THE TATTERED TAPESTRY
A FAMILY’S JOURNEY THROUGH MENTAL ILLNESS AND SUICIDE
The Fourteenth Annual Clergy & Healthcare Professionals Conference on Addictions
“Suicide: Preventing the Irreversible”
St. Elizabeth Hospital
April 22, 2004
On January 13, 2003, a dreary, damp, overcast Monday, with the temperature at
40 degrees, around 1:00pm, in a faded blue, windowless, bare, cinder block
bedroom just large enough for a king-size bed, a bedroom converted from a store
room in a vending machine repair shop and warehouse, in an aging industrial
section of the west end of Tulsa, Oklahoma, our 26 year old, beautiful, charming,
loving, occasionally brilliant, multi-talented, bi-polar daughter found a hidden, .22
caliber rifle, propped it up between the bed spring and the mattress, rested it on
her chest, reached down, pulled the trigger probably with her right thumb and
died instantly as the bullet ripped through her body, severing her aorta with what
the medical examiner later described as a “perforating contact gunshot wound of
My soul has been weeping ever since.
How she got to that desperate point and how we, her family, journeyed with her
and now without her is the tragic story I will try to weave as a family tapestry this
The twins, Kevin and Karla, joined Fran and me to form the Smith family on
August 7, 1976. Kevin was born at 7:30am and Karla at 7:40 – “the best ten
minutes of my life”, Kevin often joked. They were very different from each other
from day one – looks, personality, interests, view of the world. Strangers would
never guess that they came from the same family – or womb and certainly not
twins. But there is a strong, subterranean bond that rivets them together at their
core. Call it a twin thing but I know that it is real because I saw it for 26 years.
As they got older, sometimes I would sit back and just watch and listen. He
would try to convince her of the value of some baseball, football or basketball
game, or life in corporate America, and she would impatiently say something like
“Oh, really?” and launch into the value of Shakespeare, an economic system
based on bartering, or some aspect of eastern philosophy. They seldom agreed
on these kinds of things but there was deep respect and unquestioned love.
They knew they were safe with their twin.
The first symptoms that something was wrong appeared in early 1996, when
Karla was nineteen. A deep depression ambushed her during the second
semester of her sophomore year in college. She gradually lost interest in school
and in her relationships and became sullen and withdrawn. She said she would
snap out of it soon and get back to her usual active self. But by the beginning of
March she dropped a number of classes, was taking an “Incomplete” in a few
others, and was unable to continue. She came home.
The next month was grueling. Her depression deepened and periodically she
would lash out at us for something or another, expressing anger followed by
more withdrawal. We made arrangements for her to see a counselor and a
While she battled her illness, we battled our reactions to her. Puzzled, fearful,
angry, hurt, wishing, worrying, irritable, condemning, hopeful, disappointed, -
emotions that came and went, often simultaneously, always present in some
combination. We all dealt with it differently, sometimes well, sometimes poorly.
As Karla slid into her depression, I tried to comfort, encourage, and guide her.
She was appreciative but I was basically powerless. Feeling powerless was not
a new sensation. As the twins grew through childhood, adolescence and toward
young adulthood, the tug between my control and their independence was
evident, as it is in all families. They call it “letting go”, a fair enough term but I
always wanted to know where the “going” was headed. Determining boundaries,
limits, curfews, and behavior for teenagers is essentially slippery. It’s never
really determined and it must change regularly as the kids get older. Mixed in
with that process is an inevitable collision with powerlessness, an expectation
that my words or actions would have a predicted effect which, in fact, doesn’t
But the powerlessness in the face of Karla’s depression was devastating. She
and I always enjoyed talking with each other. We had mutual interests:
philosophy, theology, literature, writing and, in her earlier years, speech, drama,
music and a love for words. Even when we had some conflicts, usually about
curfews or money, we were connected. But when her bedroom became her
world and her bedspread turned into the walls of her prison, she couldn’t or
wouldn’t respond to me. I would go back downstairs, dejected, puzzled, and
unable to fathom the sad-eyed silence that stared at my questions, my words of
encouragement, and my “I love you’s”. It was not the stubborn, silent defiance
that showed up occasionally when she was in high school. This was a blank
nothingness, a serious commitment to not being there – or anywhere.
