FEATURE: Quiet casualties

By on July 28, 2015

Why we shouldn’t stay silent about suicides in a small town

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Jackson Hole, Wyoming – Many people who attempt suicide often talk about wanting rest or trying to find peace. They don’t want to die so much but end their pain. It’s as if their life is in discord. Joy is replaced by hopelessness. Many think of themselves as a burden. They withdraw from family and friends and insulate themselves until it’s time to pull the trigger.

Suicide, especially by firearms, has been a pandemic in Wyoming ever since John Sargent blasted his way to the boneyard in 1913 with his Sharps rifle while “God and Now We Die” played on the Victrola next to the fireplace in his cabin. The Cowboy State consistently is at or near the top of the list in deaths by suicide in the nation, running nearly twice the national average.

According to the Wyoming Department of Health, 66 percent of Wyoming’s 100 annual suicides happen with the use of firearms. From 2004 to 2013, Teton County reported an average of 3.2 suicides a year – 26 of the 33 deaths, or 79 percent, involved the use of a gun. The national average is 66 percent.

The recent suicide of a 16-year-old boy at the Van Vleck House, along with Jackson Hole native and University of Wyoming student Billy Frank’s hanging bring the often taboo and secretive aspects of suicide to the forefront. It’s a blight that small towns like Jackson would rather sweep under the rug than get to the bottom of.

Mental health issues like clinical depression, mood disorders and anxieties sometimes combine with life-changing events that push even stable people to the edge of despair. But healthcare professionals on the frontlines are getting better at diagnosing suicide risks and help is usually a phone call away.

Should I say something?

A moving video produced by Jennifer Tennican under the leadership of the Episcopal Suicide Prevention Connection debuted late last year. “Our Youth and Suicide – a six-person scene” features sound advice from teens for teens dealing with a friend who may be at risk. The message warns not to marginalize what you’re hearing. Get actively involved.

“We all have our ups and downs,” one young actor says.

“It doesn’t hurt to ask. In fact, it helps,” says another.

The direct approach of asking a friend or family member whether they are thinking about killing themselves was once thought to be too blunt or confrontational. Not anymore, experts say.

“It’s challenging,” admits Pier Trudelle, principal of Kelly and Moran elementary schools and a special projects director working with local mental health providers for the past eight years. “Anxiety or feeling sad and blue can be normal, but when does it become a concern? We need to train and build people on the front line. You need skills and tools to ask the right questions.”

Alexandra Klein, 28, is a licensed clinical social worker who deals with eating disorders and suicidal ideation patients. She admits she is not trained as a crisis hotline operator, but if she was the only thing that was standing between the ledge and sidewalk, she would start by trying to contract with the “jumper.”

“I would try to create a short-term, goal-focused situation to start,” Klein says. “Instead of saying things like: ‘Don’t ever kill yourself. That’s silly. What are you doing?’ – which you should never say, I would ask them to commit to at least staying safe for the night until [counselors] could see them in the next day. Deep psychotherapy is not going to work at that moment. It’s more like, ‘What do I need to do to at least shift your thinking in this moment?’”

Director of Statewide Suicide Prevention Terresa Humphries-Wadsworth also believes a personal connection needs to be made with depressed persons whose sadness has brought them to rock bottom.

“The first thing you try to do is connect with them on a personal level,” Humphries-Wadsworth says. “What is going on in their lives? Let them tell their story and listen for things that could potentially help, something that they could agree to live for.

Bruce Hayes, School Safety Consultant at the Wyoming Department of Education, says don’t worry about what to say or how to say it. Just say something.

“For those who sense they have a friend going through the valley of a suicide decision, I would hope we would step up to the plate and not shrink back,” he says. “Sometimes we don’t have time to research the perfect words or answers. We just need to be our best selves.”

Dismantling stigma

For many middle-age males, statistically most likely to end their lives in Wyoming or anywhere, generational taboos prevent sufferers from reaching out. In the West, where a stoic independence is the rule, toughing it out alone is thought to be the only choice. Therapy is a sign of weakness. And ready access to firearms makes for a deadly cocktail.

“It’s still a little more stigmatized for men to be in therapy and to be struggling with depression or anxiety or grief about a breakup, say,” Klein says. “I just don’t know that a man is going to scream from the rooftops that they need therapy. Asking for help is not a weakness, it actually shows strength. It’s what makes you human. Emotional dis-regulation is a human experience we all have and it’s pretty ubiquitous. I don’t know that anyone has ever said, ‘I’ve never gone through a hard time.’ It’s just not realistic.”

