My son’s suicide

My son ended his life in a tony suburb where he lived with his wife and two teenage children. He was wearing blue jeans with a belt and a maroon short-sleeved shirt with buttons. His blood-alcohol level was twice the legal limit. He was 49 years old.

All this I know from the police and medical examiner. His death, like much of his life, is a puzzle with pieces missing.

We’d been estranged over his drinking, which fueled volcanic anger when he was drunk. That happened more often as his alcoholism progressed. In the parlance of the disease, my son was a “raging alcoholic.”

It’d been several years since we talked. He’d long since blocked contact with his family.

Wildly impatient

What’s certain is that he grew up wildly impatient — for some time as a child, he simply tore off his shirts without first unbuttoning them — and that he was diagnosed as an alcoholic at age 17 after a two-day stay at a rehab clinic. A year later, he moved out of the house.

The conventional wisdom is that it’s often necessary for an alcoholic to hit bottom, to finally get fed up with being sick and tired of being sick and tired, before recovery can begin. I never stopped hoping that my son would one day reach that place, which would lead to a new life.

But he never hit bottom.

Instead, he grew more defiant, doubling down on drinking and cementing behaviors that would animate his life until the very moment he pulled the trigger. His Facebook posts featured boating adventures and holiday smiles; inside, I knew, he was boiling.

The emotional boiling I saw behind his eyes enhanced the aura of inevitability that’s often attached to suicide, the belief that nothing can be done to stop someone from taking their life once they’ve made up their mind. Ambivalence is not a factor in suicide, the thinking goes.

Moreover, there’s an idea gaining traction that the gun the criminal carries in his waistband is a far bigger threat than the gun stowed in the bedroom nightstand, that homicides far outnumber self-inflicted firearm deaths.

None of this is supported by research.

Consider the horrors of the 64-year-old gunman who opened fire on thousands of outdoor concert goers outside his hotel window in Las Vegas in 2017. Sixty people died in what became the deadliest mass shooting in U.S. history by one person — which is about the average number of U.S. firearm suicides in just one day.

“The media focuses on homicides committed with guns,” physician researcher Paul Sasha Nestadt wrote in a 2017 study. “But only one-in-three firearm deaths are homicides — the other two are suicides.”

In the county where my son died, there were 80 suicides compared to 45 homicides in 2021, according to the medical examiner’s office, a rough reflection of the U.S. ratio. And the number of suicides has been rising.

Nationally, the number of self-inflicted fatalities began increasing at the dawn of the 21st century, jumping 35.2% between 2000 and 2018 to 14.2 deaths per 100,000 population, according to the Centers for Disease Control and Prevention.

As the U.S. suicide rate rose, a cottage industry of experts has sprung up with theories about what’s behind the increase, from social media to divorce to declining church attendance.

In 2022, 49,449 people died by their own hand, which was 14.3 deaths per 100,000 population, the highest rate since 1941, according to the CDC. That’s about one self-inflicted firearm death every 11 minutes, up 2.6% since 2021.

Every year, more people die from suicide than HIV, breast cancer, war or homicide, according to the World Health Organization.

A modifiable factor

My son was not a hunter, so I don’t know how he ended up with the .20-gauge Mossberg shotgun that he used to end his life. (“When there’s potential for danger, there’s a need for a Mossberg,” the jingle goes.)

A license isn’t needed to buy a gun in Georgia, where my son lived, and Georgia, like Pennsylvania, is not among the 21 states with a red flag law allowing authorities to take guns away from people threatening to hurt themselves. In 1999, Connecticut became the first state to enact firearm seizure legislation and research since then has shown reductions in the number of self-inflicted gun deaths.

My son was nothing if not impulsive and studies show that access to firearms is perhaps the most important modifiable risk factor in suicide.

Most people who take their lives act on impulse in moments of panic or despair that lead to feelings of hopelessness. Hopelessness bridges the valley between depression and suicide, a research paper published in 2023 in the Cureus Journal of Medical Science found.

“Impulsiveness may be a catalyst in using a firearm to commit suicide and may also play a role in firearm-related homicide,” according to a 2014 study published in the Annals of Internal Medicine.

But here’s the thing: once suicidal feelings fade, 90% of those people do not go on to die by their own hand, according to a 2021 study by David Hemenway at the Injury Control Research Center at Harvard School of Public Health.

The Saturday evening of his death, my son argued with his family at dinner, cutting short a night out at a restaurant, police said. Back home, he played with the family dog. Arguing continued.

The warning lights for suicide were blinking red, but it’s not clear that my son had formed a no-turning-back intent to end his life.

More arguing, then my son went outside his garage carrying the shotgun, usually kept in a bathroom closet, police said.

I believe the shotgun was as much of a badge of hardened defiance as it was a means of protection.

In those last moments outside the garage, I also believe, my son was deeply torn between the primal instinct to live and thoughts of ending his life: along with the gun, he carried an extra shotgun shell and an unopened can of Busch Light.

Ambivalence about suicide is not unusual. A 1998 study published in the American Journal of Psychiatry found that about 25% of suicide attempts were not completed.

Moreover, a 2018 British Journal of Psychiatry study found “particularly low rates” of subsequent suicide among people who at first had changed their minds.

“Most individuals who survive an attempt do not attempt suicide again,” the study found. “Those who survive an initial attempt using one method are unlikely to switch to a different method.”

Even so, having a gun in the home increases the risk of suicide by 300%, the 2014 Annals of Internal Medicine study found.

A dream

My son was still a child in a dream I had in the weeks after his death. In the dream, some appointed hour had arrived late one night and I had to help him escape to another country.

Time was running out.

At first, we ran through the darkness holding hands, but then I picked him up to run faster, squeezing him tightly to my chest.

Suddenly, I realized I’d soon never see him again, that his welfare, the welfare of my first born child, would be in the hands of strangers I would never know. In the dream, I was convulsed by gasping sobs.

We reached a long dark hallway and I leaned forward to put him down. He wriggled free of my arms, ever impatient, and ran for a door at the end of the hall.

The door swung open wide, yellow light like the sun streaming through from the other side. He launched himself through the doorway, never looking back.

Kris B. Mamula is a health care business reporter for the Post-Gazette: kmamula@post-gazette.com.