Talking with Joel Kobren

After the 35 or so interviews for this project so far, Joel Kobren was the first person whose responses made me worry, “I wonder what people are going to think.” Joel has strong views on the language surrounding suicide, and he especially feels that the word “survivor” is not being used properly when people who have lost someone to suicide apply it to themselves. Part of that point of view comes from him being left to discover shortly after his attempt that the suicide survivors support groups listed online and elsewhere were not for people like him at all. And the mental health workers who were sending him on his way didn’t seem to realize it.

“When it comes to suicide, it is the only form of dying where those left behind consider themselves survivors of that form of death. The only one,” he says. “And when they use that language, they turn themselves into victims. And when they turn themselves into victims, that means that the person that died is a perpetrator. And I find that offensive. It’s completely wrong in its assumptions.”

Here, Joel also talks about being a generation or two older than many attempt survivors, bonding with other mental health consumers as he drives them to and from their therapy sessions and how unexpected people supported him after his attempt while others walked away.

What do you do and why? What keeps you interested in this issue?

What keeps me interested is my personal experience. To a great extent, and relative to just about every person I’ve spoken to on the subject of suicide, I’m probably the oldest guy in the conversation. My suicide was at the age of 57. And earlier this year, I turned 61, so it’s not that far back. And I’ve made for myself an enormous amount of headway in figuring out a lot of things, not the least of which is, what does it take, what do I need to figure out in order to fix some of the things that obviously went wrong? And looking at it from that perspective, my approach appears to be different. I’m not in such a hurry to move forward as much as I am to move carefully. I think it’s very easy to move forward without fixing some of the things that went wrong, only to have those things come up and bite you again. And potentially end in a suicide. One of the things I noticed at the very beginning when I woke up in the hospital two days after my suicide _ I was in the hospital for two weeks before going to a psychiatric unit for another nine days _ one of the things everybody was asking was, “Why did you do that? What were you trying to solve? Did you think it was gonna be a solution?” At the time, I looked at them and said, “What are you talking about?” Because none of that made any sense to me. I remember being in what I refer to as a depressive stupor. I was totally unaware of what was happening to me. I felt that at some point, I saw my death in front of me and I was now on a roller coaster to that point in time. And I had no control over it. I was not conscious of what was going on. I just remembered that that was the feeling that I had. And so when I reached that point, I picked up a very large revolver, loaded with very highly lethal ammunition, and put it to my chest and pulled the trigger.

Now, it’s true that on that day I was going to be evicted from the house I was in. And it’s true that the real estate manager was due to come to the house at one o’clock in the afternoon. But those facts sort of went into the hopper. And if you’ve ever seen one of those, it’s like some kind of game where you put marbles in the top and then they bounce on nails going all the way down. And that’s how information was going in. There was no clear path. It would just go into this hopper and bounce around to the bottom, and that was that. And so it all just, there was no conscious choice or decision that was applied to this information. This information was just used by my brain unconsciously under the influence of this depression that I never could have imagined how deep it really was. And when I was in the hospital, I had a lot of time to think about it. And you know, I was in a coma for two days, and when I came out of the coma, they made sure there was a psychiatrist standing right there. I remember they even brought me to consciousness to take out my intubation tube, and someone said, “No, not yet, where’s the psychiatrist, get him over here!” So I just lay there, and then they pulled the tube. they put me on a gurney, then, just like on TV, they run me to the ICU. And the psychiatrist asked, “What happened?” I said, “I missed?” And they asked, “How do you feel about that?” Which I thought was funny, because they always ask that. And I said, “Well, if you’re looking for me to be really glad I made it, you’re talking to the wrong person. You know, I can tell you that unless I find a good reason not to do it again, I’m as good as dead.”

I just knew that I was someplace that I had never been, although I had danced around it most of my life, as far back as I remember, 8 years old, always having this desire to die. And yet never, the thought of doing it myself never was in my mind. I wanted to be hit by a bus, a house to fall on me, for someone to shoot me, but the thought never occurred to do it myself. Back around 1997, 1998, I had an X-ray taken, a chest X-ray, and when it came back, the report said. “A mass is here consistent with small-cell carcinoma, yadda yadda,” They CAT scanned, did a biopsy, another biopsy, and the whole thing took place over the course of a little over a month. And all that time, I would think, “It’s finally here. OK, what am I gonna do? Well, I’m not gonna get surgery. I’m not gonna do anything. I’m just gonna do what I can do until I can’t do it anymore. And what it is is what it is.” And I had made that decision. In that context, that was a choice. I wasn’t going to do anything. I just was gonna not do anything. Finally, they got the results of the second biopsy, and it was actually a node that is normal to have after you have Valley Fever. I moved to Arizona in 1995, and in 1997 I got Valley Fever. I almost died from that. But I didn’t know what it was. If I had known, I probably would have done nothing. So I found out this was from the Valley Fever. No one had ever asked if I had had it. When I found out what it was, I became terribly depressed. I was just so bummed out. I was so disappointed. You know, there was always that aspect that I knew was there. But I never put the pieces together. And there were a lot of pieces I was never able to put together.