I couldn’t deal with it, especially when it went on for weeks. I got angry at her, at
her illness, at myself. Fleeting but intense anger. Anger born in frustration and
fueled by expectations. Where was “my favorite little girl friend”? Why can’t we
at least talk? Why isn’t the medication working faster? How could this happen to
her? What did I do wrong? What really brought this on? Should I have been
stricter with her – or, conversely, more permissive? Were there earlier signs and,
if so, did I miss them? Could I have done anything about it? Why can’t my love
for her ease her pain and control the illness? Where is this all heading? Are
there better doctors, counselors, hospitals? What will insurance cover?
I was powerless. I couldn’t do anything to help my daughter. Nothing would stop
the onslaught of the illness.
Eventually, the combination of medication, counseling, and family support
brought her back from the abyss. As the Oklahoma sun warmed the earth Karla
gradually escaped the coldness of her depression, and her natural warmth also
emerged. But it was only temporary. A year later she was again depressed.
She was always a superb writer and wrote extensively. During a later, more
stable period she described her depression this way:
“There was a time when I was completely and utterly convinced that there was
no reason for me to keep breathing. Being in my skin was painful. Every time I
woke from sleeping I was crushed by the weight of my own consciousness. I lay
in my bed for months at a time, not eating, not showering, not speaking to
anyone. There were three major depressive episodes. They came in between
attempts to do something with my life, and I really did enjoy college, I loved
learning, I loved my friendships… but the depressions would hit, and within a
month I’d be failing classes, terrified of friends, unable to hold a job, and back
home to Broken Arrow, OK, to live with my parents”.
In the summer of 1998 things changed dramatically. To make a long and tangled
story short, she ended up manic, with monumental delusions mingled with
By September even she recognized that something was wrong. But she refused
to enter a hospital voluntarily and we couldn’t admit her unless we could
demonstrate that she was an immediate physical risk to herself or to others. Her
delusions and paranoia were not enough to commit her. During a period when
she was a little calmer, she agreed to visit her Uncle Tom and Aunt Kathy (Fran’s
brother and sister-in-law) in Seattle. Both of them are counselors and had
demonstrated their love and concern for Karla many times. Karla also felt a
special connection with them. She decided that the bus would be the best way to
We made all the arrangements and put her on a bus in Tulsa with confidence
that everything was in place. But we didn’t count on the extent of her paranoia.
By the time she got to Tucumcari, New Mexico, she was convinced that the Mafia
was on the bus. She got off, left all her clothes and money on the bus, and
checked into a motel. The next morning I got a call from the Tucumcari police
asking me if I would pay her $35 motel bill. From their description, she sounded
very delusional, definitely paranoid and totally unstable. I asked what would
happen if I didn’t pay the bill, and they said that she would probably be admitted
to the state mental facility in Las Vegas, New Mexico. If I paid, she would be
released immediately. Trying to keep her safe, I refused to pay.
While the circumstances of her admittance were not what I preferred, I was
relieved that she was finally in a mental care facility. She was there for a month.
It was there that she was first diagnosed as bi-polar. We all started researching
bi-polar disorder and the more we read and studied, the more certain we were
that it was a correct diagnosis. At least, we finally knew what the enemy was.
Later, Karla described her mania. Kevin quoted her in his eulogy at the wake
service and again in his presentation at the Shiloh Methodist Church Mental
Health day in January. She says it better than I can and it bears repeating here:
"Imagine your mind as a switchboard and you are looking right at it. And on this
switchboard is everything that has ever happened in your life - every past
thought, every past event, every past emotion. And one flash appears on the
switchboard so you focus on it, but 10 seconds later, another flash appears, and
you have to look at it, but then there's another flash over there, and another one
here, and another - and your mind pushes you to see all of them because you
have to see them all and experience them all. It's constant. And I try to explain
my thoughts, and what is going on, but it's so hard to speak that fast because
everything is just so confusing."
