Among the many, many changes being proposed to the DSM is one that I consider ridiculously brilliant: A separate, standardized questionnaire to assess the risk of suicide among teens.

It’s ridiculous because everyone knows that teens are different but for some reason teens are often screened as though they are adults. For example, teenage boys are less likely to have depression, more likely to abuse alcohol and often exhibit aggressive behavior before a suicide attempt. Teen girls often have depression but are less likely to abuse alcohol. For both, suicide is often spontaneous and impulsive. Meanwhile, adult suicides often follow detailed planning, worsening of depression, heavy drinking, increased anxiety, and agitated behavior.

The recommendation for a separate assessment scale for teens is brilliant because the proposal recommends testing teens without verbally asking questions. Instead, teens will tested on paper or on a computer. It seems teens are reluctant to verbally answer personal questions asked by adult authority figures. (Imagine that.)

Finally, the proposal recommends that the results are recorded in a teen’s medical records. Seems like common sense, but apparently, doctors don’t always record the results of a suicide risk assessment in medical records.

“While clinicians must currently evaluate individuals in their care for suicide risk, there are a number of different scales in use and the evaluation is sometimes not included in the written record,” said David Shaffer, M.D., a member of the Disorders in Childhood and AdolescenceWork Group. “The use of a single research-based scale and accompanying record of assessmentmay help clinicians better assess suicide risk as well as provide important information forresearchers to help us more accurately identify and treat those at greatest risk for suicide.”

How could this proposal possibly be controversial?

I sat down and talked with several suicide survivors last night. By “survivor” I do not mean they had attempted to take their own lives. By “survivor” I mean they have survived the suicide of a loved one.

After listening for a couple of hours, I realized that the word “survivor” has never been been more aptly applied to a group of people. And after listening to these people for a couple of hours I can unequivocally say that I will never, ever try to kill myself again. Ever.

I felt uncomfortable among them, not just because their stories were terrible. It was the visceral carnage every suicide leaves behind and how it affects even the most routine, mundane tasks we all perform in our daily lives.

Something horrible happened here on Thanksgiving night. I heard about it when I walked into the newsroom on Friday morning. As the day wore on every snippet of new information was more horrific – leaving the crew of veteran reporters and editors in our newsroom shaking their heads.

In nearly 30 years of journalism – much of it as a beat reporter covering crime – I have covered many horrific crimes. This case is among the worst. Frankly, I don’t want to recount the details.

Of the four people and one unborn child executed that night, one haunts me: 6-year-old Makayla Sitton, shot five times, including her head and heart, as she slept in her bed – just hours before her premier as a ballerina in The Nutcracker. Makayla was the only child of beloved local television photojournalist Jim Sitton and his wife Muriel. Jim was trying to break into his daughter’s bedroom window when he heard the shots. Makayla’s mother, Muriel Sitton, who had served the family Thanksgiving dinner earlier, was also there.

They tried to revive their only daughter. The paramedics tried, too. Makayla died. As of Sunday night, Jim Sitton was still wearing the clothes he wore when he held his dying daughter – his left shirt sleeve speckled with blood.

I am a single mom. I have one child – Kealy – and she is the love of my life, the center of my universe and a gift beyond my wildest dreams. Like all parents I have had those horrible thoughts – what if…? Because I am a reporter and have interviewed and listened to the testimony of many parents who have lost their children, I have seen this anguish up close. It scares the hell out of me.

Three years ago, during my last major depression, I admitted that I had tried to kill myself twice before as a teen and was now thinking again killing myself. The only thing stopping me was my daughter. She was my anchor to life. I believed I had no reason to live without her.

“Anything happens to …

All threee have dates.

Bryan’s date is Oct. 10, 2008. That is the day his father killed himself. Bryan talked about his father today at the annual survivor conference sponsored by the Southeast Florida Chapter of the American Foundation for Suicide Prevention in Fort Lauderdale.

Bryan could not find enough adjectives to describe how wonderul, amazing, fun-loving, hardworking, absolutely hilarious his father was. A mountain biker, successful businessman, skiier, race car driver, a man who seemed to love his life and his life love him back.

“In his note he wrote maybe I lived too good a life,” Bryan said.

Just before Oct. 10, 2008 his father sold his possessions, he stopped doing things that he liked to do, he was in a severe depression and he had a prior suicide attempt in 2001.

“Bryan, you don’t know how bad this depression is,” Bryan recalled his father saying. “In his note he also wrote that it was too late.”

