A Personal Point of View

This article really hit home for me. When my brother took his life, everyone who knew him was at first shocked, and then angry. Even some of my own family thought I was wrong not to be angry after some time passed. This article echos what I have always felt about my own brother's actions. "If only he kept taking his medication. If only he was willing to open up to his doctor and therapist and allow himself to feel.....to do the work." When you have a chemical imbalance mixed with traumatic experiences and a sense of loss and failure, no matter what the proportions, it can be lethal. This paired with the stigma society attaches only magnifies the problem instead of understanding it in an effort to change societal thinking in my opinion. I hope you'll read this and pass it on. Maybe we can help change ignorance and fear to understanding and support.
Thanks, Susan
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Thursday August 30, 2007

Owen Wilson: On Understanding Suicide (and Attempts)
"The human heart is exquisitely fragile," Catholic author and columnist Ron Rolheiser writes in his annual column on suicide. "Our judgments need to be gentle, our understanding deep, and our forgiveness wide."
I am grateful to reader Babs for leading me to Rolheiser’s column, and am grateful for Rolheiser for prodding his readers to open their minds to try to understand the desperation of a person who seeks refuge in suicide.
How timely as I read all the tabloid reports on Owen Wilson’s attempt to end his life.
"What triggered it?" is everyone’s first question, a query that has always annoyed me. As if his break-up with Kate Hudson was the rationale behind his slashed left wrist and stomach full of pills. Such justification is our way of staying out of it, of segregating ourselves from those who can’t handle messy breakups. By assigning pain to a specific event or circumstance, we can hypothetically remain immune to that hopelessness inherit to a suicide attempt. Because we’re not dating Kate Hudson. And if we were, surely a breakup wouldn't take us to that pathetic place ...


Rolheiser quotes the same verses of William Styron that I have in previous posts. But the words are wroth repeating because, in my opinion, the author of "Sophie's Choice" best articulates the agony and torment of suicidal depression. I often play the theme song of "Rocky" as I read it (not really), but his description has that affect:
The pain of severe depression is quite unimaginable to those who have not suffered it, and it kills in many instances because its anguish can no longer be borne. The prevention of many suicides will continue to be hindered until there is a general awareness of the nature of this pain. ... and for the tragic legion who are compelled to destroy themselves there should be no more reproof attached than to the victims of terminal cancer. ... 

What I had begun to discover is that, mysteriously and in ways that are totally remote from normal experience, the gray drizzle of horror induced by depression takes on the quality of physical pain. But it is not an immediately identifiable pain, like that of a broken limb. It may be more accurate to say that despair, owing to some evil trick played upon the sick brain by the inhabiting psyche, comes to resemble the diabolical discomfort of being imprisoned in a fiercely overheated room. And because no breeze stirs this caldron, because there is no escape from the smothering confinement, it is entirely natural that the victim begins to think ceaselessly of oblivion.
 The rest of Rolheiser’s column is enlightening, as well:
Styron then describes graphically how the depressed person becomes obsessed with thoughts of oblivion:
Any of the artifacts of my house had become potential devices for my own destruction: the attic rafters (and an outside maple or two) a means to hang myself, the garage a place to inhale carbon monoxide, the bathtub a vessel to receive the flow of my opened arteries. The kitchen knives in their drawers had but one purpose for me. Death by heart attack seemed particularly inviting, absolving me as it would of active responsibility, and I had toyed with the idea of self-induced pneumonia-a long, frigid, shirt-sleeved hike though the rainy woods.

After reading virtually all the literature, medical and psychological, on the issue, Styron suggests the suicidal depression is, in the end, caused by chemical imbalance, despite the fact that other factors (lifestyle, childhood, moral values, memory) contribute. Modern sensitivities, he contends, make us reluctant to use old-fashioned words like madhouse, asylum, insanity, melancholia, lunatic, or madness, but "ever let it be doubted that depression, in its extreme form, is madness. The madness results from an aberrant biochemical process. It has been established with reasonable certainty (after strong resistance from many psychiatrists, and not all that long ago) that such madness is chemically induced amid the neurotransmitters of the brain, probably as a result of systemic stress, which for unknown reasons causes a depletion of the chemicals norespinephrine and serotonin, and the increase of a hormone, cortisal."

