Praise for The Unique Grief of Suicide: Questions and Hope "A gem of a book. Tom Smith is one of those unique human beings who, through a labor of love and generosity, is able to turn a personal tragedy into an opportunity to reach out and help many others. His work combines scientific data and personal feelings admirably" -Luis A. Giuffra, MD, PhD; professor of clinical psychiatry, Washington University School of Medicine "Very painful questions arise following the death by suicide of a loved one. Tom Smith's moving book identifies and organizes these questions-a very helpful thing in itself. But more, the book provides answers and also acknowledges that some questions do not have easy answers, reflecting accurately and sympathetically the experiences of those bereaved by suicide" -Thomas Joiner, PhD, author of Why People Die by Suicide and the Robert O. Lawton Distinguished Professor of Psychology, Florida State University With warmth and understanding, Tom Smith draws on his own grief following the suicide of his twenty-six-year-old daughter, Karla, and provides helpful resources and coping strategies to those grieving a suicide. Both practical and comforting, The Unique Grief of Suicide guides and educates those dealing with the different facets of suicide and offers a safe harbor within the storm of grief.

The Unique Grief of Suicide

Questions and HopeBy Tom Smith

iUniverse, Inc.

Copyright © 2013 Tom Smith
All right reserved.
ISBN: 978-1-4759-7003-6

Contents

Foreword........................................................................................1Introduction....................................................................................3Chapter 1: Those Who Died and Those They Left Behind The Who Question..........................9Chapter 2: Suicide and Suicide Grief The What Question.........................................31Chapter 3: The Day They Died and All the Days Thereafter The When Question.....................57Chapter 4: Does It Matter Where They Died? The Where Question..................................79Chapter 5: Grieving The Why Question...........................................................101Acknowledgments.................................................................................123Bibliography....................................................................................125Resources.......................................................................................127

Chapter One

Those Who Died and Those They Left Behind

The Who Question

Of the nearly one million suicides worldwide during 2003, including the 31,484 in the United States, the 476 in Oklahoma, and the seventy in Tulsa, the suicide of my daughter, Karla, is the one tragedy that ripped apart my heart and my life. She was twenty-six at the time, seven years after the first onslaught of her bipolar disorder. Even though she had three years of mental stability between the beginning of her illness and her death by mental illness, she ended her desperate pain on Monday, January 13. Simultaneously, she slammed us into the swirling world of suicide survivor grief. In 2003, there were literally a million similar experiences. And 2003 happens every year.

Karla fit a high-risk profile for suicide. She had bipolar disorder, had attempted suicide three times previously, and was released three days earlier from a behavioral health care center where she spent ten days being treated for depression. All of those conditions increase the possibility of suicide. A week before she entered the center, she told us how worthless she thought she was; how much of a burden she was, not only on us but on the universe; and how she couldn't stop thinking of killing herself.

When the policeman came to our door in Shiloh, Illinois, and told us that the Tulsa police department informed him that "Karla Smith has died," it was devastating. He had no details on how she died, but I knew immediately that she took her own life. It was an overwhelming shock, but it was not a surprise. It is clearly the worst thing that has ever happened to me.

Karla

Karla is a twin, born, along with her brother, Kevin, on August 7, 1976, in Ottumwa, Iowa. They are our only children, and Fran and I have enjoyed being their parents. When they were two years old, we moved to Broken Arrow, Oklahoma, a middle-class suburb of Tulsa. Their childhood and adolescence were normal enough, and they both did well in school and socially.

Since infancy, Karla was adventuresome, curious, and attracted to performing arts: acting, dancing, speech, and drama. In high school, she was a star performer in school plays, a successful member of the speech team, winning state honors in a variety of categories. She also was elected treasurer of the school's student council, which had to do more with her popularity and an appealing campaign ("Karla's the Key") than with her money management skills.

Kevin's interests and personality developed in very different directions. While he too excelled in the classroom, with a special ability in math, his extracurricular energy focused on sports. He played basketball until his sophomore year and then focused on tennis, earning All-Conference Player of the Year honors his senior year, when his team placed second in state.

Predictably, they had different groups of friends, but it was a delight for us to get to know their friends as they progressed through high school. There were some typical adolescent issues we had to deal with, but it was generally a good time in the busy Smith household during those years. Despite their differences, Kevin and Karla remained their own best friends.

They chose different colleges; Kevin went to St. Louis University, and Karla to Incarnate Word in San Antonio. She transferred to Oklahoma State University in Stillwater, Oklahoma, for her sophomore year, primarily because she wanted to spend a year in a European student exchange program, and in order to expand the number of courses available to her in her major study area, English literature. She loved learning and was a bright, enthusiastic student (although she had trouble learning Latin and Spanish, and math was always a problem, mainly because she didn't see the point), and an active member of various clubs, including the poetry group and Amnesty International.

But we were not prepared for the beginning of the second semester of her sophomore year (1996), when she suddenly became seriously depressed. We were grateful that one of her favorite professors called us to say that she had dropped out of everything. She came home, and we got her a counselor and a psychiatrist who prescribed for her the first of many antidepressants. She attempted suicide during this period, but eventually she did well enough to attend the fall semester in Utrecht, the Netherlands, where she once again became depressed. She came home without completing any classes and ended up in a treatment center in Tulsa.

Her mania emerged in 1998, which was followed in 1999 with three years of stability, when she returned to Oklahoma State University. She was three classes away from graduating with a 4.0 GPA when, unknown to us, she took herself off her lithium. Five months later she was in a major, extended manic phase that led to psychotic thinking and behavior. By Thanksgiving of 2002, she was back on her meds but moving into another depression. On New Year's Eve, 2002, Fran took her, in a catatonic state and with a suicide note in hand, to the Tulsa Behavioral Health Center, where she stayed for ten days. They released her on a Friday, against our wishes, and she shot herself the following Monday. She lives in our hearts but not in our lives.

The story of her life and our attempts to cope with her illness and death can be found in my previous book, The Tattered Tapestry: A Family's Search for Peace with Bipolar Disorder.

A Few More Statistics

Karla is much more than a statistic. But she is also a statistic. And the numbers are significant as we try to understand and cope with the reality of so many people taking their own lives. The figures show us trends and suggest a profile of who is vulnerable to suicide. We may then create strategies to intervene and prevent future premature deaths.

There are many mysteries surrounding self-inflicted death: Why? What could I have done to prevent it? Who's to blame? And back again to why did the person do it? While the statistics don't solve the mysteries, the numbers do provide a context for trying to understand who those who complete suicides are and why they take their own lives. We need this general context as we address the puzzling and heart-wrenching questions generated by a suicide.

Officially, there were 38,364 reported suicides in the United States in 2010, the most recent figures that are available as I write this book. This number means that there is a suicide...