And after I got out of the psych unit, they just told me, “You can go online and find support groups all over the place.” So I went online. So I’m still dumbfounded after getting out of the hospital. I had my bell rung like they don’t ring bells anymore. I went online, and I’m looking, and I’m looking, and I find a lot of suicide survivor support groups, and I would read further and find out that these people are _ oh, what’s the word I’m looking for?

Bereaved.

Yes, but that’s not the word I was looking for. The word is a synonym for fakes. Fakes. I find it personally offensive that these bereaved people would call themselves survivors. To me, they are no more a suicide survivor than I am a cancer survivor because my mother died of cancer or because my sister battled cancer. It doesn’t make me a survivor. My sister’s a survivor. I’m not. I just have a sister who is. And to take this, and this instance alone, and change the rules of reference is, to me, it is offensive. It is just wrought with prejudice. And I just, I don’t find it misguided, I find it wrong. I think the word I was thinking of was “charlatan.”

Wrong with the one or two people who chose to call it that?

It’s not one or two people. It’s all I was able to find. They were grief groups. They were not for survivors of suicide. They were people who had lost someone to suicide. And when it comes to suicide, it is the only form of dying where those left behind consider themselves survivors of that form of death. The only one. You can have Alzheimer’s, heart disease, cancer, anything, and those left behind are the bereft. They are not survivors of what killed the person who is their loved one. And yet they do it with suicide, and I just find it offensive. I find that the only way they can do that is to turn themselves into victims. And when they use that language, they turn themselves into victims. And when they turn themselves into victims, that means that the person that died is a perpetrator. And I find that offensive. It’s completely wrong in its assumptions. And I just, I was just absolutely amazed that that was the state of affairs in regards to suicide. I was just totally dumbfounded. And they say, “Why?” What happened was, that person became depressed. Depression is a fatal illness. It can be a fatal illness. What happens when someone dies of depression, most often is they died from a self-inflicted injury. I can’t even say that they killed themselves because that represents a choice, a decision that was made. And there was none. And the language we use to discuss suicide, I think, is extremely important. When people would ask me what had happened, I told them I had a near-fatal depressive episode. I had something. I was sick. I was ill. I didn’t give myself cancer. I didn’t choose to have my heart stop. And I didn’t ask for a mental illness that would cause me to do this. I didn’t have a choice available to me in the state of mind that I was in at the time of the event. You know, it’s, that whole conversation became a big deal to me.

And something extremely important to me here in Arizona is, there’s a lot of pushback. I almost had the go-ahead for a (attempt survivor support) group where I work, Southwest Behavioral Health. And at first it was OK, because it was a misunderstanding. And then, “No, this is what we expected.” They were very nice about it. The people I work with are really great, the company is excellent. They apologized for the misunderstanding. They didn’t act as though I did anything wrong, but it wasn’t something they wanted to get involved in because of the perceived liability that they would be exposed to. I had the same thing with the department of behavioral hearth services in Arizona. They had a program, the Arizona Dialogues. I went to a very involved three-day training in order to facilitate these dialogues that were between disparate groups of people to get conversations going. Some of these were as few as 12 people, some as many as 200 to 300 people. Most of those people were observers in those situations. A lot of people, knowing they would not be able to speak, except perhaps at the end, they still wanted to come and hear what was gonna be discussed, what people had to say. So it was a very interesting program. In fact, they’re starting it up again. And I was contacted to participate again. But with them, I suggested a dialogue on suicide, and they, at first, there was a lot of interest. And then when it went up the flagpole, it was too much liability: “Someone will get out of control and kill themself.” It’s like, how much about mental health do you know? There’s a lot of ignorance on the subject. And I think to fill the void, what a lot of people do is, I don’t mean to sound harsh, but they just make stuff up. I don’t want to say that as being mean, but having these holes of information that to most people don’t make sense, they fill those holes with ideas that they can wrap their heads around, even though that information may be erroneous. And they don’t know. And it’s not that they’re trying to create information that doesn’t exist, you know, they’re not trying to do it in a negative way, but the brain has to have a certain amount of order, and they’re just trying to bring that amount of order to a subject that they don’t really understand. And I think it’s for us, and by us I mean people that have come very close to the subject matter, to educate them. One of the things, unfortunately, that makes it difficult is that when so many people ask, “What were you thinking? What did you expect to accomplish? Why did you do that?” a lot of people feel obligated eventually … At first they say, “I don’t know.” Eventually, they feel obligated to answer those questions, throw things out that people want to hear, at least people will accept. It continues these misconceptions. Now, for the people answering the question, it’s very difficult.

