Mar 13

Madison Holleran: we must increase the dialogue about depression

MadisonHolleran
by Dr. Micaela Wexler

On January 17, 2014, Madison Holleran, an accomplished athlete and student at U Penn, jumped to her death. She seemingly had everything going for her. She was popular; she had a family who was close and supportive; she was academically gifted, having earned a 3.5 GPA her first semester at an Ivy League university; and she was a talented athlete, running on the school’s cross country team. An hour before her death, she had been making dinner plans with friends.

“You can’t really understand why a girl who seemingly has everything going for her would want to end it,” her father said.

Her death shocked so many in her college community as well as her home town who reported there had been no clues, no warning signs. People all across the country have been saddened by her death, not only because this is a tragic loss to our society, but because her death strikes fear in so many that this could happen to one of their loved ones.

As a psychiatrist, I treat a large number of people who have been left permanently scarred by the death from suicide of a loved one. Several people have expressed the fear that if suicide could claim the life of someone “who had everything,” what is to keep their loved ones safe?

One of the reasons Madison Holleran’s death by suicide was so shocking is that relatively few people in her life were familiar with the facts of her depression. Those who were found themselves at a loss as to how to help her, and were not aware of the serious risk depression poses to those it affects. The stigma of mental illness is so great that people who struggle with depression suffer in silence and isolation.

As a society, we do not know how to help people with depression. Many people do not recognize that when a person has become irritable, is feeling unmotivated, has lost interest in things that were once enjoyable, is complaining of having low energy and not being able to sleep, that person is not being lazy or “needy;” that person is most likely depressed. That person is potentially in danger of losing his or her life to suicide.

There is not enough dialogue about depression for most people in the midst of their despair to know that there is treatment available that works, that will make them feel better. This was illustrated a while back by a patient who came to see me for his monthly follow up in the clinic. He was a college professor at that time, in his 50’s. He was (most likely still is) bright, witty, very popular with his students, and a joy to see in clinic. Two years earlier, he had become acutely suicidal, and his wife had the wisdom to bring him to me for an emergency visit. She was able to petition to have him admitted to the inpatient psychiatric unit against his will. Several months later, he again became suicidal, but at that time, he entered the psychiatric unit voluntarily.

One day, as I asked my routine questions about suicidal ideation, he said to me, “That first time, I just didn’t see how it was possible to feel anything but despair. There was just too much going on in my head for me to have anything resembling a rational thought. To me, suicide was rational. Then you put me on the mood stabilizers, threw me into those groups, and by the end of the week, I was feeling better. Suicide became a ridiculous idea. The next time it happened, I knew that I would feel better. I knew that this feeling of despair would go away , that as soon as I changed my medications and got some therapy, it would go away. I just needed to get to that place.”

As a college professor who had himself been suicidal, suicide among college students was something my patient thought about regularly. He mentioned it every month at his regular visits. “There has to be a way to let EVERYONE know that there is stuff that WILL make that desperate feeling go away, that there are medications, and that you can spend a few days going to groups and coloring and talking to people and you’ll feel better!”

For me, as a psychiatrist, the greatest tragedy of Madison Holleran’s death by suicide is that even though she was in an environment with so many resources and knowledge, the information about treatment and its effectiveness remained elusive to her and her family. As so many patients tell me, “that desperate feeling is so painful, you finally just snap and want to make it go away!” They always emphasize to me how important to their lives it is to know how to get treatment.

There is a way to make the pain go away. You don’t have to jump off a building or jump in front of a car. There are therapies and medications that really do work. Suicide is the SECOND leading cause of death among college students. This is a tragedy that should not be happening on college campuses. Information about depression and treatment should be ubiquitous.

All students and professors should know the warning signs for suicide: IS PATH WARM (Ideation, Substance Abuse, Purposelessness, Anxiety, Trapped, Hopelessness, Withdrawal, Anger, Recklessness, Mood Swings).

Mental health services need to be made truly accessible. Every student, parent and professor should know the numbers to call if someone they know is depressed. The number 800-273-TALK should be on everyone’s bathroom mirror and refrigerator. Substance abuse on college campuses needs to be addressed. We need to recognize that it is not a benign part of college life, but rather a potential warning sign of depression and a risk factor for suicide.

Need help? In the U.S., call 1-800-273-TALK (8255) for the National Suicide Prevention Lifeline.