Styron was one of the lucky ones. With his suicide already planned, he drew on some last gleam of sanity and, in that, realized that he could not commit this desecration on himself and his loved ones. He woke his sleeping wife and she drove him to a hospital. In its "safety" and given "seclusion and time" he healed. He lived on to tell this insider's story.


That insider's story has a double value: Not only should it help us to understand suicide more deeply and exorcise more of its shameful stigma, but, in helping to expose the anatomy of suicide, Styron gives us better tools to help others (and ourselves) in its prevention.
Beyond that, a proper understanding of suicide should help us all walk more humbly and compassionately in grace and community, resisting the bias of the strong and unreflective who make the unfair judgment that people who are sick want to be that way. 

And I absolutely love this:
The human heart is exquisitely fragile. Our judgments need to be gentle, our understanding deep, and our forgiveness wide.

I try to stay a believer: Sister Suzie

I try to stay a believer, I really do. It's just so very hard to wake up every day, knowing I will never see my brother's sweet face again, except in memories. I look at that word....except, and pray every day that the pain will become "accept", but it's still tearing me to pieces. I miss him so much. I went to his house yesterday to try and help Susie (ex-wife) pack up his things. I thought it might help me, but clearly it's brought me back to the reality of that horrific day when he took his life in that house.

I'm so stuck in my sadness. This morning I woke up feeling like I was weighted down by it. I couldn't stop crying. I kept telling myself that there are so many people in so much pain of their own that I should stop feeling sorry for myself in my loss, but it's not just that really. It's my feelings of grief for HIM. He won't be here to see his boys growing into their manhood, evolving, getting married, having families of their own and his becoming a grandfather. He would have been a wonderful grandfather. It would have been a totally different experience for him, just as it would have for my own father. Maybe I'm not seeing it the way it would really be, but that's what I have/had planted deeply in my hopes and dreams. That's what I would have wanted to have the chance to see for him/them and me. I am so sad for his sons and the loss they will have to live with. They were cheated of his growing old, just as I am with my own father who is also not here for those experiences in his life, except losing David is even more difficult to accept. If he had only been able to learn to live with his illness and take the meds required to help him from getting so ill. I guess it just wasn't in God's plan for him.

The holidays are always such a difficult time after losing someone you love so much. This past year was especially difficult for my family. We lost my Great Aunt Essie, then my Uncle David and now, the most painful loss of all, David. I pray that we will all get through it together and appreciate having each other. He was so sad and lost in his fear. I wanted him to be happy, truly happy. He was so desperately unhappy. He deserved to find joy in his life. He tried so hard, in his own quirky way, to be kind and responsible to others. He could be so funny and addictive to be around. David had so much talent and such a creative mind. What a waste.

Don't be Angry with David

Why does a person kill themselves? Was he/she just selfish and uncaring about those left behind? What about his children? How could he leave them with these scars and questions for the rest of their lives? Shouldn't we be angry with him for leaving us all behind? How could he do this to me? It didn't have to end this way. He should of gotten help. He should have tried harder. He should have not been so thoughtless about all the people he loved. He should have thought about us instead of just himself. What could possibly make an otherwise loving, caring, considerate and compassionate person, a thoughtful father and a good friend, do such a thing? If it were me, I would never have done this to all of these people. Why does a person kill themselves?

Albert Camus starts his philosophical treatise, The Myth of Sisyphus, with the statement, "There is really only one truly philosophical question and that is if one should or should not kill themselves." He concludes that suicide is not a valid existential choice although he points out that there is no reason not to kill yourself either. Did David exercise his existential right to determine his own fate and free will by killing himself? I think not. The existential choice of self destruction is presumably made with a clear mind. It is a choice, something that has been thought out in detail and decided upon.

