Shining a Spotlight on the Darkest of Subjects

Jessica Destefano, an artist often costumed as a fairy at community events, last month revived a more sober role that she performed for five years before quitting in 1999: suicide grief recovery facilitator.

Destefano recently started a suicide recovery group in response to a spate of suicides in Laguna Beach. The group meets weekly to help aid suicide survivors, whose sorrow often is overlaid with feelings of anger and shame. She did the same in 1993, after her brother died by suicide, when she found no recovery program in her previous hometown. She went on to earn certification in grief education from a respected institute. “I only went back into it because I saw so many people in pain,” Destefano said.

Four Laguna Beach men have taken their own lives in the last three months, most recently on Tuesday, Jan. 16. Three of the four were parents to students at Laguna Beach High School.

Based on statistics compiled by the county coroner, six people died by suicide in Laguna Beach in 2006, nine in 2005, giving the town a suicide rate 2.5 times higher than the rate statewide last year, and nearly 4 times higher in 2005. California’s suicide rate is 9.4 per 100,000 people, according to the American Foundation of Suicide Prevention in New York.

Experts, though, suspect the tragic recent local events are a coincidence and not a cluster with a common thread.

“Eighty to 90 percent are suffering from a psychiatric illness called depression,” said Paul Bressman, a Los Angeles surgeon and director of the foundation. “It’s a condition, not a character flaw.” The chemical imbalance that causes depression blocks people from having feelings of satisfaction and happiness, Bressman said, and there are effective treatments.

Suicide attempts and depression remain overlooked as public health issues because of the public’s resistance to accepting them as treatable diseases, said Dr. Tom Bent, medical director and chief operating office of the Laguna Beach Community Clinic, where depression is a factor in a third of his family-practice caseload.

“If four people died at an intersection, everyone would be talking about traffic safety,” Bent said.

Yet, while a diabetic generally consents to medical intervention, a person who is depressed often refuses. “Getting people to take medical help is an uphill battle. ‘Get a grip’ or ‘Get a life.’ That’s the attitude society has,” Bent said.

“Every single one of those men would have been nurtured and loved if they would have been able to reach out,” said Patti Jo Kiraly, the LBHS PTA president. “It makes you stand back and say what’s going on?” she asked.

Experts have some answers. Middle-aged affluent white men are among those at highest risk for suicide, according to Dr. Richard Peck, a Los Angeles clinical and forensic psychologist whose specialty is suicidology.

Substance abuse and relationship discord, present in some of the local incidents, along with economic reverses, are all contributing risk factors, Peck said.

The incidence of suicide among men is five times higher than women, who are more likely to talk about suicidal feelings. Each year, 30,000 people die of suicide nationwide, a death toll that exceeds the entire Vietnam war, Destefano pointed out. Or, by comparison, the current conflict in Iraq, where 3,000 U.S. soldiers have so far died since March 2003.

Many people, though, experience traumas without resorting to destructive behavior, pointed out psychologist Judith Anderson, a Laguna Beach parent and assistant clinical professor of psychiatry and human behavior at UC Irvine. The difference appears to be a person’s internal resilience, which erodes under the confluence of underlying factors, she said.

“In the darkest moment, their intention isn’t to die but to escape the emotional pain,” she said. “Helplessness and hopelessness is so intense, the psychological pain is intolerable.”

Nearly 70 percent of those who die by suicide have seen a physician within the last 30 days, said Bressman, of the suicide prevention group. Yet many doctors don’t recognize the symptoms of depression and patients wrongly disbelieve that medication, coupled with counseling, can help them, he said. According to a 2002 study in the Annals of Internal Medicine, depression can be detected with two screening questions: Over the past two weeks have you felt depressed or helpless? Have you lost interest in things that you enjoyed?

A community such as Laguna Beach, with many opportunities for residents to connect with an array of interest groups, “should help immunize people against suicide,” contended Anderson. But countering those influences can be a family history of suicide and the holiday period, she said, where people often experience internal dissonance with popular culture’s portrayal of happy, satisfied families. “Because they’re not feeling it intensifies their despair,” she said. Post-holiday blues make January a busy month for psychologists.

An equally daunting challenge is to help suicide survivors, who alternatively feel anger and shame, emotions not typically associated with a death from natural causes or even an accident. “It is the ultimate angry act because of the devastation left behind,” Bent said. “Everyone that ever knew the person feels they should have helped.”

Suicide survivors suffer post-traumatic stress and face extra bereavement issues, Destefano said. Because of social taboos, survivors tend to conceal the nature of death, isolate themselves, search unsatisfactorily for an explanation, feel rejected and ashamed, she said.

People remain uncomfortable talking about suicide, just as they did years ago when talking about AIDS or breast cancer. The stigma is deep-seated in an individualistic culture that prides itself on problem solving, Anderson said. Suicide is viewed as pejoratively as weakness, a character flaw, rather than a chronic medical condition such as diabetes or hypertension, both Bent and Bressman said. The stigma also stems from religious beliefs in Catholicism and Judaism, which both forbid suicide.

“It’s not so comfortable sitting with someone who is in shame, feeling the darker emotions,” Anderson said. “That’s when they need their friends.”

But Anderson and high school principal Don Austin both cautioned students against shouldering responsibility as advisors to their friends who are grieving. Just as in divorce, teenagers incorrectly blame themselves for their parents’ actions because they are emotionally so self-centered, Anderson said. “Kids turn those things inward,” inappropriately weighting themselves with blame, she said.

“We’re trying to send the message that we don’t want kids being counselors,” Austin said. “Empathy, yes.” The school considered and rejected holding school-wide discussions about suicide, he said, in favor of small-group counseling with the student most immediately affected and their circle of friends.

The school’s small size gives its staff an edge in observing suicidal warning signs, such as severe sadness, a change of attire or anti-social actions, Austin said. “Globally that has not been happening here,” he said.

“Our kids aren’t dealing with three suicides; there are other personal tragedies,” Austin said, including the deaths of grandparents and classmates. “We’ve had some sad kids. I know all these kids have a support system,” he added.

For her part, Kiraly vows to get involved when she sees someone who is troubled. “The best thing the community can do for each other is to make that connection, bridge that gap. It could help.”

Bressman applauds that thinking, but urges the extra step of assisting people to seek medical care.

Destafano’s group meets at 5:30 p.m. Thursday in the Wells Fargo Bank building.