us, his parents.

Lesson 1:
Take responsibility for the mental health of your child and do not 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 we need to identify where our child is at any given moment on that wave.

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LESSON 2: Loneliness and depression are a very dangerous combination

Background to Lesson 2: “Loneliness feeds on depression and depression feeds on loneliness.” This powerful statement in B’shvil Ha’Haim’s PowerPoint presentation is one that I wish I had paid more attention to during Ariel’s z”l 10-year ordeal. It also connects to the last sentence of the previous paragraph, namely, knowing where your child is on the wave of depression. If s/he is deep in the depths of depression and getting terribly close to the low part of the wave, it is imperative that s/he not be left alone. Yes, carefully 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.

Lesson 2:
For logistical reasons, and because Ariel was considered a top-notch candidate, he was the only soldier in the paramedic course who was sent to an isolated room on an army base after he completed shifts in the MDA ambulance. Alone in his room after seeing death for the first time, his OCD-related anxiety and depression came back with a vengeance. I knew this and did nothing. 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? embarrassed?) to confront the reality of my son’s mental illness, and did not want to risk revealing this information to his commanders. I should have…but did not. So, I live with guilt and regret that I was more worried about Ariel’s z”l army career than his life.

Please be aware that 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 paralyzed 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.

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LESSON 3: Parents may not always be the best people to offer advice to their children

Background to Lesson 3: Ariel z”l was seeing the same psychologist for 10 years and taking different medications on and off for most of that time period. In addition, he saw several psychiatrists – but none of them was helpful. My wife, Devorah, took him for an interview at a CBT clinic that specialized in dealing with OCD, but Ariel z”l refused to enter the program.

Later, I spoke to him and pleaded that he consider trying CBT. During one conversation, he said, “Abba, you do not understand (a phrase that I heard many times during Ariel’s z”l 10-year struggle with depression), and said, “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”.

Lesson 3:
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. I would consider asking other family members, friends, teachers/coaches (judo coaches in Ariel’s story) to make suggestions about changes in treatment approaches. I am not sure, but I believe that had others spoken to him, there might have been less resistance on his part to trying something different. I will never know… But please consider this as a possible way of getting through to your child. Again, I am aware that 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 and/or blame our child for being “stubborn.”

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LESSON 4: Don’t be afraid to talk to your child about suicide

Background to Lesson 4: 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 — including my dear son Ariel z”l — end their lives because they are in terrible pain and are suffering, not because they heard that someone else did it and said to themselves, “why don’t I try suicide as well?” This is a superficial and total misunderstanding of people suffering from depression. For most severely depressed people, not only is there no light at the end of the tunnel, but 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.

Lesson 4:
I did ask my son 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/ avoiding the real issue at hand. Worse was that I asked a yes or no question. Ariel z”l 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. For example, 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. Ima 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 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.”

I did not engage my son in discussion, and I so wish I could have a “do-over” like 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, my son might have decided to end his life. But we will never know, and I live with the angst that something I 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.

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LESSON 5: Watch for warning signs

Background to Lesson 5: 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.

Lesson 5:
Warning signs — I saw everything and did not understand anything.
• Ariel z”l 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 quarantine: staying home, watching TV, and researching subjects on the Internet.

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LESSON 6: Be aware of potential means of suicide in your environment

Background to Lesson 6: For the last two years of Ariel’s z”l life, there was often a gun in the house when our other son came home from the army. We did not think about the ramifications of having a gun in the house for many reasons: We didn’t understand the basic definition of depression, that Ariel z”l was at risk, that he was on the low end of the depression wave, that he felt terribly isolated — and that we had never had an open discussion with him about the possibility of his ending his life by suicide.

Lesson 6:
It is imperative to reduce opportunities for suicide by reducing 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 an stumbling block before a blind person,” meaning, do not put them in a situation which may cause them to fall. I should have had the gun secured away. I did not and I have to live with this mistake.

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Final Thought:
Ariel z”l ended his pain and bequeathed it to us as we live with the angst of all the “what ifs.”

We will never know and for me, at this point, it is an irrelevant question. I choose to ride through and live my life holding sadness and joy together with dignity. I also choose to talk about this modern-day plague so, hopefully, there will be fewer people like Ariel z”l who choose to end their lives, and fewer fathers like me who have to say Kaddish for their sons.
We must talk; it can save lives.