I believe that it is a human being's right to commit suicide. I believe in free will and autonomy. I am a physician but I do not believe in euthanasia. I am undecided about the ethics of physician assisted suicide. Still, I believe that a person must be free to end their life when they want to, when they need to. I feel that this is essential as it is a person's right to put an end to intractable and terminal pain and suffering. I believe that a doctor's role is simply to relieve suffering. I think we would all agree that a cancer patient, having exhausted all tolerable therapy and who is suffering in pain should be allowed to die and maybe even assisted in this regards. There is no hope for this person. The patient realizes that he is going to die and there is no hope. This person makes a rational choice to stop living in order to avert horrible pain. The alternative may be relying on modern medicine to prolong the process, fighting against the ultimate enemy, death. I have seen many instances when death is not the enemy but a friend and savior. I believe, in this instance, it is a person's absolute right to commit suicide. I also believe the same truism exists for any terminally ill person who rationally makes the same choice. This choice can only be reasonable when one is not consumed by depression. Most hopelessly ill people have reached the stage of acceptance by this point. Most of us would respect this decision and understand. We generally would not be angered by it.

So, what about David? Certainly he was suffering. Was his suicide justified in my opinion? I do not believe that David's situation resembles either of the two scenarios mentioned. If David had made an existential choice to end his life then I believe we should all be very angry with him, as his rational action could only be described as thoughtless and selfish. Likewise, David was not terminally ill and his suicide was NOT a choice that he made or even rationally planned. He was suffering from major depression, which is neither terminal or hopeless although it feels like it is when you have it. This is a real illness with a high mortality rate. David was bipolar (manic-depressive).

Many people simply don't understand mental illness. They think that it is not a real problem. They have never experienced true depression and cannot conceive of why one can't simply snap out of it and be happy. Psychiatric disease is not considered a "valid" illness for most people. It is simply not taken seriously and most people feel that it is a cop-out. There is an unavoidable stigma in mental illness. Mental illness is not a "real", respectable disease. Indeed, it is all in their heads. There is no real pain and suffering like someone dying of cancer. The disease is the person's own fault, not like someone with colon cancer. Likewise, a suicidal death is their own doing, their own failing and as such a disgrace. "It's merely selfish, foolish, cowardly and a waste of a life." Consider that the prevalence of bipolar is 1.2 - 4.3 % of the population (3.3 - 7 Million US adults) and the lifetime suicide attempt rate is 30% and 1 in 5 are lethal. The prevalence of colon cancer is .005% or 150,000 people. There is a 60% five year survival for colon cancer in the US. Mental illness is a real disease with a high mortality rate.

I would like to try to explain what happened to David. I have some insight into the disease. David completely lacked insight. He never really believed that he was bipolar. He always thought that he was just a high energy person. He considered normal to be his hypomanic state. I never saw David in a true manic state and if he was having depressive episodes over the 45 years that I've known him, he hid them from me. I actually used to envy David because I thought he was always up and full of energy. Insomnia is a feature of mania and David was a chronic insomniac. It frequently takes up to 10 years for a correct diagnosis of bipolar to be made by physicians. Many people who suffer from this malady crave the highs so much that they refuse to take medication. The movie, Mr. Jones, with Richard Greer, depicts this scenario well.

I would like to explain the spectrum of mood disorders a little better. In my mind, the best way to understand what happens is to realize that manic depression is just an accentuation of the normal process that each of us goes through on a day to day basis. We all fluctuate around what absolute normal is, if it really exists. Some days we feel a bit high and some days we might feel a bit low.

Manic-----------------Manic
Hypomanic-----------------Hypomanic

Normal Up-----------------Normal Up
Normal-----------------Normal
Normal Down-----------------Normal Down

Dysthymia<==>Depression------------------Depression<==>Dysthymia
Major Depression------------------Major Depression
Suicidal<==>Suicidal

Normal people cycle tightly around normal, up and down in a sine wave fashion. People with unipolar depression cycle below normal. People with dysthymia spend their entire lives below normal and major depression basically includes suicidal thoughts or ideation. On the other hand, hypomania (mild mania) is a really powerful place to be with boundless happiness, energy and creativity. On the down side, it is shadowed by features such as aggravation, anger and irritability or dysphoria. This is much worse than normal happiness or anger. One may feel over confident, have no need for sleep, have racing thoughts with difficulty focusing, fast speech with increased talkativeness (force of speech) and practice risky behaviors such as hypersexuality, spending sprees, impulsiveness and poor business ventures. Mania is typically a delusional and somewhat psychotic state. One may have delusions of grandeur and believe they are Jesus or God. There are also often hallucinations. If you ever taken speed or acid, you might have an idea of what this is about. Manic-depressive people can be quite impulsive and completed suicide is an incredibly impulsive act.

