DEAR DOCTOR K: My friend’s son recently committed suicide. What can I do to support her during this awful time?DEAR READER: More than 30,000 Americans die by suicide each year, leaving behind devastated family and friends. That’s about one out of every 10,000 people in the United States.

To some extent, someone who loses a family member to suicide suffers a loss similar to that as if the person had suffered another type of unexpected or violent death, such as a heart attack, car accident or drowning.

But people who lose a family member to suicide have additional challenges. These may include shame, which is reinforced by society’s attitude about suicide. They may also struggle with guilt over whether they could have prevented the death, if only they had done something different.

One of the most important things you can do is to offer your support and compassion. Because suicide carries a stigma, some friends and family may back away, unsure what to do or say. Your simply being there will help.

Here are some more specific suggestions for supporting survivors of suicide loss:

— Normalize the grief. Encourage your friend to engage in the same rituals she would use to grieve any death. For example, she might hold a memorial service. Remind her that suicide is a tragic outcome of depression or another mental illness. In that way, it is similar to death by heart attack, which may result from cardiovascular disease.

The stigma of suicide may come from the blame that some attach to the mental illness that leads to suicide. For some people, mental illness is a character flaw, a personal weakness. They don’t see it as I and many doctors see it, as a physical illness that is caused by disordered brain chemistry. Influenced by life events, surely, but at root a physical illness like the atherosclerosis that causes a heart attack.

— Ease guilt. It may help to remind your friend that even mental health professionals cannot predict when such a death might occur — not to mention that we have very little control over someone else’s behavior. Encourage your friend to consider therapy. Cognitive behavioral therapy, interpersonal therapy and support groups can all help sort through the barrage of emotions that she is experiencing.

— Support openness. Encourage your friend to talk about her son. Let her know you are there to listen to any details about him, and about his death, that she is comfortable sharing.

— Plan ahead. Assist your friend in finding ways to mark (or simply get through) her son’s birthday, family holidays or other milestones.

The American Foundation for Suicide Prevention recommends against using the verb “commit” when talking about suicide. That’s because this word is often used to connote criminal or sinful behavior. I’ve purposely used phrases such as “die by suicide” to avoid further stigmatizing this type of death.

As seen in “ASK DR. K" by Dr. Anthony Komaroff, URL: http://www.uexpress.com/ask-dr-k/2015/10/13/suicide-is-the-result-of-disease, Copyright © October 13, 2015. All rights reserved. Reprinted with permission of the author. Dr. Anthony Komaroff is a practicing physician, Professor of Medicine at Harvard Medical School, and Editor in Chief of Harvard Health Publications.

I am one of many who would say that Robin Williams was among my favorite actors. His portrayal of a psychologist in Good Will Hunting is my all-time favorite. A colleague of mine told me her kids said to her last night, “Mrs. Doubtfire is dead.” They were crushed by this news which seemed so unbelievable based on their experience of the character. He was a figure that transcended generations. It was a very sad day for many, and my heart goes out to his family, who will bear the incredible pain of his death long after the news cycle ends.

I recalled that he had a history of struggles, but I was still shocked to hear that he had died by suicide. He was a genius and had many supports. But of course depression doesn’t calculate those things. Severe depression distorts rational thinking and can lead to the fixed idea that hopelessness and pain are to be your experience forever. I have heard this from patients who have lived after suicide attempts. They told me they had lost all perspective and simply wanted to end their pain. They often reported simply losing a sense that they mattered to other people and forgot that they too were loved.

Depression distorts reality and causes a risk of death. It is a persistent and serious public health crisis that doesn’t get enough coverage. It can happen to anyone and is associated with a great deal of the suicides in our country. When combined with a substance use disorder it becomes even riskier and harder to treat, and when it is part of a bipolar disorder it requires extra attention. Other public health problems like heart disease have seen great results in the past several decades—we cannot say the same about suicide.

What can we do about this public health crisis that takes so many from us?

Advocate. Fight for better treatments and for research into the underlying causes of psychiatric illnesses.
Be proactive. Work to be sure that people get screened for this depression and that help happens earlier. National Depression Screening Day is October 9.

• Get medical. Get checked for medical causes of depression like thyroid disease.
• Take the long view. We can encourage people to stay with treatments as some do work even after others have failed. That is well established from the STAR*D study by NIMH.
• Integrate. Co-occurring disorders (like depression and substance use) often are poorly integrated into a persons care plan. This needs to change as substance use can be a failed self medication strategy to treat depression.
• Change the field. We can demand more cognitive behavioral therapy, which clearly helps with depression, but many mental health professionals aren’t trained to provide it.
• Open up. We can change the dialogue about depression—it is a condition that needs to be talked about. Isolation and silence are the dangerous traveling partners of depression.
• Come together. Our voice is more powerful together than alone.
• Love. Like Robin’s character in Good Will Hunting we can reach out and love those we know who are struggling and let them know we are here for them.