Like I said earlier, most of these people are considerably younger than myself. I have a different way of looking at things, partly because of my age, partly because of my illness, that I never knew I had, by the way. I started showing symptoms of bipolar disorder when I turned 17. And it wasn’t until I was in therapy after my suicide and four months after I started where they said, “We want to try to rule out bipolar disorder.” So I said, “You think it’s bipolar disorder?” “Well, we want to try to rule it out.” I just sat there for a minute, and my brain did a fast rewind through my entire life to that summer I turned 17. It was like, well, of course! I didn’t know. I didn’t know why I went through so many jobs, so many girlfriends, so many relationships, so many marriages. All I knew is, I couldn’t figure out a way to hold on to any of it. I ended up in the hospital more than a year later, and when I went back in, they took me off everything I was on. I was on most of the new medications. And they went back to the old standby and put me on lithium. And once they started to see it was starting to accumulate in my blood, even though I was not up to therapeutic levels, they said, “OK.” They were in touch with my prescriber. They sent me home. Over the next number of months, they adjusted the dose to therapeutic levels. We added Wellbutrin, because I was still seeing more depression than I was comfortable with. And I was very antsy, I couldn’t figure out why. I didn’t like it. We were talking, and I told him what I used to do when I was in school around 1971, and I was working on a very big project. And I would start work at about 7, 8 at night, and I would work through the night until about 3,4 in the morning. And then I would take a nap and then I would get up, go to work, or school, depending on the schedule. Then I would do school and work, then come home, get a bite to eat, start all over again. When I started working, now here I was about 20 years old, and I was going to school in Boston, going to the Berklee College of Music. When I got my project ready, I had a card table and a folding chair, and I would take a black beauty, which is an amphetamine, and I would have about four joints rolled on the table to last me throughout the night. And then when it was time for me to go sleep for a few hours, I would take two black beauties and lay down and sleep three or four hours. And my prescriber asked, “You would take two and go to sleep?” I said, “Yup.” “I think we know what to do.” And she gave me a prescription for Ritalin. I take one in the morning, and one in the afternoon, and within 15 or 20 minutes I feel calm, relaxed, just the whole edge off. Which is not the normal response to Ritalin. So there were a number of diagnoses in my chart that were not official, so bipolar is, that’s my diagnosis. But it’s interesting, there’s the bipolar and then ADHD, more genetic than environmental. And then there’s the personality disorder and the PTSD, that’s more environmental. So it’s been a lot of discovery over the last few years as to what exactly has been holding me back. Because I never knew, and I never knew how to find out. So it has been an extremely interesting trip.

There were things, one thing I had early on in my therapy, I had no conflict resolution skills. And my therapist said, “Do you really think it’s a skill?” Well, I hope so, because I don’t have it. So it was an interesting situation. I had a conflict with a co-worker, and it became extremely volatile. Over the next few days, it didn’t get better, it got worse. Although no one said anything to me. I was just getting more worked up, didn’t know what to do. Over the course of a year it took me to figure out why I was reacting that way, why I had the lack of skills, what that lack of skill was, why did I respond to conflict in the way that i did. I could not just go forward  and say, “I’m going to do it differently.” The only way was to figure out why was I doing it that way in the first place. And I did. At one point, I thought I had figured it out, but not all had changed. It was maybe another six months before the second half of the puzzle, my brain was able to sort it out. I had never gone through an experience like that. It just never, for me, it was an achievement that to me was life-changing. And it was something that I needed so badly. And it’s part of the process of what we call recovery. For everyone, it’s different. We need to enter the conversation with respect up front. I’ve had the opportunity to do a lot of things in behavioral health in the last few years. Some things I was not happy with, some worked well, some things didn’t. I was involved in the DBSA, with another gentleman who was very active with the DBSA in California and is now in Arizona. We organized the state chapter. And when we started, there were issues where we felt, there was another organization called Mental Health America, and I’m sure they are very nice people. But I personally take umbrage. This is not competition. We’re not making money doing this. Yet what they’re doing, they put out things under DBSA and then all the contact information goes to Mental Health America. Why would I spend all my time trying to develop the organization in the state if somebody else is going to come in and steal my reference information and people’s ability to contact me? The DBSA says, “That’s not our job. Our job is to funnel down information and be a resource for chapters.” So I said, “If my job isn’t to grow the organization within the state, you’re wasting my time.” I expected to have a bigger impact. Certain things with the state didn’t work out, certain things did work out. I’m very lucky, I work where I get my services. My boss is my therapist. She’s not my direct report, she runs the program. But I still get to speak with her when I need to. So it’s great to be able to walk into her office and say, “So, you have a minute? I need to talk about something personal.” And we’ve kept it pretty straight for about two and a half years. And it’s nice to be able to walk into my prescriber and say, “I need these prescriptions.” That’s nice perk.