Need help with substance abuse or mental health issues? In the U.S., call 800-662-HELP (4357) for the SAMHSA National Helpline.

Early diagnosis beneficial in AD
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Appointment information for Dr. Micaela Wexler: wexlerpsych.com

Jan 05

When you lose a parent to suicide

PeaceWinter2By Dr. Micaela Wexler
The loss of a parent is devastating for any adult. As a psychiatrist, it is one of the most painful transitions I encounter. Your status in the world is dramatically changed. Immediately upon the death of your parent, you are plunged into a sea of nostalgia, and it is easy to feel unmoored. You are no longer being tugged by the larger vessel that guided you your entire life. Now YOU are that vessel that will have to take the lead. It is a transition that we all anticipate but for which we can never truly be prepared.

When the death is due to suicide, it is not a transition; it is a calamity. While an accidental death brings shock and denial, death from suicide generates horror, anger, guilt, confusion and shame. Add to this the fact that there is still a great deal of stigma about suicide, which can become a significant obstacle to getting help. This is most likely why people who have lost a parent to suicide are at increased risk for committing suicide themselves: the feelings are overwhelming and it is difficult to know where to turn.

It is natural to turn to family members for help. They are the ones who knew your parent best, they have been part of your entire life, and there is no need to overcome the stigma of suicide with them. However, they are not the best choice in the immediate aftermath for the simple reason too have suffered a tragedy and are devastated, and therefore unable to offer much support.
This is a time when psychiatric or mental health care is absolutely essential.

Psychiatrists and other mental health professionals are well aware of the magnitude of this event, and will treat it with the urgency it requires. Besides needing someone with whom to talk, chances are that the suicide has caused enough of a physiological shock that you also need at least a short course of pharmacological assistance until you start your recovery. A psychiatrist or therapist can assist you in this manner safely. (A therapist will refer you to a physician if you need medication.)

It’s difficult to think while in such a state of shock, so I have provided the following advice and information.

First, call your primary care physician and ask for a referral.

If that doesn’t work, call your local emergency room. They will give you the number to local resources.

If you feel utterly incapable of doing either of the two previous items, then you need emergency care. Call 911.

If you have a family member who has become non-functional due to a family member’s suicide, do not put yourself in the position of being their main support. This is risky for both of you, especially if you were also affected by the suicide.

Helping someone else before you have coped with your own feelings is simply a bad idea. You are very likely to bury your own feelings while giving someone inadequate care.

If you and your loved one were both hit by a car while crossing the street, no one would expect you to become the primary care provider. With a family suicide, you are even more incapacitated than you would be if you were hit by a car.

So, in the aftermath of a family suicide, get a psychiatrist or therapist to help you and your family.

For more information, please visit my post on losing a loved one to suicide.

Jan 01

More suicides during the holidays?

PeaceWinter2By Dr. Micaela Wexler

Holidays are associated with a higher suicide rate. Is this true? It turns out that this is largely a myth. As a psychiatrist, I can tell you that suicides are actually pretty low in December, compared to other months. Spring and fall are the seasons which have larger numbers of suicides.

The reason for this myth is most likely due to greater impact on families and friends when a suicide occurs during a holiday season. If a family member commits suicide on Christmas Day, for example, that holiday is forever marked for the family.

Despite this myth it is important to remember that people DO commit suicide during the holidays, and people with addiction disorders are at increased risk. Suicide is just as fatal, no matter when it happens.

Preventing suicide is a good New Year’s Resolution.

Start by learning the warning signs for suicide. An easy mnemonic has been developed by the American Association of Suicidology: IS PATH WARM (Ideation, Substance Abuse, Purposelessness, Anxiety, Trapped, Hopelessness, Withdrawal, Anger, Recklessness, Mood Swings). Students should know where to turn for immediate help if they suspect a fellow student is suicidal.

If you are wishing you were dead yourself, you must get help immediately. Call 911 if you don’t know what to do. Or, call one of the following numbers:
1-800-SUICIDE
1-800-273-TALK

If you just need someone to talk to, you should also call those numbers. They can point you to resources in your area.

