By: Jayson Blair
I woke up late in the morning. It was a little after 7 a.m. I have been sick for the past few days so I decided to not rush into work. I made a cup of coffee in my kitchen and then walked over to the living room. Standing between the couch and my glass coffee table, I tapped each remote and turned on CNN.The Breaking News headline, in those trademark white letters on a red background, slashed across the screen.“CNN’s Anthony Bourdain dead at 61.”My first thought was sad, but not surprising. I knew much of Bourdain’s story that he shared publicly and had a tangential connection to Bourdain through once working with his mother. I had liked her and it led me to follow his career as a chef, a guest on “Top Chef,” on his show “No Reservations” and, eventually, on his CNN program, “Parts Unknown,” a remarkable program that was as much about foreign correspondence as it was about food.I walked away from the TV. Before I made it to it to the bathroom, I heard Alisyn Camerota, the CNN anchor, say the words “… in an apparent suicide.” I turned back to the screen. I burst into tears.Another one lost to what Andrew Solomon, the noted author, calls “the Noonday Demon.”“He is absolutely the last person in the world I would have ever dreamed would do something like this,” Gladys Bourdain, the former colleague from The New York Times, told the paper on the day of his death.Only a few days before it was announced that Kate Spade, the renowned fashion designer who, like Bourdain, struggled with depression, hung herself in her Park Avenue apartment.The night before her death, The New York Post reported that Spade, spoke with her father happily about planning a trip to California to look at colleges with her daughter.Their deaths came in the same week that the federal Centers for Disease Control and Prevention reported that suicide rates, defying prevention efforts, rose 25 percent between 1999 and 2006. More people die from violence upon themselves in the form of suicide than homicide and war combined.In the days that followed the deaths of Spade and Bourdain, countless people spoke of the good moods both Bourdain and Spade were in during the days and weeks before their deaths, the bold plans for the future they discussed and lack of visible signs of suicidal ideation. In retrospect, however, the signs were all over like falling cherry petals on a Spring day.Bourdain told the world in his book Medium Raw that after his first marriage ended in 2005 that he was “aimless and regularly suicidal.” He wrote of a time in the Caribbean where he was drinking and using drugs, driving recklessly each day and visiting brothels each night.The only known accurate predictor of suicide is previous attempts. But, Kay Redfield Jamison, the eminent author and psychiatrist who lives with bipolar disorder, notes in her book on suicide, called “Night Falls Fast,” that suicide usually requires “multiple hits” in the form of some combination of a biological predisposition, major psychiatric illness and an acute life stress.No doubt, some people try to conceal their plans for suicide, but Jamison notes that “most who commit suicide explicitly, and, often, repeatedly, communicate their intentions to kill themselves to others.”Both Bourdain and Spade presenting with and acknowledged having major psychiatric illness, and each were encountering acute stress. For Bourdain, it was in the form of a grueling travel schedule at the same time his girlfriend was pictured on social media holding hands and embracing another man in France. For Spade, she was going through a difficult divorce.There are contradictory reports about whether Spade, who was diagnosed with bipolar disorder, and Bourdain, who lived with depression, were being treated for their illnesses at the time of their deaths. Having a major psychiatric illness and stopping or never being treated, is another risk factor.As someone who has both professionally and as a volunteer helped individuals who eventually died by suicide, who has lost friends and colleagues to suicide and who has and has been suicidal myself, I can say that there is little-to-no correlation between the outward appearance in the days and weeks before a suicide attempt.One colleague at The New York Times who had depression and who died by suicide during an acute stress due to a divorce in 2002 was having positive conversations with friends the weekend before he hurled himself off the side of our building. Another colleague at The Times who died by suicide was remarkably positive with his family before jumping into the Hudson River off the George Washington Memorial Bridge.Mental health clinicians use the term “affect” to describe how someone’s emotional state appears. This is different from their actual mood. For example, someone may smile at the same time they feel flat inside.Clinicians refer to this as “affect being in congruent with mood.”That is why it is critical when people with major psychiatric disorders are experiencing acute stress to look beyond the surface and provide as much support as possible, even if it does not seem necessary. I have seen this more than once with my own eyes. When one client who was having job and personal life stresses died by suicide in 2015, it was on the cusp of being optimistic about a new treatment that could potentially address his acute depression and intense anxiety. While there is little that we can do to predict the randomness of life stresses, there is a lot we can do to promote our friends and family members receive medical treatment for mental health symptoms and are regularly screened when there are biological predispositions.There are also periods, regardless of how people appear on the outside, where they are at great risk. After remission from an acute episode of bipolar disorder, for example, a person is at an especially high risk for relapse and suicide for about six months. Often, individuals who are depressed are at greater risk for suicide coming out of the bottom of their depression because they now, clinicians believe, have the energy to plan and execute on harming themselves. Sleep deprivation and suicide, for example, are also strongly correlated.Given these nuances and the prevalence of suicide, perhaps, the best thing that all of us at risk and who want to help others can do is learn more about the factors that put people in jeopardy. Groups like the American Foundation for Suicide Prevention and Active Minds have a wide variety of wonderful resources, including educational materials, available.I understand why Bourdain and Spade are dead. My tears fell because I knew they did not have to.In life Bourdain taught us about food and Spade taught us about fashion. In their deaths, my hope is that they help us learn a little bit about how to help prevent others from taking their lives.