Dear Dan,
Recently our beloved son Kenny, just 19, ended his three-year struggle with depression by taking his life.
Despite the fact that it's been almost half a year, I think of him constantly. Memories of him flood my mind all day long, especially when songs come on the radio. I still cry because the music gets me. I think to myself, Kenny liked this song.
We go out to a restaurant and see something on the menu and I think Kenny would have liked this. We all do this, including my husband and my daughter.

I drive through town and see things that remind me of him. I go into his room and it still smells of him. I have the last outfit he wore and I haven’t washed his sheets. I go in there because it makes me feel sad and happy at the same time. It makes me feel close to him.

Can you please tell me if the pain will lessen? When does it stop, and when does it get easier? When is it ok to let go?

I am torn apart by so many emotions, especially anger. I even feel angry at Kenny sometimes and that is hard. Your heart is angry but your head tells you he was sick. I

 feel angry at some of my family and some people in the community. If Kenny had died from cancer, I would probably feel less alone right now. Some people were very supportive and caring, but others were silent.
I haven’t gone to the grocery store or church since Kenny died, the memories are too painful.

 I don’t want to see anyone.I am also worried about Kenny’s sister. All these months later and she still has not yet cried for Kenny’s loss. All of us need help.
Thank you.
Trish  

Dear Trish,

I am so very sorry for your loss and your sense of isolation.

Whenever we experience trauma, we feel alone and the pain of the alienation can be excruciating.But when you lose a child to suicide, the isolation is so much worse. It's too terrifying for anyone to imagine. And in today's world, the risk of losing a child to suicide or anything else feels much higher and more frightening. So we turn away from our fear and helplessness, and turn our backs on you.
In psychological terms, six months is like yesterday. Your brain cannot fathom what has happened let alone what it means or how to cope with it. That's why these unexpected thoughts and emotions land like a tsunami. I'll bet you sometimes forget that he's gone, and then it starts all over again. And for most parents who lose a child, the guilt can feel soul-crushing; they ask themselves if they did all they should have done.
Of course you are angry at Kenny. After all, he left you in a violent way. Same with your community and your family. It must feel as if they also have left you.
Sometimes the unconscious experiences death as a murder when something evil has stolen someone precious from our lives. In the last scene in Miss Saigon, the main character’s lover commits suicide in front of him. As he cradles her in his arms, he lets out a bloodcurdling scream of grief and rage. That is the kind of scream your whole family must feel.
In Alcoholics Anonymous, a famous saying is “One Day at a Time.” Anyone in crisis will tell you that sometimes it's one hour at a time, one minute at a time. The task is to live the next moment and then do it again.
And letting go? You will never let go, and probably don't want to. Most parents I have worked with tell me the pain is excruciating but they wouldn't want to part with it as that pain is their connection to their child.
Over time, your connection to Kenny will have more texture than trauma. The pain will always be there, but there might also be warm affection, quiet longing and even gratitude for the years you had together. But that takes a long time. Not work, but time.
In the meantime…
As you know from what happened to Kenny, 90 percent of suicides happen to people with some form of mental illness, typically depression. So I understand your anxiety about your daughter, because depression has a genetic link and stress increases one's risk for a depressive episode. Do what you can to help her feel safe enough to share her feelings. But be aware that males are three to five times more likely to commit suicide than females.
We haven't heard a word about your husband’s feelings or the state of your marriage. I am sure he is in terrible pain. Men tend to be less expressive, which can add stress to a marriage that’s already stressed.
So you’re right. All three of you need help.
I would recommend your family try a few meetings of “Compassionate Friends,” a self-help group for families who lost a child. And I would recommend family therapy with someone who is skilled in dealing with this kind of trauma.T
There is so much more to say and so little space to say it so I have another offer. You could use me as a resource and stay in touch via e-mail and web chats.

Trish will be joining me on Tuesday's web chat

Hi Dan,

Thanks for listening to me. I have a 20 yr old adopted son whom from age 4 has been diagnosed as ADD, OCD, bipolar, impulsive, angry, paranoid, mood disorder, etc., and recently diagnosed as border line personality, soon to be called emotional regulation. He gets into raging cycles that he can't get out of. He has probably been to ten therapists and had fifteen different medications over the years and he is still not under control. When he does take his medications, he takes them sporadically. He cancels doctors' appointments frequently.

