After suicide: All that's left is 'why?'

Suicide remains a taboo topic, but understanding what drives people to end their lives is the key to prevention. Some families shattered by the act offer their insights.

Suzanne Taylor noticed the glance. She couldn't help but imagine what the woman was thinking.

"Yes," Suzanne thought. "I'm the parent of the child who died by suicide."

In the late afternoon of a November day, her son Grant got the .22-caliber rifle that his dad used to shoot groundhogs -- the only unlocked gun in the North Huntingdon house. He found the clip and bullets in the basement. He returned to his bedroom and fatally shot himself in the head.

He was 17.

Suicides generally are not part of the public's discourse. For privacy reasons and perhaps the stigma that surrounds them, mainstream media do not routinely report suicides committed in private -- homes or garages, university dormitories or deep in the woods.

PG graphic: Firearms account for more than half of suicides
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But they're much more prevalent than most people realize. There were 38,364 people in the United States who killed themselves in 2010, the most recent statistical year. That's more than twice the number of homicides. And that's nearly 5,000 more deaths than occurred in traffic accidents.

And for every suicide there are 25 non-fatal attempts -- a staggering 1 million people who annually try to end their lives.

A traumatic event -- a job loss, a relationship breakup, a scandal, for example -- is often assumed by friends or relatives as the "reason" a person committed suicide. But, researchers say, such a singular event was only the proverbial last straw.

• •

Suzanne and her husband Keith can't help but wonder over and over and over again why their son killed himself on Nov. 1, 2011. "What did we miss? What could we have done?"

But through counseling and support groups they know there are no simple answers. Those who commit suicide -- the nation's 10th leading cause of death -- have a fatal merging of a diagnosable mental illness such as depression, characteristics such as lifelong relationship difficulties, impulsiveness or feeling hopeless, and the onset of life stressors. By themselves, those factors are usually manageable. Combined, with no mental health intervention, they can persuade an individual that life is not worth living.

PG graphic: Regional suicide rates
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For many families like the Taylors, there are no warning signs. Grant, the youngest of three boys, was a senior varsity wrestler, a show choir member and a church youth deacon who planned to go to college.

Grant was upset but not despondent, they say, when he was suspended from Norwin High School in the fall of his senior year -- his very first school suspension -- for looking at pornography on a friend's smartphone and for having snuff in his backpack. On the second day of that in-school suspension, he was called into the principal's office and was told a female student had accused him of exposing himself in class.

As Grant was on his way home on the school bus, administrators were calling Suzanne at her work to tell her about the situation, which could possibly result in expulsion. As Grant got off the bus, he told his friends, "See you tomorrow."

Suzanne couldn't reach her son or husband by phone and rushed home. Not knowing about the latest situation, Keith arrived home first, heard Grant upstairs in his bedroom and asked if he would help cut the grass.

"I'll be out in a little bit," Grant responded as Keith went outside to start mowing.

PG graphic: Suicide rates in the U.S.
(Click image for larger version)

Grant taped a note to his desk. "Problem solved," it read. He pulled the trigger.

• •

For those in Grant's age group -- 10 to 24 -- suicide was the third leading cause of death in 2010, according to the Centers for Disease Control and Prevention. It was the second leading cause of death in the 25-34 age group.

Overall, the national suicide rate increased 3.9 percent over the preceding year, making it the highest rate in 15 years.

For those between the ages of 35 and 64, there has been a 28 percent increase over the last decade. The CDC said possible contributing factors for the rise in suicide rates among middle-aged adults include difficult economic times and increased availability of prescription painkillers.

And in the military, suicide has reached epidemic proportions, with the Pentagon reporting 349 active-duty suicides last year --120 more than the combat deaths recorded in Afghanistan.

Men are nearly four times more likely to die by suicide than women, but women attempt suicide three times as often as males. Men are more likely to choose deadlier methods, such as firearms. Women are more likely to poison themselves.

If you need help

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  • National Suicide Prevention Lifeline:


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Studies indicate that 90 percent of suicidal individuals suffer from a diagnosable mental illness like depression, bipolar disorder, psychosis or post-traumatic stress disorder. But since only a relatively small percentage of those will commit suicide, additional factors make someone vulnerable to suicide, noted Alexandre Y. Dombrovski and Katalin Szanto, psychiatrists at Western Psychiatric Institute and Clinic of UPMC.

The researchers, who are conducting cutting-edge studies of suicide attempters to gain insight into the psychological factors and decision-making processes, said characteristics that can put people at risk include substance abuse, impulsivity, a feeling of hopelessness, relationship difficulties, a predilection for aggression, and mental disorders.