Websites where you can go for help:

www.suicidology.org – American Association of Suicidology – has a section for survivors

allianceofhope.org - provides an online support group. They have different forums for the different types of survivors, ie parents, children, co-workers.

www.suicide.org – a list of resources for those at risk as well as resources for those who have lost a loved one to suicide.

www.suicide.com – created by a suicide attempt survivor to help people who are suicidal

attemptsurvivors.com – a good blog to help understand the WHY behind suicide, blog posts written by people who have survived a suicide attempt

No Time To Say Good-bye, surviving the suicide of a loved one, by Carla Fine – carlafine.com – the best book on this subject which I have read

And, a reminder: if you need IMMEDIATE help, call 911.

Sep 10

“Suicide prevention starts with you.”

By Dr. Micaela Wexler
Whenever I say this to people, they think I mean for them to help prevent suicide in other people. They immediately think about their families, friends, co-workers, children, spouses. In most cases, they are eager for tips on how to join in the fight to stop suicide.

“I mean YOU, specifically. Suicide prevention starts with YOU.”

Suicide is something that can happen to anyone. While we all need to help each other in preventing this tragedy, you can’t prevent someone else from committing suicide unless you prevent yourself from committing suicide.

“Well, that’s easy,” people tell me, “I don’t believe in suicide. Suicide is a selfish act; I would never do that to my loved ones.”

It turns out that people who commit suicide were once just like you: they didn’t believe in suicide. Like you, they had children, parents and friends. They loved them very much and did not want to hurt them. Just like you, they had religious beliefs that once gave them strength and comfort. They had goals and dreams and plans. They had crushes. They had love affairs. They had marriages.

So, to prevent suicide, you have to start by examining yourself.

Do you find yourself doing things you never did before like yelling at the grocery checkout person? Are you snapping at your husband? Does your best friend suddenly make you fly into a rage? Are you drinking more than you ever did? Are you in a financial crisis you feel you have no way out of?

Do you find yourself being careless about your safety: being less careful about locking doors at night; not slowing down for yellow lights; driving recklessly on the freeway?

Many people have these thoughts. That doesn’t mean you should ignore their seriousness. Letting thoughts like these pile up can put you on the road to developing a serious depressive episode. That is the most common reason for suicide.

If you are having these thoughts, then you are not taking care of yourself. You are not taking time to enjoy life. You are losing sight of your dreams and goals. Maybe you are not spending enough time with friends who appreciate you. Maybe you are working too much, at the expense of socializing and exercising.

You can do things immediately if any of these situations pertain to you. Right now, take a deep breath and think of something positive you will do for yourself TODAY. It can be something simple like taking a walk, calling a good friend, making plans to go watch a movie, buying yourself a new song, playing a computer game.

Look at your schedule and see what items are on it that make you feel good. How can you add more? You may not be able to get out of your financial crisis, but you can probably find someone to talk to, either about your problem, or something completely unrelated, to take your mind off your crisis.

If you are having the thoughts I’ve mentioned, this is a sign you need to find time to reflect on what is good about you and your life; you need to make it a DAILY practice; you need to refocus on your hopes and dreams. You need to reach out to loved ones, clergy, maybe a therapist, or the employee assistance program.

There are some thoughts that will require much more than than what you can do alone. There are thoughts that are a sign of something serious that needs immediate professional attention.

Do you feel you have no purpose in life? Do you feel completely hopeless? Do you ever find yourself having thoughts about what it would be like to be dead? Do you find yourself thinking that people would be better off without you in their lives? Do you find yourself going beyond simply not slowing down for yellow lights, and actually running red lights? Do find yourself wondering what it would be like to go toppling off the overpass? Do you notice you are preoccupied with the after life?

These are all thoughts that are a sign of serious suicide risk. Do not ignore this. There are several options for immediate help, from calling 911 and talking to the police, to calling 1-800-273-TALK or 1-800-SUICIDE (1-800-273-8255, 1-800-784-3433) or going to the emergency room. Either one of these options will lead to a trained professional who can help determine the type of help you need immediately.

Nine out of ten people who commit suicide had a diagnosable mental disorder. But, only THREE out of 10 people who die by suicide received mental health care in the year prior to their suicide.

So, start preventing suicide by taking a look at yourself. Because, trust me, we need you around.

Jul 14

How do I help my mom get over my brother’s suicide?

By Dr. Micaela Wexler
Sadly, as a rural psychiatrist, I have heard several versions of this question. Each time I have heard it, it has been a painful reminder that there really is not much support for families who have lost a loved one to suicide, especially in the rural setting.