The aloneness is what drives emotional pain home. Humphries-Wadsworth thinks it’s important to remind suicidal people what they are going through is more common than they might think. She also stresses the direct approach when talking about a newly implemented program reaching communities statewide called Applied Suicide Intervention Skills Training (ASIST).

“We are training people in how to talk to someone who they are worried about. It’s very direct,” Humphries-Wadsworth said. “The person who is at risk really wants someone to show they care. We are social animals. We need connection with other people.”

ASIST has put an estimated 6 percent of frontline social workers, police, counselors, doctors and teachers through a two-day 16-hour workshop designed to teach people to recognize the signs of suicide risk and to know what actions to take.

Licensed Clinical Professional Counselor Adam Williamson has worked with numerous students as a nationally certified counselor. He is a team member on a Regional School Suicide Response team which was called in to Teton County School District No. 401 after Sophia Vickrey, 16, and Brandon Coburn, 15, took their own lives within a week of each other in 2010. Williamson says kids are getting the message.

“In this community there are plenty of options. Very capable options,” Williamson said. “This community in many ways is a model of how it should look. We are already being emulated and that’s pretty cool.”

Trudelle thinks mandatory educational training for teachers and school administrators brought about by the Jason Flatt Act in 2014 has been effective in making sure students don’t slip through the cracks. “The State of Wyoming is acutely aware that suicide is an issue,” she says. “You have what happened in 2010 in Teton County, Idaho, and it heightens you’re awareness. It makes you more vigilant. Our schools do a good job working with students.”

150729CoverStory-2Social media’s role

Virtually every study on Facebook and depression – there are dozens – shows a direct relationship between the amount of time spent online and increased sadness. A medium that purports to connect us to our friends and the world in reality leaves us alone in the dark staring at glowing screens. Cyber bullying and the pressure to live up to our peers’ perfect lives sends some over the edge.

“Social media is truly a double-edged sword,” Hayes warned. “It can keep young people connected, remind friends and family of birthdays, or let a mom tell her child she loves him. Unfortunately, it can also be used to make fun, demean, discourage and degrade.”

Williamson is not alone in calling Facebook an illusion.

“I think the problem is it’s an unreal expectation of what life looks like,” he said. “Facebook is really well studied. One of the interesting results to come out is the number of friends that you have correlates directly with how poorly you view your own body. And the more time you spend in front of Facebook, the less self esteem you have. Facebook completely wrecks sense of self on these studies.”

A recent study from the University of Houston published in the Journal of Social and Clinical Psychology was the first to link social comparison to depressive symptoms. Research from University of Innsbruck in Austria, appearing in the peer-reviewed journal “Computers in Human Behavior” last year, went even further: The longer you’re on Facebook, the worse you feel.

“I think it’s a crisis, I really do,” Klein said. “Facebook and Instagram and all these social networks are really misleading. It gives the illusion of being so tied-in to the cool group. That’s not always the case. They get the effect of feeling connected and heard, and I don’t think that’s really most users’ internal experience at all. I think they feel more and more isolated.”

As schools struggle with removing bullying from the playground, cyber bullying is now the scourge of the Internet. Some states, like Pennsylvania, have made it a crime.

“In some ways it can be even more traumatizing and damaging than [face-to-face altercations],” Klein said. “It’s documented forever online and everyone can see it. I think it’s really worrisome.”

Humphries-Wadsworth points to the ease of flaming from behind an avatar or screen name. “It takes just a second to click and share, and it’s out to all their friends,” she said. “It is worse than any gossip mill in history. And because kids are impulsive, they do things quickly and under anonymity that they would have never said to somebody in person.”

Red flags: Signs someone may want out… permanently

We all deal with life’s ups and downs, some better than others. But why do optimists calmly make lemonade from lemons while others bawl their eyes out at a sad movie? Experts are drifting from a nature versus nurture model and leaning into a nature via nurture one. Poor choices in coping mechanisms like binge eating or substance abuse increase the likelihood that suicide ideation could be just around the corner from an unexpected life crisis.

“The [catalyst] for suicide ideation is loss,” Humphries-Wadsworth said. “Loss of relationships, financial security, social status. Substance use also is a contributing factor.”

