Suicide.  Self-inflicted death. The pain that drives an individual to commit suicide is mirrored by the pain experienced by those left behind to mourn.

In the past year, suicide has touched a number of families and individuals in our community. Two newly married men.  A high school boy. A college student. A friend. We react with shock that spirals into grief punctuated by a simple question: Why? And “was there something we could have done? Or noticed?”

Suicide is on the rise, both in the military and within our communities. By a margin of 2-1, it outstrips homicide as a cause of death in the United States, and is the 11th ranked cause of death in the United States. Statistically, more men actually succeed in killing themselves, while more women attempt suicide but do not die, in part because  men typically use more violent means (guns, hanging) to end their lives than women, who often use failure-prone methods such as overdosing.

Suicide may occur for a number of reasons, including depression, shame, guilt, desperation, physical pain, emotional pressure, anxiety, financial difficulties, or other undesirable situations. The World Health Organization noted that over one million people commit suicide every year, and that it is one of the leading causes of death among teenagers and adults under 35. There are an estimated 10 to 20 million non-fatal attempted suicides every year worldwide. It is estimated that each suicide in the United States leaves an average of six people intimately affected by the death, either as a spouse, parent, significant other, sibling, or child of the deceased person. These people are referred to as survivors.

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The predominant view of modern medicine is that suicide is a mental health concern, associated with psychological factors such as the difficulty of coping with depression, inescapable suffering or fear, or other mental disorders and pressures. Suicide is sometimes interpreted as a “cry for help” and attention, or to express despair and the wish to escape, rather than a genuine intent to die. Most people who attempt suicide do not complete suicide on a first attempt; those who later gain a history of repetitions have a significantly higher probability of eventual completion of suicide.

Common Suicide Risk Indicators

• A previous suicide attempt, even if it seemed staged or designed to get attention, or boasts of past or secret suicide attempts.
• Talking about being dead or wishing they were dead, how others would be happier if he/she were dead or how much better off others will be when he/she is gone.
• Repeatedly engaging in very risky or dangerous thrill seeking behavior.
• “Getting the house in order” – making plans for the care of loved siblings, parents, relatives or pets and giving away cherished belongings to close friends.
• Extreme mood swings; very depressed episodes followed by happy episodes with no clear reason for the change.
• Regular expressions of worthlessness, helplessness, sadness and/or loneliness.
• Drastic changes in habits, friends, or appearance, ie: new friends, skipping school, dropping out of favorite activities, and no longer caring about appearance or cleanliness.
• Changes in weight, sleeping habits, and physical activity.

A risk-assessment quiz designed for teenagers is available online.

When someone dies by suicide the people left behind can wrestle with a terrible emotional pain. Teens who have had a recent loss or crisis or who had a family member or classmate who committed suicide may be especially vulnerable to suicidal thinking and behavior themselves.

If you’ve been close to someone who has attempted or committed suicide, it can help to talk with a therapist or counselor — someone who is trained in dealing with this complex issue. Or, you could join a group for survivors where you can share your feelings and get the support of people who have been in the same situation as you.

What if this is you?

If you have been thinking about suicide, get help now. Depression is powerful. You can’t wait and hope that your mood might improve. When a person has been feeling down for a long time, it’s hard to step back and be objective.

Talk to someone you trust as soon as you can. If you can’t talk to a parent or a friend, talk to a coach, a relative, a school counselor, a religious leader, or a teacher. Call a suicide crisis line (such as 1-800-SUICIDE or 1-800-999-9999) or your local emergency number (911). These toll-free lines are staffed 24 hours a day, 7 days a week by trained professionals who can help you without ever knowing your name or seeing your face. All calls are confidential — no one you know will find out that you’ve called.

What if this is someone you know?

It is always a good thing to start a conversation with someone you think may be considering suicide. It allows you to get help for the person, and just talking about it may help the person to feel less alone and more cared about and understood.

Talking things through may also give the person an opportunity to consider other solutions to problems. Most of the time, people who are considering suicide are willing to talk if someone asks them out of concern and care. Because people who are depressed are not as able to see answers as well as others, it can help to have someone work with them in coming up with at least one other way out of a bad situation.

Even if a friend or classmate swears you to secrecy, you must get help as soon as possible — your friend’s life could depend on it. Someone who is seriously thinking about suicide may have sunk so deeply into an emotional hole that the person could be unable to recognize that he or she needs help.

Trauma, PTSD, and Suicide

In a survey of 5,877 people across the United States, it was found that people who had experienced physical or sexual assault at some point in their life also had a high likelihood of attempting to take their own life at some point:

• Nearly 22% of people who had been raped had also attempted suicide at some point in their life.
• Approximately 23% of people who had experienced a physical assault had also attempted suicide at some point in their life.