As he has gotten older he is more difficult. We have called our local police several times due to his threats and physical confrontations. Most of the occurrences have been in our house, and fortunately no one has been injured. He doesn't change his attitude even after the police come to our house.He clearly does not think in a rationale manner about many issues.  If we have to call the police one more time, he will go to jail.  I feel so badly for him since I know he is not in control of himself.  The local police feel that what he does are criminal issues.

It seems the only way that a mentally ill person can receive structured mental help nowadays is when a person threatens suicide or threatens another person's life and goes into a hospital. Otherwise they go to jail. About 20% of the people in jail now have mental illnesses. I believe there are some counties that are working on helping mentally ill people in jail.  However, I don't know if they will still be saddled with an arrest conviction.  Unless there is a miracle, my son will end up in jail.  Is there any hope for my son and the other mentally ill people in jail?

Dear reader

I don't know what to tell you about your son other than an intensive course of the inpatient treatment followed by highly structured outpatient.  He can emotional regulation but he will need medication and a great deal of social support to do so.

I would also like you to know that we are doing a two-part series on my radio show about mental illness.  On September 12 we will be talking about its impact on families and on the following week, we will be talking about policy, politics and programs.

As you so aptly pointed out, what happens to so many with mental illness is tragic.  As a society, we should be ashamed.

A friend of mine was in an abusive (physically and verbally) marriage. AFTER the husband suffered brain injury in an accident, she discovered there was infidelity and other lies. The husband can no longer hurt her due to his injuries, he also does not remember the past. She is considering divorce. What would you tell her?

Your response will be greatly appreciated.

Thanks,

obviously I would need much more information and I would need it from this woman in order to explore what is best for her physically, psychologically, ethically and spiritually. So without that all I can say is what Hippocrates said: "first do no harm". So if she does leave him, make sure he receives the care he needs. And in order for her to be more comfortable inside of her skin, she needs to find compassion for both this man and herself. Both are victims and both have experienced their lives as being out of control. Granted, one did unconscionable things with those emotions that got out of control, but now she is at least safe enough to experience some modicum of care.

And this gets down to the simple fact that there are no rights and wrongs here, just decisions and consequences. If she stays, she is at risk for compromising her life in order to take care of a man who has harmed her. If she leaves, she might feel great guilt for the rest of her life. So if she stays, I hope she does so from a position of conscious choice. And if she leaves, I hope she does everything in her power to make his life comfortable so as to diminish that potential guilt.

But an emerging field called “posttraumatic growth” takes a different approach. It is about changing the way we see ourselves and finding new meaning in life.

A friend with a severely autistic son once said: “I spent the first seven years trying to change his life, never realizing how profoundly he was changing me.”

Many of us could tell similar stories about the effects of trauma. And I suspect that more people experience posttraumatic growth than posttraumatic stress (although it is possible to have both).

I recently raised the question of posttraumatic growth on my blog, and here is one amazing response from a woman named Carla:

I remember vividly hearing my physicians and attorneys discussing my “catastrophic” injury. “Catastrophic… hmmm. What are they talking about?" I recall thinking. To the people uttering these words, my spinal cord injury was the only part of my life in their awareness.

Only I knew about the troubled, thirty-two-year marriage that I left behind four years before my accident; My husband’s nearly successful suicide/homicide attempt the day after I asked for a divorce; my grandson's birth while my then-husband was in the hospital recovering from his injuries; This grandson’s untimely death at seven weeks of age from SIDS; my ex-husband's second suicide attempt; my daughter's spiraling-down bipolar psychopathology after her son's death; two home break-ins, four moves and three job changes.

What have been the take-aways from losing everything, and almost my life, during this protracted eight-year period?

My life is not easy and often I feel overwhelmed. I am often disgusted by what is involved in my bowel and bladder care. My morning routine seems to last forever. I've lost my old identity, roles, expectations, independence and dreams.

But despite, or because of these difficulties, I am aware of how my life has changed — for the better.

Faith. I now know that I will be cared for regardless of where life's circumstances place me. From the moment I realized that I was going to be crashed into, as I prayed out loud, I knew I would be taken care of. I remember hearing the words “it doesn't matter.” My interpretation of that was that whatever happened  would be ok… and it was.

Life. It is precious and can end at any moment. Because of that, I say “I love you” much more frequently than before my accident.

Kindness of others. My family and friends were treated with unbelievable care and kindness by total strangers. For every difficult situation, it was there.

Patience. Waiting has become a way of life for me until recently when I resumed driving. I still wait for appointments, return calls, new or needed equipment, and lessons for how to do new things with my often uncooperative body.

Compassion. I have gained a deeper understanding of how disabilities impact those who have them. I also feel compassion for those who do not really understand the full impact of disability and can see life only through their own eyes.