From the summer of 1999 to the summer of 2002, she stabilized. For most of
that time she stayed on her meds, received counseling, went back to school in
Stillwater, and lived a relatively normal student life.
Karla’s design in the unfolding Smith family tapestry began to take on brighter,
more hopeful colors and shapes. The heavy, dreary, frightening threads of the
past few years no longer dominated the texture of our family life.
In July of 2002, we took a family cruise and had a wonderful time. Within days of
the end of the cruise, we knew something was terribly wrong in Stillwater. After
three years of steady progress, there were signs of the beginnings of another
major attack of mania. Her telephone conversations were scattered, somewhat
incoherent, and her energy level was boundless. Her friends reported similar
behavior. Raw memories of her manic episode in 1998 flashed ominously
through my startled soul. The immediate future loomed like dark, rampaging,
deadly, Oklahoma clouds spitting out multiple, fierce tornadoes. I was terrified as
our family tapestry began to unravel again.
Mania returned and ravaged her soul.
As always, she kept a journal but it is almost unintelligible: page after page of
graphs, drawings, shorthand notes, some text, lines and arrows going in all
directions, snatches of poetry, phone numbers, lists and blank pages. It reflects
how scrambled her mind was, and how manic and, at times, how psychotic, she
Looking through the journal now, I search again for clues to her illness, not the
symptoms that show up on the pages but the causes that continue to elude me. I
want to go back to October 2002, and crawl into her mind to bring some order
and peace. I want to grab hold of her erratic impulses and force them into a
logical sequence. I want to breathe healing chemicals into her skull and
rearrange her brain cells. I want to search relentlessly through the labyrinth of
her brain, hunt down the tiny, diabolical part that feeds her illness, torture that evil
for a delicious second, and then blast it into permanent nothingness. I want to
reconnect the healthy cells with tender stitches and soothing ointments. I want to
post a permanent nurse in her brain who will immediately destroy any future
bipolar intruder who might want to attack my daughter. I want to discover the
real Karla, longing for her to reappear with all her dreams, gifts, instincts and
In reality, all I do is page through her disjointed journal, puzzled by visual
ramblings, frustrated by scribbling, and seeking clues in a clueless world.
When the medication finally took hold, the mania ended. We all knew the
depression was coming. And it did.
Her journal entry for December 19, 2002 reads like this:
On this end of psychosis, a month after the last episode, depression waits in the
wings, threatening. I feel it push in to block me from thinking about what to do.
It’s brought its army of little tin men – they are obsessions, poised and ready to
block real thought, real action, obsessions about food and sleep. And thoughts
to dismantle real thought – thoughts like I come from a different world than these
people around me...”
Despite all her efforts and taking her medication, the depression battered her
relentlessly. Her defenses – family, friends, job, school, counseling, medication,
prayer, and her own determination – crumbled like bombed-out walls of a once
beautiful home in a war-ravaged city, partially standing, uninhabitable, waiting
ominously for the next bomb or collapsing of its own disconnected dead weight in
the middle of a quiet night. Her spirit was hiding in a dark corner of this roofless,
dirty, cold, half-room with the “tin men” she described cautiously but confidently
surrounding her with guns raised and smiles on their gaunt faces. The
depression she was all too familiar with was attacking her.
I wondered if she was taking her medication which should be protecting her from
deep depression. She assured us that she was taking her pills faithfully and, in
fact, we saw her take them a number of times. But she was clearly moving into
dangerous territory. It wasn’t until later that we discovered that she was under
On December 29, 2002, Fran flew to Tulsa with Karla to help her get settled into
her new life. I took them to the airport, feeling somewhat confident that things
were under control and that the next year would be difficult but doable. I knew
that Fran would smooth out the transition problems. Little did I know that the
brief hug at the airport, along with the standard “have a good trip”, would be the
last time I would see my daughter.
By New Year’s Eve, she was so depressed that she almost shot herself and
wrote what amounted to a suicide letter, saying she can’t go on living. Fran
found her and got her to the Tulsa Center for Behavioral Health in a catatonic
state. She was there for 10 days. They released her on Friday, January 10 th,
and she shot herself the following Monday.
