My Best Friend's Suicide

Right up front, I'll be clear that names and other details have most definitely been changed. Suicide is about pain, the kind that never goes away, for those left behind. The last thing I want to do here is inflict more pain by exposing personal details that could reveal identities.

Several years ago, my best friend of twenty years killed herself. We had done our psychology internships together. Although we came at the practice of psychology from different perspectives (she was strongly behavioral and I was much more psychodynamic at the time), we had many stimulating discussions about our work. She and her husband also became an integral part of our family and became "Aunt Sheryl" and "Uncle Gary" to my two young children.

Gary was a physician in a fast-paced high-pressure trauma center. Years in that setting eventually wore on him, and he took a job with a small practice in northern California. Sheryl moved out there after handling the sale of their home on the east coast. She had practiced psychology only intermittently after internship, and hadn't completed the requirements for licensure, so still had to be supervised by others in her work. She spent the rest of her time in community and charitable work.

The move to California was hard on Sheryl. She was thousands of miles away from family, had no friends there, and no professional identity. While she had had some vague physical ailments over the years, her health took a definite turn for the worse after the move. Gary spent much of his free time researching possible diagnoses, but to no avail. To say that he became frustrated is to put it mildly. Sheryl, on the other hand, became quietly despondent and withdrawn.

The details of the night I got the call is forever seared into my brain. As soon as I heard Gary's voice, I knew Sheryl was dead, but I instantly assumed it was an auto accident. As he went through the details of coming home from work and finding her body, I was enveloped by a whirlwind of emotions--indescribable pain, anger, loss, bewilderment. I also knew that my life was forever changed by her act.

As Gary and I talked by phone during the next few days, more details came to light--the manner of death, how Sheryl had staged her death scene, the amount of planning she put into her suicide, and that Gary was even briefly considered a suspect in her death. To make matters worse, her family back East also accused him of somehow being responsible for her death, that perhaps he had neglected her after the move or hadn't done enough to ease the transition for her.

I was ready to get on the next plane and head to California to be with Gary and help him with whatever arrangements needed to be made. He asked me to wait a couple of months until he felt ready to face the task of going through her possessions. Of course, I honored that and actually shared a very special time with Gary when I finally did visit. He turned over the task of sorting her belongings to me. We sat around and talked and laughed and cried. Gary and I remain good friends. He has remarried, a very special lady who has introduced him to an entirely different way of life.

The thing about suicide is that, so often, you never get what it was really about. Sheryl left a very lengthy, cryptic letter to both Gary and me. I read that letter over and over on my way home to my family. I concluded it actually raised more questions than it answered, and I even wondered if that was Sheryl's intent in writing it. Certainly Gary and I kept second-guessing ourselves. What had we missed that might have saved her life? I read and reread her emails to me over the last few years of her life to see what was between the lines that I didn't pick up on. And I found nothing. I don't know whether that was a blessing or not. To think that I might have been able to do something, but failed to do it, would have flooded me with a sense of lifelong guilt. On the other hand, to find no clues as to her state of mind, what the tipping point between life and death was for her, has left me with a sense of helplessness that I'll carry forever.

The Intimate Hour (Part II)

What is a patient looking for when he or she comes to therapy? My experience is that, in general, he has tried everything he knows to do in dealing with an issue. He has exhausted his own personal resources. But making that initial call can be fraught with anxiety. The patient has delayed it and delayed it, while he struggles along with the situation. Admitting that you're unable to resolve a life problem on your own, that you'll have to address it with a stranger, can be a daunting prospect.

A patient is seeking first and foremost understanding. Whether in therapy or not, each of us ultimately wants our life narrative to be heard. Whether it's someone wanting to share her rage at her husband's infidelity; a person isolated and in the throes of hopelessness who writes a suicide note; or a serial killer who eventually feels compelled to describe his horrific crimes; we all desire for at least one other fellow human being to hear our story and understand our motivations.

