Talking with Janice Sorensen

I was happy to find another support for group for suicide attempt survivors, this time in Massachusetts. I came across the Alternatives to Suicide Peer Support Groups while looking over the schedule of the recent Alternatives conference, a national gathering of mental health peer support workers. So maybe the idea will grow.

Janice Sorensen was one of the presenters. Here, she talks about her own experience, her artistic response to her mother’s multiple attempts and how a diverse community has made the support groups work. “We want to find the balance between giving people a space to touch that despair and share what it is like to be in it, without making it a horror circus for someone who may be there for the first time or who may be feeling vulnerable themselves,” she says.

We spoke shortly before a massive storm hit the East Coast last week, and the posting of our conversation has been a little delayed.

Who are you?

I’m Janice Sorensen. I’m actually navigating that question at this very moment. I recently left the job I was at for a number of years, with the Western Mass Recovery Learning Community. I didn’t realize until I left what a huge part of my identity that job was. Which I think is, or can be, true for a lot of people, identifying with the work they do. Let’s see, what else. I am an artist and take any opportunity to transcribe whatever it is I’m processing in my life onto canvas or wood or glass or paper. Right now, I have a body of work called “Palimpsests in Paint.” And what I’m doing is purchasing previously painted canvases _ in other words, other people’s paintings _ at tag sales and thrift shops, and I am painting over them, allowing some of the original painting to come through. I use these underpaintings to inform my palate and the direction I take with each piece. It’s based on the, you know, the original sheepskin, what do you call it, parchment, that some of the ancient and the illuminated manuscripts were written on. The material became more valuable than the content of the document, so people would decide which documents were less important and would use those and either erase them or just write directly on top of them. So what I’m doing is a little uncomfortable for me. It’s actually very uncomfortable for me when I consider the idea of someone ever knowing that I painted over their image. I spent a lot of time thinking about whether to credit the “underartist” because I do leave some of the image coming through, but I think I am chicken-shitting my way through that one, and at this point, I’m not doing it. I would be mortified if someone ever knew I had painted over his or her piece. So there’s the discomfort that I’m doing something that feels, in some strange way, “wrong.” But it’s kind of a safe way to struggle with a dialectic. It’s not really a great sin. And there’s something bizarre about declaring, you know, what appears to be a mass-produced image of, like, an Italian canal gondola scene, or a muddy _ to my eye _ overworked still life, there’s something interesting in having a bit of power to say, “I declare you unworthy. You’re gone. You are more valuable to me as workable canvas.” I’m sort of embarrassed to say those words, but again, it’s a way to flirt with that kind of dialectic in a place with no stakes. No one’s ever gonna know.

Unless you get famous.

Yeah, that’s true. So yeah, that’s what I’m working on right now in addition to doing suicide prevention work and other consulting work in the field of mental health recovery.

Where should I go with the questions? The support group group or how you got here?

You decide.

Tell me how you got to this point.

OK. I was raised in a household with a woman who had multiple suicide attempts during my childhood, my mother. She attempted maybe six or seven times. And it had a huge impact on me, needless to say. It’s what I thought you did. I thought it was just what people did. When I had a bad day in home ec in sixth grade, I came home and took a bottle of aspirin. That’s what I did. It seemed like a perfectly normal thing to have done. And growing up with my mom also set me up to think on my feet, which I’m actually glad about. I was, with a certain frequency, having to make life-and-death decisions on my mother’s behalf. So, when I was 18, I had my first real serious suicide attempt and was very fortunate that the night watchman _ I had parked my car in a business district where I was sure there would be no passing cars at that hour, the wee hours of that morning _ the watchman saw the brake light of my car go on because I had passed out and slid down in the seat, and he called the police. The officer who was supposed to be on the other side of town was visiting his girlfriend minutes away. And my life was spared. One interesting aspect of the attempt was, at the time, I was a fundamental, evangelical, born-again Christian, and, frankly, I was thrilled I was going to see God. I sang myself to sleep, which certainly feels problematic to me now.

Now that I have kids, I have fully and completely declared that suicide is not an option. And certainly I’m grateful for that commitment once the despair has passed. I’m also very aware of the fact that my life moves in cycles. And when I was younger and things were horrible, I didn’t know that the way life works is that things get better. They may get worse again, but then they do get better again too. It took a number of years before I realized the pattern. Now I know when I’m in the absolute lowest place that I will be happy again. For a long time, it was my mantra that “It always gets better.” And, yet, there are times that I am absolutely livid, furious that suicide is not an option for me. I just want to explode in my anger that I made this commitment. But I, you know, stick with it and always find that yes, life is rich and wonderful and, like others have expressed in the history of your blog and in life in general, the lows can make normal seem rich and certainly make great seem stupendous.

Where are you now?

Where am I living?

I mean the ups and downs.

Good question. I was really sad today, being in this community. I was the Franklin County coordinator of the Western Mass Recovery Learning Community, like the hub of activity, the “activity director” practically, the person setting up movie night and presentations, the person people called when they’re in a place of crisis. And like I said, I function really well in those circumstances. I call this thing my super power. People ask, “What do you mean your super power?” Someone might diagnose you as bipolar,but  I call those qualities your “super powers.” You just need to learn how to harness and ride them. A friend recently told me I was an empath. I kind of know this, but its nice to be affirmed. So in my role as coordinator, I was really surrounded by a lot of people, coordinating things, doing the nitty-gritty, creating incredible programming, but since I left that position, there’s been a level of loneliness. I’m really trying to examine who I am, what’s my role, and do people like me, do people want to be with me.

I’m really aware of the fact that often people think everyone else is out having fun, has lots of great friends, when in fact so many people are experiencing loneliness. So I try to move past my feelings of loneliness and be the one to call other people. But it definitely has come up for me lately. Tonight, I wanted to go to an event, and I made 15 calls and sent six texts before hearing from anybody. Finally, one response. Before I got that, I wanted to start sobbing. You know, like I said, I’m in a bit of a raw state, trying to figure out what I’m doing. I have a big, beautiful house, a fantastic partner and two amazing children, 17 and 21, and we currently have an exchange student who’s just a wonderful fit for our family living with us. We have goats and chickens, I’m able to do my art, volunteering my ass off, and able to make money on the side with AirBnB, so my life is good. I’m aware of that. I know the art of appreciation for me is a good skill, to compare and contrast. When things feel hard for me, sometimes I create the picture in my mind of the people who are at this moment huddled in burned-out buildings with children and bombs going off, and they are wet and cold. And I use that to keep an awareness of what is going on in the world and also to contrast, help me appreciate the richness and beauty of my own life.

Why did you leave the job?

I guess I’m going to say that there wasn’t quite the funding for me to get the kind of support I needed to do the job well. There’s just not the funding. It was great work and hard work, and I guess it felt like time to hand off the baton.

So you’ve left the support group, too?

No, I do consulting work with a few organizations still, including facilitating the Alternatives to Suicide Peer Support Group. And I’m available to  give facilitator trainings to peer support groups. I do graphic design for them. I’m also working with the National Empowerment Center doing eCPR trainings, emotional CPR. It’s a more holistic version of Mental Health First Aid. And I am scheduled to do a training with Shery Mead’s Intentional Peer Support to learn their facilitation. I am really excited about that one. I love their product. They have really thought through beautifully what they do.

How did you come to do this support group?

We started as a grassroots organization, the Recovery Learning Community. We are all people who have had every shape, size, color and experience with the system. And what became really obvious to us is that if you are in a clinical setting with any number of agencies, and you tell your provider you’re feeling suicidal, you can expect any number of things to occur. The session may end right there, and you may be passed along to a supervisor. You may be hospitalized against your will. You may be medicated against your will. You may find the police at your door when you get home. People think that this is “mandated reporting.” They say, “We have to, by law, report that you are a harm to yourself.” This is absolutely not true. Mandated reporting is required in cases where a child or an elderly or disabled person is being abused. What people are calling “mandated reporting” is actually an agency’s policy, in order to cover their butts, in order to be cautious with regard to lawsuit. A lot of agencies have policies that require that if someone mentions they’re suicidal, the person who works with them must report it. This is not a state mandate, it’s an agency mandate.

So, at the Western Mass Recovery Learning Community we realized that if I’m feeling suicidal, and I tell you about it and the session ends, I promise I will never tell you again. So, the one thing that I may need, which is to talk about it, I won’t do. So we decided to start the Alternatives to Suicide Peer Support Groups, so people could have a safe place to talk about their thoughts and feelings of suicidality. It’s a gathering where people can come when they’re feeling great or experiencing despair. We’ve realized with the groups that suicide does not discriminate. We’ve had elderly, young, gay, straight, people of color, male, female, transgender, and so often I wish I were, you know, able to record some of the amazing conversations that go on in that space. We have a group in Greenfield, Massachusetts, we have one in Northampton and one in Springfield.

How long have they been going on?

In 2008 was when we received our first funding through the Massachusetts Coalition for Suicide Prevention. And in 2010 is when the Greenfield group started, which is the one I’m involved in. One of the main parameters of our group is that we want people to be able to say what’s happening to them, but we ask that they not paint a picture. So that means someone can say they’ve really been thinking about killing themselves, but we don’t really want to hear that someone purchased rope. We don’t want to hear someone’s story about the blood. We want to find the balance between giving people a space to touch that despair and share what it is like to be in it, without making it a horror circus for someone who may be there for the first time or who may be feeling vulnerable themselves.

Was that a decision at the start, or was it something you learned along the way?

For the group I started, I think it was something right from the beginning. I know it’s a clear directive with the group I’m working with. I’m pretty sure from the beginning. We’re pretty appreciative and sensitive of lending trauma-informed care and support. The awareness that the likelihood of someone having experienced trauma is pretty high. We don’t want to get sloppy and send someone into a terrible place because they came to the group to get support. It’s an interesting balance, and we feel we’ve navigated it pretty gracefully. And as often as someone may be sharing despair, as often we’re engaged in belly laughter. It’s a really rich time together.

People don’t expect there would be laughter, I think.

There’s no directive that we have to talk about suicide. Sometimes that kind of laughter that comes from being in a place of tension just happens. But sometimes we just talk about funny stupid stuff. We also share resources. There’s no directive we must talk about despair or of feeling suicidal, but we really try to hold the space open for that.

(I mention the fears people have expressed about support groups sharing methods and triggering each other.)

There’s also that myth that if you ask somebody about suicide, you’re giving them the idea. And you know, I believe in my heart of hearts that not to be true. Talking about it is paramount. I mean, anyone who’s done the QPR training, the Q stands for “question.” Don’t be afraid to ask someone. You’re not giving them the idea. You’re letting them you know see them.

So the group is sort of the next step.


What are the risks, and have you lost anyone?

No, we haven’t. What people often wonder is, have you had somebody there that you know is in a state of despair, and the group is over, then what happens? One of the main things of the group is, I’m the facilitator, but I’m not in charge. I could not possibly hold that for everyone. I could not possibly be in charge of everyone being alive. When the group starts, a community member takes out the group agreements and posts them. We’ve had people walk in and not know who the facilitator was. Everyone takes ownership. There have been times when everyone was having a hard time. At closing circle time, people say, “Hey, you want a cup of coffee?” It’s real relationships. It’s people being truly connected to one another.

What was the reaction at the Alternatives conference?

Very positive. Really good response. I’m not sure what else to say. I’m very happy with how it went. Good people, good questions. It makes so much sense to people, especially those who are familiar with the movement of people with similar experiences helping one another. Actually, I don’t want to say helping one another. Instead of being helped, which is kind of patronizing, it’s really supporting another person to see themselves. I feel like we reflect people to themselves, in a way. I don’t know how to say that more elegantly. I feel I’m there to really see the person, let them know they’re seen, reflect back what I see as their super powers. And everybody has them. Or to just listen, which really comes before anything else.

It’s funny, another person I interviewed this week talked about people working with their issues as superheroes.

It’s good way to describe what other people are calling the peer work, or un-diagnosing. Not only am I just describing rather than diagnosing, I’m looking at the bright side of it. I feel like everything has its positive and negative. If you’re the kind of person who is incredibly gregarious, or who’s very, very in the present moment, you may be late a lot, but the upside is, if you’re with me, you’re with me. Everything has its bright and difficult side. It’s the dialectic. And rather than have to navigate through the diagnoses I was given … I’ve been diagnosed as bipolar, schizophrenic with paranoid tendencies and clinically depressed, if I recall correctly. And that can be debilitating. I understand for some people it’s helpful to know what going on. But for me, to cloak myself in something like that, that’s not my Supergirl cape, that doesn’t help me get airspace between me and the Earth. It acts more like cement boots. Or kryptonite.

I wonder what nervous therapists think of these support groups …

They are often in the stronghold of their agency policy. And that’s just that.

I can imagine them thinking, “If these people just found the right therapist …”

Well, here in Western Mass, we have a lot of enlightened people in every aspect of life. I hate to be so arrogant or blithe about it, but we really have a lot of great therapists who do great work and who do promote our groups. You know, the bottom line is, it always comes down to the dollar, doesn’t it? If we’re available to people, it lessens other people’s and agencies’ burdens. And I think before too long, the numbers are going to show themselves. I don’t know how people can track it well, but I think we are keeping people out of the hospital, and that’s where the huge expenses lie.

How can this idea of support groups be grown?

I’m trying to let as many people know as possible, through presenting at conferences and my involvement with the local and statewide coalitions for suicide prevention. I also have a little performance piece I’ve developed, and it’s my hope that it becomes a platform for dialogue. It’s called “My Mom’s Favorite.” And it’s about my relationship to my mother’s relationship to suicide. It’s a little tricky because the piece does paint pictures, so it’s another place in my life where I’m struggling with the dialectic of wanting to share my story, create art from my own experience and act sensitively. What I am doing is to forewarn people to the intensity, make them aware ahead of time that there are some difficult parts, so people are not blindsided. And people can self-select. I’ve performed it this past year at the Massachusetts annual conference for suicide prevention and had a wonderful response. And I received funding from the Pioneer Valley Coalition for Suicide Prevention, so I’ll be performing it in January at All Souls Unitarian Church in Greenfield.

Is your performance online?

I have one very sloppy recording of it. A friend did make a short film about me that’s an edited portion of my piece, but I only have it on DVD. But I do have my written transcript. I’d be happy to send it to you.

Yes, what is it about?

It’s about how I and my brother navigated a number of my mother’s suicide attempts, and there’s some humor in it, which I think helps lighten it a bit. But I’m still struggling whether it’s fair to have some of the detail that’s in there.

What does your mother think of it? Is she still alive?

No way _ my mother is alive _ but I would never show it to her. The preface to the piece gives a sense of why I would not bother: “Just after my daughter was born, my mother asked me, ‘Honey, what do you think you’ll do different with Della from how I raised you?’ As I looked into her mouse brown eyes, the strange innocence of her inquiry threw me and for a moment, I was unable to answer, place myself in time or even breathe; our life together was flashing in my brain. I knew I had to come up with an answer for her, but would it be my answer or the one she needed to hear? It was a tough decision, rooted in a past where so many of my choices revolved around her. For instance …”

My mother is in pretty strong denial. I let my siblings read it this past year, and it affected them in different ways. My sister, it really threw her into somewhat of a tumult, working out some of the things she hadn’t quite yet explored or even looked at.

You talked a bit about your own experience, from your attempts to your deciding that suicide is not an option. How did you climb out, from one end to the other?

Well, having children was huge. That just was, like, so obvious, “You cannot pull this shit. You cannot fool around with this stuff.” And partly because, as I watched my mother over the years, I learned what doesn’t work. So if I attempt my life, it’s gonna be completed. I know what doesn’t work. As I said, it was a total fluke that my serious attempt didn’t work, because I went to great lengths. I wasn’t going to be found. It was not a cry for help. It was me wanting to be sure I was gonna see God before I’d see another day. And at times now, what I recognize is, if I’m feeling suicidal, what I know is that I feel that bad. So I need to deal with it. And sometimes that kind of thing, like in your interview with Wendy, that the weight of the blanket is too much. I’ve had that thing where it took every ounce of strength to pull the blanket off of me. Now, one of the things I know I can do, that feels like a freebie, is go running. It’s not a freebie, it’s really hard to do when I feel like crap, but the adrenaline _ no, not the adrenaline _


Yeah, endorphins. So that’s one of the things I know to do, to act on myself like those discs the EMTs put the gel on and put on your heart to get it _ Kachunk! _ running. Running does it to me. Like I said, lately I’ve been feeling alone at times. And running with my dogs does it a lot.

You mentioned once being a born-again Christian. Why did you migrate away from that, and did it have any part of your putting away suicide as an option?

I am pretty aware now of the fact that this is my big moment. If you look at all of history and all of life lived here on earth, this is my onionskin paper-thin moment. I don’t believe in reincarnation, I don’t believe in heaven, so this is it. It would be a crime to the universe to cut it short. It is not something I could ever get back.This is my big moment.

You also brought up the excellent point about affordability. How many people do you think try to handle their suicidality themselves because they can’t afford to do otherwise?

When I was talking about money, I was really talking about the money in the mental health system. I was talking about the fact that we, the Alternatives to Suicide Peer Support Groups, I believe, are keeping people out of the hospital. That is hugely cost effective, which people like to know about. The thing is, we really try to keep paperwork to a minimum. It is counter to who we are, so it is not something that is easily proven.

One thing I worry about is the number of people who end up seriously harmed because they think, “Well, maybe this will work.” Is it just me? Would warning people that it’s far more difficult than they think keep them from even going there?

I don’t think it is a good idea. That becomes a tricky topic, because what you end up saying is, “If you are going to do it, you better do it right”? I actually suffered some brain damage, I believe, from my carbon monoxide poisoning. I’ll take it. Certainly, it doesn’t compare to some of the horrible results one’s mind can conjure for an uncompleted attempt, but I am glad to be alive. And, as I said, I was certain that I would be able to end my life because I had been witness to my mother’s attempts all growing up.

Sometimes I wonder whether I’m only talking with the high-functioning, well-situated attempt survivors and am missing everyone else. Does that make sense? Is there a class of attempt survivors who would not be able to benefit, or even get to, support groups like yours?