I think suicide, from what I’m hearing on the national conversation, is that it’s extremely misunderstood. We know that over 90 percent of all suicides are people who are in the throes of either undiagnosed and/or untreated depression. It could be bipolar, schizophrenia, very often substance abuse issues, but depression seems to be the one thread that runs through all of them. And yet we still sit here and ask somebody, “What were you thinking?” Who’s got the problem? I’m sorry, but we know. I think the biggest thing is to do away with the word “suicide.” I think the word is misleading. Because when people speak of suicide, they say “He committed suicide” or “He attempted suicide.” I attempted to bake a cake, and it failed, but suicide isn’t something where I woke up one morning and said, “Hey, I’ve got a great idea.” You know that. And when I talk to others who’ve been through the experience, they know it too. But everyone else, they come up with something that effectively will get everyone off their back. But they’re younger. Everyone asking them these questions are parent figures, older, teachers. There are friends, but friends have an entirely different take on it. But we know it’s depression. We know that. Nobody says it isn’t. If we know it’s depression, why don’t we call it what it really is? A fatal depressive episode. And if we start to talk about it in terms of not something that someone does, but in terms of something that happens to them, then I think the conversation will finally start. And the understanding will start. It gets rid of the prejudice that people have. What’s the word I’m looking for?

Stigma?

Stigma, yes. Thank you. You know, because stigma really is prejudice. And the way to get rid of it is to create the understanding. And yet we can’t get rid of the stigma because we ourselves sometimes have such a difficult time understanding what is happening to us. And the behavioral health community isn’t really a lot of help. And here they sent me to the internet for support groups? They should have given me a list. And where did they send me? Grief groups. If they don’t know what’s going on out there, how are we supposed to know? I think the best place to get information is amongst ourselves.

How do we find each other?

You found me, didn’t you? It took you four years, and I have been waiting for you. I think this is definitely one way that it happens. And I think one of the reasons that it did was that article. Interestingly enough, the article was actually on DBSA. And the main person in the article was supposed to be Henry Willey, the guy I was working with in DBSA. But the writer told Henry she wanted to talk to somebody who was willing to talk without an alias. She didn’t want any more of this clandestine stuff. I really appreciated it. And a lot of people found me from that article. The last of which was one of my cousins. A heck of a way to find out what someone’s up to. So this is another step. If we work together, and you have the time and know-how … You’re obviously hip on all the internet stuff, and I know how to get on, I know how to find my e-mail. You know, you can do that. And we can talk. I don’t care how often you want to talk. I know I’m pretty much going off all night here. But I just wanted you to get a good idea of where I’m at. Because I think it’s different than a lot of people’s. And I say that based on the people that I know that also have had near-fatal depressive episodes. I don’t think there’s any other way to say it that’s more accurate for the experience we’ve been through. I get very tired very quickly, but people tried to make me feel it was my fault. I was not gonna do that for very long, and I didn’t. And my feeling very quickly became, they can either educate themselves, find information, or they just go live their life in ignorance and bliss while the rest of us work on a real problem. Because this, it so needs people that care to speak out. I was doing a lot more before I started working.

