This article discusses depression and suicide.  
     Kurt Cobain, Robin Williams, Chris Cornell and Chester Bennington.  We know these individuals because of their arts, and unfortunately, our memories of them are colored by the way they died.  Suicide.   star dying at his or her  own hand.t.   Media, both social and mainstream, becomes flooded with information about suicide, help lines, and how to spot depression.  The focus is almost always on the loss of someone influential who meant something to others as a result of their contribution to their lives.  What happens when the spotlight has disappeared and the deaths are as faded as a crumpled up piece of paper in the gutter?  The conversation dies and vigilance is replaced by complacency.  The news cycle moves onto the next hot topic.
     Depression is complicated.  There is often a fear of vulnerability.  To complicate it even more is the anxiety of being labeled.  Then there are the cliches and advice given by friends and family.  Despite the well-meant words there remains a lack of understanding of how depression cripples.  People who suffer from depression are often masters of disguise.  The need to keep up appearances consumes, strangles and exhausts. 
     Throughout my career I have worked with those who have either had suicidal ideations, have tried to commit suicide, or both.  Each case is different..  One patient, Piper, came to me after a recent bout of depression combined with suicidal ideations.  She was a college graduate, had a stable job, a home, car, and a loving family.et she felt as if she was underwater,struggling to break free of an embrace determined to drag her down.  She was depressed.
     Piper tried to end her life in her twenties, albeit unsuccessfully.  She told me she took the time to read the side effects of medications before choosing one just in case she wasn’t able to succeed.  She sought help after the first attempt, developed a greater understanding of the causes and manifestations of depression, and tried to learn how to address those causes.  She felt empowered.  Two years later,she tried again, despite her attempts to understand the disease, and the therapeutic tools that had been given to her by her therapist weren’t working.  She spent the next few years in and out of therapy as her depression waxed or waned.  She tried medication aimed at alleviating depression and suicidal ideations.  She exercised, ate the proper foods, and tried to keep control of her responses to outside stimuli.  For awhile it worked but she could not overcome her suicidal ideations.  
             She struggled with maintaining her mental health through physical exercise.  She began to notice overwhelming exhaustion but chalked it up to her workouts.  As time went on she began to notice she was sluggish, detached and constantly falling asleep.  She consulted with friends about her physical symptoms and she was advised to go see a doctor.  The doctor ordered tests and shared with her the results.
     Her body was in the midst of losing critical responders to depression, anger, alertness among many other emotions.  A tumor was found however it was not removed due to one doctor’s failure to inform another of her response to certain medications.  Then her insurance changed and she wasn’t able to access the needed health care due to the restrictions of her new plan.  The tumor remained in her body.  She began to spiral downward quietly.  She put on a positive veneer for those around her.  People praised her for her strength, people expected her to be strong since she has always been strong. 
     The weight of being strong, successful and congenial was breaking her.  She couldn’t talk to anyone as long as they thought she was strong.  She didn’t want to estrange anyone by opening up and couldn’t face telling her loved ones she was yet again drowning.  She struggled, she sought help through exercise and eventually shared her feelings with three close friends. They encouraged her to seek mental and medical help.
     Piper sat in the office of her therapist and talked about everything but her suicidal ideations.  Each session was a time to chat, talk about her career, family and explaining to her therapist how she doesn’t have time to give in to depression.  She was good at keeping up appearances until one day she realized she was tired of fighting and was cataloging items in her house she could use to kill herself.  Her next therapy session she broke down and told her therapist the truth.
     Throughout my years of working with people who have nearly succumbed to suicide I have learned a few important lessons: 1.  It’s easy to overlook the person who is “fine” 2.  Some leave clues while others struggle in silence  3.  All are afraid and 4.  Many want the release death promises to bring but  many want to live “normal” lives.

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