A patient is seeking acceptance. The slightest whiff of judgment will taint a therapeutic relationship. The therapist must have a very high tolerance for dealing with attitudes, behaviors, even lifestyles that he does not personally endorse. If he struggles with this, it behooves him--and is in his patient's best interest--to either do some work in therapy himself regarding his discomfort, or to make a referral to another therapist.

Most patients are seeking some specific means for effecting change in their lives. For all but a few, gone are the days when an individual can spend an hour a day, four to five days a week, on a therapist's couch. The vast majority of today's patients come in with a specific problem or problems. Pursuing self-actualization in therapy is a luxury that few can afford. To that end, as a new patient and I wrap up our intake session, I help them formulate and prioritize their goals for therapy. The question might be something like, "What would you like to be different in your life as a result of coming here?"

Finally, patients frequently need what I call a "takeaway". This can be something as specific as an "assignment" to journal, to chart behavior (e.g., eating, exercise), to take turns planning special events with a spouse, to read certain portions of a book or listen to a podcast, to contact an estranged family member, to think about their goals at work. You get the point. A small task or bit of information at the end of a session can reinforce the work done in the session and enhance the patient's sense that she has gained something positive and concrete from her work in therapy.

The Intimate Hour (Part I)

The process of psychotherapy is as different as each therapist-patient combination. The chemistry between patient and therapist is undeniable and plays a key role in the process. My approach has been to address each patient as an unfolding life story, with its own unique narrative, and not as a diagnostic exemplar. As we work together, I listen for and identify recurrent themes, with their moments of triumph, as well as depths of despair; with their areas of strength and resilience, and their places of weakness and flagging hope.

As a therapist, my job is to assist the patient in writing a new chapter in his narrative. Perhaps his past has been marked by repeated failures at valued tasks. Perhaps her undertakings in life have been tinged by fear and self-doubt. The therapist is a companion on the patient's journey of self-discovery and healing.

As the companion on the patient's journey, I look at the elements of the patient's life as the pieces of glass in a kaleidoscope. When the kaleidoscope is held in one way, one picture emerges. However, when the patient rotates the kaleidoscope, a different picture comes into view. And with that different picture come new possibilities. New ways of understanding what has gone before in one's life and what could lie ahead. And this is where the therapist brings her experience and psychotherapeutic tools to bear.

Endless Tears

My husband and I are on our way to the north Georgia mountains to spend yet another gorgeous fall weekend with some dear friends. As my husband took a call from a fellow racer, I gazed off at the exquisite color of the leaves. Something along the side of the road caught my eye. It was a roadside memorial. Someone had taken their last breath at that very spot. A chill ran down my spine.

It was a cross made of red and white flowers, faded and graying. An immense sadness gripped me, thinking not only of the woman (judging from the color of the flowers) who had died there, but for the family and friends who had erected that small, poignant reminder of their lost loved one.

Whether she was young or old I'll never know. But somehow I imagined her to be in her early thirties. I imagined her mother, howling in anguish upon learning of the death of her daughter. I knew for a certainty that her life was forever changed in that moment. A mother myself, I can't fathom how she could continue another day without her beloved child.

We use the word "closure" so freely and so reassuringly in this culture. But closure is a lie. There is no such thing. Yes, as people like to remind us, life does go on, after a fashion. But it is never, ever the same. Emotional scar tissue begins to form around that raw, gaping wound. But the scar lives on, and often it aches like hell.

I couldn't stop imagining this woman's life after the loss of her daughter. Was she physically unable to get out of bed for days, weeks, even months? Did she lose her appetite and begin to wither away? Did she withdraw into the privacy of her home, away from the well-meaning, but painful, questions of friends and family?

How long was it before she felt she could begin to breathe again, to look around and see some small spot of beauty or comfort in the world? How long before that wracking, searing pain began to recede ever so slowly and she had a day here and there that, to the outside world, looked "normal"? For, mercifully, just as the flowers on the roadside cross have faded in the baking sun of the Georgia summer and the cold gray drizzle of winter, her unrelenting pain, though never absent, will also begin to fade.

The Holidays: Blessing or Curse?