We are a down-to-earth group. We are fortunate to have people from all walks of life. We vary in education, race, sexual orientation, gender and socioeconomic backgrounds. But I am sure there are people who are steeped in isolation who are not able to ferret out the information and resources. That, I think is the greater problem, more so than funds. But maybe it always comes down to funds, because you need money to get the word out and do the creative outreach.

What else have I not asked?

I don’t know, it’s pretty complete.

How to get more people talking about this subject?

By being unrelenting in our perseverance. We just have to keep our door open, like a restaurant, have the food there just in case. We have to be here for when the one person who happens to be feeling vulnerable shows up. Here’s something important: Our group is not a closed group. We worked at whether it should be closed or open. But you know, the frequency with which spots opened up was pretty rare, and unless you were feeling suicidal at that exact moment, it makes it pretty hard to meet the needs of people who are in crisis. So we have an open group. There ends up being sort of a core group that acts as a nest, so when someone new joins, there’s already a climate created. People are able to hold the space for someone new. The other thing I guess I want to say is, with my performance piece, part of the point of it is to become a forum for discussion of suicide prevention. My main purpose is to really show the trajectory of what goes on in the group, a trajectory toward optimism and positiveness. That’s not to say people can’t come in with their despair, but there are enough people who hold the space that the trajectory seems to be kind of toward hope. Which, I hate using that word, but the trajectory is toward something better.

Why do you hate the word “hope”?

Oh, just some people I know say, “If I hear the word ‘hope’ one more time, I’m gonna scream!” But really, there’s not another word to substitute for hope. It’s the bird with wings, right?

Right. You’re in Massachusetts. I have to ask, since you’re about to vote on assisted suicide, where does that come in?

It’s very tricky. For most things in life, I have this springboard toward “I know what I think about that.” With assisted suicide, I’m taking in information. My instinct is toward “I would want that to be an option for myself if I was in drastic and chronic pain and unable to move or was dying of cancer and had before me the given of extreme and excruciating pain. I would want that to be an option for me.” For now, I’m exploring, not saying I’m for or against it. I’m thinking about it, and definitely I will have decided by Nov. 6. I know my instinct is toward yes, it’s something people should be allowed to do. And I know there are moments when things seem untraversable. But I’m assuming that physician-assisted suicide has all sorts of time frames, no spontaneous decisions to it. But friends I respect worry it could play out in a really terrible way for people who are disabled, so I’m trying to read up. I’m assuming, maybe I’m wrong, but I’m assuming that it couldn’t be just a spontaneous decision. I assume it would be tremendously well thought out and reasoned. Like I said, I’m uncertain.

Your attempt, was it well thought out and reasoned?

It is interesting you ask because at the time, I really thought it was. But it was, like, over 72 hours. Or a week or whatever. So yes and mostly, no.

Your kids, do they even know about all of this?

Yes. Hmm. Yeah, I think they’re both very proud of the work I do, but … You know, I didn’t suddenly one day, like, lay it on them. I’m pretty open with my kids about my life and my story. When my kids were little, they would ask, “Oh, what’s that picture from?” “Oh, that’s when Mama was in drug rehab, blah blah.” Or “Oh, that picture was when Mama was in the institution, before you were born.” There was no moment when this heavy thing fell. I think I did a good job of normalizing the process of my life and thereby doing my little part to help end the stigma. Lot’s of people have had hard moments in their lives. I know my kids are proud of the work I do. But we don’t really talk about it much. Not for any real reason. Just busy. The Alternatives conference was in Portland, and I hoped my daughter could make my presentation, since she’s at Reed, but she had class. But if she didn’t have class, I’m certain she would have tried to make it. But that’s really not the bulk of who I am.

Thank you for leading into my last question: Who else are you?

It’s a pretty long list, just like anybody’s. I’m a writer, an artist, a poet, a gardener, I am _ what am I? Michael, what am I? _ My husband said, “A writer.” Tristan, our exchange student, says, “Creative.” A dog lover. Yeah. a lot of things. I am a person who feels deeply, for sure. And I like that, but it also can be hard. But I would never trade it for not feeling deeply.

Talking with Shari Sinwelski

Earlier this year, I got the chance to meet Shari Sinwelski, who works for the pioneering group Didi Hirsch Mental Health Services in the Los Angeles area. They’ve started one of the very few support groups for attempt survivors, and now questions are coming in from around the country by people curious, though nervous, about starting their own. Shari runs the group and explains here how it’s been going and what she’s been hearing from people who’d like to see or set up similar efforts.

“Definitely there’s some energy out there,” she says. “I think people definitely need some place to go and are finding nowhere to go.”

Who are you, and how did you get into this line of work?

My name is Shari Sinwelski, and I work as the associate division director of the Suicide
Prevention Center at Didi Hirsch in Los Angeles. We have a crisis hotline, support groups, a suicide response team and a lot of community outreach and education, programs with a couple of emergency departments. One of the things I was specifically charged with when I began was to develop a suicide attempt survivor work group.

I got into the field kind of by accident. I’ve been working in suicide prevention for about 18
years. I started in this field when I began volunteering on a suicide hotline while getting my
undergrad degree in Florida. I kind of did it as lots of undergrads do, to get experience, but I
really liked it. After my degree, I ended up working as the director of the hotline there. I was in Florida for 12 years, then I was director of the suicide hotline in New Orleans after Hurricane Katrina and was there for several years. Then here. I’ve been here since _ let me think _ 2009.

How did this group get started?

The Suicide Prevention Center started the first suicide prevention hotline over 50 years ago and has always been a leader in the field of suicide prevention. There were several reasons we wanted to start this group. Some of the idea came from recommendations coming from the National Suicide Prevention Lifeline. In addition, we would receive calls on the hotline looking for a group for attempt survivors. Many people would report that when they would search for suicide survivor groups, the groups were always for people who lost someone to suicide, but never anything for someone who survived an attempt. We felt that a group like this would be a great way for people to know that they weren’t alone and hopefully a way to get rid of some of the shame and secrecy that often surrounds the topic of suicide. In addition, there was some funding here in California for early intervention., and some opportunities because there was money for prevention. Didi Hirsch was the first suicide hotline in the country, so it’s kind of in the forefront of suicide prevention. We wanted to try this, so we tried.

How does the group work, and what have been some of the concerns?

There aren’t a lot of options to look at for best practices. And so I contacted Lifeline and found out about other groups across the country. Ultimately, the only ones I reached were Stephanie Weber and Heidi Bryan. We also have some attempt survivors who volunteer on our hotline, and I had my own focus group with attempt survivors, getting some ideas on what they thought would be important. Also, we run a support group for people who have lost someone to suicide. In a way, we somewhat mirrored the group in some of the logistics. Not the concept so much, but the structure. We also consulted with Dr. Norman Farberow, one of the founding fathers of our agency and an expert in suicide prevention. He had experimented with a group for suicide attempters many years ago.

What we’ve got going right now, a year and a half so far, is a closed group, so people are only allowed to join at the beginning of the group. That helps with group bonding and helping people to really get to know each other. It’s eight weeks. The individual goes through a telephone intake with me so I can learn a little more about their experience, to make sure that we both feel a group environment is something they’re ready for. They have to wait a little for the next group to start, so I try to assess that they are safe and have resources in the meantime.

How do the sessions go?

It’s interesting. It’s a peer support group but not a therapy group. We meet once a week. Initially it was an hour and a half, but recently it went up to two hours because there were bigger groups and not enough time to get everything done. When we first started, I mapped out a plan of topics to cover each week. Honestly, as the facilitator, I felt pressured to have something to fall back on. But I think what I found as the group progressed was that I really needed to stay in tune with the pulse of the group. A lot of times we didn’t do anything that I had planned. In the first few weeks, we really just take some time for members to get to know each other. On the first night, we’d go over guidelines, things they can get from the group, the chance to introduce themselves
and share stories of their attempts if they were comfortable. Sometimes the first few groups can be really difficult for members, especially if they have never talked with anyone about their attempt. If it was difficult, we encourage them to stick with it and follow up with every new member afterward to make sure they are comfortable.

Every group is different. Some bond quickly, others are more reserved. Sometimes if they need more of a conversation starter, we show an NSPL video that shows stories of others who have survived a suicide attempt and they can relate, talk about stigma and other concerns. But one thing we’re finding is, a lot of times group members really just needed support to talk about what was going on in their lives. Because the topic of suicide can be scary for some people to talk about, once they find a safe place, it can be really freeing. So at the start of each group there’s some time for members to check in and talk about what was challenging about the week. That can also be challenging, because if members don’t have places in life to be open and honest about what’s going on, it could bring the group to a very low place if member after member after member is talking about what’s the
negative things that are going on in their lives. The group also has to be a reassuring place to come to. A place to find hope. And so one of the things we’ve always kind of emphasized is the concept of ambivalence. A lot of times people are dealing with depression, they may be experiencing a lot of pain, and it causes them to have thoughts of suicide. At the same time there is usually something that keeps them hanging on, some reasons for living. I do that on the intake, ask them to tell me about both sides: the concerns, the pain, but also the positive things that keep them going. We incorporate that theme into the check-in. It’s a time to talk about challenges in life, but also about what’s been positive and went well. What we’ve found is, it’s helped a lot, but sometimes members can’t find their own positives, so a lot of times members start to point out positives to each other.

We’ve also incorporated other things for fun. Like at the beginning, I found it pretty cold and sterile, so I always make sure we have refreshments, drinks and food, a more welcoming environment. At times we’ve done other things for fun, For example, last year we were meeting around Thanksgiving and a lot of people said they did not have plans; we made one of our groups a Thanksgiving potluck. I guess what I’m mostly trying to convey is, we try really hard to get feedback on the needs of the group. It’s really crucial if they’re only coming and talking about the negatives and struggles to find ways to incorporate hope as well, otherwise, people might not necessarily want to come because they’re already in a bad place.

How many people are in a group, and how any have been through so far?

Right now, we’re on the eighth group. We have had as few as three, and I think our biggest group was seven. We have right now four people in this group. I think there’s been a total of 24 people. Some people repeat for multiple group cycles. I should say we didn’t want people just popping in and out because we really felt people had to feel comfortable. Also because this is a topic that can be so scary. A lot of members are still thinking about suicide, and when people are just coming in and out of a group, people wonder why they’re not coming. It doesn’t help the consistency. But the eight weeks are kind of arbitrary. It’s not to say at the end, ‘OK, you’re done, everything’s perfect.’ It’s a way to allow people to join or come back again. What I found is some members at the end of eight weeks are still finding the group to be helpful. We have allowed group members to be in additional cycles. So of the 24 different people in the first seven cycles, some repeated.

Are any topics not allowed in the group?

No, we haven’t really come up with any topics so far that would be prohibited. On the other
hand, it is a group, so we are always checking in with the group to make sure that topics are comfortable for everyone. If something was distressing, we might ask members to refrain from those topics.

What’s the most surprising thing you’ve learned or observed there?

I can’t really think of anything that was surprising, per se. But I am always amazed by the
courage of the group members to be so open about the experiences and the desire to help each other even when they might be struggling.

What comes out in the support group that wouldn’t come out in a crisis call or counseling session?

I don’t think there are any topics that come up that wouldn’t come up in a crisis call. However, the opportunity to talk with others who have been through a similar experience is something that is different. Members can feel comfortable being completely open and honest with each other, knowing that they won’t be judged. They can also learn things from people who have walked in their shoes.

You’ve mentioned that people have been contacting you about the group. What are the concerns they bring up?

I think one of the things expressed to me is, is it helpful to people who are struggling so much personally to take on the struggles of other people. In other words, is it a good idea for people who are suicidal to all be in a group together. Not that being part of the group requires it, but it happens. They get to know about each other. They might be worried about someone they met or become friends with and may also be suicidal. It can have two different effects. A positive effect is that sometimes they then realize the seriousness of their own situation: ‘Oh my gosh, I wasn’t really thinking how my decisions and actions affect people around me.’ Other times, it’s frankly too much to handle when they’re dealing with stress, depression in their own life and now they have five, six others in the group to be worried about. It can be too much. A couple of people have left the group because of that. Of course, we worked with them to make sure they had other sources of support.

You mentioned screening. What kind of restrictions do you have, if any, or other concerns?

The most important thing is to try and assess if people have enough immediate support in their lives that they will be able to stay safe until the next group starts. We also want to make sure that people have a good understanding of what they can expect from the group. That they feel comfortable speaking in a group environment. It can be helpful if they have a counselor or therapist as well, but we don’t require it.

How you feel personally, taking on work like this?

I definitely feel more positive than negative. Overall, I feel the group has been helpful. We
survey participants before the group, and at the end, and the feedback has been for the most part overwhelmingly positive. At some times I wonder _ and I’m trying to find words to describe this _ it’s not a treatment group, yet sometimes members need more, and sometimes when they’re at such risk, it’s hard not to give them what they need. However, that can be a difficult position to be in. What I mean is that either they are not connected with a therapist or need more than what we can offer in the group. Maybe they would benefit from medication or individual therapy. Maybe their therapist is not comfortable talking about suicide, and they seek out other people. That can be really challenging.

We have been trying really hard to get feedback from participants about the group. So that we can make sure that it is effective and meeting people’s needs. They provide feedback on their experiences after the group, what they liked, what they would like to see change. We also had a focus group and invited everyone who had completed the group to come and give feedback to our quality assurance department. It was a great opportunity, participants were really grateful.

All of this requires extra time, too?

I would say so, for sure. A lot of times people in the group need an extra support between group sessions. That can take a lot of time. I’m not saying it’s impossible, but I think a strictly peer-run group might be hard. It would take a peer who’s really at a good strong point in life to handle the intensity. When we started, we had an attempt survivor as my co-facilitator. After a while, it became overwhelming. There were a lot of things going on in her life, and she decided she needed to take a break. If it were just a peer-run group, it could happen to a lot of people. I’m not saying it’s can’t be peer-run, but I think it definitely needs to be somebody in a good state of mind that’s able to take care of themselves while taking care of others.

Do you know of other groups out there?

I don’t know of any comprehensive listing of groups in the US, but I know there aren’t very
many. There a few others in California that are just getting started, one in Illinois, I think one
in Arizona and a few Suicide Anonymous groups around the country. There’s been lots of people who have contacted me wanting to start one, asking similar questions. I’ve had five or six of these conversations. And we had one group member who moved out of state, he’s trying to start one. Definitely there’s some energy out there. I think people
definitely need some place to go and are finding nowhere to go.

Talking with Phillip Garber and Janet Berkowitz

I recently had the chance to sit in, long distance, on a meeting of Suicide Anonymous. The support group for people who have attempted or seriously considered suicide has grown little beyond its roots in Tennessee, but an active couple in New Jersey has created another hub and is trying to reach out to people anywhere with meetings via Skype. That’s how I listened in. I found it striking how open Phillip Garber and Janet Berkowitz can be about the work they’re doing, as 12-step groups usually keep a low profile. To them, the word needs to get out there. “Come on, guys. If we had more groups for people who are suicidal, we wouldn’t need all those groups for people who lost someone to suicide,” Janet says.

They now run three weekly meetings and plan to attend the first Suicide Anonymous national conference later this year. They also use creativity and, at times, humor to address suicide issues in the communication and consulting business they run.

I had separate conversations with Phillip and Janet and include both here, starting with Phillip:

Who are you?

My name is Phillip Garber. I’m 47 years old and I live in South Jersey. And I’m originally from New York City, born and raised in Bayside, Queens. And I’m still a Mets fan, so Phillies fans, eat your heart out.

What was your experience? What happened?

Well, I’ve suffered from depression for longer than, well, I’m willing to admit it. I didn’t realize it because I didn’t have the word “depression” in my vernacular. I did not start seeing a therapist until I started dating Janet in 2001.

People advised me to visit a therapist throughout my young adulthood, but I was resistant because my father was very anti- the psychology field. His mother was suicidal, she had schizophrenia, and he just didn’t buy into it, didn’t want to look at it, and for many years didn’t communicate with his mother. He just wanted to make believe mental illness didn’t exist. So I never treated it.

The pertinent history in suicide was, in my dreams I would dream about suicide fairly often. It was my way out. If I didn’t like the way a dream was going, and I started getting fearful, I would commit suicide in the dream, and just before I died in the dream, I would return to the waking state. I knew it would wake me up. Suicide was a way out of my dream world. Then, when things got really emotionally painful, suicide became a way out of my “real world.”

The turning point was when I was 43 and had open-heart surgery. It was really humbling in so many ways. Then there were complications after the surgery. I had to get my lungs drained of excess fluid and then, after finally leaving the hospital, I returned on a number of occasions with congestive heart failure, and I needed a lot of medical attention. At that time, I had several part-time jobs and a full-time job. I was a workaholic and still am. I realized that I was not able to work nearly as much as before the surgery, so I gave up all my part-time jobs. Even still, I found that I could only work 15 hours a week at my full-time job and it was not nearly enough for my boss. He said, “I gotta let you go.” I was left with no income, and collecting unemployment was so farcical because I knew that I was disabled.

Meanwhile, Janet had given up her job because she was in a behavioral health unit, getting ECT, or electroconvulsive therapy. So we had no income. All we had was debt, and the money we did have ran out real quick.

Being a Capricorn _ Capricorns typically focus on career and responsibility _ I took myself very seriously in my role as a financial controller. And when I lost that, I lost a piece of who I am. When my chest got broken in half by surgery _ in open heart surgery, sometimes, like in my case, they have to crack open your sternum to get access to your heart _ I felt my life was broken in half in many ways. I had deep depression. My anxiety went from 2 on a scale of 1 to 10 to about 8 on average. I was getting more phobias by the minute, thinking I was in congestive heart failure many times, when I really was not. It was a real intense time for me. I felt like I was losing my mind. My body was not working anymore. My mind was not working anymore.

That is when I began thinking about suicide. I was just really isolated, even though I was with people. It seemed like I was on this crash course for suicide and that no matter what I tried, I was always ending up with the same answer. And it seemed logical because my thinking was so distorted. I felt like a burden on everybody. My aunt, who has always been a mother to me, came from New York City and just took me back to her house, and I stayed there for two weeks while Janet was still in the hospital. She just mothered me. She was tough on me at times, but it was like she really gave me space to be who I am, and she did her best to keep me out of a behavioral health unit.