When a family loses a loved one to suicide, each member experiences the trauma in their own way. The father might be numb, and in denial. The mother can be incapacitated by her guilt and loss, fearful of losing her remaining children. And, the siblings may be angry; I have heard more than one sibling express a common, and untrue myth about suicide: that the person was motivated by selfishness, and did it to intentionally hurt those left behind.

My patients who have lost a child to suicide are the most bewildered people I have encountered as a psychiatrist. I have tried to put myself in their shoes, and have found those attempts nothing short of overwhelming. I feel I would be pulverized if such an event happened in my life; I would not be able to keep from blaming myself. I don’t feel I would be able to continue living. These are the very thoughts that these parents have shared with me, in the immediate aftermath of a child’s suicide.

However, as a psychiatrist, I know that with the proper support, these thoughts will pass as the parents heal. I have watched parents survive this most horrible of events; I have been a witness as they have made the journey through their grief and learned to live again; I have watched as the healing allows them to eventually continue to advocate for their child by increasing society’s understanding of this monumental problem.

“Where did I go wrong?”
Parents feel a deep sense of guilt, both their own guilt and the guilt which society puts on parents. The guilt is incapacitating in those early days. Mothers will spend hours upon hours day after day trying to go over every single decision they have ever made regarding their child. They will reach far into their history, examining even the most trivial events. Their surviving children will have little patience for this, most likely because it is painful for them to see their parents punishing themselves. Or, they will feel resentful that so much attention is being given to the one child. Hearing their parents express this guilt makes surviving children even angrier at their siblings for doing something so “selfish.”

Surviving siblings are in need of support themselves, and will naturally turn to the people, their parents, they have always turned to first in times of great need, only to find these people completely unable to help them. In those early weeks, it would be ideal for siblings to turn to someone other than their parents for support, and for parents to find someone besides their surviving children with whom to share their grief. However, suicide carries such an immense stigma that it is rarely possible for families to do what is ideal. What happens instead is the surviving family members turn to the only people available, which can result in them further injuring themselves and each other.

“Why?!”
This is one of the most common questions a psychiatrist will hear. Parents will look for any clue possible to explain why their child did this. Their deep need to answer this question will cause them to overburden their surviving children, convinced they hold the key to this secret. This pushes the surviving children, who have not had time to process the loss themselves, to come up with an answer: selfishness. And, so one of the more destructive myths about suicide is given more life.

These families need to learn as much as possible about suicide, so they can understand the true causes, and stop blaming themselves. What I have learned as a child psychiatrist about suicide is that the “why” has nothing to do with selfishness, and everything to do with deep, emotional pain. Research on suicide has shown us that the person has to become sufficiently accustomed to pain to be able to consider something most of us would find too agonizing to carry out. This pain has many sources.

With time, parents will come to understand that they were not, could not, have been the source of so much pain. As a psychiatrist who provides emergency psychiatric care, I treat suicidal patients on a regular basis. What I often hear is that the parents are one of the few sources of comfort in their child’s life.

“What did I miss?”
Parents are convinced they should have seen the signs. Even parents who sought psychiatric help for their children for many years believe they should have been able to prevent their child’s suicide. This causes them to become frightened of “missing something again” with their other children.

Suicide is partly the result of irrational thinking, and this thinking leads children to believe they are causing too much suffering to their parents by being alive. Mental illness carries such a stigma that some people feel their parents are over burdened from having a mentally ill child, and will feel relieved when that child is gone. In their efforts to spare their parents more pain, these children will do everything they can to hide their plans, and their pain, from their parents. I have had suicidal patients in great emotional turmoil tell me they feel good only when they are with their parents, and will genuinely show no signs around them for this reason.

Another sentiment my suicidal patients express is a feeling they are a burden to their parents. This is especially true of gay teenagers who are not out to their parents: they feel they are too great a source of future pain to their parents, which contributes to their suicidal feelings.

With time, as they go through the grieving process, many parents come to understand that they truly were their child’s best, and many times only, advocate. Parents need the space and support, as well as knowledge about suicide, to make this important realization.

“They gave him everything they had.”
The financial toll on parents is a topic I have seen seldom mentioned among my psychiatric colleagues. The costs come from many sources. Chances are the family member lost to suicide was already receiving psychiatric care, placing a financial burden on the parents. The rescue attempt itself can result in astronomical medical costs, especially if the suicide is a teenager or young adult, since every effort will be made to save the patient.