It's that glorious time of year again. The heat of summer has abated (this was Georgia's hottest summer on record), and the light is changing along with the leaves. The calendar's pace seems to accelerate, each day passing faster and faster. As I schedule time with clients, family, and friends, the amount of available time seems to mysteriously dwindle.

Not that many years ago, when my children returned to school the middle of each August, a sort of mad rush toward the holidays would begin. With my girls gone during much of the day, I began planning Thanksgiving and Christmas celebrations. I began compiling gift lists based on hints dropped here and there, as well as observation of what my daughters seemed most interested in at the time, along with gift ideas that I thought would surprise, fascinate, inspire, or guide them. I planned elaborate menus for family dinners and dinner parties for sixty!

My elder daughter was home sick one day early in the school year. Over a lunch of chicken noodle soup and crackers, the subject of Christmas came up. We played a Windham Hill holiday CD as we chatted. One of the tracks had a rather Mexican flair, and we began imagining what a Mexican Christmas party would look like. We brainstormed about menus, decorations, and music. We were off and running with the idea.

My daughter was well enough for school the next day, but I kept returning to our lunchtime conversation. I decided to turn that vision of a Mexican Christmas party into a holiday reality. Over the next couple of months, I made hundreds of tissue paper flowers and yarn ojos de dios ("eye of God") to decorate Christmas trees and grace earthenware pots filled with tiny twinkling lights. I bought small chimineas and Mexican crèches. I purchased all sorts of linens in various shades of red and green, as well as vast quantities of votives and other types of candles. In other words, I transformed my home into a cozy suburban Mexican restaurant. We planned the musical selections and an extensive menu. We made nametags and ensured that everyone on the guest list would know at least one other person.

The evening went off without a hitch, everything as planned, and people thoroughly enjoyed themselves and the somewhat unconventional Christmas celebration. Our months of preparation paid off beautifully. As a result, I felt emboldened to plan other large-scale events and throw myself into months of cooking and decorating. These events were a labor of love for me, but eventually the "labor" part of the process came to loom large. While my children enjoyed the end products of my labors, I wasn't so sure about my then husband. His actions made it clear that he resented getting pulled into the process. I couldn't really blame him. After all, these shindigs were my idea and I didn't consult him about them, other than to check to see if he'd be in town that evening.

Years later, after my children were grown and had left the home and I had relocated to Georgia to start a new life, time didn't permit me to plan and host these events. After all, I was either teaching or seeing clients. And space was a factor, as well. I had downsized my home and was operating in a much smaller kitchen. I found myself going through a period of mourning my bygone entertaining diva days. I even felt guilty that I had done it for my family before, but wasn't able to do it for my beloved new husband. Frankly, he was probably relieved, knowing that I'd be preoccupied with my preparations and in a state of high anxiety.

I went through a few transitional years during which I did feel guilty about not serving up entirely homemade dishes at Thanksgiving and Christmas. I began purchasing pre-packaged holiday meals at my local grocery. To my surprise, they often rivaled my own recipes. They weren't inexpensive, but the really lovely part of finally giving myself permission to go this route was that it freed up several days before each holiday to spend with my husband and with visiting friends and relatives. This became a gift I gave to myself and them, the gift of time and loving attention.

As you prepare for your holidays this year--whatever you celebrate--perhaps a few moments of reflection on what you truly value for yourself and your family are in order. Are the holidays a time of anxiety and stress over all you need to get done, or are they occasions for reconnecting with loved ones and sharing yourself generously with them? As we approach these sacred times this year, I wish you the joys of togetherness and contentment with the blessings in your life.

The New "Normal"?

In my clinical practice, I see couples struggling with various aspects of their marriage. It may be sex, money, infidelity, childrearing, communication, you name it. For many couples, by the time they make the decision to seek therapy, significant damage has already been done to the relationship. Highly toxic attitudes and patterns of interaction may have developed which make it extremely difficult to pull the marriage back from the brink of dissolution. And so some of these couples end up divorcing.