Williamson looks for hopelessness. “We ask if there is any possible way [suicide] can wait. Can they put it off a day? Hopelessness makes no reason to wait. It won’t be better tomorrow, so what’s it matter?” he said. “We also look for a lack of social connectedness, a feeling like the person is a burden to other people.”

Previous suicide attempts and access to lethal means are also reasons to strongly suspect someone who is beyond down in the dumps might be suicidal.

Humphries ran through her checklist. “A sudden change in mood; even to upbeat. Someone who has been down for a long time all of the sudden seems happy and engaged. It might seem like a great thing but might not be,” she said. “Withdrawing from family and friends. Giving away possessions, especially something they care deeply about. And, of course, any talk about death, dying or suicide should be taken seriously.”

Klein looks for a total despair about life, a loss of passion or desire to keep going.

“It’s almost like a failure to thrive,” Klein said. “They’ve become completely complacent and they don’t present as really anxious or overwhelmed. It tends to be more someone who has lost all hope, who is isolating and becoming a little more insular and plotting something. If they start failing to reach out to their family and friends or support, that, to me, is a big red flag. So I ask then who they feel they can turn to. Who is their support group? And if they can’t name anyone that they feel safe with, and that they feel heard by, that they can call in crisis, then that indicates an isolation. That is a huge problem and is often an indication that someone is at risk of harming themselves.”

Still, even the best practitioners are fooled and surprised by a call in the middle of the night that their patient did it. Klein was familiar with the recent suicide of a 16-year-old boy at Van Vleck whose body was found at bed check on June 25, 2015.

“I wasn’t his primary therapist but I ran a group with him a few times. It was a pretty distressing situation for everyone. He was actually one of the ones that we did not suspect at all. Not to say that that means anything because sometimes it comes completely out of left field, but as far as what I know of the situation there weren’t a ton of red flags. There weren’t these huge alarms going off.”

Trudelle says teens and pre-teens can be especially tough to figure out and get through to. “With kids, it can happen really quickly,” she says. “They don’t have a lot of brain development to see very far into the future. Kids live in the now and don’t often think of the future. If the now has been awful for a long time they often don’t see any future.”

150729CoverStory-3Press coverage: tiptoeing around the daisies

Covering suicide in a small town is nearly impossible. Out of deference to the victim’s surviving family members and a tight knit community desire to keep messy details out of the paper, suicide gets covered delicately, if at all. Obituaries gloss over unglamorous aspects of decedents’ demise, making no mention of the word never spoken aloud: suicide, the second-leading cause of death in Wyoming for ages 10 to 34.

Media reports about suicide could lead to more suicides though. Statistics do seem to imply that news stories about suicide glorify the act to the point of leading to copycat behavior.

“It can be a challenge, especially with youth,” Trudelle acknowledged. “It’s rarely actually listed as the cause of death. We all do know that copycat issue is a concern. But small towns, family concerns – that adds another layer of sensitivity. One way media can continue to provide support is to get in front of suicide with the message of prevention. Just like with drunk driving. We need to be proactive and talking about awareness.”

Williamson says he knows the taboo topic makes it tough for reporters to tackle.

“I know it’s difficult,” he said. “But keep in mind you don’t really want to do a lot of postvention stuff as prevention, because you make people feel like they missed the warning signs and they could have done something to prevent it. It makes them feel bad. I might suggest focusing on the issue of mental health and not the person himself. We don’t address the person and their pain when we do [grief counseling after a suicide]. We focus on the kids’ reactions to the incident and shift focus away from the decedent.”

Williamson said he sometimes has a problem with clergy leaders who proclaim suicide victims have gone on to a better place of peaceful rest in their funeral eulogies. “That message doesn’t help sometimes,” he said.

Mass shootings also seem to benefit from a plethora of news coverage. Shootings at schools, theaters and churches have become a regular occurrence in America. Some therapists believe they are a violent form of suicide.

“Most definitely [mass public shootings are a form of suicide],” Williamson said. “Murder-suicide is huge right now. We are getting better and predicting suicide but still super terrible at predicting violence to each other.”

Klein, too, thinks mass murderers are suicidal with extra rage. “I think the mass shooter is much aligned with the type of person who commits suicide,” she said. “If you are going to kill a group of people I don’t think you are too fearful of losing your own life. So I would say it’s potentially the same thing. Both cases show someone affected by some sort of severe mental illness.” PJH

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