"You can have these characteristics and be fine until you experience an episode of depression or psychosis or an alcohol binge or sometimes several things at the same time. That's when people have the highest risk," Dr. Dombrovski said.

"It's a combination of vulnerability and stressors," Dr. Szanto added. "However, if you have good protective factors, social support, good treatment for substance abuse or psychiatric illness, you may never get suicidal, even if you have these predilections."

• •

What remains of Karla McWilliams' essence are the photographs. In them all, her face is electric, her smile wide and welcoming, her eyes blue and sparkling.

So happy, her mother, Rita, once remarked.

"It's an act, Mom," Karla responded. "I'm always acting,"

Try as she may, Karla never found the happiness her photographs imply. Mental illness, first diagnosed when she was a teen, and a series of traumatic incidents robbed her of that possibility. On Nov. 20, 2012, she stopped looking and killed herself. She was 29.

"It was a struggle all her life. She tried really, really hard," Rita said. "I thought she'd make it but she never did."

Karla's troubles began in the seventh grade. The straight-A student couldn't sleep and one night woke up her parents at 3 a.m. Crying, she said, "You have to help me, Mom. I can't go on."

Diagnosed with severe depression, she was put on the anti-depressant Zoloft. But the next year, when Karla was 14 and starting the school year at Greensburg Central Catholic, Rita found her crying in the game room, holding her dog.

"I'm saying goodbye to Patches," Karla said. "I'm saying good-bye to you, Mom, but don't tell Dad because he'll be too upset. I won't be here in the morning. I hear voices coming out of the closet telling me to kill myself. I have to kill myself."

Thus began a life of in-patient and out-patient treatment, various diagnoses including anxiety, depression, suicidal tendencies, and resistance to medication and several suicide attempts. For a time, she would be on the upswing but then some trauma would rip her down. Her apartment building burned, killing her dog and destroying all she owned. She was sexually assaulted twice. A boyfriend was killed at a construction site. Her fiance broke off their wedding plans.

Still, along the way, she earned her high school diploma and an associate's degree with high honors in human services, put herself through modeling school, and worked as an intern at the non-profit agency Mental Health America of Westmoreland County, where her mother, a former teacher, also worked. She also became a statewide advocate for better transitioning of mental health services for teens moving into adulthood.

The end came last November. After Rita left for work, Karla turned on a Christian TV station and put her comforter and pillows in the bathtub. She sealed the bathroom door with tape, lit a small charcoal grill and lay down in the tub, clutched rosary beads and waited to die.

Later, when Rita broke through the screen door with the police behind her she found a note warning of toxic fumes but reassuring her the dogs were safe. "You did everything you could, Mom," the note said. "I'm so, so sorry. I love you now and always and forever."

Next to her heart, Rita wears a locket containing the last photo taken of Karla. In it, the woman with the sparkling blue eyes is smiling, as ever.

• •

Suicides are a major public health issue but, unlike homicides and motor vehicle deaths, they're not reported in the media unless they're committed in public or involve someone famous such as former NFL star Junior Seau, movie director Tony Scott or country singer Mindy McCready.

"There is a stigma. As a nation, we don't talk enough about suicide," said Charles F. Reynolds III, a Western Psych psychiatrist whose research into depression and suicide prevention, particularly among older individuals, is internationally recognized.

"Unless we shine the light on it, it's going to continue to be a real issue. Stigma I think is a huge issue [with suicide], and mental illness itself is still stigmatized. Rather than recognizing mental illness as a complex brain disorder we continue to stigmatize it as a failure of character."

• •

For years, Jill Kowalewski had been looking forward to renewing her marriage vows with her husband, John, on the couple's 15th wedding anniversary.

But on that day, Sept. 26, 2002, she stood alone in the soaking rain, waiting to attend her first support group for survivors of suicide.

John, 35, had killed himself in their Kansas home eight months earlier, on Jan. 18, 2002. Despite some problems, the couple had built a good life together. With his suicide, John left his Greensburg Salem High School sweetheart to raise their two young sons, ages 10 and 9, and with mortgages on homes in Kansas and Arizona.

"As the boys have grown and are doing well I am able to forgive him a little bit more but I was angry because I looked at it as 'You divorced me in the most brutal way you could. You hurt my boys and this is the legacy you left them.' "

John had started his truck parked in the family's garage, lay down in the truck bed and wrote a suicide note. In it, he revealed he had been sexually abused multiple times by multiple people as a child, was addicted to pornography, accepted blame for whatever problems the couple had, professed his love and said they all would be better off without him.