When Janet finished her stay at the behavioral health unit where she got the ECT, I went back home to be with her. I just felt so separate from her. Janet said to me, “Phil, your body is stable now. Now it is time to take care of your mind.”

Upon her suggestion, I went into a behavioral health unit, my first in-patient stay. It was just before Thanksgiving 2008. I followed up with five weeks of outpatient therapy. In the meantime, I was still having major anxiety issues. I could not even help Janet with her drama teaching jobs, like I had been doing for years. I could not even sit in a crowded restaurant. I was getting so paranoid. Also, my brain functioning was not the same. I believe it was the extraordinarily strong anesthesia that is used during open-heart surgery. To this day, I don’t think my brain functions the way it did before my heart surgery. I would say that after April of 2009, eight months after my surgery, I might have been at about 75 percent of my normal brain functioning.

About a week after I was released from the outpatient therapy, I had a psychotic episode, starving myself, not taking meds, not drinking, completely dehydrated, not sleeping. So I went to another hospital and I stayed there 11 days. That helped. I was on a mood stabilizer after that.

Even with the mood stabilizer, I began to think of suicide again, and I really wanted out. I voluntarily checked myself into another behavioral health unit in March of 2009. During that in-patient stay, I had told the psychiatrist about the strained relationship between me and my father, mainly because he would not accept my decision to be with Janet. My father never wanted anything to do with her. He saw Janet as a threat. Janet was sick and needed me to take care of her. Meanwhile, my father wanted to make sure that I would be available to take care of him. The psychiatrist promised that if we had a family meeting between me, Janet and my father, it would be fruitful. We ended up having the family meeting with the psychiatrist just before I was discharged, and Janet had to go out of her way and pick up my father from Pennsylvania. And thank God she had friends in the car to buffer her from my father. And sure enough, the loose cannon that my father was, during the meeting he said, “The main problem is her. She’s poison. My son never had a mental problem or illness until he met her.” Janet is very sensitive, and that really stuck. She had been steadily going downhill during my absence. I had been at the behavioral health unit for two and a half weeks, the longest so far. I believe that my father’s remarks about Janet sent her over the edge. So, like 10 days after I was released from that behavioral health unit, Janet went back in another behavioral health unit and had more ECT. I was like, “I’ll take care of everything.” I committed to taking over Janet’s drama teaching jobs completely impulsively.

As soon as I got out of the behavioral health unit, on March 26, 2009, I was just pushing and pushing and pushing like I always tend to do when I get out of the hospital. I finished up a lot of paperwork and got caught up on bills. I wanted to get back to work, to be able to do something to help our financial situation. Inside, I was just a mess. On April 15, 2009, I completed both my taxes and Janet’s taxes, ran up to Princeton to see her and have her sign the tax return, mailed it at the very last minute. It was also the ninth anniversary of our first date. There was no time, and neither of us were in any mood, to celebrate.

The next day, I attempted suicide. In my distorted state of mind, I truly believed that everyone would be better off without me. I blamed myself for everything! The bottom line was, I judged I was going to be a continued burden, and people might miss me, but in the long run they’d be better off without me. These were the types of lies I was telling myself. My whole life had become a mess, a failure. I was facing a second bankruptcy.

The tough part through that whole period is that I stopped feeling God’s presence. I had been a really spiritual person since at least my early twenties. I meditated often and felt God’s presence often, before my heart surgery. Now, I just couldn’t feel God. I believed that I was unworthy of God. Just after I had made my attempt, I laid on my bed and said, “God, please take me!” I was believing that God makes junk _ me _ which is another lie that I was believing.

And I don’t like to tell how I attempted suicide. One of the things we discourage in the Suicide Anonymous rooms is the methods. I will say that basically because of what I did, I was incoherent and stumbling around for nearly two days, until a friend found me. The only thing I remember is tripping and falling and breaking things and cutting myself up. Those are just a few vague memories of that time period. The weird part is, the man who found me said, “Seems like you were perfectly lucid.” He didn’t even think it was an emergency: “OK, you did this and this, but you looked fine.” He wanted to take me to a behavioral health unit. But others were there and said, “Hey, we’ve got to take him to the emergency room. There’s a suicide note.” I had written a suicide note. I said, “Please don’t blame Janet. I was really fucked up long before she came along.”

When I woke up in the hospital, I was filled even more with shame. And I was even more of a burden to everybody. Between the shame, the guilt, I was beyond depression, like I was despondent. And I was in a lot of pain, physically and emotionally.

My cousin Len called me like every day and basically stopped his life for me and came and talked to the psychiatrist, talked to my support people. I have a tremendous support system, but I felt I was not worthy and didn’t call a soul on the night I attempted suicide.  Len would call me every day, and it was a surreal scene. I would talk to him, and he’s part motivational speaker and part guru, he’s very spiritual. He’s Buddhist, and I’m more Hindu than any other religion. We were both born Jewish, that’s the funny part. He told me, “I want you to go and look in the mirror and say, ‘I love myself.'” Mind you, the bathroom door was open because I was under 24-hour watch. I could just imagine what they were thinking, “This guy just attempted suicide and was yelling in the mirror, ‘I love myself,’ what’s that about?” But it helped open me up and helped me to heal. I began to understand more and more how meaningful I was in other people’s lives. It really humbled me, filled me with gratitude.

Maybe five or six days later, I just felt God. It was the first time I got back to feeling God. I felt that God was saying to me, “Phil, you’re here for a reason, and it’s very specific. You’ll know what it is. Just be open to it.”

Months later, I began to start thinking that I really wanted to put the whole issue of suicide behind me. I wanted to move on with my life. Meanwhile, Janet was still struggling with suicidal depression. In May of 2010, a friend suggested to Janet that it might be a good idea to go back to creating her suicide awareness workshop. Then, because Janet finally found a place to talk about suicidal ideation and behavior safely, Suicide Anonymous, Janet decided to start a Suicide Anonymous meeting of her own in southern New Jersey.

Then, for me, it really felt like, “OK, this is it, the bandwagon to jump on. This is where the mission is. This is no coincidence, that two people met each other and fell in love, who have both suffered, although in different ways, from suicidal ideation and behavior.”

And that pain in the end has brought me, like the old Jewish saying _ maybe it’s not Jewish _ “What doesn’t kill you makes you stronger.” Even though I still struggle tremendously, I thank God for it because otherwise I couldn’t be the person I am, couldn’t be of help to people. From my early 20’s on, I have wanted to help people in one way or another.

I believe that what Janet and I have to offer is of great value. People have said just that. We do have a staff psychologist who works with Creative Communication Builders. We even have done workshops for clinicians for continuing education credits. That’s been just a great experience. It’s been a struggle for me because I have less education. And I have been seeing myself as “less than” the clinicians because of my lack of education.

But I’ve been getting amazing insights lately. I see an amazing therapist and I work really hard at everything. I’m just grateful for the help I get. I’m not the same person I was, even yesterday. I keep improving and moving forward.

When you made your attempt, did you think this was going to do it?

Oh yeah. I had done some things that in my mind made it a certainty. Part of it was from a distorted sense of reality. And part of it was, on that day it was more impulsive. I had not really thought it out: “How many of this do I have to take?” It wasn’t researched. I think sometimes there are people who are just really serious about it and think it out and have a sound plan, and I didn’t. Within a two-hour period, I just went from a fairly stable moment to a complete and utter determination to attempt suicide, to complete it. And so it was like in that moment, a moment of clarity. Looking back, yeah, I’m sure now I have the knowledge that my method for attempting suicide was not sufficient enough to complete the task. But the point is, yes, in that moment I thought that was it. And some people say they get kind of a rush or relief when they attempt suicide or before they attempt suicide. I did get that sense of relief: “Oh, I’m now unburdened. I don’t have to deal with this anymore.”

That seems like a heck of a risk to be taking.

Yeah, it really distorts your thinking. It was a psychotic moment. It was just not normal thinking. And after that, I never got to that point. I got to points where I was seriously thinking about it and wanting to die, but not any kind of serious plan. And my bottom line in SA is, whenever I have any kind of serious thought, like, “I really feel like dying” _ the mind plays tricks, and I don’t call someone every time it pops in my head _ that’s when I call someone. And I’ve stuck to it. And I’ve celebrated a year’s sobriety. We started SA in August 2010. It was not until May 2011 that I finally planned that bottom line and stuck to it.

You said you had a tremendous support system, but you didn’t call them. How can you be sure you’ll call them in the future?

That’s just it. I force myself now. Here is an example: I was watching our dog, Dodger, today because he had major surgery two days ago, so I’m really nervous about him. Today I accidentally brushed against him with my leg, and I was like, “Argh!” I screamed. I realize that I have a serious problem with anxiety. I said to myself, “Wait, I’m gonna call somebody.” I called someone from my men’s group. Then, the woman he is dating _ I’d introduced her to him _ calls me and tells me that she just wanted to check up on me and see how Dodger was doing. I unburdened myself to her. She’s very spiritual, and she decided to lead me through a visualization exercise, and it really helped calm me down. That’s when my heart says, “See? God is here.” And so I’m determined to reach out because I didn’t reach out on that night. And I see the possibilities and beauty left in my life. I see beyond the hopelessness. I get into that hopeless place sometimes, and I can move through it a lot more quickly now.

The impulsivity part of suicide must drive therapists wild. Do you have any suggestions on how they should approach it?

One of the things I have realized over the years is that my greatest strength is in owning my weaknesses and asking for help. People get so lonely and cut off. It’s just a matter of finding someone who cares. And there’s somebody out there that I’m a gift to. And there are others who are a gift to me. And sometimes I gain more from the times that I am speaking with someone in an effort to support them, than when I call someone to support me. So giving and receiving become one and the same for me. With this in mind, I think that the most important thing a therapist can do for a client is encourage them to be a part of support groups. Also, one of the things I have realized about my life, which applies here for therapists, is that I cannot fix anyone. They have to do the work. I can only assist as much as they let me. Also, I am not responsible for another’s behavior. I could love and support a person and do every possible thing I can think of to keep them safe. In the end, if they complete a suicide it is their choice. I am not speaking of the morality of that choice. This reminds me that I am not God. Because, for me, attempting suicide was me believing that I was God. I realize in my life that God is in charge, not me.

Also, another thing I have discovered is that ultimately, my vocation is irrelevant. I am here to love people _ starting with me; sometimes the most difficult thing for me to do _ and allow myself to be loved by others _ also difficult for me, sometimes.

How did people respond when you started talking about this?

I look at it this way. I got to a point where I was willing to be vulnerable, bare my soul, because I felt and I saw that in baring my soul, somebody’s gonna get something out of it. So it became worthwhile. And at this point, my personal anonymity is not important. I go by SA traditions as much as I can, but if I see a higher purpose, I say, “You know what? I need to go with this higher purpose.” I’m not proud of everything I’ve done, but I’m proud of who I really am _ a child of God. And so, we do things that sometimes push the envelope. We had an article in The Philadelphia Inquirer about SA: “Hey, you might not know this, but there is SA.” You see, tradition No. 5 states that each group has but one primary purpose: to carry its message to those who still suffer from suicidal ideation and behavior. But then tradition No. 11 states that our public relations policy is based on attraction rather than promotion. We need always maintain personal anonymity at the level of press, radio, TV, film and other public media. We need guard with special care the anonymity of all fellow SA members. So by having these newspaper articles, it may be dangerous to someone’s personal anonymity. We did our best to make sure that we were following No. 11 as best as possible. We keep our focus on No. 5 because there are so many people out there with suicidal ideation and behavior that never heard of SA. And because we can now Skype them into meetings, they can be a part of our meetings from the other side of the world.

How did the reporters respond when you contacted them?

They were basically intrigued. Like, “Really, a suicide support group? OK.” Then they start thinking, “It’s dangerous.” But recent studies show that talking about it helps more than it hurts. Then the 12-step part: “Addiction, how? You do it and you’re gone.” But it’s like a default mechanism in my brain. It starts for me when life and relationships get very difficult or if I am suffering with severe emotional pain. Then the thoughts of hopelessness come. Then the thoughts of suicide come. The thoughts of suicide become similar to an alcoholic getting a drink. A psychiatrist has done a study that the addictive pattern of suicidal behavior is the same as the addictive pattern of every other addiction. I can send it if you want.

What kind of responses did you get?

It’s interesting. We seemed to get more from the story in the Burlington County Times! Maybe it wasn’t clear in the Inquirer that we have Skype availability. We’re still working on getting it in The New York Times, working on getting it out in the public and having people in mental health facilities use us as a reference. You know, to tell people, “It’s a good idea to go.” A lot of people are really shy about it because it’s all about liability. Because when you come to an SA meeting, no one’s going to report it. We do other things. It’s one of the things where it makes it more difficult on Skype, but if I’m in a room with somebody, I’m getting used to telling whether someone is a danger to themself or others. If I judge they are, I don’t leave them alone. If they want us to take them to the hospital, we can. I leave it to them. I just do my absolute best not to leave them alone. I also make sure to keep their confidentiality.

Have you had to do that?

We do what we have to do not to leave them alone. You can leave it at that. A lot of professionals have that fear, what if someone goes to an SA meeting, then attempts or completes suicide after that? The professional has that fear they can be held liable, lose their career. A lot won’t recommend SA.

About how many people have come through the group so far?

Anywhere from 50 to 75. We’ve had people come and go. Sometimes they stay for a long time. Janet would say 100 at least. We’ve been one year with one meeting, two years with the other. A lot of people have trouble talking about it, owning it as an addiction, and would sooner go to other 12-step groups. But a lot of other 12-step groups say, “Oh, we can’t talk about suicide.” For these reasons, SA has not caught on as fast as some other 12 step groups. I think it’s gonna take time.

You mentioned the first SA conference later this year?

Yes, there’s gonna be a conference in Memphis, where SA started. We haven’t really firmed up plans about it, but it will be when we go down in October. I’m looking forward to that, to see how that works. And our organization, CCB, is doing something on World Suicide Prevention Day this year. It’s on Sept. 10. We’re gonna have the four-hour version of our suicide awareness workshop. We do a very different workshop, filled with creative arts. Janet does mime pieces. And it’s a lot of interactive exercises. There’s not much of a didactic element. I don’t believe in PowerPoint presentations. We’re more of a hands-on, artsy, creative approach. We even have a game with a point about suicide, and we have fun with it. Fun and laughter have been medicinal for both of us. I’ve always said laughter is the best medicine.

How does the game work?

It’s called “Sequential Ball Throw”. We have a circle of people. Each person gets a number. I could be number one, let’s say, you’d be number two, but you wouldn’t be next to me. So what happens is, each person throws to the next number, one to two to three, and you have to remember who is before and after you. And what happens is, we have, like, if we have two circles, Janet is in one and I’m in the other, and at different times each of us says, “I gotta go to the bathroom, cover for me.” The rule is that you have to throw it the person with the next number. Covering for someone would be breaking the rules. So what happens when someone leaves the circle? The analogy is, what happens when someone commits suicide? You just go on? No, we have to stop, to heal, to look at this, make sure it doesn’t happen again. They say every person who completes suicide potentially affects the lives of hundreds. If a student completes a suicide, it affects every student in the school and their friends, neighbors, etc. Such a wide range of effects.

Do people like the game?

Yeah. And the idea is, we have them guess how it pertains to suicide. Sometimes they get it right, sometimes they get really creative.

(I ask about the stigma around suicide and what to do about it.)

One reaction that pissed both of us off is, someone who was active as a peer specialist _ I didn’t witness it, but a close friend said _ that when they heard about SA they said, “Ooh, that gives me the creeps.” And you know, it’s like, “You’re in this business of being a peer specialist and helping people who are potentially suicidal or have been, and you don’t want to discuss it?” To me, SA is a monumental discovery, like we discovered another planet out there, you know? For Janet, it was an oasis in the desert, when she needed it the most. For me, it has continued to keep me on track and allow me to have a quick course correction when I get a little off track. As much as I love the men in my men’s group, a lot of them just don’t get it. So maybe that is one of the reasons why I did not reach out to the men in my men’s group for support on the night I attempted suicide. If they knew, maybe they would shun me. In SA, I’m with people who get it.

Does the men’s group know now?

I’m tremendously honest with them about everything. I’ve opened up about all of it since. It’s not like I’m proud of it, “Hey, I attempted suicide, look at me!” It’s that I put myself out there because I wanted help. And I’m not backing down from telling anybody. And I must say, a couple of my bookkeeping clients I’ve not told person-to-person. They know I have issues. I’m trying to draw an analogy here. It’s the same way I don’t discuss my spiritual beliefs with them either, you now? I’m there to do the job, and I do the job. Meanwhile, they could have read about me in the Inquirer, which talked about me and what I did. The reporter put the method in there. I guess it doesn’t matter to me anymore. So even though I haven’t told some people face to face, I’ve put myself out there. If they found out, it’s OK

What have I not asked you that you’d like to mention?

You asked about impulsivity. I’ll send you something else, too. I think it summarizes it well. We took this training, applied suicide intervention skills training (ASIST). It’s one of the foremost suicide prevention trainings in the world. We were very lucky. It was offered by the most wonderful people in the world, the New Jersey Self-Help Clearinghouse. They’re so amazing. I pray Gov. Christie doesn’t cut them out, they provide such amazing service. You can just call them up. They have information on every self-help group in NJ. They provide trainings. They support people in starting meetings. I don’t know if we could have started two SA meetings without the help of the Clearinghouse. So the ASIST training, it talks about somebody who absolutely is in crisis, has a plan of suicide. It offers a very specific model and the steps to go through. You listen to that person tell you everything, why they want to end their life, then you say, “Wait a minute. Is it fair to say there’s some things in life you do like? Some reasons you do want to live?” To establish an ambivalence, which is to say, that part of them wants to live, part wants to die. If they didn’t want to live, they would have ended their life already or attempted to do so. That’s the cold hard fact. So you establish what draws them to life, what is their hope. You get them back in touch with that hope, the possibilities in their future, the joys of their past that could happen again. You start to focus on that, and it short-circuits the tendency impulsivity. When I am impulsive, all I can see is what is happening inside me right now. But what about the future?