These rates of suicide attempts increased considerably among people who had experienced multiple incidents of sexual (42.9%) or physical assault (73.5%). They also found that a history of sexual molestation, physical abuse as a child, and neglect as a child were associated with high rates of suicide attempts (17.4% to 23.9%)

People with a diagnosis of PTSD are also at greater risk to attempt suicide. Among people who have had a diagnosis of PTSD at some point in their lifetime, approximately 27% have also attempted suicide.

Suicide has also become an item of serious concern within the military, which has recorded epidemic levels of suicide in the past year. The stress of repeated deployments  on both military personnel and their families has triggered a surge of emotional/psychiatric issues, including surges in both suicide and domestic violence. The surge in numbers has  forced the Pentagon to focus more intently on suicide prevention among its personnel.

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Source Material:

• TeensHealth: The Nemours Foundation
• World Health Organization
• SAVE: Suicide Awareness Voices of  Education
• Suicide.com
• National Suicide Prevention Lifeline
• National Institute of Mental Health

CAMTAN is the local organization assisting individuals affected by the HIV pandemic within our own demographic. an IRS certified local 501 (C) 3 non-profit in need of community support.

As 2008 comes to a close, consider making a tax-deductible donation to this Clarksville-based non-profit. Started by a small collective of local ministerial leaders and lay people, the Clarksville Area Ministers Technical Assistance Network (CAMTAN) seeks to provide assistance, support and education to persons affected by the HIV/AIDS pandemic and the greater community.

While Metro-Nashville has Nashville Cares, MICTAN, the Ryan White Foundation, Operation Stand Down Nashville-Street Front, a transportation funding grant from the Nashville United Way and a array of philanthropic foundations: Clarksville, Montgomery County, Dover, Stewart County, Erin, Houston County, Charlotte, Dickson, Dickson County, Springfield, Robertson County, Cumberland City, and other outlying areas must relay on the limited resources provided by a small collective of churches and a few private individuals, with which CAMTAN seeks to address the physical and psychological stresses that can accompany an HIV/AIDS infection.

Rev. James W. Hill Jr., pastor of Greenwood C.M. Baptist Church, serves as the Senior Executive Director of this all volunteer effort. Rev. Hill has attended numerous training seminars with the Nashville United Way -Ryan White Foundation, Operation Stand Down Nashville, the MICTAN initiative and Tennessee Dept. of Health to become certified as a HIV/AIDS counselor-facilitator.

MICTAN is the much larger and better funded Metro-Nashville equivalent of CAMTAN- a faith-based fellowship ministry to those impacted by the HIV/AIDS virus. These efforts are non-judgmental and focus on assisting the client in stabilizing their lives in the areas of housing, medication, counseling, personal relationships, fellowship and employment sustainability and include a general community health education outreach. Of the five county service area, Clarksville leads with the highest number of STDs and HIV transmission cases. The need for education and awareness is real and growing. CAMTAN is seeking to raise funding so that they can hire a case manager, a secretary and a driver and stabilize their client medical appointment transportation support system.

Rev. Timothy Grant- CAMTAN booth, 2008 African Street Festival

CAMTAN has participated in and sponsored several health fairs over the past years in an effort to increase community awareness of the various and diverse health issues confronting our collective communities. Information is available on cancer- be it either female or male breast cancer, colo-rectal or prostate cancer, cervical cancer or testicular cancer. Additionally diabetes, hypertension, obesity and weight control, sexually transmitted diseases (STDs), depression and other mental health issues are all matters that CAMTAN seeks to aide the community in understanding and confronting. All of these health concerns are also of concern to individuals confronting an HIV/AIDS infection, along with issues of homelessness, abandonment and physical or domestic abuse. CAMTAN seeks to educate the community to raise the level of awareness and understanding of these issues and improve the public’s preventive posture addressing these concerns. It also seeks to provide assistance to those confronting an HIV/AIDS infection and/or the consequences of such an infection upon the client or family members.

Donations, both monetary and in-kind services, may be sent to: CAMTAN, 1325 Dodd Street, Clarksville, TN 37040. Receipts will be sent acknowledging all donations for tax reporting purposes. Please include a self-addressed, stamped envelope for the return receipt. Rev. Hill is also available to speak with interested groups and coordinate CAMTAN participation in health fairs and other community events. Contact CAMTAN at 931-249-4262/552-3611. Send e-mail to: .

“One morning I found I simply could not get out of bed. The simple action of pushing back the sheet was too hard. I had nothing left…”

“My mother’s brain is gone, but her body is like the energizer bunny. Keeps on going and going and going … and I can’t keep up. I’m so tired I am getting sick all the time…”

“Dad keeps sneaking out. How can someone who remembers nothing be so clever … he’s an escape artist…”

For the millions of caregivers tackling the challenge of caring for someone with Dementia, most commonly in the form of Alzheimer’s disease affecting a parent, spouse or sibling, things like exhaustion, stress, declining health (their own), anger, rage, guilt and other emotions and issues are “normal.” It’s what happens when otherwise healthy people are suddenly confronted with the 24/7 reality of care-giving. A kind of care-giving measured not in days, weeks, or months, but years.

