Post Mortem

Give Sorrow WordsIn writing Give Sorrow Words I wanted to invite readers to join me on my journey. I wanted our story to unfold naturally, not be weighed down by facts, statistics and research. I also wanted readers to understand that there is never one reason in suicide. My research within this chapter confirms that fact. The Post Mortem chapter, which specifically relates to current mental health research in depression and suicide is included in the  Afterword section of the book.

Post Mortem: Oakville, June 20, 2012

Everybody who knew Daniel was as shocked by his suicide as we were. None of us knew the other Daniel; particularly in the last months of his life. Changes in his brain functioning, chronic health conditions and alcohol contributed to our son’s bouts of mania and depression. In his last hours Daniel would not have recognized himself.

Two days after what would have been Daniel’s 26th birthday, I came across a vital piece of information that had eluded me. In the Globe and Mail newspaper, I stumbled onto an article entitled: The fragility of the teenaged brain. The Globe described a study, led by researchers at the University of Montreal, that claimed a blow or bruising to the frontal lobes could cause severe damage, even trauma if it affected the cognitive part of the brain responsible for decision-making and organization responses. This vital part of the brain (known as the sub cortal region) controls moods and behaviour.

Since my son’s death I had read the literature on mental illnesses, depression and disorders of the brain. I had also reached out to clinical professionals whose day-to-day work involves diagnosing and treating diseases of the brain. Including Dr. Roger McIntyre, Professor of Psychiatry and Pharmacology at the University of Toronto and Head of the Mood Disorders Psychopharmacology Unit, University Health Network in Toronto. Dr. McIntyre’s research into inflammation and its connection to mood disorders are in part responsible for reshaping the model of treatment for sufferers of depression. Dr. McIntyre explains,

It is not uncommon because of the effect of depression on the brain that it can take the sufferers ability to have insight and hovering capacity as to what they are going through. In other words it is the case that depression hijacks people and locks them into a reality misperception and distortion that is immutable in many case. It is not volitional what they are doing. Most suicide is impulsive and many who survive attempt really didn’t want to do it to completion.

I had become a lay expert on depression, but I still felt as if I was missing an essential piece of information that would connect events to the changes in Daniel’s behaviour. But after reading the Globe article, the research and studies made more sense. Daniel was an avid boarder; snowboard, long board and wakeboard. As an adolescent I know he fell hard, hitting his head at high speed. Particularly, when he wake-boarded; possibly jarring his brain or worse, sustaining brain damage (or concussions). In the developing brain, a severe blow to the head can lead to deficits in the brain’s working memory. The blow can affect a person’s ability to ‘hold and manipulate information for short periods of time.’ It can also lead to impaired concentration and be the cause of severe headaches, both of which Daniel suffered.

Daniel routinely snowboarded into half pipes to get some backside air or perform an alley-oop; rotating 180 degrees towards the up side of the half-pipe. He lived for the high of floating above the ground. But there were times when he fell hard or slammed into the wall of the half pipe. He adopted the same risk-taking behaviour while riding his wakeboard. Daniel would instruct me to drive the boat at 22 mph while he waited for the precise moment when there was enough tension on the towrope to give him the best pop (or air) to complete his trick. Then he would attempt a big spin and land hard on the water and sometimes his head would take the force of the fall. As the driver of the boat I saw some of those falls; as I turned the boat around to pick him up he would wave his arm in the air, signaling he was fine. Let’s do it again.

We encouraged athletic participation in our family, when what we needed to be was more aware of the risks, the symptoms and long term side effects associated with the extreme sports that Daniel participated in.

I had also read about epigenetics, which refers to a ‘heritable but mutable set of processes that regulate the expression of particular genes in certain cell types and/or at specific developmental time points’. Recent studies by Poulter et al.  reported ‘alterations in epigenetic markers in suicide victims suggesting a link between mechanisms that regulate gene expression and Major Depressive Disorder (MDD)’.

Further research has shown that epigenetic modifications ‘can occur in response to drug abuse, stress, learning, and early life experience’.

I knew that my son’s asthma and anaphylaxis created a burden of anxiety that affected him all his life. One study in particular: Chronic Physical Conditions and Their Association With First Onset of Suicidal Behavior in the World Mental Health Surveys, confirmed what I had felt in regards to Daniel’s ongoing health challenges:

Most physical conditions were associated with suicidal ideation; chronic headache, other chronic pain, and respiratory conditions were associated with attempts in the total sample. Physical conditions were especially predictive of suicidality if they occurred early in life. As the number of physical conditions increased, the risk of suicidal outcomes also increased.

And then the conclusion: ‘The presence of physical conditions is a risk factor for suicidal behavior even in the absence of mental disorder’. Kate M. Scott et al.

