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

Jun 28

Rural Psychiatry

By Dr. Micaela Wexler
I am a  psychiatrist working in a rural setting in Missouri. I provide both inpatient and outpatient care, as well as consultations on the medical unit, and emergency psychiatry. I treat children, adolescents, adults and geriatric patients. My specialty is treating family psychiatry.
I received my medical degree from Western University in Pomona, CA, and completed my residency in psychiatry at Kansas University Medical Center.
When I accepted this job right after residency, I had several fantasies about what I would experience.  I thought it was going to be an easy way to pay off my student loans and  I felt guilty signing the contract.   I thought I would have enough leisure time to learn how to play golf, remodel a Victorian house, and  make a quilt. I was worried that I would be bored at work and lose all the skills I had learned in residency. On the other hand, I was very scared about the statistics involving substance abuse and suicide for rural physicians, especially psychiatrists.
Three years into my job, none of these fears, or fantasies, have come true. I decided to preserve rather than remodel my Victorian house. I still haven’t made a quilt.  But, no, this job is not boring, and I won’t lose my skills. Rural psychiatry is hard work, but it is very rewarding. Every single day I see a new, challenging case. I see between 20 to 30 patients a day.  And, I have been forced to learn new skills: autism assessment, family therapy, marriage therapy.
My patients have complex situations; the suicide rate is much higher than in the urban setting; the unemployment rate is difficult to confront; and, the substance abuse problem can be mind numbingly overwhelming.
My biggest challenge is confronting the severe shortage of mental health services day after day. And, while I do feel overwhelmed at times, I also have had many days when I see the hopefulness that comes from helping people through desperate situations.
And, there have been some wonderful surprises for me. My neighbors are phenomonemal, making sure I am safe and well cared for. The employees also take care of me. Something I did not expect at all from a small town is the openness neighbors and hospital employees have shown about my “alternative lifestyle.” To them, I am not part of a “lesbian” couple; I am simply part of a couple. Everyone has been so welcoming to my partner, me and our daughter. People here have their priorities straight: they LOVE children, and it doesn’t matter to them how those children got here.