I don’t want to get into guilt: “You have a child, you need to stay here.” I don’t like to motivate with guilt. Meanwhile, Janet will tell you her story, and the dog who just went through with surgery. Janet is clear that that dog kept her alive. They had a bond where she felt like she didn’t want to leave him standing in the window waiting for her. I have enough support, I could deal with it, but that poor dog wouldn’t know what to do. At the end of the day, whatever keeps a person alive, I will use. Sometimes I get Machiavellian. Sometimes there are no rules. The rules are what God tells me to do in this moment.

Who else are you?

I love baseball. I love sports. My father and I could argue about a million different things, but we could talk about sports forever

I’m a lot about deep connection. A lot of the most beautiful work to me is connecting with people. The other thing is, I’m impulsive and I can be very impulsively silly and ridiculous and goofy. I love to make people laugh, I love funny movies, I love watching Bugs Bunny. I love feeding my inner child. I found a therapist who is not only cool with that but encouraged it. I am willing to be ridiculous, and that’s a part I’m really willing to share. It seems to me that people are too serious in the world. People need to loosen up and lighten up, enjoy the moment. There’s so much comedy to be grasped, if you look at life like it is a movie. As Bugs Bunny said, “Don’t take life too seriously. You’ll never get out of it alive.” And I try my best to remember that always

And my deep spirituality, and belief in God, that’s a very big part of who I am. I follow the teachings of a man who is not with us anymore, but he brought a lot of India’s teachings to America. I’ll send you his name. It’s a tough one. Janet and I met at this interfaith church. And it celebrates everything. I call it a New Age hippie church. It is called Pebble Hill Interfaith Church in Doylestown, Pennsylvania, and it was recommended to me by a friend back in the late 80’s. I went there once, it was too weird, everybody was overly happy. Then, when I was at this spirituality group, about three years later, they told me about Pebble Hill again, and I stayed for a number of years. Janet and I had a ceremony there. And so Pebble Hill’s very near and dear to my heart

There are so many times when I feel God’s presence and miracles all around me. It is humbling and brings me great gratitude.


Who are you?

Janet Berkowitz: Well, I am … I don’t know how to answer that question. My life is about creativity. My whole core, everything I do, is about finding a creative solution to a problem. And some of the ways I manifest that is through mime. I’m a mime and an actress. I’m a dancer, a very unique dancer.  I’m an artist; mostly I do collage. I’ve taught drama since the 1980s to all kinds of children, some being emotionally disturbed or cognitively challenged. I’ve also done it in prisons, where I love to perform. What else? I’m an animal lover. My pets are like my children. I’m just basically an artist, very blessed in the arts. And everything I do is a devotion to my Higher Power, which I call God.

What has been your experience with suicide?

The first time that suicide actively came into my life, I was 8 years old, and I was bitterly teased every day. I hated going to school and made up all kinds of excuses not to go. Then I planned at 8 years old to jump off a bridge near my house. And I found out a few years ago that the water was only two feet deep. So my body would have been a mess had I jumped. I don’t know how I came out of it, but I did. It started again after I graduated high school in 1976. I traveled cross country with friends and I remember being extremely scared, always covering it up so no one knew. I remember having a vague sense of wanting to die.

And it came back again in 1979. I was in college, where I was studying psychology. I wanted to be the greatest psychologist that ever lived _ grandiose thinking like that is common with bipolar disorder, I soon found out. I finally dropped out of college. Actually, my therapist suggested that I drop out, which was very devastating for my family. I was raised Jewish, and there was a lot of pressure for Jewish children to become doctors, lawyers, all that. I was doing drugs, mostly marijuana. I loved marijuana. And I was doing LSD, not a lot, about 10 times. This became what I call my “manic summer of ‘79.” I’d go to New York City and dance in the streets wherever I heard music. People would come around and watch me and I felt like I was bringing them God.

The last time I did LSD, it was very bad. That was the beginning of the suicidal stuff again. And when I become suicidal, it’s not over a specific event. The word “suicide” begins repeating in my head, like a ticker tape with the word “suicide” written over and over again. It feels like no oxygen going to my brain. I call it the vacuum state. I’d go to the library and pore over books about suicide. I started to write a suicide note, and there were pieces of paper hidden all over the house. I hid them in the couch and everywhere, notes about why I wanted to die. I never really wanted to die, I just wanted to stop the word in my head. In early 1980, I drove up to a mountain to jump. I wanted to die in nature, because I loved it so much. It wasn’t a straight drop, so I didn’t jump. I recall feeling immediate relief and then the frustration of not knowing what to do next. I came home and my therapist said, “If you don’t tell your parents, I’m not going to see you anymore.” I told my parents, and it was one of the scariest things I’ve done. They were loving and as supportive as they knew to be. I remember my father telling me he had once been suicidal. It was one of the closest moments I ever shared with him.

The therapist convinced me to go into a mental hospital. It was difficult. My mother was all about looking good to other people. But I needed to talk about it. Besides, I tend to be an open book. They told me I was bipolar, which fit. They gave me lithium, and within days I was feeling better. I don’t know if it was the placebo effect or what. I got out of the hospital two months later, and for the rest of the year the word “suicide” continued on and off. Finally I had a dream where my grandmother rose out of her coffin and said to me, “You are not to kill yourself, you have much more living to do.” It was such a lucid dream that I came out of my suicidal depression. It worked. So it was great. I was better for a while.

Throughout the ’80s I started doing self-help trainings like Lifespring and EST training, now called The Forum. I threw my medicine in the toilet because the trainings would say things like, “You don’t need medicine or psychiatry, just the training.” Then I’d get manic and in trouble again. Finally in 1987 I went to India with friends, and I had an evening where I had an insight, a very deep insight. I realized I needed to stop smoking pot. I went home and I kept smoking pot, until one night I just got it, that I couldn’t fit any more pot in my brain. I decided to go to rehab. And I’ve been clean and sober ever since, 25 years now. It was hard at first. I didn’t mind giving up pot, but I didn’t want to stop drinking. They told me you gotta stop them both for it to work. I finally got it. Also, I tried living in long-term treatment care. I didn’t want to burden my parents. Everywhere I went was terrible. I came home against medical advice, became suicidal again and ended up in the hospital.

I always put myself in the hospital. I’ve never been committed. While in the hospital in 1987, I would wake up naturally every night at exactly 3:20 a.m., and they wouldn’t let me leave my room or turn on lights. I did the only thing I could think of. I would get on my knees and pray that this would go away so I could help other people who were suicidal. When I got out of the hospital, I was going to meetings, AA, many kinds of 12-step groups. I’ve really been working hard on myself.

And in 1990 I had to address another problem. I was a self-injurer, but not like a cutter or burner. I went to Chicago to a program for self-injury, a special one I’d seen on TV. We were not allowed to talk about what we did, just about our feelings. While there, I saw myself rapid cycling, emotionally. In the past, the periods of mania and depression would each last for quite a while. This was new to me. At that point, I was off my lithium. I was now begging to take it again, and it worked.

Through the ’90s, I got really busy teaching drama. I had a very nice and prestigious job as an assistant drama teacher, eventually teaching my own class. Phil, my partner _ I call him my husband _ soon started teaching drama with me. We work well together. It was a tremendous amount of work, too much after a while. We stopped doing it this past year. But in the back of my mind was always stirring the wish to help people who are suicidal.

I got out of the hospital and stayed out for 18 years. I thought this was it. Then in 2007, it came out of nowhere. My mother died in 2005, and that may have had an effect. I started thinking about suicide again, and it freaked me out, so scary; it got faster and faster. I had to leave work to deal with it. And during that time, Phil started getting really depressed. There was a year in there, like 2009, we were both in and out of hospitals. He’d be a mess, and I’d be strong, I’d be a mess, and he’d be strong. It was unbelievable. That year, I was in the hospital three times, and they were giving me shock treatments, about 40 of them. I had already taken about 75 percent of the meds on the market. I could not talk about the fact that I was suicidal in groups, because I feared being sent to a state hospital. This is a big problem I hear from other consumers.

The third time I was hospitalized, I one day decided to trust my psychiatrist and said to her that when I’m depressed, I don’t want to hear anyone’s good news, just bad. She said at that point she no longer knew what to do with me and would have to put me in long-term treatment care. The only place that could take me with my insurance was a state hospital. I said no. She said I had two other choices: more shock treatments or go back on Seroquel. Apparently it was a medicine that had helped me in the past. I said fine, I’ll take it. And over the next few days, I convinced her each day I was getting better. I wasn’t. I was planning to kill myself when I got home. And they believed me, hook line and sinker. That’s how good an actress I am. That’s dangerous, when you can convince everyone you’re safe and are not. They let me go. The third day I was home, I had plans to kill myself because Phil would be away at work. I woke up that day with this thought in my head: “Suicide denied.” I said, “All right, I won’t kill myself today.” The next day I woke up and planned to kill myself, and I heard it again, “Suicide denied.” Day after day, this kept me from attempting suicide.

In the midst of these hospitalizations, I’d been in several day programs always thinking, “I don’t belong here.” It really humbled me, being with people with mental illness. One of the things it taught me was not to believe all those clichés that therapists repeat, like, “You have to love yourself to love others.” Because I hated myself, I used to force myself to walk around the hospital smiling at people. In being nice to other people, I learned to like myself.

There was a counselor in the day program who said, “You’ve got to get underneath this suicide stuff.” I said, “Just forget it. I’m an Aquarian, destined for greatness or madness.” I read that in the play “Hair.” I didn’t feel sad or upset about things. I was emotionally dead. I just felt my brain was going crazy. A lot of people in Suicide Anonymous say that. Then the therapist helped me to get in touch with my anger at my mother, and all my emotions started coming to the surface.

I started to hear guidance to do something about it all. I looked for a suicide support group for myself. I looked all over the country, but I couldn’t find anything for people who were suicidal. I could only find groups for people who lost someone to suicide. I couldn’t believe it. Come on, guys. If we had more groups for people who are suicidal, we wouldn’t need all those groups for people who lost someone to suicide. I couldn’t make sense of it.

At that point, I had found out about Suicide Anonymous in Tennessee. God bless America that I did. I was ready to move to Tennessee, I was so desperate for it. But I was too messed up to move. So I started my own group. I had to, to save my life, just for me. We had four people at the start. Then we started calling churches and libraries, handing out fliers. It’s been growing slowly. Even in Tennessee, it’s growing slowly. I think because it’s such a tough topic for people. Some people come and say, “Oh my God, this is the best thing since sliced bread,” but then they never come back. There have been a lot of miracles around it.

I finally started to feel well, but in 2011, I was diagnosed with borderline personality disorder. It was really hard for me to look at that, and I became suicidal again. The SA meetings helped me pull through that. And a few months ago, I started hearing the word “suicide” again, and I knew I wasn’t getting enough support. I started calling people more. I pulled out of it. I see how much this works. Now we have two meetings, one in Burlington County and one in Camden County. Anyone anywhere in the world can Skype or call into these meetings. We also started a meeting strictly on Skype. And I’m now the Outreach coordinator for the Suicide Anonymous World Service Organization.

I also went back to an old idea I’d had to design a workshop on suicide awareness and prevention using the arts and fun interactive activities. We now call it “Creative Crisis Care: Suicide Denied.”  I have a vocational counselor who loves me and whom I love like a mother. She said, “I believe in what you’re doing. Come to our self-help center and do your workshop.” We now do it for consumers and clinicians all over New Jersey and Pennsylvania. This keeps me sane, too.

What are your impressions of the people who come to meetings and stay?

I love them. They’re beautiful people, very committed and deep. I’ve seen people come who are desperate, and within three meetings they’re feeling such hope again. And the ones who come regularly are doing so much better. They all say the same thing; they can’t talk about suicide in the hospital, can’t tell the therapist because they’re scared of being put away. In these meetings we can’t report anyone, because it’s anonymous. But if someone is seriously suicidal, we don’t leave them alone. Phil and I are trained to assist people who are in trouble and know how to get them to a safety.

And I attribute a lot to Phil and I, we’re very honest in the way we share. I also think it’s because we’re talking about suicide. It’s as deep as you can get, one of the greatest fears there is, if not the greatest. My sense is, the thought of killing yourself is more fearful than the thought of killing someone else. It’s an act of murder, murder of the self, We get a lot of people who say they want to kill themselves because they’re so sad. I think if you look you will see a lot of anger there. I know when I stopped feeling suicidal, tremendous rage came up. I’m just now beginning to forgive in a natural way.

You say people can talk openly in SA meetings, but are there any guidelines, places you just can’t go?

No, I don’t think so. One of the guidelines is, don’t talk about events. In other words, how you tried to kill yourself, just about the experience. We don’t usually stop people if they discuss how they did it unless it’s very gory or weird and we think people are getting triggered. We say just stick to the experience. Sometimes we get people who talk a lot, a long time. A lot of 12-step meetings time you. But we like to let people get it off their chest. If they’re really going too long, we stop them gently.

What can you do to grow the groups and create more groups elsewhere?

Well, word of mouth is the way 12-steps work. You’re not supposed to promote. I had an article in the Philly Inquirer and one in the local paper. I don’t care if we’re breaking 12-step tradition. We want to get the word out. We hang fliers up, talk to people at hospitals about it. We present at conferences. We’re just doing everything we know how. We just maintain anonymity when we do this.

What are some of the questions people ask when they hear about it?

We get people who are not actively suicidal. They just don’t want to wake up. They’re not planning to kill themselves, but they want to die naturally by disease, heart attacks, etc. They think they don’t belong at meetings. We say yes, that’s a form of suicide. At meetings, they say their name and “I wish for death” instead of “I’m a suicide addict.” Another issue that comes up for everybody with a 12-step group is, “I don’t believe in God, can I come?” Absolutely. We don’t talk about God as much as a higher power. Your higher power could be a dog, anything or anyone. My higher power was my dog when I was too far gone to even imagine God.

The group talks in terms of addiction. Do you think everyone who thinks about suicide is addicted?

No. I don’t think everyone who thinks about suicide is an addict. That’s another big question that comes up. It’s up to you to decide whether you’re an addict or not. Many people have fleeting thoughts of suicide. But if the thoughts are making life unmanageable, then I’d say that’s addiction. We have people attend who never attempted it, like me, yet know they are addicted.

The man who started this is a psychiatrist. He attempted it seven times. Then he got it. He was an addict. He did a study about suicide addiction and found it follows all the same steps as any other addiction: fantasizing, rituals like saving pills, collecting ropes, withdrawal when an attempt fails, etc. We’re not finding a lot of people in the mental health field who get it as an addiction. But they will. It will come. I’m convinced that SA will be the next big thing, because suicide is the next big problem.

What do you mean, the next big problem?

People are killing themselves right and left. The numbers are going up for people who are middle-aged because of the economy being difficult, and the numbers are going up for teenagers. They can’t make sense of things on this planet. The numbers are increasing terribly. Phil and I are tracking the statistics.

Ken Tullis, the founder of SA, what does he think about what you’re doing?

He’s very grateful. He’s hard to get. We’ve talked to him a couple of times. He’s quite busy now, travels the world talking about this, which I’m thrilled about. I just wish he were a little more available. But it is what it is.

You hear a lot of personal stories in the groups. How are you holding up? How do you protect yourself?

Oh, I love it. I was born for this. My theory is that Spirit wanted me so much to do this that I had to go through it one more time in 2007 to get it. I wake up and come to life when people start talking about this stuff, because I crave truthfulness and this is about as truthful as one can get. I’m a helper, I like to help people. Also, it’s what I was sent to this planet to do. I’m very excited to be involved in this. But I am learning to set boundaries to take care of myself. If someone is relying too much on me for help I either have to end the relationship and/or send them in the direction of more help.

Suicide still has such a stigma. How to break it down?

I talk about it like people talk about making dinner. I make it easy and comfortable. People do our workshops and say it’s the funnest thing they’ve done in a long time, mostly because it’s using the arts. Anything can be made creative and fun, I don’t care how bad it is. A lot of love, a lot of compassion and constant willingness to look at myself is the key. It helps to remember that whatever I see going on outside of me is because it’s going on inside of me.

The portrayals of suicide in the arts and media, do you feel they’re accurate?

I haven’t seen a whole lot out there about suicide, so I don’t know. I think “Girl, Interrupted” was a great movie about this stuff. But I haven’t been able to watch a lot about it because it’s too painful and scary. It triggers me.

What have I not asked that you’d like to add?

It’s just that I never dreamed I’d be sitting here talking about this, no way. Three years ago I was too ashamed to even utter the word “suicide.” I urge people not to give up. It takes a lot of work. You just need a little bit of willingness to start. It’s easier to do the work than to hold it in in the long run. And talking about it really helps.

I often ask the question, “Who else are you?” but you’ve answered that well already. Is there another side of you to mention?

I’m kind of like a fairy-princess type, very down to earth, and also playful and childlike. When I’m around kids, I get right there in the sandbox with them. That’s what keeps me happy. I’m willing to be silly. People have to give up this intense desire to look good.

Talking with Cathy Read-Wilson

How many people working on crisis lines have had their own experience with suicide? Cathy Read-Wilson’s suicide attempt came after she had started volunteering with one. She found that the organization didn’t panic, later hired her and has worked with her ever since.

Cathy explains the system, including how it keeps her supervisor informed when she has a crisis while keeping the record of the crisis relatively anonymous. She’s also free to mention her experience to callers. “I have had callers happy they had a person on the other end of the line who knew what they were talking about,” she says. “And they know I’m not calling 911 on them, because I know that sucks. But I tell them that if I need to, I will.”

She decided to speak out about her experience because she found it hard to find resources for attempt survivors, and she came across Yvonne Bergmans‘ group in Toronto.

Who are you?

I’m a mother of three kids, ages 22, 19 and 15. I live in a small town, fairly small, Elmira, Ontario. I grew up here. I went off to university in Hamilton, ended up coming back, getting married, raising a family. I’ve done all sorts of work in the meantime, working in a newspaper setting, washing windows, doing anything I could, until recently, I decided to move to a profession that I’m doing now, counseling.

What kind of counseling?

What I’ve been doing part time is working on a crisis phone line. A lot of work is either distress or crisis intervention. It could mean just listening to people as they needto vent, or helping keep them from grabbing a drink when they’ve been clean for a while. I’m moving into more front-line work. I’m working on the AIDS committee for Cambridge-Kitchener-Waterloo area. I’m working on the education end of things, reducing stigma.

In your work for crisis lines, did you disclose your own experience?

