The one year anniversary of my mother's suicide is approaching, and I'm grappling with what we could have done differently.
My mother struggled with her mental health for her whole life. Her father was an alcoholic and her own mother had postpartum depression and a thyroid condition that made it hard for her to get out of bed a lot of the time, or to parent in an attuned or attentive way.
My mother's family made several international moves before she was ten. Now as someone whose job is largely suicide risk assessment, I know that that that's a major chronic risk factor for suicide later in life. She actually checked pretty much every box for every chronic risk factor, except for being male, street involved, or indigenous- although at one time they lived on an isolated First Nations reservation with a lot of violence, alcoholism, and inter generational trauma, and she mentioned to me feeling that white therapists could never know what it was like to be a child in that setting.
I had a middle class childhood with music lessons, summer camp, a trip to Europe when I graduated. It was punctuated here and there with being sent to my grandmother's house in another city for a month or three at a time, during which time I wouldn't attend school. It didn't bother me- I liked my grandma's house and I did well in school anyway. This would usually happen if my mother had a stomach flu or something. She'd throw up for a few days, maybe faint, and I'd go away for a bit. I didn't think it was weird. She couldn't really maintain friendships, so we didn't have people over or go to many social things. We didn't have "family friends" per se.
When I was fourteen my mother had her first suicide attempt that I was aware of. I stayed home from school to care for her and eventually got offered the choice of a call to CPS or a truancy officer.
As a teenager, particularly as I spent more time around other people's families, I became aware that my mother's communication could be cruel. Once she told me she was done being a parent to me because I ate the chocolates for a few days ahead in my Advent calendar. She tended towards black and white thinking. In college I lost my debit card and she tried to make me sign a contract saying she could make my life decisions for the next five years. She sent long, cruel emails saying she never wanted to talk to me again, or long emails professing her love and devotion and apologizing for how she damaged me and ruined my life.
When I left for college, she made a more serious suicide attempt. She started experiencing chronic pain that doctors said was just stress, and no one would treat. She started drinking to cope. Suicide attempts increased in frequency. My stepfather didn't even tell me about all of them.
Throughout my twenties, she was in and out of treatment for alcoholism. It was all subsidized faith based treatment centers, and she was never able to access real, evidence based therapy for her mental health, her substance use, her trauma, or her pain.
One of the suicide attempts caused her to seizure and hit her head. She had brain damage, and after that was barely recognizable as my bright, quick, quirky mom.
Occasionally she would be hospitalized, but it always focused on behaviorally containing her for a bit after a suicide attempt, tweaking her meds, and never actually reducing her distress.
In December of 2019, she was diagnosed with BPD. She discovered forums for family members of people with BPD and NPD and read about herself in terrible terms: that she was manipulative, that her pain wasn't real, that family members should cut themselves off from her, that she had no capacity for empathy, reciprocal relationships, or recovery. She sent an email identifying all of this to us, and self diagnosing as a narcissist we should stay away from.
Then she intentionally ODed in a hotel room at 56.
I know I personally couldn't have saved her, but I wonder what we, collectively, as a society could have done better. I see so much rhetoric online vilifying people with BPD, and I get really triggered and kind of depressed seeing the lack of compassion for people who struggle to fit with their environments in this way. All the advice is cut them off, excommunicate them, focus on your own boundaries. I work in healthcare and people with BPD are treated as low suicide risk because they're understood to be manipulative and just trying to get attention. The research says BPD is a much better predictor of suicide than any mood disorder, but we turn people with BPD away and dismiss their pain. There is no publicly funded access to DBT where I live or where she lived. And I think more glaringly, there's just no sympathy for this constellation of difficulties.
I look back on her life, and I wonder, how could I/we have been more gentle with her, and helped her know that her life was precious and meant something? I work in a field where I have some influence, and I've designed a training on compassionate and evidence based suicide risk assessment of people with personality disorders, in her memory. I would like to use my position to do more. |
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