I went back to work over two and a half years ago now. Even though I’m working part time, I put in whatever’s needed to get it done. There are a lot of clients that rely on the work that I get done. It’s great. And for the first time … In all my other jobs, it was about “How important can I be to make myself more needed or make more money?” And for the first time, it’s about the work that I do that’s important. It has never been, I have never walked away from a day at work and thought, “Boy, wow, did I do a great job today!” It’s like, “I’m not the issue here. The work that I do is the issue. The people that I do work for, in terms of the clients, they’re the issue.” And to me, to have that perspective, to finally have that clarity, it’s huge. Huge to me. And it just makes me want to work. Not just suicide prevention, and the classes I’ve taken, I’ve done a number of multi-day suicide prevention trainings. And even in my office, if there’s a therapist that’s on the phone with a client, and the therapist tells the director they have somebody on the phone who’s suicidal or in crisis, or the front desk gets someone in crisis and possibly suicidal, I have become the go-to guy. And as that continued to happen and that’s developed in the office, it’s, to me, it’s very odd that rather than finding something that I can be proud of, I find it’s something that’s like, “Oh good, because I don’t trust anybody see to talk to these clients.” It’s true! And my therapist, who’s also the director of the program, she says, “OK, you did this, you did that, now can you feel you did something good? Be proud of yourself?” And where in the beginning that was a goal, now it’s like, “I don’t have time for that. I’m more concerned about the clients. And I want to be the one, you call me at home, I’m only 15 minutes from the office. I’ll come in. Make me the crisis guy.” But not because I get a raise or I get prestige. It means nothing. The only thing that means to me is that I feel my clients are safer. And I tell my therapist that I say “my clients,” not like I feel they’re mine, and she said, “Good, because you can get too emotionally involved.” Eventually, and especially for someone like me who puts themself in the firing line, eventually I’m going to lose someone. That’s just the nature of the beast. I cannot save everyone, and I know that. I’m not happy about that, but I know that. So there’s a huge risk that I take. She’s aware, I’m aware, we’re all aware. We do what we gotta do. But I didn’t even think of it until she brought it to my attention. It’s not about me. And for so long it had to be about me, because I was holding on by a thread. Like that little kitten hanging out of the tree by one little claw, you know? And that’s what I was doing for 40 years. And it’s a long time to be hanging there. And now that I’m not, I find I’m not trying to accomplish what I thought I was trying to accomplish. No, I can accomplish more than that. It’s a very, very interesting experience for me. It really is.

How do you protect yourself? And are you still in the process of saving yourself? Does that make sense?

Yes, absolutely right. And very observant. The process that I’ve gone through and the changes I’ve gone through, I never could have imagined. Those are helping me protect myself. I’m very observant, for instance, when I’m at work and working with clients, driving them to and from their appointments, they are in the van for more than twice as long as they are with their therapist. It would be like 45 minutes from their home into the office, a 50-minute hour, then I have them for 45 minutes going home. Very few people don’t say anything. There are some that won’t talk, but they’re relatively few, and what’s amazed me is that I have been able to connect with 17, 18, 19-year-old girls. I’m a 61-year-old guy. I don’t see that connection, but yet it’s there. And you know, I will sometimes ask questions that I decided to ask to see just how far the connection is. And they’re open and honest and talking abut their lives and what they want to do, where they want to go, what’s happening with their parents, stuff like that. I can give them a perspective they respect. It’s interesting to me how that seems to work. That protects me. I always keep in my head that they are who they are, what they are. I can’t change anything, but I can influence things. That influence, it’s given me that distance. Even though somebody, it’s weird, sometimes these girls, they’ll come up, in a group or something, they’ll come up and give me a big hug, that’s fine. You know.

But my brain, I don’t know why, my brain puts it into perspective quickly. Like, this is probably gonna sound very morbid, but I always think if I never saw this kid again, I would really miss them. And that would be OK. Now, if I didn’t see them for a hundred million different reasons, it doesn’t have to be anything bad. It’s just that I would miss them, and that would be OK. So I remove from the equation, my happiness doesn’t rely on this relationship. And so it’s always about them not being there. And that goes with anyone that I know. Some of the people are much more troubled than others. It keeps me, I don’t think about myself that much anymore. And I think part of it is, I don’t need to. I think now I can finally just do the things that I want to do, without being in fear of it coming to an end. Which is how I lived my life. Whenever things were going well, it was like, “OK, when is this gonna go to hell?” Because it always did. I never had a job more than two years in my life. Now it’s finally going on three years. It’s still getting past a big point. You’re right, I do have to be aware all the time of protecting myself. But it’s weird, I would not feel comfortable trusting anyone else to be where I am, do what I do. I’m going to have to at some point. When my position changes and they have to hire more drivers, and I’ll be overseeing and doing more case management. I know that’s going to be coming down the pike. I know I’ll have to give it up. It’s just gonna have to be hard.

This not trusting others to handle things, do you think it’s in any way like the idea of not trusting people to run suicide attempt survivor support groups? Or am I misunderstanding what you were saying?