Later, Jill cried to a friend that John would still be alive had she not made an issue of finding pornography on their computer the day before he killed himself. "She said, 'Everyone else had a fight with their husbands, too, but they didn't go in the garage and kill themselves, did they?' I needed to hear that."

So distraught was Jill after the suicide she ended up in a psychiatric hospital for five days, diagnosed with grief-induced psychosis.

She and the boys moved back to Saltsburg, Indiana County, went to therapy, earned her human services degree from Seton Hill University and worked for a time at Mental Health America of Westmoreland County. There she met Beth Crofutt, who likewise lost her spouse to suicide. They started the suicide support group LOSS (Loved Ones Stolen By Suicide) in the fall of 2007.

"When people come to group they realize they're not alone, there's someone sitting there whose spouse, child or parent also did this dreadful thing. I'm just trying to find some good in this horrible loss of mine. This is the good I've found."

• •

Four to eight people grieve intensely for each suicide, studies show. One of Dr. Reynolds' research projects is studying how best to deal with prolonged, complicated grief unleashed on loved ones by a traumatic event, particularly a suicide.

Part of the experience of complicated grief in suicide survivors is trying to make sense out of the senseless.

"The feelings of guilt that often burden survivors of suicide are key themes we see," said Dr. Reynolds, former president of the American Foundation for Suicide Prevention.

"We try to help them see mental illness is no less than any other medical illness. It can sometimes be terminal, can sometimes be fatal, and there are consequences for those so afflicted."

• •

There are days that Fran Samber pretends her brother Michael Unglo is still in New York City -- still an advertising copywriter making a six-figure salary, running marathons, traveling to Europe, living a happy life.

But three years ago Saturday, on May 4, 2010, Michael killed himself while in a residential mental health treatment facility. He was 39.

"Until the day I die, I am completely altered by his death and there's no changing that," Fran said.

Michael first attempted suicide in 2008 in New York. When he awoke from a coma in the hospital with his two brothers around him, he revealed what he had repressed for years: "Richard Dorsch raped me!"

A former priest, Mr. Dorsch had been the family's pastor in the 1980s at All Saints Church in Etna, where Michael had been an altar boy. He had been removed from the ministry after his 1994 conviction of molesting a 13-year-old boy in North Park and had been accused in other pedophile cases, but as with Michael, criminal and civil statutes of limitations had expired.

Michael tried to return to work but "once the floodgates were opened, there was no stopping" the flashbacks of being raped from fifth through eighth grades, Fran said.

The Catholic Diocese of Pittsburgh agreed to pay for his therapy at in-patient stints in New York and Maryland and finally in Massachusetts. But in early 2010, the diocese informed Michael it would cut off funding after a final $75,000 payment, even though a center doctor told diocesan officials on April 5, 2010, he still needed treatment. A day short of a month later, he died of a self-inflicted cut. His family's wrongful death suit filed against the diocese was rejected by state courts.

"When you have someone you truly love actually perform an action that results in the end of their life, you just can't wrap your mind around it," Fran says. "I'll die and never understand it."

• •

The research being conducted by Dr. Dombrovski and Dr. Szanto seeks to elucidate the distortions in the thinking of a suicidal person.

People who are suicidal are shortsighted and prefer immediate rewards, their findings show. These are the people who would rather take $10 now rather than $50 in six months. Additionally, they tend to ignore important information in their decision-making.

"In gambling, they would ignore the odds in how they bet," Dr. Dombrovski said. "That echoes their experience in a suicidal crisis when there are important things to think about, like 'How will this affect my family?' They don't seem to be thinking about that in the crisis."

Dr. Szanto said about one-third of suicide attempters report thinking their family would be better off without them and another third don't consider what the consequences would be for their family.

"The whole suicidal crisis unfolds in a very limited time," Dr. Dombrovski said. "People are not thinking very deeply at these moments. Once they come out of that state they see things completely differently."

Indeed, the researchers' studies show that 75 percent of those who attempted suicide ultimately believe it was a foolish act.

• •

Enveloped by the night, racked by grief, Michael Vernon sat on his mother's grave.

"Why did you do this?" he yelled. "How could leave us? Why? Why?"

Tears flowed. No answers came. He returned night after night. Always the questions went unanswered.

He was 29 when his mother, Nancy Jean Vernon of Homestead, hung herself from a punching bag in her basement. She had told his father, who uses a wheelchair because of a car accident and also has multiple sclerosis, that she was going to do some laundry.