A little after 5:00 that Monday evening, I got home from the office. Ten minutes
later, a policeman rang the doorbell. I thought Fran was in an accident. He told
me that he had no details but that “Karla Smith had passed away”. I yelled
something unintelligible, could not remain standing, and fell on the couch,
repeating that she must have killed herself and sobbing convulsively. The officer
tried to console me but it wasn’t possible.
A few minutes later Fran came home and I told her that Karla had died. Her
reaction was similar to mine: tears and shock. It dawned on me later: we both
believed the report. We did not accept her death emotionally (I still haven’t
accepted it completely) but we knew the report was true. Karla was dead.
The only way I can describe Kevin’s reaction when we called him, and then my
reaction to him, is that we wailed together. Long, loud, haunting, guttural sounds,
emanating from the soul, traveling slowly through the abdomen, chest, lungs,
throat, head, nose, gaining momentum and strength, picking up a shape, a
resonance, a nuance, a depth as it journeyed through every speck of the body
and finally erupting from the mouth, unformed, indiscriminate, toneless because it
incorporates all tones and echoing the inconsolable cry of all grief-stricken
people of all times. We wailed. It was primal, prehistoric and futuristic. It still
reverberates in my being. For a long time, we wailed.
After the funeral we went to Tulsa to sell her car and gather some of her stuff.
And we went to the room where she died. Standing in that small, bare, cinder
block bedroom, I slowly sank into a swirling awareness that this was where she
took her last breath. I was there, in the hospital room in Ottumwa, Iowa, when
she took her first breath. That beautiful 4 pound 13 oz miracle stopped breathing
in this cramped, dreary bedroom 26 years later. I sobbed. I didn’t recall any
specifics of those 26 years; I didn’t even have a clear picture of her in my mind.
My memory was simply not working. I felt suspended but surrounded by
absence. The hole in my soul expanded until the absence swallowed my body,
mind, feelings and spirit. It was tapestry unraveled. I still don’t know how long
this state of intense pain lasted. At some point, I moved on to the sad tasks at
hand, but actually, that feeling of abandonment never ended. Periodically, it
reappears even now.
Karla-grief hides within all my thoughts, a subtext that carries on its own dialogue
regardless of what else I am thinking about. I don’t remember being able to do
that with any other subject or person prior to her death. I don’t consider that
ability a gift; it’s more of an intrusion, and I attribute it to Karla-grief.
My emotional life lost its center. I thought I was pretty stable emotionally –
usually having appropriate feelings at appropriate levels at appropriate times.
Mad, glad, and sad all had their rightfully assigned duties and they were
functioning – appropriately. Most of the time. In any case, I was relatively
pleased with my emotional life. Now, it is emotional chaos. It isn’t that I am
completely out of control and at the mercy of raging, and conflicting feelings. It’s
more that I lost confidence in my ability to respond appropriately to any given
situation. Mad, glad and sad are not fulfilling their rightful tasks. A lot of sad
mingles in with glad. And mad shows up anywhere, at any time. Sad has
arrogantly moved to center stage and will not relinquish his time even though he
knows the cues for glad and mad. Emotional chaos follows, even though I
somehow keep going and most people are not aware of the quiet struggle I have
to get those three key emotions back into their own rooms.
Karla-grief also infiltrates my social life. Outside of family and a few friends I’m
not too interested in doing anything or going anywhere with others. It seems like
too much energy and work to socialize. I thought I might be prone to vegetating
in front of the TV but that is surprisingly not helpful. I know because I tried. In
any case, being alone is usually more attractive than socializing or meeting in
groups. When I am alone, I can be with Karla without distractions.
Physically, I actually lost some useless weight since she died. Initially, I just
didn’t eat much but more recently I am deliberately dieting. I definitely needed to
lose the pounds but I confess that the diet is more than weight loss; it’s also
about trying to get control of my life. Maybe if I can rein in my weight problem, I
can also rein in my Karla-grief. A gimmick. But it can’t hurt me.