It’s not a misunderstanding at all. There are certain things, I think more accurate is, I don’t feel comfortable. If there was a client on the phone, and that client was suicidal, I could look at everyone in the office, including the Ph.Ds that we have, and I can tell you that there’s not one of them that I would feel comfortable with talking to that client. And I can equally tell you that not one of them would be comfortable talking with that client.

But that’s their job.

That’s correct.

And it’s possible they might have had this experience themselves but don’t dare mention it.

That’s correct. But based on their, just certain conversations, I doubt … In general, you’re right. You know, there are a lot of therapists, people in behavioral health who’ve had experience with self-inflicted injuries that would never, ever tell anyone because of the fear of repercussions. But sometimes, and I think … If you mention something, and somebody doesn’t want anybody to know, and you’re being really open about your experience, there are certain signals they can’t almost help but give off. Where you would pick up and probably not say anything, but you’d walk away thinking, “That person knows more than they’re telling.” You also know how important is it to respect their privacy. They know how to seek you out. If they don’t, it’s their prerogative. I was going to tell you about Magellan. The reason you hear so much about Magellan, they are for Maricopa County, which is Phoenix and the surrounding areas.

Is what they’re doing innovative? Is that why I hear about them?

There’s one guy there, David …

Covington.

Covington. This is essentially his pet project. I was part of the initial group that he put together. And one of the things that got me there was the promise of a support group for people that had a near-fatal depressive episode. And when I got there, there were two or three meetings prior. Those were interesting. We were all going in the right direction. Then we were going to have this meeting for people who had lived through it. And it wasn’t that at all. It was a group of people who had survived, and now David wants us to research and find the best practices in the country for suicide prevention. And I said, “Well, is there any place in the country that has shown a marked decrease in suicide over the last three to five years?” And somebody said, “That’s not what we’re looking for.” I said, “But David said he’s looking for best practices. Wouldn’t the best practice result in a decrease in suicides over the past three to five years?” Apparently, I have a very strange way of looking at things, because I was told that’s not what they were looking for. I couldn’t understand how to go about it. He said he didn’t just want a Google search. If it’s not reduced incidents, what’s your criteria? You know? And I said, “What if we looked at results, didn’t find any results, and we created a best practice that actually works? Would that not be a project?” No. So I wrote six or eight pages, a paper called “The Language of Suicide.” And David read it, we talked abut it, he got my ideas: “You’re right! That’s it!” I’m like, “OK, I don’t really care about being right, how can I contribute?” “I’ll let you know.” So I’m still waiting. That was about three years ago. I get it. I understand. Which is a terrible thing, because it means I can’t be mad at him. I’d rather be mad at him. He can’t afford to put himself in a position where he doesn’t know everything, or at least most of everything. He needs to be, and maybe it’s because of his position, but he needs to know all the players and all the plays, and he needs to be able to wrap his mind around everything. And although he might have been able to glimpse a lot of the things I was talking about, once he left, he really had to think about it and really truly understand it. It became more difficult to understand it relative to what he already knows. You cannot call it suicide and a fatal depressive episode at the same time. They mean two completely different things. And that’s the most important change in perception that we can make to understand the experience without actually having to go through the experience.

How do we do that?

People like you. Because if you … Let’s say you started a blog. Or added to your blog. I really don’t know how they work, so I couldn’t really tell you. Let’s say you did something and called it “The Language of Suicide.” And you were able to get this change in writing. And we got it on the internet, and there’s now some place that people would land that would disseminate this concept. One of these people could be someone who could add to the effort. But that’s the only way that I know, because I’ve talked to people who are, shall we say, influential and powerful, both in private industry and in the state, the office of individual and family affairs, and they like it, and then they don’t do anything about it. Either it’s too much work, or it might be too difficult, meaning it’s too much work. And I think that the main reason for that is, they don’t really have a stake in it.

Changing the language, that’s what will swing open the door?

I certainly think it will crack open the door and start a conversation. I was in sales for a number of years, and one of the things that was very successful was, when I would put something out there, I would do it so they’re not necessarily going to get it, but I would get them to ask the question. Two things: Even if they were not interested before, they are now. Or at least curious. The other thing is that if I had told them the information before, they would have shut off because I was telling them about what I wanted them to know. And if it was about me, they’re not interested. But if they ask, now what I’m saying is the answer to their question. Now they’re listening. They asked for the info, they wanted to hear, now they’re listening, because they don’t want to look like idiots. The method of getting people to accept new information is to get them to ask for it. And so if they see a phrase, like, say, “fatal depressive episode,” and they say, “Well, what’s that?” that’s a home run. Because they’ve just asked you to explain everything you want them to know. It’s interesting because some people have seen the phrase and they’ll say, “Oh wow, how interesting.” And again, you may have to say, “Isn’t that phrase so much more accurate than saying suicide?” Either they say “Yes” or they say “Huh?” So either you have an ally or someone you can make an ally. But starting a conversation is really important.