Afterward, his father told Michael that he had refused a suicide pact proposed by Nancy, 56, who suffered from depression.

She was the second woman in the family who had killed herself and been found by Michael's father. Nancy's mother had suffocated herself. She had been about the same age as Nancy, on the cusp of the peak age group for female suicides, 45-54.

"I did the guy thing, I was good at shutting it off even though when it opened back out the pain was overbearing. I didn't know how to handle it," Michael, now 46, recalled, sitting in his Ligonier home.

He turned to drugs and alcohol for about two years, bottling up his emotions during the day and letting them erupt in the cemetery at night. Finally, he decided that he wouldn't let her end control his future. He cleaned himself up and met Jo, who would become his second wife.

A registered nurse, she got him to see a therapist and he has attended the LOSS support group for three years.

"My anger toward her is gone. Counseling taught me to deal with emotions, group taught me to realize it was an illness. It was a death like anyone else's but it has a stigma."

Committed to helping others avoid his experience, he is in the process of becoming a facilitator for a suicide support group in the Ligonier area.

He now remembers his mother in happiness. On his desk in the mortgage office he and Jo operate is a framed photo of him and Nancy, joyfully dancing cheek-to-cheek.

• •

Suicide rates can be reduced by "limiting access to things that kill you," Dr. Dombrovski said. In England, for example, the suicide rate was cut when the over-the-counter pain reliever acetaminophen was packaged in blister packs, making it more difficult to access enough pills to overdose. In Sri Lanka, there was a major drop in the suicide rate when access to pesticides was limited.

Dr. Szanto said studies elsewhere showed declines in suicides with better treatment of depression by educating primary care physicians about mental illness and suicide risk factors, and coordination between primary care providers and mental health resources, so they all would be readily available to patients.

In the United States, where firearms are used in slightly more than half of the nation's suicides, reducing access would produce a drop in the suicide rate, researchers say. Many suicidal people lacking access to a firearm won't pursue other means, Dr. Dombrovski noted.

"We try to persuade patients and family members to remove firearms until the patient feels better or to take other steps to lock up firearms, to decrease their availability," noted Dr. Reynolds, director of the Advanced Center for Interventions and Services Research for Late-Life Mood Disorders.

"You just don't see this in other countries that have a more restrictive set of policies on gun control," he said. "It's a peculiarly American issue."

• •

Cotton and rice were growing on the successful Woodrow Plantation in Mississippi in 1977 when owner Charles F. Reynolds, a "hale fellow well met," grabbed one of his .22-caliber rifles and killed himself. He was 90.

At the time, Dr. Reynolds, his grandson and namesake, was a psychiatric resident at Western Psych with an interest in geriatric psychiatry. His grandfather's suicide solidified his professional path.

His grandfather developed depression in the wake of a stroke and a painful herpetic infection "and saw no point in going on and shot himself," said Dr. Reynolds. "It's a sad story but I'm afraid it's a typical story."

Suicides among men over 75 are three times the national average.

Dr. Reynolds said his grandfather had seen his primary care physician shortly before the suicide, which is fairly typical among elderly suicides.

"His comment to me was 'Your granddaddy didn't have any more windmills to tilt at.' I thought that was pretty eloquent. It raises a pretty profound issue: Is it ever reasonable for older adults to take their own lives? It can be a rational issue but 90 percent of suicide cases are the product of mental illness.

What pushes people over the edge to suicide, Dr. Reynolds said, is "feeling trapped, feeling hopeless, feeling such a sense of there being no future. What's the point of having no more windmills to tilt at?"

"As a clinician my view is to treat his depression, help him feel better, and he may well have a different perspective on things. If people get help, most of the risk for suicide can be successfully managed."

• •

Four days after Grant took his own life, the Taylors' oldest son, Alex, asked his parents to come outside the family home.

In the darkened distance they saw flickering flames, like fireflies floating down Mitchell Drive toward them. It was a procession of 150 of Grant's classmates carrying candles in silence.

They wore T-shirts honoring Grant that said "Never Take Life for Granted -- 11-1-11."

Amassed outside the family's home, they sang "Because I Knew You" from the Broadway play "Wicked," a song Grant had sung in show choir. The final lines: "Because I knew you, I have been changed for good."

A poem. More songs. The students approached the Taylors and placed flowers at their feet.

And then, as they had arrived, they departed in silence -- but for the tears.

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Michael A. Fuoco: or 412-263-1968. First Published May 5, 2013 4:00 AM


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