My spiritual life is also being hammered by her death. Many people get angry at
God for allowing something like this to happen. I never felt that way. The God I
believe in doesn’t act that way. They (Father, Son and Holy Spirit) love Karla,
forgive her sins, and never interfere with her free will or the natural
consequences of human behavior. My spiritual issues are not related to God but
to me. I do pray but not regularly enough. My meditation time becomes
conscious Karla time, and while I know that God hears whatever is in and on my
heart, I drift away into a sadness that feels like self pity. I trust that God is with
me in this tough time but I’m not sure I am with Them.
My thinking, perspective, and view of everything are now changed. My energy
level is weakened. My values are rearranged. My goals are modified. My
expectations are permanently altered. Along with Karla-grief, there are a few
other things in life that have this profound and extensive impact. Genuine love
does it. So does birth. A life-altering spiritual conversion also qualifies. But
that’s about it. Everything else is a relative molehill.
Everyone tells me, and all the books reinforce it, that regrets are useless. They
will hinder healing, feed the grief and open the door to depression. That’s
probably true. I try to ignore my regrets when they flash naked across my mind.
I don’t want to dwell on them because there is nothing I can do about past
decisions or words or actions taken or not taken.
But the fleeting regrets don’t just go away. There are a series of “what if’s”, “why
didn’t I’s”, “I should have’s”, “I could have’s” and simple admissions that I was too
dumb to pick up a danger signal that weekend before she died. For example,
why didn’t I go to Tulsa that weekend? We didn’t want her to be released from
the hospital, we knew it was a dangerous time, we knew she was not monitored,
we knew she was intending to enroll in school and that it might be complicated,
we knew she had suicidal thoughts within the past week. Knowing all that why in
the hell didn’t I just get on an airplane, spend the weekend with her, help her get
enrolled and support her regardless of what happened? That would have been
simple enough. If I did that, she probably would be alive today. Now that’s a
regret worthy of sleepless nights and fitful days!
If I keep thinking about it, I’m sure I could list many more regrets, not only related
to that weekend, but to many years of decision-making with her and her illness.
I want to put these regrets behind me. Maybe in time, I will get there. Maybe it’s
still too early. All I can say right now is that these regrets have not gone away,
and my grief will not let me ignore them.
Actually, regret is a euphemism for blame. Regret implies remorse and
disappointment while blame includes responsibility, guilt and fault. Somewhere
in the house of regret lives the feeling of fault. Whom do I blame for Karla’s
suicide? The best answer, of course, is to blame no one or anything (except her
illness). Blame, like regret, is useless. And at some point, I predict that I will be
able to honestly come to that position. But I’m not there yet.
Right now there’s plenty of blame for everyone. I blame myself for not doing
more; I blame us as a family for not protecting her better that final weekend; I
certainly blame the hospital for releasing her too soon; I blame society for not
understanding mental illness and for allowing a two-tier treatment approach –
one for the rich and an inferior one for the poor; I blame insurance companies for
not covering mental disease for college students; I blame….. I blame…. I blame.
There’s plenty of blame to go around, and I know that if I nurture this blame, give
it more time and energy, allow it to develop theories and long lists of accusations,
seek more details to support my instincts and talk about it more, I will be very
angry and spend the rest of my life seeking revenge.
I do not want to live the rest of my life with blame, anger, revenge, depression
and rage at the core of my emotional life. On the other hand, I don’t want to
dismiss these feelings too abruptly either. Part of grieving is resolving these
emotions. I am convinced that acceptance and peace are possible, even in a
situation like Karla’s suicide. But it is not easy or simple.
Ultimately, I just miss her. I miss her smile: she was a beautiful young woman,
5’4”, weighed around 115 pounds, good figure, strikingly blue eyes, high
cheekbones, and gorgeous, long blond hair. Her smile lit up her whole being and
doubled her attractiveness. I want to see that smile again – not in a picture or
video – but on her face, reflecting her spirit.