It makes it very easy for me to work with individuals. In some ways, it’s more easy to work with a suicidal person than a co-worker. I would disclose depending onthe situation. It’s supposed to be about the caller, but I found that sharing a bit about my experience has benefited. I have had callers happy they had a person on the other end of the line who knew what they were talking about. And they know I’m not calling 911 on them, because I know that sucks. But I tell them that if I need to, I will.

But did you tell the crisis line organizers when you joined them?

Actually, my attempt was while working with them. My first two attempts, I call them pseudo-attempts, were 10, 15 years ago. I started volunteering three, three and half years ago. I literally had quit my job as a part-time custodian, getting more into social services. What I could share then was my struggle at times with depression, how I ended up being on sick leave because of mental health, how I could relate to bereavement, PTSD, the kind of stuff relevant then. Literally two years ago, I actually had my major attempt. And so it was ultimately only since then that I disclose my attempt. I mean, I use my own services now.

You didn’t know about them before?

When I went through other struggles, I had no idea that a phone line existed. Now, actually within the last six months, I’ve phoned coworkers late at night. There’s a very political way of the organization in working with it, no backlash. I’m very fortunate. They have full respect for the fact that I am using it, really.

How does it work?

If I phone in, coworkers will make note of the call but make it at an anonymous level. And that way, volunteers can’t necessarily see it. If I choose, they could put my name in. My coworkers actually have a copy of my crisis plan right by their desk. I can access the schedule, so I know who I’m going to be talking to. It’s kept anonymous when it’s put in the computer. My supervisor is notified, though. So she is aware. If there’s any contact with the mobile crisis team, it’s kept relatively anonymous. The paper trail gets folded up, put in an envelope and given to the supervisor’s superior. So there’s a record, but nothing no one else needs to know about.

How does it feel coming in to work afterward?

I could show up the next morning at work, yeah. I’ve only used it a few times. At first, it was somewhat awkward. My first person on my crisis plan is my supervisor. So she knew prior. It just happened that the mobile crisis person that morning was also the union rep. He was actually the one, he saw us talking, came in, explained to me the confidentiality stuff. I had no idea. The call had to be made, I didn’t know how it would be processed. But knowing now, I’m OK with that. I’ve got a great support system. And I’m not the only one who used the services. We provide a service for others in need, and we should be able to offer it to our own employees.

Is this a private organization, or a governmental one?

It’s the Canadian Mental Health Association. Out of the Grand River branch. Which may not be standard throughout Canada.

(I ask about the difference in stigma around suicide in Canada and the U.S.)

There is stigma. I had been looking for work, with resumes out there like crazy. I know it’s a tough market. But I’m so open, I’ve been in newspapers, on TV, that a part of me wonders _ it also shows up on my police check _ to what extent I was not getting a job because of my openness about my suicide attempt. I don’t know. I speculate it might be some there. For the most part, I get a positive response. I don’t know what they’re saying behind my back. I guess I don’t really care.

How did it come about, your openness?

My attempt was July 7, 2010. I was in the middle of my master’s course. I went in on a Wednesday to the hospital, and I was able to get myself into crisis respite on Monday. I did stuff I wouldn’t recommend to clients to get through the system. Once I got there, I started Googling “suicide survivors.” Everything that started coming up was those bereaved by suicide, and I got rather ticked off at that. No, I’m a survivor, too. I’m not going to keep quiet about it. I was very open with my kids, my family. There was only so much I could hide already. With my kids, I had a counseling session, and the counselor asked, “How do you want me to do this?” I said to right out suicide, call it exactly the way it is. It does no one good to sweeten it up, to make false comments. As far as coming out to the public, it was a year later. I was open with close friends, within my work environment. I didn’t not talk about it. I’m actually a shit instigator: “What did you do this weekend?” “I attempted suicide.” The deer in the headlights response. The humor gets us through. But I was determined something needed to be done. On suicide awareness day, I had my own event in Elmira. Basically there was a newspaper article for all of Elmira to read about my attempt, like coming out of the closet, so to speak. The interesting thing is, my parents live in town and people would go to them before talking with me, comment how brave I was, blah blah blah. Now more people come up to me still. They actually bring it up in conversation. I always thank them.

They never go over the line? Is there no line?

I’m open to anything. I always have the right to not answer. I’ve been asked “Why,” “How could you possibly feel that low,” “What about your children,” if I ever got angry at God, so a more religious component. No, I’ll answer whatever. The most hurtful comment came from someone I knew fairly well, it had to do with it referred to as a selfish thing to do. That one hurt. But for the most part, no. And if I’m in the right frame of mind, if someone asks if I’m doing it for the attention, really, none of us do it for attention, right? You have to be in a pretty deep hole. If I’m not in the right frame of mind, I take it personally.

If you’re in the right frame of mind, what would you say?

I would say it’s more a cry for help than a cry for attention. The words are not there. You don’t have the words to speak for yourself. I’ve been trained, I know intervention, but if I’m in crisis tomorrow, will I know how to pull that stuff out of a hat? Not necessarily.

About the comment on being selfish, did you have any response?

I never did. It was someone I had greatly respected growing up. I just put it in the back of my mind. Sometimes you say things in the moment you don’t necessarily mean. And you know, if I were to see him now, I probably would say something to that effect. but at the time, I didn’t know what to say.

Is there any downside to being open?

Yeah. It’s the triggers. And I have to really be careful I’m not overdoing it in my suicide prevention promotion stuff. I suffer from emotional hangovers, so I can be go, go, go, go for a while but then pay for it after the fact. I slide pretty quickly. But do I ever regret my reason for sliding? No. And if I slide so far I have another attempt, would I regret it? No. Because I still would have accomplished stuff prior to it.

Is there any risk in you talking with me? You know there is the common concern about attempt survivors talking with each other about it.

That’s such a myth. The best group I ever sat in on was Yvonne Bergmans‘, sitting in as a peer. and being able to sit in on a room of fascinating, creative, intelligent individuals and hear their struggle, like yours. No, I still keep in contact. Our conversation is generally, “How can we continue to talk more about it so it becomes less of a concern and so more people reach out and get help?” There are times _ I was at my therapist’s yesterday, I was literally given the choice of hospital, respite or otherwise, and that was a little over 24 hours ago. I never know what will be triggered, to get to that certain point. I’m sure she’d cringe at a comment where I’d be willing to risk my life literally by talking about it, but she knows me well enough. I’m determined enough to talk about it. And, by the way, I didn’t end up in respite or the hospital.

How did you manage that? 24 hours?

Well, resiliency. I guess I just have a driven mindset. Ultimately, I think those with high ideation and behavior, they don’t really want to die of suicide, it’s in the moment, “I can’t take it anymore,” right? So I’m fortunate with the resources that I have. I have a crisis plan I’ve used regularly in the last few years. I put people on there specifically I know I can’t bullshit. So I hate them in the moment and would like them to go away. I know there’s a backlash on me right there because they’ll be reading this!

How do we make people more comfortable with the topic?

Starting the conversation. Every opportunity we have. The people I talk with from the group, my youngest is 15, their kids are a little younger. But we all believe in talking about it, going into the school system. It’s something we would like to do. Opening it up to youth groups. Any opportunity we have where we can share our story in a conversational kind of way, right? Because we could talk and talk and talk, but once you talk for a little while, people start to get curious and ask questions, and it becomes more of a conversation, and right there it just opened the door for them to be with a peer somewhere down the road who sends out a red flag, “I wish I were dead,” that one meeting could turn into saving a life down the road. That individual will be comfortable enough to ask, “Are you thinking of suicide?” Saying the word is the hardest, right? When I was in training for the crisis line, I learned how to say the word directly and not, “Are you thinking of hurting yourself?” Having them say the word “suicide,” they’re using it and they’re not going to get a negative reaction. There’s a few of us, we’re all to the point where we would much rather open up and try to share our stories than try to keep closed about it.

Is there anyone, any organization, leaning in and saying, “Talk, but tell it this way?”

I’ve never had anyone tell it to me, but maybe they did and I chose not to hear it. You know, one of the first things Yvonne says in the group is, she basically says the whole group process is a learning process. You are the experts, I am also a co-learner. So ultimately I have that dual hat, which helps. I spoke with a group of individuals, medical students. I was there because of my mental health and suicide attempts, but even in that context, it was interesting. There was no sort of guidelines, “You shouldn’t say this to medical students,” everything was up front. I can always learn from someone else. I like that expert stuff.

These are relatively smaller-scale efforts. What about talking on a bigger scale, through the media and such?

Maybe down the road? Maybe open the door to work organizations, a fascinating place to have maybe a day where you have someone come in and talk about it. No one is immune to suicide. I would say nine out of 10 people, if not 10 out of 10 people I’ve spoken to or in front of, have a story to share. The more we talk, the more the word will hopefully get out. I’d love to say one day I’ll be a big international speaker inspiring people’s lives, right? Yeah, grandiose and ideal.

I wonder if talking on a larger scale would change the response.

The domino effect, right? I go out and speak often with Tana Nash. She lost her sister and grandmother to suicide. Oftentimes we get together. If I had not had my attempt, I would not have met her, had those connections. I would not have met Yvonne. Not that I recommend that; I always put that in parentheses. Where was I going with that? Oh, I go out with Tana, and in going out with her, I recognize there may be 15 people, 50 people in the audience. The benefit of the smaller group we’ve seen is, there’s more disclosure in that group because of the comfort level. Whereas in group of, like, 150, you might have disclosure, but after and one on one. So ultimately, even if there’s just one person I’m talking to, I kind of look at it from that perspective. You’ve gotta start somewhere. But that’s OK. But we’re doing a television series, going for filming tomorrow. The local cable station is doing a series, “Mind Matters.” Canada AM had a big special on suicide. the potential is out there, right?

What about the people whose attempts are so quick, so impulsive, that there’s not much time to reach them when they think they’d need it?

How to get to them? First of all, they’re in the moment and don’t necessarily … You hear a lot about having plans, leaving notes and stuff. But if you look at the statistics, not many leave notes. It’s all a very individual thing. I guess you’ve just got to hope. We’re not talking about how we’ve tried it. I don’t even get into my means. I might sort of vaguely dance about it. That’s one of the rules in the group. We don’t talk about our means. Just the thoughts, how to control and work with those. The crisis plan, I’m a firm believer in that. In mine, I’m very open. For instance, in starting this job next week, I might give them a copy of my plan, though I don’t have to have it. I mentioned it in my interview with them. The more I mention it, the better chance I have at my own survival. right? We don’t do the group with the expectation that we’re going to come out without the thoughts or behavior. Even when you’re feeling good for a while, you have the “OK, it will never come back again,” but when it does, you just have to accept and contain it so not to have those spontaneous moments. I don’t ever expect it to be easy. And maybe I make it sound easy, and I had someone in the hospital who said, “How do you do it?” Another thing is, don’t compare yourself to that person and how you think they’re doing. She ended up dying by suicide. It was very difficult for me. We each have our own stuff. I never know when will be spontaneous or last minute. I don’t know. I hope I’ll have the right frame of mind to text. I’m big on texting. It was an email that saved my life. You just have to use the tools you have.

How did an e-mail save your life?

I sent out about 22 e-mails. I did not get up with the intention. I had major back pain and started trying to treat it. A combo of pills and alcohol. I knew I wasn’t in a good head space, I knew where I was going. So I sent out very vague messages. The last one I sent to two specific individuals. I found a poem online that said what I was doing, what my intention was. It was not “I love you, blah blah,” basically, “This is were I’m at, what I’m doing.” I sent one to my counselor and the other to someone at work. My counselor read it, where she never ever reads e-mails before going out to supper, but she read it that night. She didn’t second-guess it. She phoned me on my cell. I had charged my cell, done the laundry. I was literally playing the Russian roulette. If there was no intervention, it’s all right, I’ve got everything done. I was not willing to disclose where I was. I hung up on her. She made calls to find out where I was. She talked to my daughter. Somewhere in there I had texted a friend, who had already phoned my daughter to say something was wrong because I had spelled a word wrong in my text. My daughter and friends already were trying to find me. My therapist ended up phoning me back, tried again to use the kid card, saying my daughter was in tears. But it was not working. She hung up on me, called 911. I answered again, and the number showed up unknown. I thought it was her, but it was 911. A number of years ago, I did a 911 course. What saved me at that point was analyzing the job she was doing. I started thinking, “North, south, east, west” and told her how to get there. She kept me conscious until they got there. The therapist told me there was nothing short of miraculous that they found me

Is there any sort of pride in this? To look back over it all for the details?

It makes it scarier, to go back and find what went wrong. To others, it would be what I did right. But if I get determined again, I know what not to do to get that much closer.


I wish I could answer that. I think it’s just part of my way of thinking. It’s just a mindset the mind goes into. And it’s hard to draw it out, it’s hard to pull out of it. But at the base of it is the hopelessness and the wanting to end the pain.

Do others create crisis plans around you?

I’m sure they make phone calls behind my back. I set myself up, right? But I also have to appreciate that side of it, too. As much as I might be ticked off at my therapist in the moment, I’m grateful in the end. When i was house-sitting at my parents’, I had a neighbor call my cousin out of concern because I hadn’t taken in the recycle bin. To make sure he called, to make sure I was OK, right? I could look at it as the busybody neighbor, or I could look at it as they were concerned, wanting to make sure I was OK. There’s always two sides.

How are your children?

My youngest is very much my hawkeye. He was the one to check on me afterwards: “Mom, do I have to worry tonight?” He’ll be going out the door: “What are you doing today? So you’ll call me if you go out?” “I’ll leave a note.” “No, so you’ll call? I know they worry at times. My sister is trying like anything to understand, because she never experienced depression. Again, I don’t mind people asking, I don’t mind the conversation. With this intervention stuff, the people I don’t want to see me at my worst are my closest family, because I don’t want to scare them. Like the onion, layers of support. As I get to the external edge, the more and more in crisis, I’m gonna look more to the professionals then. I am one of these professionals. I know it will take a certain type of intervention to get through to me. Besides, I have certain people on that outside edge I can make comments to, and it’s OK. It’s a friend as well as a professional thing.

(I ask about professionals who have their own experiences with suicide attempts and whether they should be more open about them.)

I’m sure there’s lots out there. In some cases, unfortunately, their work environment is not so open to it, right? They’ve got a lot to learn in the workforce to deal with someone with mental health issues. A good chunk in the helping profession, that’s probably why we’re in it, right? So depending on whether it’s domestic violence or whatever,  there’s a clumping of individuals that’s where their specialty kind of lies. There’s an extent of disclosure. But when it comes to suicide, you probably wouldn’t get a lot as open. But there are. Because I’ve talked to individuals who’ve had suicide attempts, but even their co-workers may not know. In a sense, I wish medical professionals had more of that component to it, the lived experience. I wonder whether it’s not lacking a little bit because it’s so clinical. That’s why it was nice to talk to those medical students. It was not just me that day, there were people with chronic illness. They were learning what it’s like to live in those shoes.

(She asks me why I decided to be open about this subject, and I told her. I said it could be exhausting to try to hide it.)

Exactly, it’s exhausting to try to hide it. And it’s exhaustion that drives us to do it. My first attempt, no one knew it was an attempt. The second one, my one friend knew, she got me to go to the doctor and get antidepressants. But no one knew. At _ how old am I? _ at 47 years of age, my family only then found out, the depression, the thoughts I’d been living with since I was a teenager, if not earlier.

And? How did you approach it? How did they take it?

Even when I weaseled my way out of the hospital, I thought it would be fairly easy. I’m surprised at how draining an effect it was. It was a lot tougher than anticipated. My mother insisted on a group session when she found out I took my husband and kids in. I hear a lot of the time that “I don’t have support, I don’t have this, that.” I recognize how fortunate I am, but in retrospect, I did not have that support when I was hiding it. I was the happy-go-lucky citizen of Elmira, a member of the theater company, you name it. When I had the event at my church, they just couldn’t believe this was the same person who was Sunday school coordinator for four years, always being bubbly and bouncy.

Can you tell now, looking at people, that they have their own experiences and may be trying to hide it?

I never really thought about it, I guess it would depend on the conversation. Honestly, the poem I sent out as a help message, the individual who wrote that, I tried to track her down. I found different poems written by this young lady, I felt that was where she was. I’ve been trying to track down a way of contacting her. There is no way. My gut is, she may no longer be with us. Learning to go with your gut, right? That part of me has been strengthened. When talking with people on the phone, you don’t have body language, any of that stuff, right? Sometimes, yes, in the stuff they’re saying, the way they’re approaching things … I would not hesitate to question. I’ve got a friend who is generally good at getting back at e-mails. She’s not. She’s been going through stuff. I’m going to tune into her not responding right away. It was the death of a friend that really bottomed me out, watching the death of a friend at 46. So I kind of look into that whole loss thing, the loss of a job, a friend, endings, right, so when I hear people talking about the things they lost, yeah, I start to tune in a bit differently. Even if they say they’re OK, I might tweak in a sense of concern, but do I know? No, I don’t really know how a person is coping unless I ask.

(I asked about other signs she picks up on.)

A change in behavior is one of the biggest. Really, anything you notice in the other person that doesn’t quite seem like the person you are most familiar with. It doesn’t necessarily mean you jump to suicide, but it might be something on their mind. But this friend of mine, she lost her friend to cancer, she lost her mother, she’s not e-mailing, sure. I’m gonna start to bug her. Not necessarily because I’m thinking she’ll become suicidal, but I know she’s having a hard time coping. Suicide wouldn’t necessarily be in everyone’s line of thought. When a group like Yvonne’s, for those of us who struggle on an everyday basis, one of the common denominators is past trauma. That’s where the hard work comes in, I really do believe you have to do trauma work. I think to a certain extent there’s stuff to be worked on to start to be able to move beyond and cope differently. And yes, I avoid my own trauma work.

Wait a minute, you don’t do it at all?

No, not that, but if I can distract the counselor, get off kilter …

There’s a debate in Canada right now over the right to die. Is that a completely different topic?