Chances are someone you know is struggling with depression, and this is a simple way that can make a difference.

Rest in Peace Robin. We shall all miss you.

Photo: Flickr / Eva Rinaldi

"ASK DR. K": What are some suicidal signs to watch for in someone severely depressed?

DEAR DOCTOR K:

My husband suffers from severe depression, and I’m worried he might take his own life. How do I know if my fears are warranted?

DEAR READER:

FAMILY HISTORY. People with a close blood relative who has committed or attempted suicide have a much higher than average risk of suicide. The risk of suicide also is higher if close relatives have had a history of any type of mental illness or violent acts.

ACCESS TO GUNS. Having a gun in the home makes suicide more likely.

SUBSTANCE ABUSE. Alcohol or drug use can erase inhibitions and anxiety that might help keep suicide at bay.

PREVIOUS ATTEMPTS. People who have attempted suicide are more likely to commit suicide than those who haven’t tried it before.

A SIGNIFICANT LIFE CHANGE. A change in a person’s life can also abruptly increase their risk of suicide (though most people in these circumstances do not kill themselves). For example:

SETTING AFFAIRS IN ORDER. Finally, there is a warning sign that is paradoxical and dangerously misleading. Has your husband recently sorted out his finances, given away mementos, or called or visited loved ones? Along with these activities, has he seemed calmer and happier lately?

Of course, you want your husband to be happy. But if he seems suddenly happier and is doing things that people do as they approach the end of their life, be really worried. Rather than being a sign of returning health, his happiness may indicate that he is at peace — after having made a final decision.

A friend of mine lost his wife just this way. After many months of suffering, she finally seemed happier. She stopped seeing a psychiatrist, which he also interpreted as a very good sign. Then one day the unimaginable happened, and he was devastated.

Look out for the factors I’ve discussed. If you believe your husband is suicidal, seek help immediately:

As seen in “ASK DR. K" by Dr. Anthony Komaroff, URL: http://www.askdoctork.com/suicidal-signs-watch-someone-severely-depressed-201405076350, Copyright © May 7, 2014. All rights reserved. Reprinted with permission of the author. Dr. Anthony Komaroff is a practicing physician, Professor of Medicine at Harvard Medical School, and Editor in Chief of Harvard Health Publications.

"Journey to Survival: Searching for 'Normal'"

By Deena Baxter

The Callous Call From Hell came unexpectedly: “This is the landlord in Brazil. Your son is dead.” That was the moment my unwanted journey to survival began, a search for “normal”, after losing our youngest son to suicide - death by mental illness.

Survival is a destination with no map to guide us. It’s located beyond our national borders, in a state of being, a state of mind. Cyber Siri was no help: she had a melt-down and Apple refused my request for an iPhone refund. What use is a ‘knowledge navigator’ if it can’t provide destination coordinates? I was left to my own devices with my home team: me, myself and I. The first priority was to inform my husband, our other two sons and family, a task so arduous and painful I’ll spare you the details. The second priority was to honor our son’s wish to be buried in the U.S.; easier said than done, considering he left no will or estate plan but did leave a Brazilian wife and Brazil laws and customs foreign in more ways than you can imagine.

I was left to find a way to respectfully honor his mind, body and soul - and hold on to mine. There was only one path that worked for me: learning to be present in the moment, quiet my aching being and learn to listen to the messages from my heart. Eckhart Tolle’s concept of “the power of now”, along with his teachings, became life changing and life affirming. That clarity enabled me to put together a Survival Kit, adding helpful tools along the way: books, compassionate friends, a support group, and more. Some tools worked better than others, some were discarded, other remain a vital part of my kit. Equally important, I carved out sacred time to talk with my husband and respect his own journey, one far different from mine. Priorities changed: I let go of tasks, some friendships a little past expired, and accepted, with sadness, that some friends turned out not to be. Perhaps you can relate.

My journey to survival is two-years young. It has unfolded with many twists and turns that led me to question what is truly normal in our society and who gets to decide: The American Psychiatric Association, Big Pharma, Big Media, your doctor, your mother, your ex-husband, your child, or other perfectly imperfect humans? I came to accept the sad and painful truth: how the stigma of mental illness keeps it cloaked in denial and how that can play out when the patient, the family and society collude to maintain the status quo. I found a purpose in all this knowledge and sadness; using heartache, humor, and art to help bring mental illness out of the darkness, into the light and give it a life-affirming voice - a voice worth listening to.

In partnership with NAMI of Collier County, I launched The Surviving Suicide & Sudden Loss Project including a book titled Surviving Suicide: Searching for “Normal” with Heartache and Humor and this website focused on mental health. My hope is that this project benefits you or someone in your world, too.