After your attempt, you seemed to know right away who would end up standing by you and who would not. How did you sense that so quickly?

Well, I certainly never knew who, just that there would be surprises, and I didn’t want to be blindsided. My wife, now ex-wife, was the first to go. I think it helped that she was so blunt about it. She shut off my cell phone within the first three days so when I woke from my coma, I couldn’t make any calls, including to her. She called about a week later on the hospital phone. The conversation went like this: “Hello?” “Hi. I just want you to know that I’m never getting over this and we’re done.” “Don’t you at least want to have a conversation about what happened?” “No. Goodbye.” Click. My friend Richard, who I met in 2001 as a colleague at work, and whom I wasn’t really very close to at the time, was there for me in as much as he could be. After the gunshot, after waiting for an hour and a half for the “lights to go out,” I called Richard, who happened to have visited the night before with his wife. They felt something might be wrong and did everything they could to get me to give up my last gun, having sold all the others, or stay at their house to swim, hot tub or just hang out. Obviously, I declined. The call was simple, in its effort to buffer the shock: “Richard, I think I just shot myself.” It took him about 30 minutes to get to my house on his motorcycle and another 15 for the ambulance. They ended up airlifting me to the nearest trauma center. After getting out of the psych unit, Richard picked me up, about a 50-mile trip one way. He welcomed me into his home for a week, thinking that’s all I would need to get a job and find a place to live. He just didn’t know. Now, as I assist him with his substance abuse and parenting problems, I still have to reassure him that he did what he was able to do at time. He still brings up that he should have done more. He has no idea how much he did. Ann, my ex-wife’s son’s ex-wife _ my ex-step-daughter-in-law _ had lost her grandmother, her mother and her 32-year-old brother within the last 18 months. Upon hearing I was in the hospital, and why, they would not take anyone’s word for it; they wanted to see me for themselves. They and Richard were the only visitors I had in the two weeks spent in the ICU. After the week at Richard’s, I went to stay with Ann, her new husband and my three grandchildren. Ann’s ex-husband went the route of telling her I am not to be anywhere around the kids, that I was dangerous and she should not let me into the house. He added a letter to me that can only be described as the quintessential “poison pen” letter of about six pages, if I remember correctly. Obviously, I no longer have it. My sisters didn’t call for quite a while, weeks or a month or so. My father never did. However, when he went to visit my younger sister in Las Vegas, she called me to see if they could drive down for a couple of days. They spent two nights, over which time hardly much was said. I don’t think my father said two words in all that time. No support there. A cousin of mine runs a program on his computer that searches for the name “Kobren” on the internet. He does this for business reasons, as he is often quoted on business matters. He found the same article you did and called another cousin that I’m closer to. He found me through Facebook, which another colleague of mine suggested I set up, and was totally and completely supportive, both financially and emotionally. We hadn’t spoken in almost 20 years. No one else really matters. If that changes, I will either welcome it or mourn the loss, but I will still continue to move forward.

You mentioned more than once that you’re probably older than many people who’ve had this experience. Have you noticed that there seems to be more emphasis on suicide prevention for the young, and how do you feel about that? Does that necessarily mean that the issue of suicide for middle-aged and older people is neglected somehow?

Statistically, men 65 and older represent the greatest risk for suicide. That said, I personally don’t believe that any current campaign directed at any demographic will significantly reduce the incidence of suicide due to their approach. From what I’ve seen, they concentrate on the reasons someone would “want” to take their life and the reasons they shouldn’t take their life. No one focuses on the signs of the onset of the depression that can cause the self-infliction of a fatal injury. I find that disturbing.

Have you ever lost anyone close to you to suicide?

Yes. A friend who I was pretty close to from 1996 until her death in 2002. I had been becoming more distant since I had met the woman who I was going to marry. She died in February, but I didn’t find out until April or May. None of our mutual friends thought to call me. Fact is, I blamed myself too.

I’m assuming that when you shot yourself, you thought it would kill you. I tend to worry a lot about people seriously messing themselves up because they go into an attempt thinking, “Well, maybe this will work.” If suicide prevention included the message that it’s very hard to kill yourself and no method is foolproof, do you think that would be a powerful deterrent?