Hypomania is the feeling that many people with bipolar crave. This is what David thought was his normal or high energy state. I have never known anyone with bipolar to never crash. This can be the complete spectrum down to depression and major depression. This cycle may occur on a daily basis (rapid cycling), weekly or monthly. A doctor may only see the person at one extreme or the other, such as mania where schizophrenia might be suspected or major depression where unipolar depression might be diagnosed. This leads to a delay in diagnosis. Most family members and friends see the real person though. In addition, antidepressants, such as Prozac, can cause mania as a side effect. So can stimulant drugs such as cocaine and speed. A lyric from a song that I wrote describes this, "manic moments, morose in misery, like a seed the sound Marie."

Bipolar is a very common disease and some of the most creative people in human history have suffered with it, such as Mozart and Van Gogh. "Manic depression drove the creative engines of some of the greatest artists and writers and musicians in history, as well as fed the destructive appetites of history's worst tyrants." Here is a more complete list. Many of these people remained undiagnosed and untreated (when treatment was available) for many years. Self medication with illegal drugs is very common and substance abuse is often highly associated with mood disorders. No wonder being a heroin addict seems to be a prerequisite for being a great musician. It is said that the creativity of mania is flavored by the experience of angst and the blues of depression. The medications used to treat mania such a Lithium are called mood stabilizers. The problem with them is that they decrease a person's creativity and this leads to noncompliance. David stopped his medications, but he was never placed on a mood stabilizer. He was only treated with drugs like Prozac.

Let me present an analogy. The myth of Sisyphus is that this Greek man was punished by the gods. He had to push a large boulder to the top of a mountain and when finished, release it to roll back down, only then to push it back up and this for eternity. Camus viewed this as a metaphor of the absurdity of normal life, the existential dilemma. He concluded though that Sisyphus was happy. You might consider this to be the normal fluctuation that people experience around normal. Imagine if you will that major depression is akin to falling into an abyss and grabbing hold of some rocks on the way down. If you lose your grip, you will fall into the abyss and die (suicide). Otherwise, you must use all of your strength to climb out of this hole in order to scale Everest again. Coming out of major depression is like having to crawl out of the abyss and then when one feels totally awful and weak. This is a terrible chore, something that one does not want to ever re-experience. Everything seems completely hopeless and dismal. One feels entirely helpless. All is despair. There is no pleasure at all. This is the complete opposite of hedonism and depression is anhedonia. It is reversible, but believe me, you never want to be there in the first place. Imagine falling into depression repeatedly. The suffering seems immeasurable. Sometimes it is intolerable and suicide follows, losing your grip.

Suicide is an impulsive act. The choice to pull the trigger occurs in an impulsive instant. Bipolar people are often quite impulsive. If you can get past that impulsive moment, rationality may reappear and life will go on. This is why when a person has a plan of just how they will kill themselves, they are at great risk. If they have the means at hand, the result may be dismal and lethal. David had an extensive gun collection which he refused to relinquish. When I talked to him the week before he departed on the phone, he mentioned that he felt unsafe being alone. When I asked him about guns at home, he skirted the question. He told his sister Suzie, who wanted to remove the weapons, that he had no ammunition. Obviously he purchased bullets.

Fred Clarke: Eulogy

These are speaking notes for the eulogy I gave at David’s service that Sunday.

Name Fred Clarke

1973 Vanderbilt, started and met David.

Susie and David knew both of them before they met. They were in 2 circles of friends.

I woke up Thursday morning after David passed away.
And for the first time in 34 years I realized that I could not call him.
And for the first time in 34 years I realized that he could not call me and wake me up.
He certainly got up early each day.
We talked early Wednesday morning and agreed to try to meet later that day. I never saw him but I am grateful that we at least had that final chance to talk.