As Alzheimer’s reaches near epidemic proportions and is affecting ever increasing millions of people who are living longer (if not always better), and the pool of available caregivers shrinks, the pressures are mounting. And caregivers are crumbling under the weight of their complex responsibilities.

At one time caregivers were told were told “it’s all in your head” when they complained of fatigue, and all these other mental and physical issues. That great multipurpose line implied that not being a person of superpowers and extraordinary coping skills was a reflection on one’s competence in dealing with life.

The professionals were wrong. It’s not “in your head.” It’s real, and it has a name: Caregiver Syndrome, the technical name now being applied to the basic stresses on body, mind and spirit that care-giving for someone with Dementia can cause.

Dr. Jean Posner, a Baltimore neurologist, who has studied the syndrome and the symptoms, calls it “a debilitating condition” triggered by “unrelieved, constant care” of someone with dementia or other chronic illness.

Only a decade ago, when the realities of the AD explosion became a visible, talked about and increasingly debated growing reality did health administrators, doctors and government officials start taking a good look at who is going to care, not only for the patients, but the caregivers. And how will that be accomplished?

The statistics are intimidating: one in every four families now cares for someone over the age of 50. In 2000, some 35 million Americans were over 65; that number, augmented by the post World War II bubble of baby-boomers, will hit 71 million — double — by 2030. The numbers are staggering and threaten to collapse the system of medical and elder care.

Caregivers, those unpaid, committed souls working from a sense of love and responsibility on the frontlines of home health care, are most commonly affected by depression, anxiety and anger. But these emotional stresses also translate into physical conditions of high blood pressure, diabetes and deteriorating immune systems and even progressive memory loss — mimicking the symptoms of those they care for. The older the caregiver, the higher the risks, and some it is now documented that over 60% of caregivers will experience at least some combination of these symptoms. Prolonged and elevated levels of stress hormones are triggered by prolonged care-giving, which usually dovetails with self-neglect. Caregivers are so busy caring for someone, they fail to care for themselves. Caregiver stress can be the match of Post Traumatic Stress Disorder.

It’s not just the physical care-giving; watching the decline and the certainty of the progression of dementing illnesses is literally watching someone die. Not a single age-related death but a lengthy decline that may last for years, accompanied by an ongoing sense of loss triggered in small increments: one function, one memory at a time evaporates. Each one constitutes a loss. And the losses are relentless.

After not just months but years of coping with these periodic losses, after this “staging down” or chronic deterioration has drained the caregivers and left their charges little more than shells of their former selves, after a thousand small deaths within the human brain, these caregivers are KO’ed by the reality of physical death. In the aftermath of a death from Dementia, the caregivers collapse. Some are relieved, but too many are simply unable to reclaim the time, energy and vitality expended in the relative isolation of multi-year care-giving.

Caregiver Syndrome is acknowledged among providers of care to the terminally ill — and make no mistake, Dementias are terminal illnesses — but it has yet to be acknowledged in American medical training and literature. So doctors miss it.

Many years ago, families took care of each and their aging and infirm relatives. it was simply the way things were handled. Nursing homes and assisted living sites were anomalies.

In the high pitched rapid fire pace of 21st century lifestyles, less value is placed on the efforts of care-giving, and the attached responsibilities are more often seen as ongoing burdens. Our society simply does not place adequate value on its elders or the people who care for them, creating an isolation and lack of peripheral and direct supports that affect many who give care. These unsung heroes become shadows figures in a world that is passing them by.

The American Academy of Family Physicians and the National Center for Care-giving are lobbying for the implementation of stress and depression screening for all caregivers, and urging those who feel overwhelmed by the pressures of giving care to speak candidly with their physicians (and social workers, if such professionals are involved in a dementia case). Respite time, social supports and improved training in care-giving and coping skills may go a long way to relieving the impact of care-giving on the human body and its overstressed mind.

Caregivers often feel as if they are going crazy. They are not. And now there is a name attached to what they feel. Caregiver Syndrome. It’s not just all in their heads.

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Editor’s Note: Local Councils on Aging, the National Alzheimer’s Association, local hospitals, mental health agencies and senior service providers all offer assistance and information at varying levels to caregivers in need of assistance. One phone call can make a difference in the quality of life for both the caregiver and the person being cared for.

If you need information on Alzheimer’s Disease or how to provide care for someone with Dementia in any of its forms, call the National Alzheimer’s Association 24-hour hotline at 1-800-272-3900.

The U.S. Administration on Aging also offers an Eldercare Locater Service. Call 1-800-677-1116 Monday through Friday from 9 a.m. to 8 p.m. eastern Standard Time.