They’ll be talking about that at the upcoming conference. There is a difference between someone being chronically ill and wishing to die and someone just wishing to die because they can’t take it anymore. I think they’re really looking at assisted suicide for those chronically ill, who are not going to live anyway. There is a distinction there. I personally, yeah, it would hurt if someone I knew died by suicide, I would definitely never consider assisting them in that, as I would never expect anyone to assist me. Yet on the flip side, I would understand why they maybe made that choice and maybe ended up dying by suicide. Yeah, it’s two different topics, right? And I think the whole, like, you’re looking at individuals who can’t look after themselves, function poorly, have no sense of life, that comes into that. It’s a debate, all right. It will be interesting to see how that conversation goes.

Are you speaking at conference?


And finally, who else are you, aside from these experiences?

This is what has made me, really. To me, maybe this is who I am. I mean, I wouldn’t be having this conversation with you, right? OK. Photography, I love my photography. I played a lot of sports growing up. I  was a very active person. There’s not a lot that I wouldn’t do on a challenge, so I hope to jump out of an airplane next year. With a chute. I have my goals and my aspirations, and they keep changing. But really, I have to look at my experience with my suicide as my stepping stone for who I am now and where I want to go and who I want to be. And ultimately, I would like to help others.

I wish you luck with your new job.

Thank you. I’m excited and nervous.

Talking with Yvonne Bergmans

“So many care providers only see people when they’re not well. They don’t get to see the other side. The gift I have, I get to see all sides.”

Yvonne Bergmans started a support group for suicide attempt survivors at St. Michael’s Hospital in Toronto more than a dozen years ago, and she has been pushing for more recognition of their voices ever since. She’s happy to report that this year, a national conference on suicidology for the first time will put a “huge focus” on attempt survivors and their stories. Her group has been featured in a documentary, which can be viewed online, and some members have posed for a series of portraits and interviews. A few have collaborated with Bergmans for published academic studies. They are fascinating.

Two group members tell their story, with strong advice for professionals, in a 2007 study. Anger, accusations and even eye-rolling don’t help in a crisis, they say. “Don’t punish me for being ill. Admit to yourself that you may not understand. Let me help you.” Even simple, practical things: Don’t lose their personal items. Keep their families informed. And this: “Call me by my name. … When I am in crisis and I feel that all is lost, I must remember that I am someone.” They remind the reader that they are educated, employed and high-functioning, but such things don’t mean a crisis can’t happen.

In a 2009 study, other group members talk about the risks and benefits of being open about their experiences. “When I naively disclosed (about suicide attempts) in my college mental health-related classes, I was shocked at classmates’ reactions, which were split between the morbidly curious and the physically repulsed,” one writes. And yet, “my clients with suicide issues or a history of attempts have appreciated the honesty,” another writes. “They tell me they can relate better to me; it gives me ‘street cred.'”

One of the support group’s first steps is to create a safe space not only for members but also for the topic of suicide and its effect on others. “We often go at it from the perspective of how to communicate your distress,” Bergmans says, “and have people hear it and not freak out.”

She also introduced me to the concept of the “prosumer,” the professional caregiver with his or her own experience with suicidality. Something to explore for later.

How did the group come about?

It came about 13 years ago when I was hired by the then-chair in suicide studies, Paul Links. Psychiatrists saw a lot of people with recurrent suicide attempts coming into the emergency department, and there was a definite gap in service for these people. There were very few places people could go. He hired me to create an intervention. I was hired in November 1998, and in February 1999 I started the first group. We started and just kept on going. It was sort of a situation where I initially was told we’d be doing a DBT (dialectical behavior therapy) program. It just didn’t work for me as a therapist, getting my tongue around the language. Clients were not terribly engaged. Together we started creating an intervention that they could engage in, and we have now had probably well over 300 clients.

Was the documentary a good representation of how the group goes?

Yeah. There were probably more men in that group than there are normally.

As the group grew, what adjustments did you make to help people open up?

It was not really an issue. Once it was safe enough to talk about suicide without getting into means and methods, and you could use the word and not have people freak out and rather ask the question “What does it mean for you?” and recognizing that it doesn’t always mean imminent death, and people coming to a place where there’s no judgment, this is your reality, and being with people who get it. That’s one of the most important pieces. People are not completely alone and adrift in the intensity and pain of experiences. So the way we approach it is in talking about suicidality. We often go at it from the perspective of how to communicate your distress and have people hear it and not freak out.

So, how do you?

We do a number of things. The first is, can you identify how safe or unsafe you feel? Can you identify what it is taking you to the place where suicidal ideation is so great where you think you can’t manage? Things like, “I called colleagues, I called friends, I tried distracting myself, and I still feel unsafe. I can’t deal on my own, I need help.” The other thing is, “I need to be in a place safe enough that I’m nowhere near the environment where this got triggered or started, I can’t be anywhere near my means, and I need someone to help me with that.” There’s a lot of work about developing a language of safety. Knowing early warning signs, knowing the tools to use. And being a teacher to the care providers you work with. We work from the perspective that everyone is a learner and teacher. They are experts by experience.

(I asked about the level of nervousness among therapists in working with suicidal people and whether it’s different in Canada.)

I’d say it’s about the same. You’re working with a person with a high potential of dying. It’s just scary. Yeah, so comfort is something we try to work on. When we do groups, I have many colleagues from various professions working with me, co-facilitating, so they develop a skill set. So they come to realize that when our clients are in good shape, they’re just a hoot and half, a human being you could meet anywhere, a cooking course or anywhere. And the difference between the acute phase and their normal lives. It’s a very different presentation. So many care providers only see people when they’re not well. They don’t get to see the other side. The gift I have, I get to see all sides.

What are their responses to seeing people on the other side?

I don’t think I’ve had any co-facilitator who hasn’t found it a useful experience, having learned something.

Is the group always a mix of people in their normal state and in crisis?

Yeah, and sometimes we get a group when all are in really rough shape. You take it as it comes every week. You certainly hope that people, even when feeling really vulnerable and fragile, they are still able to use some of the skills they were using, and whatever little energy they might have had to get themselves here. A skill called determination.

Have you lost people, or had people leave the program?

Yes, we have lost some people that I’m aware of, probably lost five by suicide. We had a few lost to various medical conditions. And there are people who said, “See you later, never see you again.” Others show up five years later. You can do two groups with us, and we’ve had some grads to come back and become peer facilitators.

How are you, doing this for so long?

It’s a gift. A real honor seeing people shift and change. As a care provider, I can walk with them on the journey, but I have to be clear I can’t do it for them. It’s a parallel process whereby I’m inviting them to participate in a safe place for themselves. I have to do the same professionally, ask others to be another set of eyes. So as a result, we always make sure to have weekly supervision with all facilitators so we can stay honest about our emotions.

What are your personal experiences with suicide? Or is it something where you know you’ll never have to deal with it?

I don’t think anyone can ever be sure they’ll never have that struggle. I think I can’t ever assume I won’t get to that place. I started this job in November, and the following August, my cousin died by suicide. It went from professional to personal.

Did you want to leave, or to work harder?

No, it just left me knowing where I needed to be at this point in time in my life.

Does the group address some of the root problems behind some suicidality, economic ones and so on?

I can certainly help get them to case managers who can help them. I do a lot of crisis management. There’s an expectation that they have a support system, because in the group, there are things they’re not going to share that have personal meaning for them because it’s a group. I can point them to directions and assume they follow up. I assume capacity and capability.

Are there cases where you turn people away?

We rarely turn away. Maybe because of a psychotic disorder. and sometimes the housing situation for people is so fragile they don’t know if they’re able to get to group, so sometimes that’s been an issue. I say that very, very rarely.

What have been the surprises? Any points of view you hadn’t considered before?

That’s really hard to answer. Because every day there’s something new. To say what stands out, I couldn’t name anything. It depends on the day and people in it. People’s persistence and resilience perpetually humble me.

Any examples?

Just the lives that people have to live, endure and survive. You just sit back and go, “Wow, have you got a lot of strength and courage.” Some people might think they have a great big black cloud over their head. A wide variety of different experiences.

Any way to make the cloud go away?

I’m not going to make it go away. I can give you an umbrella and show you how to open it!

(I asked about the openness around the topic of suicide in Canada vs. the U.S.)

Absolutely not. It’s SO not different. A stigma is a stigma.

That’s just the way it is?

Heavens, no. The AAS (American Association of Suicidology) is doing a great job giving people who have attempts, giving them a platform. We are trying to do the same in Canada. And a huge focus in our conference this fall is going to be on honoring the voices of those who’ve had the experiences.

For the first time?

It’s been an evolution. I’d say the evolution has been in the last 10 years. This year’s organizers made a very clear, a mandated part of the conference that more sessions will have first voices. And the AAS did that in their spring conference. I think it’s a general move now.

Why did it take so long?

Stigma. Fear. Prejudice.

But these are the therapists and researchers.

Yeah. Sometimes people have to get out of their own box. I’ve been jumping up and down for a loooong time. My role as a social worker and advocate, it’s been a long path. A very long path in terms of having the voices listened to without the professionals taking over in terms of the sound, shall we say. Because I think medicine has traditionally been quite hierarchical, “This is what you’ll do, what’s good for you.” Whereas social work has client-centered approaches. Nursing has jumped on the bandwagon of late.

(I asked about professionals having their own experiences but not saying so, or saying it quietly, and whether they tell her.)

I think it’s when I go to conference. There’s a small body of literature that talks about it with the “prosumer.” They’ve been able to say they have participated in both realities. And it’s an “and” as opposed to a “but.”

How does the trend move along to more openness?

I think persistently we plug along together. Raising awareness. That suicide is preventable in most cases. Recognizing that it’s very much as it used to be with cancer or HIV, these perceptions are what need to be blown out of the water. And alongside that, the resources. Right now there’s not a whole lot of resources for people struggling with suicidality. The resource allocation at the larger social level is imperative. A lot of myths-busting needs to happen!

Do you have a favorite myth?

Not really

The one about just trying to get attention, just a gesture?

Yeah, that’s where I get a frying pan … Just kidding. That’s so disrespectful. What we often have is, if a person is saying they want to die by suicide, there’s a need not being met. If you tell them it’s manipulation, you’ve missed the point.

How to make this a more comfortable subject in public?

It’s portrayed in the media in such a sensationalized way. There’s not a whole lot of understanding of the despair and compassion required. It’s everybody’s biggest fear, right? How to say, “This is a fear and we can talk about the fear.” I don’t know a whole lot of people who have made it through and can say, “This is what it is. This is how you can be helpful. This is a real struggle. And it feels like a life sentence. And it can be different.” It seems to be more deficit-focused. And if you focus on what’s wrong, you’re not going to get to what’s right.

Among the 300 or so people you’ve worked with, are any of them outspoken?

Yeah. Definitely there will be one, two, three, possibly four at the conference. And there have been a couple who have been interviewed in the Ottawa Citizen. They did a series. And the folks who responded to yourself or to Doug. That’s where there are openings.

Who else is doing what you’re doing?

There’s a group called SAFER in British Columbia. To the best of my knowledge, we’re the only game in Toronto.

What about the issue of involuntary commitment, does that come up with your group?

I can’t commit anybody. I don’t have that capacity. When I work with people, we start with the premise that we all have a right to feel safe,and a responsibility to ensure others feel safe around you. I also work with the second premise that behavior is a choice with an effect. If I’m feeling unsafe, I tell the client I feel unsafe and need help. I always work with the folks so they make their own choice. I’ll support them, meet them at the emergency department, whatever it takes. There are times I’ve had to call 911. I hate it and people get angry when I do it. But when comes to this, I’ll do it.

While they’re in the group?

Somebody calls me outside the group. If it’s in group, I’ve been known to walk with people down to the emergency department. Or to my office, figure out a strategy, talk every few hours with them, ask them to let me know how they’re doing. Sometimes going to the ER can be more traumatizing than their actual feelings.

How will people ever feel comfortable enough to come out? What else needs to happen?

Currently, if a person is brought into the hospital by police, it is on their record that they have has an interaction with police, It does not clearly state it was a contact only. As a result, if people need to have a police check done for work purposes, it comes in the report. This is traumatizing and stigmatizing, and many have lost employment opportunities because if it. Sadly, it does not get removed for five years, and then only if the person requests it. Currently, there is a coalition trying to work on changing this because it is so discriminatory.

Any other ideas in mind that you’d like to pursue if you had the resources?

I would have a Maytree. I would have a number of Maytrees. And it would have a dog, and a cat, and music therapy, and dance therapy, and art therapy, a little medication if needed. If you need meds, a doc would be on site who could do it. And no one on staff freaks out at the word “suicide” and you’re not dumped out if you have suicidal thinking. It’s pretty hard for folks to talk about it if they feel constantly under threat with no safe place to go. How can they heal and become advocates for themselves and one another?

How’s that idea going?

I have mentioned it for the past 12 years. I have invited many people to find me millions of dollars. Interestingly, everybody I’ve invited hasn’t been able to, so there you have it. That’s my biggest bugaboo, people being thrown out of programs at the thought of suicide. My biggest frustration, but hey, life happens.

What else would you like to say?

Nothing I can think of.

Who else are you? The group isn’t all you do.

You haven’t seen my workplace, have you? I started off as a youth worker, a special ed behavioral teacher, the guidance counselor at an inner-city school. Then I ended up here. Every stop prepared me for the next one.

When the word “suicide” first came up, what was your response?

I had basically called to say, “Listen, do you have any jobs for part-time casual?” and they said, “Paul has this suicide thing going on, he said it’s yet to be created.” I said, “Hmm, I’ve worked with high risk for all of my career. I’ve worked with groups. Suicide is the new factor here. Let’s go for it.”

Can the public come to the conference?

Absolutely! In October in Niagara Falls.

Talking with Cory Cobern

Cory Cobern is in the middle of making himself over. The father of two is soon to become a social worker and runs one of the very few support groups for suicide attempt survivors in the U.S. It’s encouraging to hear that his openness about his own experience didn’t keep him from working for a crisis hotline. The director welcomed him and got him to create and lead the support group.

There seems to be a common fear that people in such groups will compare methods and then employ them. Cory isn’t seeing that. In fact, he says, they turn each other off the idea with the fear of failing and being worse off than they were before. One person has liver problems. One has a reconstructed face. “Everyone pretty much says, ‘Why would I want to attempt again when everyone here has failed?'” he says. “It’s kind of a twisted way of thinking, but wow, here’s eight people who tried an average of four times, and none succeeded. They laugh about it now: ‘We tried so many times and still couldn’t end it? There must be a reason.'”

Now he’s wondering how to further crack the public silence around suicide. He recently fought for and got a front-page story about his group in a local newspaper, but he says he hasn’t heard one response.

“Everyone needs someone to talk to and not be judged like, ‘Wow, you’re weird,'” Cory says. “Because if you ask me, there are a lot of things out there that are a lot weirder.”

Who are you?

I’m going to be 43. I’ve been married for about 18 years, with two children. I worked in the computer industry for about 15 years, decided that was enough, and now I’m a senior at George Mason, majoring in social work. I have two brothers. I don’t know what else.

What’s your background in this area?

I have schizoaffective disorder. I was diagnosed with that when I was 30, when my mother died. I had some issues, major depression issues, and I went to a counselor. They diagnosed me, and my wife and I denied it and recently accepted it. The next year, my father died, and things continued to go downhill. We moved from California to northern Virginia in 2003 when our youngest son was born. And things were OK the next couple of years. I got out of my depression, everything. Then in about 2006, I started having issues with voices and suicidal thoughts, and after a couple of attempts, which were my first, I decided, “OK, maybe I have schizoaffective disorder,” and I started medication. I had more attempts until 2008. By that time, I was no longer able to work, things were too bad with medication. At that point, I was on a ton of medication, I think overmedicated. And I lost my job. And actually, it turned out to be a good thing. I spent the next nine months or so doing nothing. When I was at work, I couldn’t focus. I lost my job, stayed at home, things got worse and worse. And when I lost my job, I lost my benefits. I got on my wife’s benefits. I got a new doctor. I went through three or four doctors and they had said, “You’re on so much medication that we won’t take you.” I went to see her and she said, “I’m cutting your medication in half.”

Now I’ve been seeing the same psychiatrist for four years. I’m on a tenth of what I was on before. During this process I was at home, and she said, “You need to get out of the house.” I said, “OK, what do I need to do?” So actually, I signed up for my first online class at Northern Virginia Community College. I had hated school, was never a student, but looking back now, a lot of it was voices. I couldn’t focus. So I took my first class, passed it, and liked it. I started looking at other things I could do. I found the helpline, sent in a resume, was looking to volunteer. Then I got a call from the helpline asking if I wanted to come in for orientation. I went in and became part of the staff about six months after that. They had an opening and asked if I was interested. I said yes.

As I continued to do that, I was taking more and more classes. I had things to focus on. And so I started increasing my load of school, and in 2010 I got an associate’s degree. I am still with the helpline. I find that now, even if I have a bad day, I can get on the helpline and the bad day goes away. I can put everything of mine away and focus on others. So I continued to go to school, and my wife and I talked. I had always wanted to be a social worker, a therapist. In my yearbook, everyone knew. We said, “OK, let’s do that.” I started classes, slowly, and last semester I took 15 units, this semester 18 units.

My mindset has totally changed. Everything is clearer for me. I couldn’t build anything before. Now I can do whatever needs to be done. So I had, total, five hospitalizations. I have two children, one has Asperger’s, and the youngest has bipolar. It’s all been a wakeup call, a reminder of what’s out there, what others go through.

How old are your children?

12 and 9.

How did the attempt survivors’ support group come about?

It branched off the helpline. When I started, I was upfront. I really knew nothing about the helpline. I went in, went through training. My boss, Vicki, was very easy to talk to. Almost from day one she said, “I always wanted this group.” For the next seven or eight months, we talked about it. I started doing more and more. After about eight months in, she said, “So, what you think?” I said it was a great idea. We put together some ideas and launched the group in December 2010. And it’s been going ever since.

It’s hard to get anyone to really publicize it. Most people come from word of mouth. I’d love for it to increase, but I’m not sure how to reach people. It’s such a sensitive subject. The only things that are publicized are completed suicides or the family members, the survivors. This the only group of its type in Virginia, Maryland, D.C., the tri-state area. There are groups out there, a 12-step group based out of Memphis. But otherwise, this has been a big learning experience for me. All the materials, I come up with myself. I scour the Web. There’s very little out there. It redirects you to other things, like family members. There’s just very little out there for attempters.

Why did Vicki want to do the group, and why did she come to you?