I don’t think so. The method I used was pretty “foolproof,” and yet it didn’t work. By the time I started therapy, after my release from the hospital, I had come up with an even more foolproof method. The idea of surviving would never have deterred me since I would be sure that “That only happens to other people.”

Here I go painting you with a broad brush, but there’s the idea that older men are more hesitant to ask for help when it comes to mental health or emotional issues. If you’d agree, what do you think would be the best approach to ease that?

It seems to me that they’re not so much reluctant to ask for help as much as they feel that their reasons may be different. In some cases, loneliness and isolation will lead to the depression that puts them at risk. For others, pain and deteriorating health may be prompting an “end of life” decision. I know many people disregard the issue, claiming it’s just another death by self-inflicted injury, while others say it is a choice.

I want to go back to the part about suicide survivor support groups, because you were quite passionate about it. Are you actually angry at them, the people who lost someone?

It’s not so much I get angry at them in an overtly angry way. I went to a meeting, a suicide prevention meeting, and at the end of the meeting there were two women that attended that were part of a grief group. And as much as I wanted to, at the time, it was very early on, maybe six months after my event, and I find it sometimes difficult to be angry at people for the way they feel about certain things. I tend to take an attitude of, if they choose to be ignorant, that’s their problem. Yes, they’re making it more difficult for what I want to do, which is to reduce the prejudice around suicide, by telling everybody it’s the worst thing in the world and then saying, “Look what they did to me.” Excuse me, they didn’t do anything to you. They’re the ones in the ground. It happened to them. A lot of what it seemed like was they felt very guilty, thought there was something they should have been able to do. They think they should have been able to stop it. And I can understand that, given their misconception of what it is really all about. But if they were better informed as to what exactly was happening or did happen, they might be able to get past that and stop looking at themselves as survivors. I don’t think they need to stop looking at themselves at survivors first. I think they need a reason not to see themselves as survivors, and the reason would be, it wasn’t something their loved one did, it was something that happened to them. And if happened to them, how could they be responsible?

I think it comes from the language in funeral notices: “So and so is survived by …”

I thought the same thing. But why are they the only group that latches on to that? I think it’s because, and this is what bothers me so much, there’s only one way that could have happened. By calling themselves survivors, if you look at any other group, they had something terrible happen to them that they lived through. Unfortunately, these people haven’t decided to live through it yet. They’re keeping themselves as survivors. They’re making themselves victims. It stands to reason that if you’re the victim, who’re the perpetrator? It upsets me, but I could certainly have a rational conversation with someone. What would really get me crazy is when, after that conversation, they tell me I’m nuts. Maybe so, but I’m taking medication. What are you doing?

(The phone accidentally cuts off. I call him back, and he apologizes.)

I was thinking, nice way to have the last word! But I wanted to ask the question I like to ask at the end: Who else are you?

A really great question. And thinking about it, originally my brain was going to a, “What else do I do?” It’s not what else do I do. She asked, “What else am I?” I looked at that one thing that I’ve always hung on to, and that especially when I was starting out to get better, what I held on to for dear life. I am my integrity. I am everything that I believe is right and wrong. I am my honesty, my willingness to help with both feet, not just “OK, here’s this and goodbye.” I am the person that, given being affected by my illnesses all those years, I am the person that I have created, the person that I always wanted to be, at least as close to that as I can possibly get. But that has always been a guiding principle of my life. I read somewhere a long time ago, “Live your life as though you were writing your obituary.” I guess I took that to heart. In doing that, I’m not necessarily being 100 percent successful at it the whole time, but being the person that at least thinks about that and works toward that, that to me is a person worth being. And that’s always been important to me. It’s funny, my therapist is always like, “Well, aren’t you proud of that yet?” I’m willing to wait so that on my tombstone they can write, “I’m proud of what I did. I’m proud of how I did it.” That’ll work for me. Though honestly, I can’t say I’ve always been that way. I have, but I’ve also been affected by other things. The only way I knew how to keep a job or do a job or have a job or just, you know, something. But it’s different now. In a very strange sense _ and I never ever look at it this way, I really don’t, but with you, I will make this one exception _ in a sense, my event was a really great thing for me. Because at that point, there was no way of going on with that I had, there really wasn’t. I had absolutely no way of figuring anything out. I couldn’t do it anymore. It was done. But the only thing to move forward was to have received the help that I got after the event. And it saved my life. Actually … The help, yeah. it not only saved my life, it actually gave me my life. It didn’t give me my life back, it just gave me my life. So I mean, maybe the reason I’m so passionate is because of that fact. I feel that I owe, you know, I owe it to maybe try to help some people, some person, get their life without having to go through that.