As a therapist, my task then becomes helping them navigate the process of divorce with as little emotional damage as possible. If there are children, this involves helping them forge a plan for coparenting that keeps the best interests of the children front and center. Even when there is significant animosity between the ex-spouses, emotions must be managed so that parents are responsible and cooperative caretakers. The children's needs always come first.

Another therapeutic task is helping the partners to begin to utilize the divorce process as a vehicle for personal transformation. Yes, divorce feels like a tragedy to many people. It can lead to feelings of depression, lowered self-esteem, even worthlessness and hopelessness. But, like all life crises, it holds the potential to help us discover new or hitherto untapped aspects of ourselves. For instance, if one has been financially dependent on a spouse, divorce may force us to become resourceful and self-sufficient. If one has never lived alone, it may require that we learn to tolerate solitude and loneliness.

There are a number of common emotional responses to divorce. The partner who wants the divorce may feel an overwhelming sense of relief. For the partner who wants instead to save the marriage, feelings can range from anger to fear and anxiety to depression. An almost universal response to divorce is the sense that one has failed at something that was meaningful, a major life task, as well as a primary source of one's identity.

It's common for those who've gone through a divorce to view a previous marriage as "failed". After all, the " 'til death do us part" clearly didn't work, did it? We rarely marry with the thought that we'll divorce. Most of us still hold to the fairy tale ideal of "happily ever after". This may carry us through the stress of wedding planning and the honeymoon. The real test of the marriage begins the day after the honeymoon ends, however. The newlywed couple now begins to settle into daily life. Stresses and strains of jobs, finances, and in-laws can quickly take their toll. The newlyweds may find themselves arguing and unable to resolve conflict.

While at any given time, more than half of us are in a first marriage, a second marriage is not uncommon. Approximately forty-three percent of all first marriages end in divorce within the first fifteen years, but seventy-five percent of those people will go on to remarry, usually within the first three years after a divorce. An interesting fact is that, for most of this country's history, remarriage occurred after a spouse had died. By the late 1980's, less than ten percent of those who remarried did so because they had lost a spouse.

This certainly lines up with what I observe in my clinical practice, in which it's not all that rare these days to see a couple, one of whom is in a second or third marriage, and the other one in a third or fourth marriage. Given the prevalence of divorce and remarriage in our culture, perhaps it's time to reconsider what "normal" means in the context of marriage. Our ideal, for many years, has been monogamy--one man and one woman (please note that the question of gay and lesbian marriage is a different topic) for life. Of course, this often takes place after an extensive period of dating numerous other people until we find the "right" one. The expectation is that we will then settle down and be sexually and emotionally faithful to our spouse.

The subject of divorce, infidelity, and why monogamy seems so fragile in this society is a vast subject and requires attention in a separate piece. But the reality is that, while we continue to pay lip service to monogamy, many of us will end our first marriages and enter into a second marriage--perhaps even a third and a fourth--as time passes. As a culture, we're still devoted to the institution of marriage and the ideal of total, eternal commitment. We still believe we can "make a go of it" with another person, that this time we've found the right one. Statistics tell a different story. The odds of second and subsequent marriages lasting decrease with each new marriage.

So, we hold onto the hope that our marriage will last forever. And, if both partners give it their very best effort and cherish the relationship, it probably will. However, for approximately one-half of us, something goes awry. We get tired of working on the marriage, we begin leading parallel lives, we get careless with outside relationships and an affair develops, and so on. The outcome is divorce and, in many cases, remarriage. We tend to refer to this pattern, somewhat tongue in cheek, as "serial monogamy". And perhaps this is the new "normal" for love and marriage, American style.

Jeanette Sliwinski: Broken Dreams

While pounding the treadmill this morning, I scrolled through my TV guide and came across the program, "Snapped". A long-time true crime and mystery buff, I figured this would be as good a means of distracting myself from the tedium of exercising as anything else. This episode featured the story of Jeanette Sliwinski, a young woman whose life came into sharp public focus on July 14, 2005, when she took the lives of three innocent people in an apparent attempt to end her own life. Driving at over 90 mph, she slammed her red Mustang into the back of a Honda Civic waiting at a red light. John Glick and Michael Dahlquist likely never knew what hit them. Doug Meis, however, lived for several hours after the dreadful event. Talk about being in the wrong place at the wrong time.