Much of the current research strongly links asthma and depression in a variety of findings: asthma and depression may have an ‘additive’ adverse effect on the normal asthma-related quality of life reductions.  Specific asthma symptoms appear to be linked to depression; sadness and depression can produce respiratory effects consistent with asthma exacerbations; depression appears to be negatively related to asthma treatment compliance; corticosteroid use in asthma treatment has been associated with depression, Opolski & Wilson, 2005.

In the 2000 Behavioral Risk Factor Surveillance System Study, asthma sufferers reported significantly more ‘unhealthy days both physically and mentally’ than the non- sufferers. Further proof that individuals who experience chronic asthmatic symptoms tend to have a reduced health-related quality of life.

Daniel did not wake up one morning and figure he’d had enough. Life over. No, there were critical factors and important events that all played into his last day. Awful isn’t it? To realize you didn’t really know what you were doing while you were raising your kids?

At least now I can point to the beginning of our son’s malaise with some understanding. Daniel’s fearless nature drove him to get involved in BMX biking and then into extreme boarding sports as a teenager.  I know that he suffered repeated blows to his head, and if he had ever had a concussion it would have gone undiagnosed. In high school he began having sinus and migraine headaches. During this time there would have been imperceptible decreases in his brain activity, eventually leading to his inability to concentrate and to follow instruction.

We don’t have absolute proof that brain injury was a factor in Daniel’s death; however, what we do have is a growing body of evidence in regards to suicide, specifically in young males that can be attributed to an undiagnosed brain injury. And if that was the case, I understand why Daniel was unable to concentrate in his first year of university. He began falling behind and feeling guilty for not going to school and then he concealed his troubles. He began drinking to alleviate his growing malaise. My son’s narrative had changed between high school and his first year at university and not for the good.

Post mortem studies on suicide indicate a localized reduction in serotonin transporter binding, in the ventromedial prefrontal cortex. Specifically, this region of the brain is associated with willed action, mood and decision-making. Abnormalities increase the risk of impulsive dis-inhibited behaviour, which makes a high risk of suicide more likely. Research on suicidal behaviour implicates altered serotonin functions, genetics and epigenetic and childhood adversity. (J. J. Mann, MD and D. M. Currier, PhD.)

What I have come to acknowledge is that Bruce and I were both responsible for our son’s well being. So it would follow that we had responsibility in his untimely death, but we couldn’t help what we were unable to comprehend. Daniel had adapted all his life to health challenges. His melancholy was another problem that he would work through on his own.

So much of the literature on depression talks about a point in a person’s life when ‘the switch’ that controls depression is flipped on. The circuitry of the brain changes as a result of experiences, genetics, lifestyle and god dam bad luck. The switch that had been flipped set in motion the way he interpreted his experiences. Add to that his childhood chronic health conditions virtually setting him up to view himself through a negative lens. Daniel’s physical health conditions were a risk factor for suicidal behaviour.  Looking back, we knew nothing of synapses and brain circuitry and the catastrophic fallout from long-term depression.

Daniel was a daydreamer. Sensitive and inquisitive by nature he was forever trying to interpret the world around him. As a young man he identified with those who were marginalized; people who were considered the underdogs. He was attracted to lyrics and literature that evoked powerful emotions; love and loss, suffering and hope. Conceivably, Daniel was drawn to painful narratives as a way to figure out what was taking over his own life.


A final note from Dr. McIntyre,

Mood disorders are prevalent, often recurrent and severe mental disorders that have their age of onset for most individuals between the ages of 15-30.  The onset of depression at this time of life has a significant impact on educational attainment, occupational trajectory, personality development, interpersonal relations, and romantic life.  In addition, individuals with depression find themselves at increased risk for many medical disorders that are more typically encountered in individuals’ of older age i.e. cardiovascular disease, hypertension, diabetes mellitus type II.  It is now known that mood disorders are the leading cause of disability in North America.  It is also well established that mood disorders insufficiently treated is associated with high rates of premature mortality.

The exact causes of mood disorder are not precisely known.  It is however agreed that a complex interaction between genetic predisposition as well as environmental stress lead to depression syndromes.  It is also well documented that mood disorders are associated with changes in the structure, function and chemical composition of the brain (and body).  Along with the familiar “chemical imbalance in the brain” hypothesis, research additionally indicates that abnormalities in the body’s inflammatory system and metabolic system may be causative.

The features of depression affect a person thinking, emotions and behaviour as evidenced by their difficulty in interpersonal relations and the workplace.  It is well established that suicidality is part of depression and in many cases, but not all, can be prevented.   The most important step towards reducing tragic outcomes in depression is to reduce stigma and other barriers to healthcare and improve outcomes with available treatments.  In the future, it is our hope that in addition to curing depression, we will be able to prevent the onset in the first place:  These are goals that are very much within our grasp.