In the words of Rita Mae Brown: “The statistics on sanity are that one out of every four people is suffering from a mental illness. Look at your 3 best friends. If they’re ok, then it’s you.”

Surviving Milestones, Birthdays & Holidays:

• Stay tethered and anchored to reality: Meditation, prayer, a nature walk, yoga - find what works for you.
• Have a plan: Let your heart be your guide. Do what feels right. If you are in a relationship, do this in partnership or with other trusted family or friends.
• Support: Take time for solitude and grieving but don’t isolate. Establish a support system (support group, religious leader, therapist).
• Pick and choose your battles: You don’t have to engage in every battle you are invited to.
• Smile: There isn’t much laughter in medicine but there is much medicine in laughter.

A version of this article was published in è Bella Magazine, October 2014, Copyright © 2014. Reprinted with permission of the author.

"Navigating Through the Unexpected"

By Deena Baxter

To successfully weather life’s unforeseen challenges, you’ll need a tool kit.

Rise and shine! My pulsing alarm clock awakens me to another day's journey through life. In the rearview mirror I see how far I've come: more than half way to my destination, with successes and failures behind me but uncertain when and where the trip will end, and whether my Bucket List will be completed. There are no roadmaps available. What I do have is a Tool Kit alongside my Bucket List that helps me negotiate the inevitable random speed bumps, detours, and bridge collapses along the way. It includes endurance, resourcefulness, resilience, reinvention and renewal, and when all else fails, humor.

Don’t Avoid Risk: One of my MBA professors said it best: "You'll never achieve success if you're afraid to fail. Give yourself permission to take risks, learn from your failures and start anew." This gemstone helped me re-frame my life and learn to be more comfortable with uncertainty. At work, it empowered me to speak up at meetings, demand raises for my team based on performance, and look for creative ways to solve problems. Shortly after earning my degree, my high-tech employer began "right-sizing"—which is business-speak meaning, "Our employees are our most valued asset…until they're not." The day I delivered my 53rd pink slip, I resigned. "Layoffs are becoming my core competency,” I told my boss. “My soul is dying, and this is not why I earned my MBA."

Risky? You betcha! Suddenly, the cutthroat corporate ladder to success and the generous stock options simply weren't worth the price. I repackaged my skills and, within three months, landed a new career in academia, managing an international research program at MIT—the hardest work I ever loved.

Reinvent on the Fly: It was tougher applying those tools to my personal life: a divorce, single motherhood and a re-marriage pre-packaged with the role of stepmother. We certainly weren't The Brady Bunch (nor did we have a peppy theme song). Our family tree was redefined with new branches, including ex-spouses, new in-laws and “outlaws.” The tree also struggled to thrive under unfamiliar conditions: Sunlight filtered through a canopy of divorce laws. Holidays and vacations required new parenting skills, with children from both marriages competing with each other and demanding a piece of us. Thankfully, love did get us through, but our hearts had lots of Band-Aids.

Build a New Bridge: Bucket List achievements are easier when the road is clear, the pavement is dry, and the wind is at your back. What tests our metal is when the bridge collapses. In my case, it was losing our youngest son to suicide in 2012—at which point the trip took an abrupt detour.

This was the ultimate mudslide; there was no way to avoid getting dirty. There was no ignoring the awfulness. I had to sit with uncomfortable feelings and be open to their messages. Until then, I often was so focused and stressed that I ignored that inner voice, often to my own detriment. Spiritual teacher Eckhart Tolle notes that, “Even within the seemingly most unacceptable and painful situation is concealed a deeper good, and within every disaster is contained the seed of grace."

Staying present: Learning to be present and valuing the moment made me more open to the beauty of simple things: the scents and sounds of nature, meeting new people along the way, and taking “time outs” to appreciate serendipitous moments. Today, when I have the inevitable “bad hair day,” I try to put things in perspective, to recognize there’s no need to get derailed by it. After all, we all have bad days, because each of us is perfectly imperfectly human. My new mantra is: "Take a deep breath, this too shall pass, get out of your own skin, get a haircut and reach out and help someone in need."

Today I'm focused on giving mental illness a voice through my writing, and launching a guided meditation program based on Eckhart Tolle’s work. I no longer view success as the end-point; rather, it’s about how we stay grounded navigating through the maze. It’s how we renew our minds, bodies and spirits while negotiating major change, adjusting to new realities and establishing our "new normal."

The women and men I meet who travel that road while remaining grounded are those I deem "successful." Some are in the spotlight, but the vast majority live far from center stage. They have redefined the road to success: What matters most to them, and to me, is the quality of the journey.

A version of this article was published in è Bella Magazine, January 2014, Copyright © 2014. Reprinted with permission of the author.