Fellow Travelers

By Georgina K. Smith, Ph.D.

“You wake up in Chicago, pull back the curtain and you KNOW where you are. You could be nowhere else. You are in a big, brash, muscular, broad shouldered motherfuckin’ city. A metropolis, completely non-neurotic, ever-moving, big hearted but cold blooded machine with millions of moving parts-a beast that will, if disrespected or not taken seriously, roll over you without remorse” -Anthony Bourdain

Mr. Bourdain’s words reach far beyond Chicago. He could have been speaking in part about addiction, depression, the cold blooded machine of suicidality.

Over the past eight days the world lost Kate Spade and Anthony Bourdain. The world also lost many other people to suicide whose names did not make the news. My heart feels heavy and I feel compelled, like many others, to say something, and still what I have to say feels somehow incomplete.

I’ve heard people talk about the selfishness of the act of suicide and their anger about it. There is a devastating, traumatic legacy that suicide leaves behind with a penetrating transmission of pain. The person who dies by suicide, however, is often in such extreme mental suffering, pain and anguish, that suicide may present the only seeming reprieve they are able to give themselves and others, feeling that their existence is too painful to them and all those surrounding them. It can feel like the escape out of a burning building when the building burning is them. This kind of pain often creates a suffering that inhibits the brain’s ability to think rationally, to find hope, to connect to coping and managing. It can create a pain so great mentally and at times physically that living feels like too great a burden to bear. It can create a fight or flight response that meets so imperfectly with an impulse that the result is suicide. So often these individuals want to live. They just want to experience a different life than the skin they are in.

But let’s be clear. It is not only the mentally ill who are vulnerable to suicide. Yes, depression, mood disorders and other forms of mental illness are significant factors and can feel unbearable to live with. But many who die by suicide are not mentally ill. They are grieving or they are traumatized or addicted or they are in such deep loneliness and shame over events in their life or enduring such desperate life circumstances that suicide seems like the only way out. Trauma, grief, shame, disconnection, mental illness can make the acts of daily living, of daily transactions with others, with the world, feel like the person is a live wire navigating torrential rain storms, volcanic eruptions, earthquakes, and violent weather changes. With depression, light stings, gravity crushes, and depression pulls the chains that they are pushing against. The energy to navigate their inner world and its response to the outer world can feel exhausting, like a never ending game of chicken. And the response of the outer world when they can’t understand the person’s struggles and reactions can often reinforce the shame, self-hatred, and hopelessness. And it’s no one’s fault.

Success, like that of Kate Spade and Anthony Bourdain, does not create an immunity to struggle, to depression, to suicide. Rather it can create a suffocating cocoon of isolation and paradox, where there is a violent fracture and conflict between the experience and presentation of inner and outer worlds that cannot be reconciled. A very fragile heart beats inside the superimposed persona of a superhuman. What a lonely place. Success and fame beg for a form of public servitude, are synonymous with luck, fortune and happiness, and the prerequisite for gratitude and a ban of the right to complain or suffer. But from the homeless person on skid row to the individual in their Bel Air mansion to the school teacher to the actress or the janitor or the stay at home dad or the veteran or the blue collar construction worker or the executive working mom or middle school student, mental illness, loneliness, and suffering do not discriminate. Access to resources and to help, however, sadly does. And we have a long way to go. 

The World Health Organization estimates that 1 person dies by suicide every 40 seconds. According to the United States Department of Veterans Affairs, an estimated 22 veterans per day die by suicide. So why are we not talking about them? Why do we seem to come to a stunned halt when we hear the news of Kate Spade and Anthony Bourdain? I imagine it is because we may understand a little more about the anguish and trauma that veterans are enduring. But perhaps we cannot as easily grasp how people who appear to have it all, who appear happy, successful, can suffer the same fate. I believe it triggers an existential dread in us; a fear that if they can’t make it, how will we? And in these days and times, I believe the news hits us on an already pulsing raw nerve. The political divide. The gun violence. The rocked sense of safety in our communities. Never at any time in my past decade of private practice have I seen so many patients consistently coming in speaking about the impact they are experiencing from our country’s current state of affairs and politics and their escalated fears and tensions. So perhaps we hold on to the happy stories when we hear them, perky Kate Spade and her colorful creations – a light. Anthony Bourdain – the best kind of bad boy with an honest voice, who breathed the essence of realness and human connection and purpose. If their lights go out, how do ours stay on?

We have to talk about it and find a way to create connection. We have to talk about our struggles. About our ‘not okay-ness’ behind our social media smiles. About our grief, our depression, our traumas, our desperation, our suicidality. And no, you don’t have to lay your story out for public consumption. You decide. You choose who you tell. You have the right to your boundaries and your privacy. But tell someone. And for those that speak out in any way, anywhere, thank you for your courage. For your presence. For your heart beat. For your bravery.  For still holding on. I know it’s not easy. I’m a fellow traveler.