In the case of one family I was familiar with, the suicide (which occurred years ago) took place by gunshot, in the home. That family faced costs in the clean up. The home lost value due to a suicide taking place there. This was compounded by the family’s inability to properly maintain the home during the grieving process. Most people who commit suicide have a compromised financial situation: they generally do not leave assets, many leave behind significant amounts of debt, and surprisingly few have insurance, including burial insurance. The parents are also left with one less child to share in the costs of their care in their later years.

If the surviving family members are able to heal and stay together, ie, adult children moving back in with parents, this has the potential to soften the financial blow. This is one of the advantages families in the rural setting do seem to have. The loss of value to the home will not be as relevant if they are all able to continue living in it for an extended amount of time. With time, they will form new memories in their home, and it will stop being a house where someone shot themselves and become, once again, a home where a family lived, and loved together.

Support in the form of therapy, education and medications, if needed, will go a long way in helping a family properly heal. This, unfortunately, is often in short supply in the rural setting. This is unfortunate because family members who have been given proper support and treatment are society’s greatest hope in helping to prevent future tragedies.

If you have lost a child to suicide, regardless of your child’s age, I highly recommend the following web site: childsuicide.org It is the best resource I have found online for parents dealing with this tragedy.

Jul 12

Lost a family member to suicide? There is help.

By Dr. Micaela Wexler
If you have lost a family member to suicide, you should know that you and your surviving family members are at an increased risk for suicide. All family members should know the warning signs for suicide. An easy mnemonic has been developed by the American Association of Suicidology: IS PATH WARM (Ideation, Substance Abuse, Purposelessness, Anxiety, Trapped, Hopelessness, Withdrawal, Anger, Recklessness, Mood Swings).

If you are wishing you were dead yourself, or feel you have these signs, you must get help immediately. Call 911 if you don’t know what to do. Or, call one of the following numbers:
1-800-SUICIDE
1-800-273-TALK

If you just need someone to talk to, you should also call those numbers. They can point you to resources in your area.

Websites where you can go for help:

www.suicidology.org – American Association of Suicidology – has a section for survivors

allianceofhope.org - provides an online support group. They have different forums for the different types of survivors, ie parents, children, co-workers.

www.suicide.org – a list of resources for those at risk as well as resources for those who have lost a loved one to suicide.

www.suicide.com – created by a suicide attempt survivor to help people who are suicidal

attemptsurvivors.com – a good blog to help understand the WHY behind suicide, blog posts written by people who have survived a suicide attempt

No Time To Say Good-bye, surviving the suicide of a loved one, by Carla Fine – carlafine.com – the best book on this subject which I have read

It is normal to feel intense emotions: guilt, fear, anger, hopelessness. A death from suicide is different from any other death because it is a violent choice. Many family members find it difficult to get through each day after a loved one commits suicide.

Regardless of how you feel, suicide is NOT done to punish those left behind. A person commits suicide due to unbearable emotional pain.

While it is true that there are known warning signs for suicide, some people may give no warning at all: they may seem peaceful or happy before committing suicide. This is common for people who have decided and planned out their suicide, because they feel they have finally discovered a way out of their pain. These suicides are the most shocking and devastating for families.

Other people who commit suicide do give signs that families don’t notice until it is too late. The following are some of these signs:
- a preoccupation with death or the afterlife
- sadness, hopelessness, loss of interest in life or those around them
- giving away belongings
- sudden change from severe sadness to seeming to be at peace
- sudden interest in “clearing the air” about past conflicts, events
- hints about suicide
- reckless behavior
- self injurious behavior
- previous suicide attempts
- loss of appetite, weight, energy, decrease in activities
- constant negative comments about themselves

If you realize your loved one was showing these signs, you should not blame yourself. These signs are subtle, easy to miss. Suicide is difficult for most people to talk about or confront. And, many people who are not suicidal also show these signs.

Every member of the family will react to the suicide in a different way. There is no correct way to respond.

If the loved one was a teenager or child, the younger siblings will need extra care and attention.

In the immediate aftermath of a suicide, other family members, especially the PARENTS, will not be good sources of support.

Do not suffer alone. Go to the resources I’ve listed. Or contact me. I am not able to provide care through my web site, but I might be able to point you to someone who can.