She’s run a group for survivors for about 17 years, and she always wanted to run one for attempt survivors but thought she was not appropriate for it. She knew I was a previous attempter. She said, “You can relate to them, you have a common thread with them.” We weren’t sure how it would go over. And she’d never had anyone at the helpline who, if they had been an attempter, had informed her.

What made you comfortable in mentioning your experience in the first place?

I just felt that going to this type of work, I had to be open about it and not hide that I had a mental illness or that I had attempted. Nobody asked. I just felt it was something they needed to know in case things didn’t work out. Nothing personal, but if this makes things worse, I was not going to stay around. Once again, Vicki was so easy to talk to. A very easy person to talk to for two or three hours straight. She always seemed open and accepting.

How did you get the group rolling?

Good question. The first meeting we had was in December. I had five people show up. We had sent out a notice announcing the group. I sent a letter out to basically every therapist in Prince William County informing them of the group. I never heard back from any of them, but seeing as on the first day we had five people, they heard it from somewhere. I sent letters to hospitals in the area. That’s basically it. Also to the local papers and to The Washington Post. It’s not something I ever really delved into, where they heard about it. I know one person heard from her therapist. Another came to a teleconference for suicide survivors, actually two people. Others heard from word of mouth. What we have is, anyone who wants to come to the group, at an undisclosed location, they call the helpline and leave their information. I call back and do a phone interview to make sure they are actual attempters, make sure they are OK for the group. I don’t turn anyone away, but I don’t want anyone else there.

How did it go the first time?

The first time actually went very well. I kind of explained what I thought the purpose of the group was. I actually told my story, which kind of loosened everyone else up. I rarely tell my story. We have enough people to tell now, so I don’t have to. I wasn’t quite sure what to do, and no one seemed quite sure what to expect, so I said, “OK.” I told my story, and three others told their stories. The other two waited for a while to tell, but that was kind of the icebreaker.

What have you learned, and what has surprised you, in getting people talking?

I have a good core of people who have been there since day one or three months afterwards, and for the most part I start with, “How’s everyone?” _ a quick wellness check. I can rely on them to get others talking. If not, I know most of my group members now that I can say, “OK, what’s going on with you?” They may pause for a minute or two, or pass, but within 10 minutes they’re ready to talk. And this being an attempters’ group, there is no taboo subject, because anything can lead someone to another attempt. It can be a family problem, they got a bill, drugs, alcohol, family, work. We talk about everything, because it all affects.

What guidelines do you have?

I don’t have any. We have paper guidelines, but if somebody wants to talk about something, I’m open to it. I don’t want anyone to go home and say, “This was on my mind.” I always tell them, “I’m never going to leave you more upset than when you came in.”

Is there any kind of safety net for when the group isn’t in session?

I don’t really have a safety net outside observation and listening to everyone. Should I have people sign a safety contract? I’ve gone back and forth. I’m just a facilitator. I gave everyone the helpline number, and I gave all my cellphone number. I’m kind of still playing it by ear and winging it, because it’s worked. I have people say, “I’m upset,” then after an hour or hour and a half say, “I feel better.” I try to enforce that they talk to people, family,. And the core group members, they’re not shy. If they’re feeling bad, they spit it out.

How many people do you have now?

Four come regularly. Up to six people max. To be honest, if I ever get 12 people regularly, I’ll close the group and start another. That’s my max number.

Did you come in thinking you knew everything because you’re an attempt survivor?

I thought I knew a lot of it because of the helpline more so than my story. I deal with so many people who are suicidal on the helpline that it really opened my eyes to see the larger picture beyond myself. It’s really a blessing. When I went in, I had no idea what to expect, going in blind. None of the stories have really surprised me. Maybe dismay at hearing how they tried, how many times. I thought I tried a lot with five, but that’s very little compared to some of them. Or the severity of their attempts, or the lasting consequences. I have someone with liver problems because they tried to overdose on pills. I have another who says, “I’m here for a reason, because I didn’t succeed.”

Do you get into them wishing they hadn’t attempted?

I don’t recall hearing from anyone who wished they hadn’t, because it’s part of who they are now. The biggest wish I heard is that they hadn’t tried it that way. I think everyone who continues to come to the group is, well, let me step back. When we started, a number of people were thinking suicide was an option. Now, either they’re lying to my face, but they say suicide is not an option at this point. My last one, she’s still not entirely taken it off the table, Her future was always in the next two or three months, but now it’s, “Well, maybe if my husband dies, that’s the only option.” It’s no longer, “Well, maybe next month I should try.”

And everyone pretty much knows now, everyone pretty much says, “Why would I want to attempt again when everyone here has failed?” It’s kind of a twisted way of thinking, but wow, here’s eight people who tried an average of four times, and none succeeded. They laugh about it now: “We tried so many times and still couldn’t end it? There must be a reason.”

What’s the reason? Have you found it?

Some people say God. I don’t know. They say, “Wow, you tried 300 pills and you’re still here? You tried a shotgun, and you’re still here? You ran into an electric pole going 120 miles an hour, and you’re still here?” I’ve heard people who said, “I took 20 pills and thought it would do me, and you took 300?” They look at each other and go, “Wow.” Like me, I couldn’t do pain. A lot of people say that. That’s not really an option. They kind of turn each other off.

When the issue of attempt survivor support groups comes up, people mention the fear of comparing methods and getting better at it.

My group is fear of failing: “Wow, we tried this many times and didn’t succeed.” The fear of failing and the fear of failing and being much worse off: liver problems, being brain dead and being on a machine. It’s interesting to see how they progress, how we’ve all progressed over it, from the first day or so. How the mindsets have changed, how they’ve changed each other. We listen to each other, respect each other. One of my guys, he was in prison, he just says, “What’s bugging you?” Most of my people are very refined. He’s an ex-con. The nicest guy, but he’s not going to pussyfoot around. He’s gonna ask.

So how will you get others to join the group? You sent me the newspaper article …

I was hoping. I haven’t heard anything since that article. I haven’t heard from a single person. It’s very daunting. I fought to get this article done, and they obliged me, and nothing came of it. One thing I’m hoping is, starting in September, I’ll be doing clinicals at a mental hospital. I will be working with suicide attempters. I hope to increase the numbers. I don’t know. I was very gung-ho when the group started. I was going to the local community college, literally 10 minutes away. Now I’m going to George Mason, a minimum of 45 minutes away. I’ve got clinicals, internships. I don’t have time to go to the library and put up a flier. I don’t have time to do that anymore. It’s very frustrating because I don’t know how to grow it. I would love to get involved with local hospitals and have them refer.

The reporter who did the article said the police scanner mentions seven or eight suicide attempts a week. Well, how do I reach those people? I thought the article would help, especially considering it made the front page. I think it’s gonna take a lot more. I think it will take actually going to hospitals, meeting with somebody. I think it will take someone higher up in hospitals or the police department to say, “Tell them about this.” There’s gotta be a way. I’ve talked to different attempters’ groups like in California, and no one can give me ideas on how to grow the group.

At least you know a common situation.

Right. It’s a very taboo subject, and people are very afraid to talk about it.

What makes you so comfortable with being outspoken?

One thing, I’ve been there and seen the worst. My wife, kids, brothers went through all of that with me. My psychiatrist enabled me to become the person I am with her support and correct medication. Vicki was supportive since day one. Working the helpline has opened my eyes in so many ways. And I always wanted to be a social worker. If you can’t advocate for yourself, who can you advocate for? My convictions run deep: In order to truly help someone, you have to help yourself. I’d be a crummy social worker if I had attempted suicide and only tell someone, “Oh, you don’t want to do that.” I think that’s the big thing. I have no problem being honest and open.

Should therapists talk about own experiences?

In my opinion, I think a lot of people go into this type of field because they have had these issues, regardless of it being domestic violence, sexual abuse, suicide. Maybe not to them but to family or friends, growing up. I think it influences a lot, more than they’re willing to admit. I’ve had a lot of people say, “Wow, you used your first AND last name in the paper!” I’m OK with it.

What’s it going to take to get more people to mention their first and last name, or to mention this at all?

Lots more exposure. It happens. There’s nothing wrong with somebody who just happened to try to take their own life. They shouldn’t be an outcast, a pariah just because they attempted. There’s so much confusion, they don’t understand: “Why would they do that?” Well, they really don’t know what’s going on in their lives, their mind, just like we don’t know what’s going on behind closed doors. I just think a lot of it is that people are confused and scared by it, because I think seven out of every 10 people have thought about it, whether very seriously or just wishing to end it all. I think a lot have thought about it in passing, and it scares them.

Because they don’t want the thought to become more serious.

Right. Or they don’t want to be embarrassed or ashamed or something. That’s only my opinion.

What else would you like to say?

I guess the biggest thing is, we’re trying to help ourselves out of this. I understand, I’ve been there. When you’re in the deepest, darkest hole, it’s hard to get out and see any sunlight. Suicide is a permanent solution to a temporary problem. Every one of my group members can attest to that. No matter how bad it is, it can get better. Everyone needs someone to talk to and not be judged like, “Wow, you’re weird.” Because if you ask me, there are a lot of things out there that are a lot weirder. I’d take a suicidal person any day other than a homicidal person, you know.

Who else are you?

My wife, Jayne, we started dating when I was in high school, and we’ve been together ever since. I have two boys. Literally, if I’m not in school or at work, I’m doing family time with my wife and kids. There is not a whole lot else. I have a half-brother and full brother, both in California. Unfortunately, I don’t get to see them that much.

I think a lot of this progressed with both my parents. My mother with pancreatic cancer, then my father with pancreatic cancer. My mother died on Oct. 15, 2000, which happened to be my father’s birthday. My father died a year and five days later. They’d been divorced 12 years. 12 years? Longer than that. Anyway. My mother despised the man. I have no doubt she died on that day for a reason. And her last days were a morphine-induced coma. I have no doubt she managed to save herself for that day. I also have no doubt my father never stopped loving my mother. They made me who I am today. Their deaths were so close together. When my mother was diagnosed, she was told she had months to live, and she lived three years. My stepfather took care of her, but during the week, I’d be there. Otherwise my older brother would be there. And I was there when she died. That really devastated me. My father a year later fell and broke his leg, and we took him to the emergency room. After being there nine hours, we knew there was a problem. Two weeks later, he was gone. So cancer, yeah, really opened my eyes. Even though it devastated me, it also helped me become who I am today.

This probably is not a fair question, but would you ever consider suicide again?

I would never, ever consider suicide again. Never. Ever. No ifs ands or buts. The only suicide I would consider is no life support, no extraordinary measures.

Is there any one thing that brought you to “No, never”?

I think it’s the combination of realizing I have mental illness, my wife’s support, the helpline, and now everything I’ve learned in social work classes. Now I know the statistic that every suicide is said to affect 60 people. You know, whether it’s your next-door neighbor or whatnot, but wow. Also, you know, it’s more likely that if someone you know commits suicide then it’s more likely that you commit. My youngest will be 9 next month, and he’s been hospitalized three times for suicidal ideation. I could not be a role model for that. Because if I took what I consider now the easy way out, then: “Well, Dad did it. I can do it.” Does that make sense?

Those are why I would never. I see people with terminal illness. When I started with the helpline, one question was who believes in it, to what degree. Then, it was, “Sure, yes.” Now it is, “No.” It will get better. It really will. I have a frequent caller, calling more than a year now. When she started, she had cancer and wanted to end it. The doctors were, “It’s terminal.” A year later, she’s cancer-free. It just goes to show, you never know. And if you take that quick, easy _ not necessarily easy _ that quick jump, you don’t know what you’re missing, your entire life could change.

I guess you could say the same thing about me. Now I say never. Could that change the next year? I guess. I don’t see it changing. I know I put my family and friends and everyone through hell, being hospitalized and everything. I can’t see doing it again.

Talking with Katie Ayotte

Katie Ayotte’s story is a striking mix of what resources are becoming possible for suicide attempt survivors and the disconnects that remain. At least two fascinating twists lie ahead as she talks about becoming a peer leader of a rare attempt survivors support group in the U.S.

Katie also expresses a major problem of suicide more clearly than I’ve been able to do myself. “When you live in a society where you can’t mention the word ‘suicide,’ or live in fear of saying the word ‘suicide’ and there being some negative consequences _ as long as you live in that kind of world, you’re not going to be able to prevent it.,” she says.

Who are you?

I’m Google-able. I’m a person with a Serious Mental Illness, though I consider it Seriously More Interesting. I’ve had a serious mental illness since I was very young. My first suicide attempt was when I was 12. I now speak out about suicide and work to reduce the stigma and shame around it.

Your first attempt was when you were 12. How old are you?

I’m 50.

And now you speak out about suicide. How did the change come about?

It came about with my last attempt, about three years ago as of July. I sit on the board for Magellan, a half-community, half-Magellan governance board. I’m the Adult Recipient of Care representative. I represent the adults who receive care within the behavioral health care system. I’ve been on the board since 2008. During one of our board meetings … Now, no one on the board knew I was struggling with depression, they would have considered me “high-functioning.” I didn’t allow them to see me depressed or down. I had lost my job in 2009, a job I really felt at home with. But certain circumstances came about and I quit on the advice of my doctor so my health would get better. I was struggling quite a bit. Around mid-July I attempted suicide. I was at the board meeting and David Covington had mentioned they were starting a programatic suicide deterrent task force committee.

I had voiced to David that I’d like to be on the steering committee. He told me when it would meet the first time. Little did he know when I asked that three weeks prior I had attempted to end my own life. So I went in without a thought of telling anybody what I had been through. It was probably the furthest from my mind. David started the conversation around suicide, what survivors look like, how he saw it to be able to prevent suicide. There was a lot of talk in the room, and I found it very frustrating, hearing a lot of stereotypes, stigma, fear. And I asked David if I could _ there were probably about 30 people _ if I could have the microphone. He said, “Sure.” And for whatever reason, I felt it necessary to share that three weeks prior I had tried to kill myself. I told them the story of my job, how I had felt hopeless and helpless and a burden on my family because I wasn’t bringing in income. I briefly told how I attempted and what stopped me from completing. Needless to say, the room got very quiet. I had wanted to put a human face to it, so they were not talking about “those people,” that I was one of them. And from there it moved forward. I had a small article written about me in a local magazine called “Together AZ.” That went well. And from there, David Covington asked me if I was willing to do an interview with Ed McMahon, a local talk show host.

Ed McMahon?

Well, it’s not THE talk show host. Or Pat McMahon? It’s on YouTube. Anyway, a local TV show. I just felt the need, the importance that somebody put a face to it. People would look at me and go, “I never would have thought that you would be one of those people.” I had a lot of people say that. I think that just fueled my desire even more. I did a campaign for Magellan, “One in Four,” on depression and a campaign called “Extraordinary People” where I shared my attempt.

What happened next?

I just started getting asked more and more to share my story. I found it to be very powerful to tell it and change people’s point of view.

What were people’s reactions, especially at that meeting? What were the first things they said?

Things like, “Oh my God, I’m sorry. We didn’t know.” “I had no idea.” Typical reactions. “Is there anything we can do to help?”

And what was your response?

You know, it was somewhat comforting that they cared enough to say something. But part of me was like, they were saying these things because they were uncomfortable with the story around suicide that I’d just shared.

Were most, if not all, of them mental health workers?

Most of them were, from various fields.

Shouldn’t they be used to hearing from people about suicide?

You would think so. I guess they weren’t prepared for someone to be so open. Suicide is still a word with a lot of stigma.

Have you noticed any change in reactions since you started speaking out?

People reach out and get to know me better. They’re more interested in getting to know me, they aren’t cut off by my suicide attempt, which is good. Unfortunately, now we’re starting up a suicide attempt survivors’ group and we have to work within the behavioral health system, and there are a lot of guidelines we have to work within. We run into a lot of stigma.

From whom?

Anyone from doctors to case managers. It’s a really interesting experience. I forget what a bubble I live in, my little world where I can talk openly about suicide and not think twice about it. But just the thought of getting a bunch of people who’ve had suicidal thoughts makes people uncomfortable. The fear of the contagion effect. Actually, it’s the opposite. If someone is able to talk, it reduces the risk.

Do you have any examples of people’s reactions? Things people said that made you want to smack yourself in the forehead and think, “I can’t believe they said that”?

I had a personal experience with a doctor that made me want to smack HIM in the forehead. My regular doctor, who had build a trusting relationship, had retired. So I’ve had a string of temporary doctors. This last one, who shall remain nameless, I went in to see him because my anxieties were high. He was taking down my history and asked what I did. I told him about my work. And he just locked onto the word “suicide.” “When was your last attempt? How many times have you attempted? How? When was your most serious attempt?” I was dumbfounded. Instead of focusing on what I had come there for, he locked on the suicide bit. I told him, “You know, I’m in a good place, I have my supports _ Hello, look at what I’m doing.” He had the nerve, when handing me my scrip for Klonopin, he held it for just that extra second before releasing it, looked at me and said, “Now, you’re not going to overdose on this, are you?”

Now I understand what people say when they refer themselves to the group, when they don’t want their doctors or case managers to know. I got it. When I tell different doctors what I do for a living, they get that look like, “Is that a good idea?” You can tell it makes them uncomfortable.

Have you found a way to put them at ease?

I try. I try to explain about the group, that I have a safety plan in place, that I have people around me who love me. I can go to my husband or my mother if I have suicidal thoughts. My mother lives with my husband and I. If I come in, sit on the floor and put my head on my mother’s knees and say, “One of those days,” she knows I’m having suicidal thoughts. The same with my husband. And an open conversation can be had around it.

They know what to do? And it works?

Yeah. It’s mostly listening, letting me get the thoughts out. They’re not trying to fix anything.

It sounds awfully simple.

Yeah. It does. And that’s what we try to provide in the group, a safe place where they can get it out and feel better. Instead of trying to stifle those thoughts or figuring out how to work out those thoughts ourselves, on our own, when they run wild on us.

And this work is a good idea for you?

Without a doubt, it is. Even if I’m having a bad day, I can tell the group. I’m a peer. Just like they are. I want them to realize they have the same power I have.

What about taking on their emotions? Isn’t the group intense?