The weights of all these precursors to suicide can create a tipping point where everything becomes out of balance. Trauma can create defense and coping systems that are completely necessary and rational at the time of the trauma, but over time long-term can tip a person into illness in part because of the stress hormones surging through brain and body. The weight of these precursors may also show up as the crushing burden of depression. And depression will curl up with its host at night, never leaving their side, infusing itself into dreams and nightmares and humming a pulsing undertone of anxiety as a constant reminder of its presence and power. And during the day it may dress up with its host, don a smile, and play right along with what the day needs, what the surround needs, with what the act of living needs, whispering its persistent dread and doubts and questions, telling its old stories, and playing out its old fears, pulling shade over the light. It will make eyes heavy, hands shake, and the normalcy of daily exchanges feel alien and harsh. And it will speak its language of shame, toxicity, brokenness and blame till it becomes the host’s language and identity. It beats and burns and erases its victim till there is no shelter they believe they can escape to anymore. They just want out. Yet still trips are planned, work is attended, relationships exist, hellos and I’m fines are exchanged. And we may never know what lies under the surface because for many, arriving at this end can finally appear like the most possible, rational thing to do and they may seem temporarily more okay in their acceptance of this.

To the people who are suffering and who are still here trying to find a way to hold on and find a way out in waking life: know that it’s okay to not be okay, keep talking to your loved ones, keep going to therapy, keep asking for help, keep taking your medications if that’s something you need or talking to your doctor about changing the medication. Find your community, your people. Focus on any moments of okay-ness and find ways to understand them and expand them, find the things and the people that can be your lifelines and reality tests when the darkness pulls for you. Practice being a voice of compassion and kindness. You are not the violent weather pulsing through you. You matter. You’re loveable. You’re loved. Find that voice inside that will speak back to the voice of shame, blame, anger and hatred, that can find different responses to the weather inside of you. Find purpose and gratitude, even if that is in the fact that you got out of bed today, that you showered, that you smiled at someone, or someone smiled at you, that you felt the sun on your skin or the bite of the cold wind. Keep putting one foot in front of the other because that’s the only way you will ever know what lies around each new corner. Your broken past is not the evidence for your future even though it will try to convince you it is. Find whatever works for you – medication, religion, the gym, music, spirituality, 12 step programs, therapy, comedy, meditation, nature, your dog, your cat. Check in on your most basic needs – are you eating? Hydrated? Sleeping? And when nothing is working, do nothing. Minimize the damage. Go to bed one more night before making the last decision, the final act. Wait. Then wait again. The absence of action is sometimes all you need to do when you are at the lowest point. Not everything will work all the time, but there can still be relief, healing, progress, change. The maintenance of any form of recovery requires a practice and a management and some form of ‘balanced’ lifestyle (whatever that may look like to you…try not to attach to an idea of perfect balance. It does not exist. Navigating our flux within a more manageable range is what I mean by ‘balance’). Recovery needs you to keep showing up.

This isn’t a matter of will. Of fortitude. Of moral choosing. This is life or death. And if death becomes the only choice, then what profound suffering must have preceded. And what profound suffering will continue for all those impacted. Some make it out. Some do not. We have to talk about mental illness. We have to talk about emotional suffering and struggle. But we also have to recognize that certain systems - macro and micro - do not promote openness, communication, acceptance. We have to reduce stigma and fear and educate. We have to stop with minimization and invalidation. If people who are suffering could “just get out of bed and do it” they would. The brain is an organ capable of illness and dysregulation just like any other organ. But we do not bring chicken soup to those with mental illness. We bring judgment and expectation. Until we have walked in their shoes, we simply cannot know the extent of pain in their world.

I have come to believe that those suffering with depression and other forms of mental illness and trauma who are still here are not better or immune to what the future could bring. There may be a darkness that is never too far away, and a sometimes unexplainable impulse towards suicide that may be dormant but ever present. Rather those who are still here are continuing to make difficult choices every day, every moment. It’s not about being better or stronger or less sick. Some find a way to live by going straight towards their trauma and pain. If trauma and pain are your kin, coursing through your veins, many who know them so intimately choose to find their life purpose in them, not by running away from them. And for every fear and every doubt that tells you to take a step away and a step down, take a step towards. And sometimes it will be messy, you’ll overcompensate, or feel too much or not enough, or make mistakes, but you’ll be alive to make another choice. And when shame and failure want to take you out, walk into the swampy mess of it all and own your vulnerability the best you can, trusting that the hellish feelings will pass and that they are not facts. The storm will pass, even if there’s another one right behind it, but then it will pass too. Trusting that somehow things can work out. But they can’t work out if you’re not here.

We are not just the presentation of our social media profiles. We are complex, broken and beautiful and we need connection. We need resources from all spheres – physical, social, emotional, financial, spiritual. We need meaning, purpose, curiosity, hope. We need accountability. We need to feel seen and heard. Many of us are fighting demons that others will never see. Embrace your humanness and imperfection, ask questions, ask even your strongest friend if they’re ok. Make eye contact and don’t look away. Go deeper. Ask for help. Offer help. Get educated about mental illness, get real, be patient, be tolerant, be kind. Please be kind. Don’t brave this world alone.

Resources

National Suicide Prevention Hotline: 1-800-273-8255

Substance Abuse and Mental Health Services Administration Treatment Referral Helpline: 1-800-662-4357

Didi Hirsch (Low Cost) Mental Health Services: 888-807-7250

Psychologytoday.com (therapist, psychiatrist, treatment center locator)