"The heartbreak of losing my sister, my best friend, to mental illness."

I am so sorry. Please forgive me. I love you all so much.

The note was simple, the handwriting was clear, uniform, not erratic. I asked the Detective how she looked. Was she put together, or did it look like she woke up and did not know what she was doing?

Trigger warning: This post is about suicide and mental illness. It may be triggering for some readers.

She answered me very calmly, “She was very put together, hair brushed, clean, dressed.” Did it look like she tried to stop herself? Again, calmly, the Detective answered, “No, she could have stopped herself and did not.” It was hard for me to imagine that this was an intentional act, but the facts were clear. My sister, a devoted wife, and mother of three beautiful children had taken her own life. That was two years ago, May 31st, 2013.

How she got to this point remains a source of frustration and pain for everyone who knew her. Amy was a wonderful mother, daughter, wife and sister. She volunteered at the children’s school, attended every function, baked cookies for the neighbors. She was an avid crocheter and taught children how to knit at her son’s elementary school. She was an accomplished nurse and worked up until the time she had her third child. She was a generous person and was always willing to help those around her. I spoke to Amy every day, if not more than once a day since I moved away to go to college. She had been married for over 15 years and her husband adored her.

While Amy always had many people who wanted to be her friend, she held few people close. In spite of her tremendous beauty, she was terribly insecure about her appearance. She had her ups and downs like most people; but nothing that caused too much alarm. Life’s usual challenges and bouts of frustration with life, but not more.

However, the two years that preceded her death were different. Amy became a completely different person. The trigger for this is difficult to know. I was living in California, and my family in Omaha, Nebraska. Our mother, who was 85 at the time, had increasing health issues. Amy’s children were getting older and less reliant on her. Amy seemed to become more withdrawn from people. She stopped returning phone calls and refused to engage in any social activities. In spite of barely leaving the house, she became increasingly preoccupied with her looks, specifically with her face and the quality of her skin. She began to get laser treatments for red spots and other minor defects that no one could see but Amy and the doctors who readily took her money.

Instead of feeling like the lasers were making her look better, Amy was convinced the treatments were leaving scars on her face. She then went to other doctors to treat the “scars” that again, no one else could see. I would talk to my brother-in-law and nephews regularly, whose feelings, understandably, went from sympathetic, to angry to sad in trying to figure out how to deal with the situation. Our pleading with Amy to go talk with a therapist was unsuccessful. She did not think anything was wrong with her and refused to go. She said once her skin was taken care of, everything would be fine.

At this point, the situation went from bad to worse. Our mother passed away, and Amy became obsessed with a single spot on her face. No one else could see it, but she was convinced it was not only there, but very disfiguring to her.

Amy would stare in a mirror for 8 to 10 hours a day. I would never have believed it, had I not witnessed it for myself. It was unimaginable. At this point, it became clear to me that we were dealing with a very serious mental health situation.

Continual pleadings with Amy to see a psychiatrist finally resulted in her seeing a specialist in Obsessive Compulsive Disorders. She went to several doctors, who did not understand the situation, others which she did not like. Then, finally, she found one she would agree to see with some regularity. My brother-in-law and I would call her psychiatrist repeatedly to get them to understand the facts. Amy would only tell them what she wanted them to hear. Since Amy was a nurse, she understood what to say and what not to say.

Over a year went by of a menial existence for Amy and her family. I went from talking to Amy nearly every day of my life, to barely talking to her. She wouldn’t take my calls. She stopped attending school events, stopped cooking meals, and laid on the couch all day. At this point, her psychiatrist put her on a combination of Prozac, Zoloft, Lexapro and other antidepressants. We all thought this was shocking given the gravity of the situation.

As an adult, you cannot make someone get help if they don’t want it. If someone is mentally ill, they likely will not understand they need treatment. It is a frustrating situation designed to help protect people but ends up hurting people when you cannot force them to get treatment. Amy’s “treatment” consisted of talking to her doctor for 15 minutes a month to get her medication. That’s it. No cognitive therapy. No deeper intervention.

