After their father’s death in November, Aimee Venable considered lying to her four children about how he died.
“That’s your first instinct because you want to protect them from other people,” said Ms. Venable, 34. “But he was their dad, and they deserve to know just like I deserved to know.”
Struggling with depression and despondent over his recent divorce, Keith Venable sat in his truck in the driveway of his father’s home and swallowed 60 pills. He died that day at Grandview Medical Center in Jasper, Tenn., Ms. Venable said. He was 32.
For Ms. Venable and her children, their devastating loss is complicated by the guilt, anger and stigma that come with suicide.
“You feel so alone, and then you realize there are other people out there,” said Ms. Venable, a Ringgold, Ga., resident who attends a support group in Chattanooga for survivors of suicide.
In Tennessee, the number of reported suicides increased nearly 22 percent between 1996 and 2006, from 710 to 866, state records show. Suicide is far more common than homicide. In 2006, 482 people died by homicide in Tennessee while 866 died by suicide. In Hamilton County that year, there were 22 homicides and 36 suicides.
Stigmas about suicide and depression complicate both the lives of survivors and suicide prevention efforts, said people who have lost loved ones to suicide.
“We’re not just dealing with a death. We’re dealing with a death that has carried a stigma for 1,600 years,” said Jimmy Powell, a Chattanooga resident whose son, Eric Powell, died by suicide in 1999 at age 27.
For people ages 25 to 34, suicide is the second-leading cause of death — behind accidents — in the state. And Tennessee had the highest suicide rate in the Southeast in 2005, according to a January report from the American Association of Suicidology.
Just uttering the word can be enough to upset people, said Gloria Hastings, whose brother, 46-year-old Allen King, died in 2005.
“Using the term ‘suicide’ can be like dropping a hot potato in someone’s lap. I’ve seen people physically recoil,” said Ms. Hastings, of East Ridge.
Joan Shulman, whose son, Jesse Epstein, died in 2004 at the age of 47, said her generation was raised never to mention suicide. “It was a big stigma,” said Ms. Shulman, a Chattanooga resident.
She struggled for the first year after her son’s death with how to answer questions. Finally, Ms. Shulman decided that she couldn’t lie and didn’t want to.
“It was such a relief,” she said, “but it was a real conversation-stopper.”
As the number of reported suicides in Tennessee has risen in recent years, the most dramatic increases have occurred among men in middle age or older.
“When you look at (who) dies by suicide in Tennessee, it’s the middle-aged Caucasian male,” said Scott Ridgway, the director of the Tennessee Suicide Prevention Network.
Between 1996 and 2006, there was a 71 percent increase in reported suicides among people ages 45 to 54 in Tennessee. Reported suicides also were up 58 percent in those ages 55 to 64; 46 percent in those 75 to 84.
Staff Photo by Meghan Brown -- Gloria Hastings facilitates Suicide Isn't The End, a local support group for suicide survivors. Her brother Allen King, died in 2005.
The 45-to-65 age group is something of a “lost generation,” said Dan Doresk, a crisis therapist with Fortwood Mental Health Center in Chattanooga.
“We supply interaction for kids through the schools, the elderly through other programs,” he said. “But that group, where are they?”
The vast majority of people who die by suicide are white and male. In 2005:
* About 74 percent of suicides in Tennessee were white men; about 17 percent were white women
* About 6 percent were black men; less than 1 percent were black women
Lygia Williams, who oversees suicide prevention efforts through the Tennessee Department of Mental Health and Developmental Disabilities, said the pressure of culture may play a role.
“Part of it may be some of the expectations that we place on men or that men place on themselves,” she said.
Sam Bernard, a Chattanooga psychologist who is chairman of the Tennessee Suicide Prevention Network advisory council, said retirement or job loss often is an element of suicide in older men.
“His identity becomes his job function,” Dr. Bernard said. “If that guy stays on that track, that his identity is what he does, when retirement comes or downsizing comes, that identity disintegrates.”
As her 68-year-old father was preparing to retire last year after working steadily since 1969, Mary looked forward to the time he would be able to spend with her three children, who are in elementary, middle and high school.
“All these years that he’s missed of my children’s lives because he was working. We were so excited about his retirement,” said Mary, a Chattanooga resident who asked that her last name be omitted to protect her family’s privacy.
In September, about a month before he was scheduled to retire, her father died.
“We last talked on a Tuesday and he took his life on Thursday night,” Mary said. “There are just so many unanswered questions you have to learn to live with.”
She was honest with her children about their grandfather’s death.
She had known her father grappled with depression, Mary said, but never realized the depth of his struggle. And she is deeply troubled that, at the end of his life, her father didn’t feel he could ask for help.
“The funeral was just standing room only, and I thought, ‘Did you not know how many people loved you?’”
FIGHTING THE STIGMA
After his son’s death, Mr. Powell began researching the origins of the stigma surrounding suicide. Growing up, Mr. Powell had been taught in church that suicide was a sin. But they knew their son was a Christian, said Mr. Powell and his wife, Nancy.
“We know where he is and we know we’ll see him again,” Mrs. Powell said. “We’re not ashamed he had depression. We’re not ashamed of how he died.”
Religious teachings are at the root of the stigma of suicide, but scaring people and condemning those who died by suicide won’t help prevent the deaths, Mr. Powell said.
“Having something wrong with your brain is no different than having something wrong with your heart,” Mr. Powell said. “Two-thirds of people suffering from depression don’t realize they have a treatable disease.”
In many cases, health insurance covers less of the cost of mental health treatment than other health care, a situation U.S. lawmakers are trying to address with two pieces of legislation now in House and Senate committees.
One measure would require parity in coverage for mental health care treatment, while another would increase the percentage of mental health care treatment Medicare covers from 50 percent to 80 percent.
Until insurers treat mental health as they do physical health, there will be stigma and hurdles to access to care, said Mark Shively, manager of adult outpatient services at Fortwood Mental Health Center.
“That’s the litmus test,” he said.
Dorthy Stephens, vice president of services at Fortwood, said most of the adults she has talked with through the center’s crisis team date their struggles with depression back to their childhood or teen years. But until those people came to the point of crisis, most had not sought help.
“People feel that if you’re not bleeding or you don’t have a broken bone things must be OK,” she said.
Overcoming the stigmas of suicide and preventing the deaths will first mean getting past hesitance to address depression, Mrs. Hastings said.
“If we can’t talk about depression, how are we going to talk about suicide?” said Mrs. Hastings, who facilitates a support group in Chattanooga for survivors of suicide.
Ms. Venable said she had watched for years as Mr. Venable struggled with depression and then addiction to stimulants. But she did not realize what was wrong.
Now, she said, she tries to help her children, who are 6, 8, 10 and 14, understand the depth of their father’s illness.
“All four of them have at some point said, ‘Why wouldn’t Daddy stay for us? Why didn’t we make him happy?” Ms. Venable said. “I tell them when you have a disease of the mind you just can’t be happy like other people are happy.”