Paul lost his partner of 16 years on March 10, 2005 but that was not the worst day of his life. March 11, 2005 was the worst day of his life. That day he called his family, his partner’s family and friends.

“In addition to the stigma of suicide, I was shunned by coworkers because we were a gay couple,” Paul told the audience here in Fort Lauderdale today. “I am not going to deny that he died by suicide or that I loved this man.”

“The more we discuss suicide, the more we say the word “suicide”, the less stigma there will be,” Paul said. “Please say the word “suicide.” It’s a form of death.”

Renae’s son was 25-years-old when he shot himself. That was one year and seven months ago.

“From the day the sheriff came to my door until today, I have not cried,” she said. “It is amazing how the word has moved on and dragged me along. There are some of the longest days and nights but the longest years that have ever been.”

She is mad at the authorities, who treat suicide like a crime: “We are subjected to their accusations and questions. People feel like they have the right to …

There are books on display by the front table here at the annual conference for survivors sponsored by the southeast Florida Chapter of the American Foundation for Suicide Prevention. There are books on grief, why people commit suicide, my new book on my experience with depression, bipolar and alcoholism, along with brochures and newsletters.

“Are there any books for children?” one woman asked during the Q&A.

Yes, a Michael T. Miles, a psychologist who works with children told the crowd: The Fall of Freddie the Leaf
by Leo Buscaglia.

Let me know if you know of other books.

I am spending today with several dozen survivors at a gathering sponsored by the southeast Florida chapter of the American Foundation for Suicide Prevention. On each table are programs for the event, LifeSavers candy and packets of Kleenex. I want to share with you what I experience here today. I have never been to this annual event before. I am told it will change my life. I believe them.

I found this in the folder on my table.

Survivors Bill of Rights
I have the right to be free of guilt.
I have the right not to feel reponsible for the suicide death.
I have the right to express my feelings and emotions, even if they do not seem acceptable, as long as they do not interfere with the rights of others.
I have the right to have my questions answered honestly by authorities and family members.
I have the right not to be deceived because others feel they can spare me further grief.
I have the right to maintain a sense of hopefulness.
I have the right to peace and dignity.
I have the right to positive feelings about the one I lost through suicide, regardless of events prior to or at the time of the untimely death.
I have the right to retain my individuality and not be judged because of the suicide death.
I have the right to seek counseling and support groups to enable me to explore my feelings honestly to further the acceptance process.
I have the right to reach acceptance.
I have the right to a new beginning.
I have the right to be.

From JoAnn Mecca’s Center for Inner Growth and Wholeness

Today is National Suicide Survivors Day. Survivors are the loved ones who live with anguished – and sometimes angry – hearts. Their lives are consumed with unimaginable sorrow and unanswered questions: What could I have done? How could I have missed this? Why? Why? Why? How do I live with this?

“You don’t,” said a mother whose son killed himself with a gunshot to the head. “You learn to live around it.”

My thoughts today turn to two coworkers – one drank himself to death, the other swallowed a bottle of pills and left behind two young sons. “He’s really cold,” one of the boys told me as we stood beside his father’s casket.

My thoughts today are with another friend who left left behind twin boys – just toddlers – when he closed the garage door and turned the ignition key on his truck. My prayers today are for the widow of German soccer star Robert Enke – whose husband stepped in front of a train two weeks ago. He had depression and was overwhelmed with fear that if his illness became public the baby girl the couple adopted earlier this year would be taken from them – just as their natural daughter was taken from them several years ago when her heart failed.

I will spent today at a local conference of suicide survivors. I doubt I will be able to listen to all of the speakers’ stories. But I will try. Suicide scares me. I have seen a glimpse of the unfathomable grief it leaves behind. Suicide scares me because I know I am capable of it. Twice before I have tried. I know the thoughts. I know the singleness of purpose. I know the pain. I know, I know, I know.

Today I will pray that God gives the survivors serenity, acceptance and absolution from their unnecessary guilt. Even if just for a moment, God, just let them have some peace.

I was a panelist last Friday on the BBC radio program called World Have Your Say. The title of the program was Should You Make Your Mental Illness Public? Debates like this are being held throughout Europe as the continent mourns the suicide of Robert Enke, the beloved German soccer player and young husband and father. Enke kept his illness from everyone but his wife. And now we are asking ourselves all kinds of questions about how mental illness should be handled in public. But our panel discussion strayed to whether employers should be allowed to ask and employees be required to tell employers about their mental illness.