Jeanette's story is a tragedy from a number of perspectives. The families and friends of her victims will forever be deprived of their companionship, their smiles, and their unfolding life stories. The world will never know what they might have gone on to accomplish. But Jeanette's story, too, is sad beyond words. A withdrawn, socially awkward child who seemed uncomfortable in her own skin, she managed to "reinvent" herself during high school into a physically striking young woman. And her appearance became her identity and sense of self.

Jeanette worked as a stripper (perhaps as early as high school, by some accounts) and a lingerie model to help finance her college education. In 2002, she and her boyfriend moved to Los Angeles, where she dreamed of becoming a supermodel. Over time, however, she found work only as a trade show model, considered to be the lowest rung of the ladder in the world of modeling. It was also during this time that Jeanette's boyfriend broke up with her. Her hopes for career and romance dashed, she unhappily returned home to live with her parents.

By all accounts, Jeanette's mental health was tenuous during this time. She was treated for an unspecified mental illness with a variety of medications. She was also allegedly self-medicating with herbal preparations and using alcohol and club drugs. Her mental status became the central issue in her trial, with her attorneys offering an insanity defense.

While watching her story unfold, I couldn't help but wonder how things might have turned out differently if Jeanette's modeling dreams had come true and if her relationship with her boyfriend had continued. Would she have found the happiness she apparently thought that life would bring her? Would she have gone on to live a productive life instead of making headlines for killing three people? Or, what if she had anchored her ultimate life dreams to something less fleeting and superficial than physical appearance? Clearly, the world of modeling makes stringent demands in terms of diet and exercise, a willingness to tolerate being objectified, and cutthroat competition.

I contemplated the role of personal dreams in all our lives. They start early for many of us--veterinarian, lawyer, teacher, doctor, artist. They are the point on our own personal horizon that identifies us and keeps us moving forward during good times and bad. As children, these dreams remain largely that--fantasies that provide us with comfort, escape, and a sense of direction in life.

As we move into our teen years and begin to have some control over the realization of our dreams, a number of things can happen. Depending on the clarity of our dreams, opportunities for exploration, support from parents and teachers, and the overall level of psychological health of our environment, we may well make significant progress toward accomplishing our goals. We can seek out opportunities for volunteer work, take music or art lessons, join a sports team, etc. These opportunities allow us to assess how much of a match a particular activity is for our personality and our individual preferences.

During this time, many of us essentially put our dreams on hold. We don't take steps to explore them, even though we may continue to identify them as personal goals. This may be a function of our level of motivation, or we may get somewhat sidetracked by the peer scene that is so compelling during the high school years. Then there are those young people whose dreams wither due to lack of nurturance. Or perhaps their dreams are actively discouraged or even ridiculed during the adolescent years. Parents may exert a negative effect on pursuit of dreams. he social environment in school, as well, may prove overwhelming for some students.

At any rate, whether due to lack of opportunity to explore different activities, lack of parental or teacher support, or serious difficulties in psychosocial or psychosexual development, one's dreams can become derailed. The future one had envisioned turns into day after day tedium, or, worse, a nightmare, as in the case of Jeanette Sliwinski.

There is no ultimate psychological "safety net". Teachers, guidance counselors, fellow students, parents, and friends can all strive to be alert to individuals who appear to be unduly struggling with life. Jeanette Sliwinski had already received mental health services and was scheduled to be seen on the very day that she snuffed out three lives, ostensibly in an attempt to take her own life.

I can't help but wonder how things might have turned out differently for her, John Glick, Michael Dahlquist, and Doug Meis had her life dreams been different, or at least nurtured differently, and had she accepted the harsh reality that few women make it to the top in the world she had chosen for herself. Unlike the victims of her incredibly selfish act, Jeanette Sliwinski will get a second chance at life. She was paroled after serving less than half her sentence. She may even be eligible for a driver's license this fall. One can only wonder what her dreams for herself are now and how they will impact those around her.