Monday, August 11, 2008

Risk after Surviving a Partner's Suicide

Up until 2005, there had been no important studies about the link between partners' suicides. Then a Danish study appeared in the Journal of Epidemiology and Community Health, which showed that the partner of a person who committed suicide is significantly more likely to take his or her own life. Researchers from the University of Aarhus looked at data from the Danish national medical register on 475,000 people. This was made up of 9,000 people who had committed suicide aged 25 to 60, their partners and children, and a comparison group.

The findings were dramatic: male partners were 46 times more likely to commit suicide, if they had lost a partner to suicide themselves. Women were rougly 15 times more likely to commit suicide, if they had lost a partner. The interpretation of the United Kingdom's Samaritans were that men were more at risk because they had more trouble seeking emotional help than women.
The Danish study was significant in that it showed just how much more at risk partners are after a suicide, when compared to other groups of survivors. Other family members, for example, are 2 1/2 times more likely to commit suicide.

Given the affect that suicide has on partners, it is of concern that very little has been written specifically about being the partner of a suicide survivor. Carla Fine's book, No Time to Say Goodbye: Surviving the Suicide of a Loved One is the first book specifically focused on suicide survivors, and she discusses the suicide of her husband as well as many other families' experiences. My book, Surviving Ben's Suicide: A Woman's Journey of Self-Discovery is the first literary memoir about surviving a partner's suicide. My hope is that in the coming years the veil of stigma will be lifted on surviving a partner's suicide and more survivors will be able to speak openly about their experiences.

Thursday, August 7, 2008

Being a Partner of a Bipolar and Borderline Personality Disorder Sufferer

Recently, a reader of my book was very upset that I allowed myself to remain in the relationship with my college boyfriend, Ben, when he was treating me so badly. Because my relationship with Ben was extremely complicated, I felt that I needed to explain my reasons for staying in that relationship in some detail. What better place to do so than right here in my blog?

Ben had bipolar disorder, which meant that he had episodes of mania and depression. At times, he had mixed episodes, where both mood disorders manifested. When Ben was more manic, he was extremely irritable and even verbally aggressive towards me. He had trouble sleeping and talked in an anxious fast-paced manner. At other times, he was euphoric. And then there were the depressive periods, when he was extremely sad, self-loathing, despondent and became isolated. During those times, he sometimes showed apathy or indifference towards me and showed signs of depersonalization, when he became detached from me and the rest of the world around him.

Further deepening the complexity of our relationship, Ben also had Borderline Personality Disorder (BPD). This meant that he had a long-term disturbance with personality function with dramatic mood variations. People who suffer from Borderline Personality Disorder often have chaotic and unstable relationships. They--as I believe Ben did--saw things in terms of black and white and experience what is called "splitting". According to Mitchell & Black (1995), "This makes them experience love and sexuality in perverse and violent qualities which they cannot integrate with the tender, intimate side of relationships."

I find the borderline pathology of "splitting" particularly enlightening when I look back on my relationship with Ben. People with this pathology tend to fuse anxieties in their closest relationships, because they do not have normal boundaries of self and other. They often feel almost as if they disappear into the person they love. This, in turn, creates extreme anxiety. To overcome this anxiety, the "other" (me) is made into the "bad" person. The reason the borderline person does this is so that the other person can be made responsible for the anxiety. However, if the other person is thought to be bad, then the self has to be bad, too. Viewing the self as bad cannot be tolerated for long, so another switch takes place: the self is good, which, in turn, means that the other is good as well. If the self is good and the other is good, however, where is the beginning and end to the self? Extreme anxiety results from this cycle.

There are scenes in my book, where I believe one can see this pattern playing out. Towards the end of my relationship with Ben, I could sense him struggling with "splitting" in the course of a single phone call. One moment he would tell me that I was a horrible person and that I was responsible for his problems and the next he would tell me that I was the purest and best person in his life and that I was the only one who could take him out of his despair.

To be in a relationship with someone who has severe bipolar and borderline personality disorders means, I believe, that one is in for a seriously challenging and mercurial experience. This type of relationship is not, by nature, "healthy", because one half of the partnership is coping with a serious illness and is, therefore, unhealthy. Having established that, however, where does one go? Is it right to merely abandon a partner because he is chronically ill or is there a way to try to stay together?

In my case, I loved Ben and felt committed to staying together and trying to help him find a way to live with his illness. Of course, I was young--nineteen and twenty--when we dated. I didn't know as much then as I know now about mental illness or about myself and how I cannot completely control another human being's illness or life. I knew, however, that I deeply cared about Ben and that many times he brought me true happiness. There were times of hope amidst the darkness, and during those times I felt that I could "reach" him and that, in fact, he was seriously trying to find help for his illness.

I can equate the experience of dating someone who is bipolar with BPD to being in a partnership with an alcoholic. By nature, that relationship is unhealthy, too. One partner has a disease. However, does the partner without the disease merely leave the partner with the disease? What I would say is that as long as the person with the disease is actively trying to get help and wants to be helped, then it is understandable for the partner without the disease to try to make the relationship work. At the point when the person with the disease slips into such a darkness, however, in which he or she cannot be reached or does not want to get help, and in which it is harming the partner without the disease to such an extent that he or she finds it hard to function, I think it is acceptable to step back and tell the partner that until they find adequate help, you will have to leave the relationship and protect yourself. That, of course, is what I told Ben a couple months before he committed suicide.

The decision to end our relationship was one of the hardest decisions I have ever had to make. I only did it after I felt that I had exhausted all alternatives. Loving someone who was chronically ill challenged me emotionally and physically, but I do not regret attempting to make our relationship work. There are 3.3 million bipolar patients and 5.4 borderline patients in the USA today. Many of those people have found ways to cope in their relationships. Those couples, however, have to work hard at their relationships and at making sure that each person in the pair has outside help, since relationships of this type can be unusually unstable and demanding.

Part of why I wrote Surviving Ben's Suicide, was because I wanted people to have a window into how a relationship with a bipolar and borderline partner works and just how difficult it is for both people involved.

I made a conscious effort, partly by way of literary agents' and editors' suggestions, not to make my book into a prescriptive or self-help book, in which I go into great detail about Ben's illnesses and how they affected me. Instead, I decided to try to "show" how our relationship worked so that other people, who have gone or are going through similar situations would identify and not feel so alone in their struggles.

I have found it fascinating to hear from readers of my memoir, who have struggled with a mental illness or been on the other side of a partnership that my book has allowed them to see the unhealthy aspects of their own relationships more clearly so that they can try to improve them. I have had others write to me to say that after reading about my tumultuous relationship with Ben, they realize how difficult their relationship had been and that they do not blame themselves so much anymore for not being able to save their partner from suicide.

I would love to hear your thoughts on this extremely complicated and painful subject. Please leave me a comment or email me at