Forgiveness. I don't believe most people awaken with an intention to kill or injure others. Bad things happen in every life and forgiving those who may have caused an accident or injury frees up personal energy for healing. Remaining in the past or becoming bitter hurts the grudge holder rather than punishing others.

Gratitude. I feel this every day for the recovery I have been blessed with, and for friends and family who love me and whom I love.

Expression of Grief and Sadness. These may follow massive emotional and physical adjustments and they’re a blessing in disguise. They open up space for necessary change. To quote the 70s production, Free To Be… You and Me: “it's ok to cry, crying gets the sad out of you.”

Love. Life is unpredictable and fragile. It is important to let others know what they mean to you at every chance.

Resilience and Persistence. Giving up is not an option even when it seems attractive. Turning the impossible into the possible is only accomplished by bouncing back and working hard to overcome, accept, or adapt to continuous change.

Mindfulness. Focusing on the present and appreciating your surroundings is a blessing that I often overlooked in my former, hurried, multitasking life. I am able to take the time to hear and appreciate others' life stories more fully since my accident.

Certainly not everyone who experiences trauma grows as a result. And it is important to know that trauma disturbs everything in the emotional system and most people need a good deal of time to begin to heal.  Growth in the wake of trauma can take months or years to gain perspective.  But for many of us, trauma steals old identities and forces us to take a fresh look at our lives and our priorities.  Most of us who have experienced emotional growth after trauma say that once they stopped fighting and opened up to the new truth of their lives, they were able  to take a fresh look at who they really are at core and what it really means to be alive.

Son's PSTD from Iraq
Q: Dear Dr. Gottlieb,
May I say how much I admire and respect you. My son is an Iraq Vet. He is suffering from PSTD and was diagnosed like the lady in this weeks forum in 45 mins. as having ADD. My son is 27 and is married but having difficulties. Andrew is very bright, charismatic and gets along with a lot of people. He is very depressed and unmotivated and is currently separated from his wife. I am helpless to assist him. The VA has let him down and he did get a Dr.s name but has not called him. Andrew is difficult since he is sometimes brighter and intuitive about the person who is treating him. On two occasions he quit because of his sense that the Dr. was inept. I can only pray, love, and support him. I would love if you could see him since I truly respect your common sense approach and deep empathy with your patients. Or if you could recommend a therapist who is strong in PSTD and the issues that surround it like social, marriage,etc. The person has to be strong because Andrew is one of the most strong willed humans I have ever encountered.

Respectfully,
Mary Colket
Glen Mills, PA

Mary I don't know anyone in Glen Mills who specializes in PTSD with veterans, and that is exactly who I would want him to see.  I am posting this in hopes that some mental health professionals who have this specialty will comment so that we can get your son the help he needs and deserves

With the divorce rate just under 50% most who get divorced remarry creating a stepfamily.  And anyone who has ever been in a stepfamily knows that they are complicated to say the least!  Tuesday's web chat will be about many of the issues stepfamilies face and how they can be resolved.  The next letter illustrates a classic problem in stepfamilies:

Dear  Dan,

I think I am having some stepfamily problems.  My husband and I are in a relatively new second marriage.    He has one son and I have a daughter. 
 
Last night my son  had 2 friends over, it was late when my husband returned home from a long day and he was tired and hungry. Nevertheless, not only did he not say hello to the girls, he didn't even acknowledge their presence.  The next morning when he left for work, the girls were still there and he still didn't acknowledge them.

 I am put off by this, as I feel an acknowledgement is priority for everyone all the time.  Later I told him it was important to me that he acknowledge the children.  He said he did not feel like it was necessary or that my daughter would have really cared last night, they were doing their thing.   I thought my husbands lack of consideration to my feelings and my request was hurtful, however I have decided to let it go or he will become angry  and think I am a nag.

Lastly, if his daughter was at our house and his friends were over, he would have greeted him.  He will from time to time greet my kids, on his terms though, he decides when to greet and not to .

So is this a case of "I have made my bed and now sleep in it" or is there a way to reason?

Struggling in a stepfamily                                 

Dear struggling,

Shortly before I received your e-mail, I received one from a fellow in Haverford who was considering marrying for the second time and asked my advice.  I told them his timing was perfect because this is the time to begin talking about what it means to be a family.

