No Note, No Explanation

Illustration by Michael Morgenstern

Every 11 minutes, someone in the U.S. takes their own life, according to the American Association of Suicidology, a mental health advocacy and suicide prevention organization based in Washington, D.C. The nonprofit estimates the number of suicide loss survivors (people who know someone personally who died by suicide) at more than 5.4 million. In 2019, that was one in 60 Americans.

Then came the year 2020. Though it’s too early to quantify the pandemic’s impact on suicide rates, certain early indicators are troubling.

Prior to the arrival of Covid-19, U.S. deaths by suicide were already on the rise, increasing 35% between 1999 and 2018, according to the National Center for Health Statistics. Now the coronavirus and its many stressors—financial hardship, job loss, illness, isolation and grief among them—threaten to make a growing problem worse.

In a June 2020 survey conducted by the Centers for Disease Control and Prevention (CDC), more than 10% of adult respondents reported that they had seriously considered suicide in the past 30 days, compared with 4% in a similar study in 2018.

“The added stress and trauma of the pandemic is leading to a stronger sense of helplessness and hopelessness for many of the most vulnerable community members,” stated a recent report issued by PRS CrisisLink, an Oakton, Virginia-based nonprofit that provides a crisis hotline, text line and other suicide prevention services for Northern Virginia residents.

Stress, social isolation and mood disorders (depression, especially) are risk factors for suicide. So is knowing someone who died by suicide—particularly a family member.

After her father’s death, Pamela feared her mother might also end her own life. “My mom would go off, whether to go grocery shopping or to the store, and I would run around the house looking for her,” Pamela says. “I just expected to find her sitting in the car with the garage door closed and the motor running.”

I was recently visiting with a friend on her front lawn when her neighbor walked up and joined our conversation.

After a few quick pleasantries, the neighbor confided that she was struggling to come to terms with a friend’s suicide. He and his wife had moved to a retirement community just a few months earlier.

“They thought it would be a good idea to be in a place where they could get more care in case something happened,” the neighbor said.

Soon after the move, the man found out he had cancer. He ended his life a short time later.

“I just heard a few hours ago,” the neighbor shared, still in shock over the news.

The neighbor and my friend, both of them cancer survivors, wondered aloud if the diagnosis had been a factor; if the isolation of quarantine, compounded by the move to a new home, had also contributed to his act.

On my drive home, I kept imagining the man enveloped in mental anguish, feeling he had only one option. My thoughts returned to the friend I lost.

Laura Mayer, program director for PRS CrisisLink’s call center, says it’s not uncommon for the living to try and imagine themselves in the position of the person who has died.

“We often try to put ourselves in that position to learn from it, control it and to seek understanding as to why that person did what they did,” she says. “The empathy we have for those in pain makes it more devastating. It’s an attempt to understand the ‘why,’ which is unique in suicide grief. ”

Some describe suicide as a selfish act. It isn’t.

Consider that the definition of selfishness is “seeking or concentrating on one’s own advantage, pleasure or well-being without regard for others.” Suicide doesn’t result in pleasure, advantage or well-being. People who end their lives often feel like they are a burden to their loved ones. They may be experiencing such deep emotional pain that they see a departure as the only choice.

Colleen Creighton, an Arlington resident and CEO of the American Association of Suicidology (AAS), offers this analogy: “When someone is going through this, they feel like they are trapped in a burning building and there is no way out. Do they jump out the window, or do they stay and be burned alive?” The response is almost a reflex.

Four decades after her father’s death, Pamela says she has come to terms with the fact that he left without a last word.

“I know why he didn’t leave a note,” she says. “Because he was so far gone that he was just on this one track, you know? In some ways that’s a consolation for me, to realize that, OK, he didn’t have time to sit down and pen a last letter because he was just so tunnel-visioned that he couldn’t. He just had this one task at hand. That’s the way I kind of think about it now.”

In retrospect, she believes her father struggled with depression.

“He did the best he could,” she says, “I just don’t think he got the help he needed. It was unfortunate that he was in that kind of macho environment where you can’t share your feelings and you can’t reach out for help. But I think the culture has changed. I’ve even had the daughter of one of his colleagues reach out to me and say, ‘Because of what your father went through, because of his death, my father was able to get the help he needed.’ So I do think my dad left a legacy in that regard.”