Fifteen minutes a month.

It was clear Amy was terribly ill. The drugs made her a zombie, but it was a better state than staring in the mirror for eight hours a day. In doing our research, her husband and I concluded that she had Body Dysmorphic Disorder coupled with depression. When you read the literature, it seems fairly obvious. We tried to talk with her doctor about this with no success. I was desperate, leaving messages for her doctor, writing letters to Amy, trying to breakthrough. Nothing worked.

Finally, Amy’s husband convinced her to check into an inpatient treatment centre. Amy reluctantly packed a small bag and got in the car. Half way during the drive, Amy lost her nerve and jumped out of the moving car. As dangerous as the situation was, this was finally our opportunity to get Amy committed, so she could receive a proper evaluation. The police came to the house, a report was filed, and Amy’s husband officially was able to get her “committed against her will”. However, our hope was short lived. Amy was “committed” for a 72-hour hold but convinced the doctors she was fine. I was livid.

She was a mother of three who jumped out of a moving car,
and you think she is fine?

Amy was also completely embarrassed to be in the medical center. As a nurse, she knew many of the nurses and doctors in the facility and the stigma of being mentally ill was shattering to her already fragile self. They released her, added an antipsychotic, Risperdal, and had her see a psychiatrist once a month to obtain the medication.

Months passed, and Amy seemed to get slightly better. She did a few activities and went to a few school functions. She was an avid knitter and begun to knit again. She knitted hats and gave them away to the homeless. She started to leave the kids notes, send me letters and presents and let everyone know that she loved them. Now, I understand, this is when she must have decided it was time. Like many people who decide to end their life, she began to give some things away, but nothing so noticeable that anyone caught on. Only now, as we piece everything together, do we understand what she was doing.

Even in her death, Amy was thoughtful. Although I know her pain was tremendous, she waited until the last day of school to do it. I know she must have planned to do it before, but waited, not wanting to ruin the kids’ school year or jeopardise their grades.

Amy had a severe mental illness that went undiagnosed and was not treated properly. She had insurance, and there were no financial barriers to her treatment. Still, she could not get the treatment she deserved to save her.

Maybe she didn’t want to be saved. It is hard to know, but when you are in the depths of such despair, you must rely on others to help get you out of it.

Not a day goes by where I don’t think about what I could have done differently, should have done differently to save her. Anyone who has dealt with this knows the guilt you feel is tremendous. There have been many stories in the news lately about suicide, Students in Palo Alto, Madison Holleran, Robin Williams. All complicated in their own way. The hardest thing about suicide is there are so many questions that you can never get answered. You go back and trace every conversation over and over. What could you have done? In the end, it doesn’t matter. What’s done is done and you have to find a way to make peace with it. It is nearly impossible to do so, but you have to try. For Amy’s children, every day, I try.

At her funeral, the Cantor said that Amy was ill, and her illness was no different than her dying from cancer. I agree. It is unfortunate that mental illness is still treated with such little care and has such a stigma. If it weren’t for that, maybe Amy and many others would be alive today. I am telling her story because too many people keep mental illness a secret. I’m not judging this decision; I understand.

I decided to tell the truth to try to lessen the stigma of mental illness
and maybe, in a very small way help change the system.

Undoubtedly, when I told people the truth about how my sister died, some looked at me differently. I know some people thought my sister was weak and selfish. Instead of showing compassion, they stood in judgment. However, far more people, very successful people, came to me and expressed their fragility, bouts with depression, and even their own thoughts of suicide. In spite of what people project on the outside, you never know what is going on inside. I understand this now more than ever. I hope she is in peace now. I believe she is.

A version of this post was originally published on Medium.com

If you are or someone you know may be at risk of suicide or needs to speak to someone, please call Life Line on 13 11 14.

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