There are so many stories and so many experiences
College, the Exit-In, Farm, Town, Family, nights, days, helping each other, etc. etc. etc.

One thing I have always known about David, that it was hard for him to express his feelings, his emotions.

But he did. He did express them. David revealed them to all of us
Through his incredible music and musical talents
Through his magnificent carpentry and wood-working skills
Through his kindness and willingness to help others
He touched all of us here and he touched so many more people
A vast cross-section of people from varied walks of life
I heard him admit that so many people touched him as well.

He enjoyed being out and about, meeting people, bargain hunting at yard sales and flea markets; he liked searching for things and through things.
He enjoyed exploring life

I am here to honor my best friend…David’s life, his family, his two sons, and his friends.

I miss my best friend. I miss him dearly

I loved David. I will continue to love him, as he is part of my heart,
Part of all our hearts
He is with me and will continue to be with me each and every day in so many different ways.

I love you David Caro. I always will. I wish you a good journey. I know I will meet and see you again, my friend. But in the meantime I will miss you deeply with all my heart.

I love you
Fred

Digitizing David's songs

UPDATED HERE (08-22-2006)

I was asked how to capture David's music from cassette to computer for uploading to the web and to this blog. At this time you will have to send or upload the files to my website (see below) and I will list them for you. I will also be happy to accept any material by snail mail.

Here is how to perform this task:

Digitizing David's music can be easy or hard, depending on your computer knowledge and your resources. The simplest method, which is what I used to capture his music from a cassette, is to connect the output of your stereo cassette to the stereo line in of your audiocard (light blue).

I've written a little program that you can use to record the music directly to an MP3 file. You may download the program here. Click on MP3Recorder.zip and download it. Simply unzip it and run the installation program.

This is the program icon on your desktop.

This is the interface.

The completed mp3 file will reside in the program directory: C:\Program Files\MP3Recorder

I would suggest that you start the recording process, stop, and then listen to the MP3 file (use Winamp or WMP) to make sure the volume is ok. Try to avoid a very high volume which might cut off the loud peaks. The mp3's will be labeled GID-0001.Mp3 and up.

You may upload files using this site: http://www.davidcaro.com/Wex/default.asp

Use the little folder on the right of the page to upload.

If there is a problem, let me know. You may also mail the tapes to me and I can do this for you and place them on CD's. Either way is fine for me.

I live for little moments like that

I was sitting in the playground in the mall with Sarah today, reviewing some papers, reading some magazines and listening to mp3's when Brad Paisley's song "I live for little moments like that" came on. I was taken back to January of this year when David was in Florida visiting. Whenever something happened that he liked, he would say "I live for little moments like that". He must have said it about 100 times. He cleaned up my apartment for me as I am a slob and he was anxious about his date that night with Yvonne. He was so happy then and we had such a great time.

From Sister Suzie

Although I don't remember exactly when this photo was taken, I do remember that David was trying to enjoy life. He was taking road trips with his motorcycle buddies John and Jerry, enjoying his music and friends. His life was slowly coming together. I remember it was around the holidays (Thanksgiving or Christmas time) when this picture was taken by my mother in her livingroom. He cooked a wonderful meal for all of his immediate family, including his sons. I wanted to share it with all of you. I also wanted to say how grateful I am for all of the wonderful friends David had in his life. He was a very special part of all of our lives and his leaving the way he did has truly left deep sadness that will take a long time to recover from. I know that I will never fully recover, but I have so many wonderful memories to hold close to my heart.

The eulogies given by Larry, Fred and Everett said it all. They brought many tears to my eyes and touched my soul. I hope they will share what they said here, so we can all remember how very special David was and will remain, in our hearts. Thanks to Warren Goff for creating this and giving us all the opportunity to show our love for David. It helps ease the unbearable pain of losing him. Hopefully this site, dedicated to my brother, will grow and be shared by many. Please bring your photos, songs, comments and anything else you can emit, to keep his memory alive in all of us.

With love and gratitude,
Sister Suzie