My brother, Wayne, would have celebrated his 41st birthday this month, but he died by suicide 10 years ago. If you’ve ever doubted that stigma surrounds this topic, consider that it has taken me (a psychologist who’s spent years working with trauma and empathizing with clients’ darkest moments) a decade to acknowledge his suicide in a public, uncensored venue. My CDP colleagues have written powerful blogs about coping in survivors of suicide (see recent posts by Dr. Lisa French here and Dr. Regina Shillinglaw here) that inspired to me to reflect both on how I’ve coped with Wayne’s death, and how it has influenced my clinical work.
Wayne was always a complicated person who defied description. He routinely got suspended from school, but was also the most charismatic person I’ve ever known. It’s impossible to travel around NY without running into someone who wants to share their memory about Wayne making them laugh or helping them out. In many ways, he was a typical older brother: he teased me mercilessly, but would physically threaten anyone else who tried to do the same (I still feel a little bad for that guy in the bowling alley). You can add him to the list of people whom you’d never expect to die by suicide. Much like Robin Williams (the legendary actor who died by suicide in 2014), Wayne always seemed like he was having more fun than anyone else in the room.
As it so often happens with loss, Wayne’s death feels both like it happened just yesterday, but also like it happened eons ago. I’m sure I passed through each of the “5 stages of grief” -- denial, anger, depression, bargaining, and acceptance -- though I remember some more clearly than others. It seems ridiculously trite to say, but being a sibling survivor of suicide was and is the hardest thing I’ve ever had to do. Even 10 years later, I am always trying to find a balance between processing my own emotions and being a rock for my parents. I am forever grateful for the outpouring of support that my parents received from friends, neighbors, and family. However, I also understand why sibling survivors are called “the forgotten mourners,” often receiving less support than parents or significant others. That said, the benefit of having many friends who are also mental health professionals ensured that I did not fall into that category. Some friends knew exactly what to say, sent brownies, and then came over to eat them with me. Other friends were clearly less comfortable and seemed to have developed a sudden interest in my thoughts on the weather. In a funny way, that latter group of conversations was equally powerful; the fact that people reached out even when they were uncomfortable ensured that I was not a forgotten mourner.
As with any loss, I have found ways to honor my brother’s memory. Some ways are more obvious and easily shareable, like me writing this blog or running a suicide awareness and prevention 5k in his honor. Other forms of remembrance can only be appreciated if you understand our complicated relationship and shared dark sense of humor. Like the fact that when I ran that 5k, the hilliest course I’ve ever run, I cursed him for continuing to be the quintessential older brother and finding a way to torture me from beyond the grave. I like to imagine him laughing harder and harder as each new expletive bounced around my brain.
On a professional level, Wayne’s suicide had a profound impact on my work. I’d like to say it made me a better clinician, but I’m not sure that’s wholly true. On the one hand, I have become a very cautious clinician. I spend a lot of time assessing suicide risk factors, discussing safety plans, and consulting with treatment teams. My documentation is always thorough and timely, and I teach my students to ask very difficult questions about suicide. It’s as if my mantra has become, “Not on my watch!”
But on the other hand, Wayne’s suicide has made me doubt my clinical skills. I was already working as a psychologist when Wayne died and I’ve always been plagued by guilt-laden thoughts such as “What should I have done differently?” and “What warning signs did I miss?” I’ve accepted that I’ll probably always entertain those thoughts to some extent, even if all of my education and experience point to these being unanswerable, unhelpful, and unfair questions. And despite all of my clinical caution, I have had patients who made suicide attempts while under my care; it has happened “on my watch”. Because I was lucky to work with a supportive group of colleagues and supervisors who shared their own experiences, I felt sadness and a desire to deliver even better clinical care without the accompanying burden of guilt or shame. But I did often fear what other providers would think of me. If they knew about my brother’s suicide, would they think I was incompetent? What if my patients found out? Would they also think I was incompetent? Or would they try to protect me from emotional pain by censoring their own? I worried about my ability to handle the emotional burdens of being a clinical psychologist. What if a patient presented with a similar story to my own? Would I have enough emotional fortitude and professionalism to stay engaged without becoming overwhelmed or vicariously traumatized?
Fortunately, over time, I have figured out what I need to stay healthy and effective as a psychologist. Of course, my needs have changed over the past decade. Initially, I avoided working with clients who presented with grief. Within a few months I felt able to work with grief as long as I could consult with trusted colleagues. This process of what I’ll call “professional recovery” continued over the years with me regaining confidence in my abilities. I still set a limit for myself in working with patients whose traumas remind me of my brother’s suicide. Twice in the past six years I’ve referred new patients to colleagues because I did not feel that I could remain objective or engaged. I don’t know if my professional limits will continue to change over time, but I know having a small group of trustworthy colleagues to consult with has been the most important factor in my professional recovery.
It is my hope that this post is received less as a self-indulgent memoir and more as my personal attempt to reduce the stigma associated with suicide. I wish to end with some eloquent guidance for survivors of suicide and maybe title it “My 10-Point Plan for Coping with Suicide and Overcoming Stigma and Still Being a Super-Awesome Clinician.” I would design a pastel-hued pamphlet and include stock photos of a puppy and people holding hands. But the reality is that, like many survivors, I’m making up my 10-point plan as I go along. Today it includes writing this blog, but it has also included periods of blasting emo rock in my car (a long, long time ago…I swear!). My own patience and acceptance of this process waxes and wanes over time, but all of my psychology training tells me that this is normal and expectable. Perhaps the only constant in this process for me has been the presence of a handful of trustworthy, empathic friends and colleagues who admitted that they didn’t always know the “right” thing to say, but who sent brownies, talked about the weather, shared their own stories, and made room on their caseloads for my referrals.
Carin M. Lefkowitz, Psy.D., is a clinical psychologist and Cognitive Behavioral Therapy Trainer at the Center for Deployment Psychology (CDP) at the Uniformed Services University of the Health Sciences in Bethesda, Maryland.