I used the word “abhorrent” to describe the idea. Where would it stop? Would bosses be allowed to ask about other medical conditions, such as AIDS? In a way it is not really an issue. If an employer really wants to know whether a job candidate or employee is being treated for a mental illness, just do a drug test. Most workers believe they are being tested for marijuana and opiates. But there are employment drug tests that screen for a smorgasbord of drugs, including antidepressants and mood stabilizers.

The civil libertarian in me want to stamp her feet and claim invasion of privacy. But I understand why employers want to know. Depression is the number one workplace disability in the United States. Overall, mental illness costs employers an estimated $140 billion a year in disability, lost wages and productivity. There is also the “Ola Nolen” factor. I covered Ola Nolen’s murder trial back when I was a beat reporter. Ola – a sweet-looking grandmother – had thrown gasoline on a coworker and tossed a match on her because she believed the woman had stolen the $1 million check that John F. Kennedy had given Ola to solve the Cuban Missile Crisis. Ola had paranoid schizophrenia. Would Ola’s horribly burned coworker be alive today if Ola’s employer knew she was mentally ill? We don’t know.

Last week a gunman in Orlando walked into the engineering firm that laid him off last year and opened fire. One man was killed and …

Stigma kills.

Robert Enke, the beloved goalkeeper for the German national soccer team, stepped in front of a train on Tuesday.  Enke, 32, was at the height of his career – expected to be the German team’s goalkeeper  in the 2010 World Cup. He and his wife Teresa had adopted a daughter, Leila, earlier this year. Leila is 18 months old. Three years ago the couple’s 2-year-daughter, Lara, died of a heart condition.

Enke had battled battled depression for six years but feared that if his depression became public they would lose Leila, his widow said.

“We had Lara; we have Leila. I always wanted to help him to get through it,” she told reporters. “He didn’t want it to come out because of fear. He was scared of losing Leila.”

Sit down, close your eyes and imagine – if you can – what it would feel like if you suffered from a reviled illness and believed that your child would be taken from you if word of your illness got out. People with cancer or heart disease or diabetes do not have these worries. They can focus on getting well. But not people with mental illnesses. Those of us with mental illness have to worry about losing our friends, family and job – not to mention insurance – if our alcoholism, depression, bipolar or schizophrenia etc. becomes public.

Regardless of whether you are a soccer fan, we can honor Enke’s memory by speaking up and out. Loud. Anytime you hear anyone poke fun at the mentally ill, doubt their suffering or joke about their medication, chime in, interrupt and defend Enke’s despair. It was horribly real. Make a statement when you see an antidepressant ad on television, listen to Nirvana or read about Anna Nicole. The stigma is not going to go away on its own.

Unfortunately Enke believed that he had to choose between getting well and losing his daughter or staying sick and keeping his family together. Sadly, he got it backward. By staying sick his daughter lost her father.

God rest …

I emceed the annual Out of the Darkness walk last Saturday for our local chapter of the American Foundation for Suicide Prevention. This group is very special to me – not just because I have two suicide attempts in my past. It is because of their extraordinary devotion and perseverance to this cause in the face of overwhelming stigma. More and more we hear a celebrity, coworker, neighbor or friend talk about their depression or bipolar or even their struggle with drugs and alcohol. But discussing an actual suicide with the loved one left behind is still the ultimate taboo. You just don’t do it.

We want to hear the gory details, but we dare not ask. Instead, we rely on hearsay and gossip. We tell ourselves that we do this because we don’t want to inflict any more pain on the grieving loved ones. But we really do it because suicide scares the hell out of us and if it could happen to them, it could happen to someone I love.

After the walkers took off I hung out with several couples whose children had killed themselves. It had been many years since their children’s suicides and all of them now volunteer to help others deal with their grief. I asked if I could ask them some questions – not about details of their children’s suicide but about etiquette.

I have friends of friends who have killed themselves but no one close to me has committed suicide. I, too, am very uncomfortable discussing it with a grieving loved one. I don’t know how to start a conversation and I don’t know how to respond if they decide to talk about it.

So, I asked these parents: “What should I say?” “What questions can I ask and what questions should I not ask?” “Is it okay to ask why it happened?

One mother told me she thought I should break the silence by saying: “I hear you had a wonderful son/daughter/husband.”

“Don’t approach it from the perspective of loss,” she said. “This way they will focus on the good rather than the event.”

One of the fathers disagreed: “I think you …