And, a reminder: if you need IMMEDIATE help, call 911.

Jun 29

Surviving teenage suicide

By Dr. Micaela Wexler
Teenage suicide is the most frightening event I have faced as a psychiatrist. It causes more pain and destruction than any other cause of death. The life cut short is often one full of promise and hope. In the aftermath of a teenage suicide, survivors are confused, consumed with guilt, overwhelmed with their feelings of anger, loss, betrayal, and fear. They really are not in the best position to ask for help.
The problem I have encountered as a psychiatrist is that survivors tend to be ignored, mostly because people do not know what to do. Or, they are scared of interfering. Or, they don’t realize just how fragile and in need of help survivors are.
So, how do we support these survivors? In this post I will share tips I have learned from my own experience as a psychiatrist, and at the end, I will give links to some helpful resources specifically for suicide survivors.
Parents, it is normal to feel tremendous guilt. It is very likely that you will become incapacitated by your grief. However, you are not at fault. Teenage suicide is a societal problem. If it was possible for a PARENT to prevent the suicide of their son or daughter, we wouldn’t HAVE a teenage suicide problem. When the funeral is over and all your child’s friends have disappeared, your feelings will worsen. Be careful who you reach out to. Reach out to someone with experience dealing with suicide: a professional, a medical doctor, clergy. Do not reach out to anyone who makes you feel at fault, and this includes family, friends, even your spouse. Ideally, you should reach out to other parents who have survived a similar loss, but that may be difficult to do in the immediate aftermath. Call 1-800-SUICIDE if you don’t know what else to do. Leave a post on this web site. Do not isolate yourself.
If you know a parent whose child has recently committed suicide, reach out to that parent ONLY if you can do it in a supportive manner. If you’re thinking to yourself: she shouldn’t have gone back to work, he shouldn’t have filed for divorce, they shouldn’t have pushed him so hard, etc, then DO NOT reach out yourself. Find someone else to offer that parent support. Only reach out if you are convinced you will be positive and supportive.
If you have a brother or sister who has recently committed suicide, your parents will not be there for you in the immediate aftermath. You will have to reach out to someone else: grandparents, relatives, your friends’ parents. If you have other brothers and sisters, reach out to them and be there for them. Your world has just been destroyed, and you may wonder what you did to contribute to your brother or sister’s actions. Most likely, you did nothing. Suicide has many causes; brothers and sisters are powerless to prevent such a monumental problem. Until you process your grief, the best thing you can do is talk about your brother or sister’s life. Do not hide your brother or sister’s cause of death. Ask your parents to send you to see a therapist, especially if you feel suicidal yourself. Call 1-800-SUICIDE.
Friends of the teenager need to reach out to each other. If you were a close friend, reach out to other close friends. Do not suffer alone. Go to the memorial services and the funeral. Make a Facebook page celebrating your friend’s life. You will blame yourself, this is normal, but do not hurt yourself. Call 1-800-SUICIDE if you are having a hard time coping with this. Give yourself a break: see if you can lighten school and work activities in the early days. Go see a therapist. And, remember that your other friends are entitled to their feelings, also. Some of them might be angry and blame the suicide victim, some may blame other people. This is all normal. What is not normal is to hurt yourself.
If your teenage child has lost a friend to suicide, your child needs you. Friends of a teenage suicide victim are at an increased suicide risk. Expect your child to be moody, angry, emotional, irresponsible, lazy, or completely in denial. Some teenagers are completely unable to confront a loss of this magnitude, and may behave as if nothing happened. That doesn’t mean they are not affected. A teenager who has recently lost a friend to suicide should not be left completely alone. Take all suicidal threats seriously. Watch your child for behavior out of the ordinary. Make sure your child has the support he or she needs.

Suicide is growing at an alarming rate, and affects everyone in our society. Caring for the survivors of suicide is an important job that requires everybody’s help. The obvious survivors of the teenage suicide include parents siblings, relatives, friends, acquaintances, teachers, coaches, clergy. But if we stop to think about it, we are ALL survivors because we are all negatively affected by teenage suicide. We are all forever deprived of the promise of that young person’s life.

The American Association of Suicidology has an excellent page with resources for survivors.

Alliance of Hope offers an online support group.

The following is an excellent book about surviving suicide:

No Time To Say Good-bye – Surviving the suicide of a loved one, by Carla Fine