So far, it hasn’t been. It has the potential to be, which is why I have supports in place. I have a co-facilitator, a supervisor, who is a clinician, in place. If there are challenges, there are people I can go to. Going through the phases of talking about it has made me very open about talking about suicide now. I feel it’s easy to go to somebody and say, “You know, I’m feeling challenges from suicidal thoughts.” With the group, I want them to understand I’m not perfect.

Tell me about the group. How many people do you have? What are they like?

We have seven members. It’s a very diverse group. Right now we have two men, two transgender and three ladies. They’re all primarily in the serious mental health behavioral system, where we get referrals from. Most are on disability. There’s one that works, and one does a lot of volunteer work. Three or four are actually participating in several groups or classes.

How does the group go? Have they loosened up at all since it started?

Yes. A normal group starts with the check-in: How’s your day, what’s worked and what’s not worked for you the past couple of weeks. Myself or the other facilitator brings a discussion topic unless a topic has already started during the check-in. We feel the group right now is very nurturing of each other. It’s loosened up quite a bit. It’s really interesting to see the group dynamics change from just two or three members. It was a little tight. It felt almost restricted. They weren’t as open.

What are you all learning from them? What’s been surprising?

What we’re learning is that this type of group is needed. People really are open to talking about suicidal thoughts. It goes against most of the stigmas out there. We’ve been surprised that most of the referrals have been self-referrals. So it’s been enlightening. When they find out the group exists, they want to be part of it. In general, I’m amazed at the compassion they have for each other, the support when one of them is having a challenge.

You mentioned having some restrictions with the group’s setup. What kind of guidelines are there?

As far as who can be in the group, I wish the guidelines weren’t there. I wish the group was open the public in general. It probably would have a better turnout. Because it’s funded by Magellan, we have to keep it within their guidelines. People in the group have to be Title 19, which is … I don’t know how to explain it in terms for someone not living in Arizona. Criteria such as having a serious mental illness, attempting suicide or having suicidal ideations, and you have to meet certain financial criteria. What that means is, you have to fall below a certain _ I hate using the word “poverty level” _ but a certain low-income category. Which makes them eligible for more services. Certain people like myself fall just above and have less available to us.

So if you weren’t the facilitator, would you be able to join the group?

No. Absolutely not. Because I don’t fall within the criteria. I’m only in because I’ve been involved since the very beginning.

How do you grow more of these groups?

Well, we keep getting out there, saying the word “suicide,” don’t shy away from using the word. We go out to the clinics, go to advisory board councils, talk about the group. We’re getting ready to do another round.

What about getting these kinds of groups to spread at the national level?

I guess just by getting people used to the word “suicide,” having people be OK with someone saying, “I’m having thoughts of suicide” or “I attempted it.” It’s got to be a cultural change. There won’t be one until we have more people with a voice ready and able to share their stories.

How do you know when you’re ready to share?

I believe that’s an individual and circumstantial process. I was in a certain circumstance when I felt it was important for me to speak out. One thing I can say is, someone who decides to speak out publicly really needs to make sure they have supports in place. That way, if something does trigger you, you have someone who gets what a bad day feels like.

(I asked about the concerns that led me to start the blog, described in “About the Blog.”)

Well, yeah. Of course there’s a concern that someone will do something that’s going to permanently affect their lives in a way they weren’t expecting. I can’t even imagine, having come so close to a completed suicide, finding that you’ve paralyzed yourself. There’s always a concern that someone will take a step too far, end up hurting themselves in a manner they didn’t expect. I know there’s a lot of times I worry about the people in the group _ we’re lucky, no one has attempted since they’ve been in the group _ how would I react if somebody attempted and became permanently disabled because of it? There are people who take these risks. I know in my last attempt, it was impulsive. I got halfway through a bottle of Klonopin and decided this was not what I wanted to do. I was in a panic. Was I too late? What happens now? Had I gone too far? I proceeded to make myself throw up as much as I could to keep myself from suffering permanent damage. I was fearful of saying something to my husband or my mother. Both were home and had no idea. This was before we had open conversation.

I hope this wasn’t the same bottle of Klonopin that the doctor handed you.

Yes, it was.

What! Do you find any humor in that, irony or something?

Yeah. He had no idea. The fact is that, the way he said it _ “You’re not going to overdose on ME, are you?” OK, I know whose ass you’re covering!

Yeah, I know others have had experiences like me who say, “Oh no, this is not what I meant to do.” And I bet some end up in worse-case scenarios, end up killing themselves or being disabled one way or another.

What can be done about that? There’s suicide prevention, crisis lines, lethal means restriction work

That’s a hard one. You’ve got all those things, but when you live in a society where you can’t mention the word “suicide,” or live in fear of saying the word “suicide” and there being some negative consequences _ as long as you live in that kind of world, you’re not going to be able to prevent it.

That sounds like a good ending. One more question: Who else are you, outside this issue?

I’m a wife, a mother, a daughter, a friend. I mean, I have a wonderful husband and mother who are just so supportive and caring. I have a wonderful daughter and two absolutely amazing granddaughters. I’m just really blessed to have parts of my family close to me. I come from an abusive background. Coming from an abusive home, I never would have thought I would have the closeness I do. I feel incredibly blessed. Like with my mom living with us. She’s 75. I always told my husband it’s a package deal. You get me, you get her.

After hearing this, I feel I should ask the question many people might ask: Why would you want to leave all of that?

As much joy as I have, there have been times when the emotional pain has been as much or greater. The pain and depression just get so overwhelming, and I just lose the ability to fight.

Anything else?


New: The Waking Up Alive house

The resources for people in a suicidal crisis are often pretty bleak beyond a crisis line call. I was happy to hear about a new project called Waking Up Alive, which appears to be the first of its kind in the United States and one of a handful in the world.

Sabrina Strong, a suicide attempt survivor herself, is the executive director of the New Mexico-based project, which is modeled closely on the pioneering Maytree Respite Centre in London. Maytree has been open for more than a decade as a welcome alternative to emergency rooms and psychiatric wards. It was founded by a longtime member of the Samaritans, which is well known for its “befriending” approach with crisis callers. Think of “befriending” as “making them feel more normal.”

Essentially, both Waking Up Alive and Maytree are homes, normal-looking residential homes, where people seriously considering suicide can stay for up to five days and try to clear their minds. The homes are meant to be a calm environment, with volunteers available around the clock for company and support. People can also leave whenever they choose, which certainly isn’t the case with psych wards.

An outside evaluationof Maytree after its first three years can be found here. It found that 70 percent of Maytree’s 159 guests by then had at least one suicide attempt before arriving. The report has some touching details, including one man describing life as like driving down a two-lane road, with no exit or shoulder, stuck behind a truck and trying to reach a destination he could never see.

Here is another independent report on Maytree from last year. It not only discusses similar programs in Canada and Ireland, but it also talks about other alternative approaches in Norway and elsewhere.

But back to Waking Up Alive. Opening a respite home for suicidal people in the U.S. wasn’t easy. “We’re soooooo litigious here,” Sabrina says. “We’ve hit the point in this country where people are so afraid of doing the wrong thing for someone who’s suicidal that they say, ‘You’re going to the hospital,’ and that’s it. Nobody actually wants to help someone before they’re hospitalized.”

By the way, the Waking Up Alive service, like Maytree, is free. Not bad, considering how much money they’re paying to nervous insurers.

Sabrina can tell you more:

So, where did you get the idea for this project?

It’s sort of an idea a lot of people in the suicide prevention field have kicked around, creating an in-between option for people who are suicidal but not enough to be hospitalized _ because that’s the traditional answer. Not only does that model not work, because a lot of times hospitals will not take people who want to be there, but some people are forced to be there, and that’s really a dehumanizing experience for a lot of people. A lot of people in the field say, “There’s got to be something we can do, a safe place.” But they couldn’t quite figure out how to do it. There are a lot of moving parts to creating a program like this.

Out here, we’re just so frustrated by how emergency departments, the crisis intervention system, worked. It’s obviously broken. There’s not enough capacity to meet needs. The only option was the hospital, so people waited six to eight hours in a waiting room with people who were psychotic or obviously criminally insane, escorted by police. They spend so much time in the waiting room that they start thinking, “Maybe I’m not suicidal. Maybe I’ll just go home.” And if you don’t have health insurance, nobody wants to take you. A lot of people are falling through the cracks. There’s no place to go for the specific help they need that allows them to keep their dignity and sense of control and safety.

We knew we needed something. We had an idea that that something would be a residential option. It was more of a pipe dream. A lot of people had the same pipe dream. But the liability in this country is too horrifying to wrap their heads around. Definitely in this country, but also around the world, there’s almost a critical mass that people know we need this. They don’t necessarily know what “this” is, but something better. I don’t know if it’s the way people are talking about suicide now, or those people working hardcore in suicide prevention and knowing. Regardless, I found someone who had the idea and found out how to do it. That someone was Paddy Bazeley with the Maytree Respite Centre. She started the program in London. She came from the Samaritans, the UK crisis line, and did that for years. She kept hearing over and over, “If just I could go somewhere for a few days, I could work this out on my own.” I don’t know about you, but I tried that, but you tuck all of these problems in your suitcase and take them with you. You end up in a strange place, and the suicide risk is greater.

Her idea was to have a house, a residential house, a place where people can come and stay. It’s not going to be clinical, not going to be medical. They don’t even search people, which is not an option for us. Basically, the stay there is about five days. That came about through trial and error. People get enough of a break, enough solid time to think and reflect and bounce ideas off of people. At the same time, they’re not away from home too long. It’s not like going to rehab. They’ve been doing this, I think, for 11 years now. It’s successful, and a lot of people around the world are figuring out how to replicate it. As far as I know, we’re the first in the U.S.

Do you know of others outside the U.S.?

There’s one in Ireland. And I got an e-mail from a woman in the Netherlands, though it’s not exactly the same program. I just started getting e-mails from a woman in Australia, she has some kind of fellowship on how to replicate that crisis model in their country. And because Maytree is aware of us, they’ve started referring people to us.

Just as you’re starting it all!

I know. It’s pretty scary.

Have people arrived yet? How has that gone?

Yep. It works exactly the way we thought. The first guest came through a couple weeks ago. It was kind of a trial basis, to make adjustments. We explained up front to people exactly what to expect. Part of making these models work is always having someone make the hard policy decisions. Somebody decides, “This is how it’s going to be.” Paddy’s way is, they don’t search people, and a lot of people think that’s crazy. That’s not for us. We have gun ownership in this country, and a lot of guns in the Southwest. We can’t not search them.

Clinicians are looking for that, a program that has been thoughtful about the risks. That’s why we require a referral from a mental health clinician. We can’t just take everybody on their word, that they’re going to be OK. We expect people to have problems, and we want to make sure they’re not at such imminent risk to themselves that they need to be in the hospital. We’re actually trying to get people earlier in their crisis, before the choice isn’t theirs anymore.

We are very up front with people, so they’re not surprised. I remember that kind of experience being hospitalized. It was really frightening. Like, “OK, now we’re going to strip search you.” I was like, “How did I get to this point?” Like, oh my gosh, it’s just an experience not to repeat.

So people who come don’t have to worry about insurance. It’s all free, right?

Right. As long as we can manage to keep it free. We’ll open it up to people out of state, but they’ll have to pay. We’ve had people contact us, desperate. People are looking for anything. They’ll take anything. We have a teeny-tiny bit of funding, but we keep it reserved for people who live in this state.

How many people have come through?

So far, just the one. The word is still percolating. Clinicians are starting to contact us and ask us five million questions. They like what they’ve heard. They appreciate how well thought out it is. People appreciate that. Because we’re obviously shifting the liability to clinicians because they’re making the referral, they want to make sure nothing will come back on them. We’re soooooo litigious here. We’ve hit the point in this country where people are so afraid of doing the wrong thing for someone who’s suicidal that they say, “You’re going to the hospital,” and that’s it. Nobody actually wants to help someone before they’re hospitalized.

What’s so brave about you?

So yeah, everybody asked, “You’re really going to do it?” It cost us an arm and a leg and a firstborn just to insure the program. That’s why it took so long. We couldn’t get anybody to even entertain the idea. Once we pulled together the insurance quotes, it was outrageous. I was told that was to be  expected.

How much is the insurance?

About $7,000 a year. Not cheap.

I read over the Maytree site and how it works. Have you made any changes? Especially to the policies of no follow-up contact after a person leaves and the limit of having just one stay?

I want to. The follow-up piece is something you have to be incredibly thoughtful about, and find a way to pay for it. So I do follow-up phone calls, e-mails to collect data for grants, because people want to know, “Does it work?” I want to follow up after a week, a month and a year. To me, it’s not ethical to call someone once a year and ask, “Are you still alive?” and stick that in the win column. It also opens up a world of things when you ask someone, “How’s it going?” and hear “Life sucks” and you have an obligation to do something. I have a lot of ideas. But securing the core of the program is step one. You have to be thoughtful, because you’re opening up a huge can of worms when you ask, “How have you been?”

Also, we talked about that, not being able to come back. Most people in the mental health world understand that. You have what are called repeat offenders, who come back again and again and again. Who knows. They’re hungry and you feed them, or they’re homeless, or they’re really just miserable all the time. You end up finding out more and more about that person and their life and their illness, and we’re not equipped to do that. We deal with suicide, not with the disorder or the self-injury or whatever the diagnosis is, and the more contact there is, the more you have to know about that.

I never say never. Because some people are chronically suicidal, and they might not get the same benefit out of it, there are different conditions under which some people might be able to return. But it’s not a revolving door. We’re not here to be abused, but we don’t want some people to feel they can never come back. And actually, Maytree does the same thing. If there’s a circumstance that changes in that person’s life, they sometimes take people back. And they have taken people back.

In an early article in the UK press about Maytree, Paddy talked pretty straightforwardly about the possibility of having a death there. How do you address that?

Yes. They have 10 years of data on how it works. She said that we can expect people to kill themselves in the program _ or, excuse me, to try to kill themselves. They’ve never had a death. It’s a worst-case scenario we have to plan for. We tell volunteers, “You’re choosing to do this. You’re working with high-risk people, and at some point you’re going to lose somebody.” You’re playing the odds. They had one person go home and the next day kill themselves. It’s gonna happen. People are going to make what in their mind is an informed decision. All we can control is what happens here, to a certain extent. That’s why we search, and why we ask them not to bring more than seven days of medication.

People may try to kill themselves on site, but don’t I recommend it. We will have eyes on them every 15 minutes, if they’re talking, if they’re journaling. We’re prepared as much as we possibly can be. There were a handful of attempts at Maytree, every time an overdose, and every time the person thought better of it and went and told them. I tell people, “Just don’t freak out, OK?”

Talk a bit about your background, having attempted suicide yourself, and any concerns about how this work will affect you.

Yes. I was chronically suicidal for about a decade, in my late teens and 20s. It ended in a serious suicide attempt, and I spent four or five days in a locked psychiatric unit. It was a turning point. It got me to a point where I could finally get the help I needed. But at same time, it was such a long, drawn-out downward spiral that someone should have been able to step in at some point and say, “You need help. Let me help you.” How many years do you have to go through that before an intervention? It took a few years to even figure out how to talk about it, and taking that and being comfortable sharing that in a professional setting.

Any reasonable person would be nervous going into this. I talked with my therapist. He actually helped a little bit getting this project off the ground, and he knows what I’m doing. I know at some point something is going to happen. I tell people, “I don’t expect you to be superhuman. You will trip over your own baggage. I just want you to know it’s there. If something sets you off, we’re going to sit down and have a chat about that.” I think that’s the best you can hope for.

Did you plan and furnish the house yourself?

Yeah. We got a start-up grant to do what we needed. We got a lot of stuff donated. After that, we bought things here and there. We’re renting. We’ve been lucky enough to have people who sort of believed in us and helped us along the way.

Do you have your own favorite space in the house?

I like a lot of the spaces in here. We took a lot of care selecting things, just the right setup. Every sitting area, I really love. It’s a place where people want to sit and talk. That’s what Maytree is, a lot of tiny rooms with chairs to sit and talk.

Have you been to Maytree?


Professionally or personally?

I was on vacation, and we were at the point where we were kicking around the idea. I started Googling suicide prevention programs in the UK, and I said, “This is the thing. Someone’s actually done this.” I went and talked with Patty and got a tour of the house. It was pretty awesome. I asked her every question I could think of. The truth is, it’s a very simple model. If you don’t mess with it too much, it has a magic of its own. It’s a place where people are not going to freak out if you’re talking about suicide.

Did you have one big burning question for Patty?

It was more like, “How do we do this? What are the things that absolutely make this program what it is?” And she said, “It’s a program about talking. There’s really no structure to it. It’s really just talking and talking, and talking some more.” It’s not a place that’s a revolving door. It’s putting ownership on people where they have to make the most of their time. The last thing she said to me was, “My advice is, just do it. You’ll be surprised to find what will happen. You’ll be surprised at what kind of support you’re going to get.” And I did. Literally, I got home and I had a grant announcement in my in-box and I said, “I think we can get this.” And we got it. And I thought, “Oh my god, these people are as crazy as I am.” But people understand the need for it. They love we’re doing something _ we’re doing anything _ we’re doing something new and radical: “Wait, we’re the first one in the country, and we’re in Albuquerque?” Hey, it’s just happening. It’s just happening. And it’s been nonstop since.

It can be difficult finding people to support anything related to the topic of suicide. Would you like to thank anyone here?

OptumHealth of New Mexico, because they took a chance on us. They gave us every penny we asked for and said, “Go do it.” And our volunteers and staff, they’re kind of amazing. That anyone wants to do this amazes me. Obviously, the folks at Maytree, Patty was great. Hopefully we can pay it forward to help other places get off the ground. I didn’t realize how much of a big deal it would be not just here in the U.S., but internationally. Since we’re on the short list of places that got it off the ground.

Outside of this work and your experience, who else are you?

That could take forever to answer. I’m a lot of things. Just right now, this here’s one of the things taking up all my time. I know once we can get it off the ground, I can go back to having a life. Right now, this is where I want to be. I’m always doing something about some taboo topic that just makes my parents cringe: “What is she doing now?” I guess they’re probably happy I’m not doing safe sex education anymore.

Have they been by the house?

Oh yeah. My mom is a volunteer here. My dad actually is working overseas, but he did a few things cosmetically we needed done here.

Your mom is a volunteer!

I’m as surprised as anyone else.