When people get married for the first time, they bring in a set of expectations and experiences from their family of origin and rarely do partners see the world through the same lens as both have a different vision of what it means to be family.  But when they get married a second time, those expectations have been modified by everyone's battle experience which is usually negative.  So everyone usually comes to these families with some anxiety and apprehension and many carry baggage from the previous marriage.

So the questions about what does it mean to be in family, be married, be a man/woman, be a parent should be discussed way back in the beginning of the process.  And the children should also be brought in to the discussion.

Every stepfamily I've treated has struggled with issues of loyalty.  Biological parents feel loyal to their children who have already suffered.  Meanwhile, this loyalty can do great harm to the fragile new marriage.  This is a complicated and difficult issue as children really do suffer when there is divorce and do need to support of their parents.  But when a child of divorce has lived alone with a parent for a while, they are not going to be happy about sharing time and space.  All of these things need to be talked out with everyone in the family.  It's very important that stepfamilies do not divide by biology.  And although this is may be difficult for the first few years as everyone tries to get to know one another, it's very important not to have secret alliances.

So, struggling, even though you may have not had these discussions, it's never too late.  You see, there are always stories behind the story.  When you say how important it is to be acknowledged, that sounds like a high stakes issue from childhood and may have nothing to do with your daughter.  I don't know why your husband won't acknowledge the children, but there is a story about that also.

And the most important issue is the fact that you are hurt.  If something is happening in your marriage that is hurting you, that's never okay.  That doesn't necessarily mean that your husband should change his behavior to address your pain, but it does mean that the two of you have to talk about this.

And please keep in mind blended families are difficult and so are second marriages.  As far as I am concerned, what makes the prognosis better is devotion.  If the two of you are devoted to this relationship and this family, you might still need counseling, but you should do pretty well.

A new question is in your Philly.com Q&A Forum:

forgiving myself
Q: My daughter died three years ago of mesothelioma at age 38. She had suffered from depression, panic and anxiety from a very young age.

When she was two, I had a depression and didnt respond to her for months. I was not a hugging, loving mother similar to my own mother. And, like my own mother, I did all that I could to be a good mother. But, now I know, I could have done so much more for my daughter;s self esteem and confidence. I did everything I could to help her through her hard times. It is just now that I know all that I could have done. I cannot forgive myself.
Warwick, NY

Like everyone reading this post, I wish I had the power of forgiveness.  I wish somehow I could take away your almost unfathomable pain.  I wish neither you, your mother or daughter had this horrible disorder known as depression which saps life and closes hearts.  I wish that gene had died out in your family many generations ago. 

And most of all, I wish you had more time with your daughter.

 You conclude your letter by saying you cannot forgive yourself, but I would ask you if you are willing to forgive yourself. It's a difficult question and a painful one, but requires a thoughtful honest answer.  Many people who have lost loved ones tell me they are not willing to let go of the resentment they feel towards themselves.  But it's not the resentment they are clutching; it is the memories of their loved one.  They tell me they are afraid that if their pain and guilt diminishes, so might their memories.

If you are willing to forgive yourself, what do you think it would take?  Answer that question carefully, decide what you need to do and please do it.

Several years after my sister died, I wanted to know what different religious perspectives thought about where she is now.  Frankly, I don't recall most of them as they didn't seem to make much sense to me.  But I do remember what one Buddhist said.  He told me that he lost his brother several years earlier.  He said that when his brother was alive: "he was alive for me in 50 different ways.  And now, he is alive for me in 49 ways ". 

The pain of losing a child never goes away.  There are always sad memories and an ache inside your heart for where your child once was.  I am sure your love for your daughter endures.  When the day comes that you begin to release your grasp on your guilt, what can you do with all of that love you have for your daughter?  How can you honor her memory?

If someone calls you tomorrow and said they lost a child and felt consumed with regret about things they have done or didn't do with a child, how would you feel?  I don't know what kind of person you were before this terrible tragedy, but I would guess that given your history of depression you are a pretty sensitive person.  And I would also guess that you would feel great compassion and understanding for this person who called you.  You would encourage them forgive to themselves, you might remind them that they loved their child very much and did everything in their power to be good parents.  You might cry for them and with them and for yourself.

Gerda Weissman Klein survived the Nazi death camps and, along with her husband, created a foundation that teaches tolerance to children.  She once said that no pain should be wasted; that we can use our pain to help others.

When you lose a child, the grief can be crippling. And sometimes that grief turns into a clinical depression that needs to be treated.  But somehow, no matter what, the spirit emerges.  We might be battered and bruised and carry scars of our suffering, but for most life resumes.  And when you are ready, please know that the world is open to you and could benefit from your compassion.