I miss her enthusiasm and passion: she was never bland. She had definite ideas
and opinions. She was decidedly liberal and progressive in politics, religion and
social policy and did not hesitate to express her opinions with conviction. She
was anti-war, even helping to organize and speak at a peace rally on the
Oklahoma State University campus in the fall of 2002. We didn’t always agree
but I miss just sitting back and watching her in an animated discussion, stating
her position clearly and articulately. Sometimes I would just marvel at her
commitment, knowledge and enthusiasm and just say to myself: “Go, girl!” She
made me proud, even when I didn’t agree with her.
I miss our conversations: we talked often – on many levels, some like the
animated debates I just mentioned but usually more intimate and personal. We
talked about books, ideas, philosophy, religion, history, relationships, family,
school, work, my writing, her writing, even sports occasionally. Talk is the air of
relationships and we often breathed the same air. My air is stale without her.
I miss her personality: we are all unique but being unique was a deliberate and
deep-seated motivation for her. In many ways, the picture of her in this talk
reflects the impact of her illness on her personality. We knew her before bipolar
attacked her and when that disorder was “ordered”. Kevin described her real
personality in his tribute to her at the wake service. That’s what I miss every day.
I miss being there when she and Kevin were together: just watching them relate,
sometimes bantering, sometimes serious filled me with awe. I so delighted in
each of them separately but there was an added thrill when they were together.
It made a daddy proud, and it played a perfectly tuned, soothing, musical cord in
me that resonated throughout my being.
I miss her relationship with Fran: it was a beautiful blending of that mysterious
mother-daughter thing that we men generally don’t get. Consignment store
shopping, cooking, advice sharing, dominoes, hair, fashion, relationships – all
those things that the two of them had almost automatically. It was fun to see it
and witness it, even though it was usually beyond me.
I miss her career: I always enjoyed discussing her classes with her and I believed
she would eventually wind up as a counselor, teacher, or some other helping
professional. Regardless of whatever other career choices she would have
made, she undoubtedly would have continued writing, and I already miss all
those conversations about her writing as well.
I miss her family: at some point, she would have married. I miss a son-in-law,
and I miss her children, my grandchildren. I know they don’t exist, but now, they
will never exist. I miss the idea and the dream of having grandchildren through
her and her husband. I looked forward to her little kids, their birthday parties,
Thanksgiving, Christmas, and one of Karla’s favorite holidays – the fourth of July.
It would have been a glorious part of my twilight years.
I miss her wedding: an event that would have been a great and unique
In other words, I miss what would have been. Missing her is the nucleus of my
Ultimately, anger, grief, frustration and powerlessness are supposed to lead to
acceptance and peace. Good idea! What I have learned so far is that this
passage takes a long time.
My faith provides a context for my acceptance. My personal story includes my
faith, in life as well as in Karla’s death. My faith does not take away my pain –
obviously. But my belief in a loving, compassionate God, an afterlife called
heaven, a union between the living and the dead, and a continuing existence for
Karla and for me after I die, colors the way I handle my grief. This faith helps me
accept things in life, and in death.
Accepting something is very different from admitting something. I admit that
Karla has died, although admission is not as automatic as it sounds.
But I still don’t accept it. Acceptance absorbs the pain and transforms it into
serenity. I know what acceptance feels like because I have experienced it in
other areas of my life. But I’m not there yet with Karla. I miss her. I will always
miss her. I want to always miss her. But I want to accept missing her. Some
day I will.
Before I close, and because you are a specialized audience, I have some
comments for the medical community and some comments for the religious
community. These observations flow from my experience with Karla’s illness and
First, for the medical people:
1. Karla was released from the Tulsa Center for Behavioral Health on Friday,
January 10th, 2003, after ten days of treatment following a December 31
suicide plan. The Center has three units: crisis, stabilization and in-
patient. We were very pleased on January 8th when the doctor in
stabilization told us Karla was being transferred to in-patient. Our
understanding was that she would remain in the Center for at least
another week, perhaps two.
The next day a different doctor from the in-patient unit decided to release
her the following day. Fran and I found out about this decision after the
fact and we both, in separate phone calls, objected. We knew Karla
needed more time for the medication to take hold and to be in a structured
environment. Why they released her on a Friday afternoon without a
monitored plan for the weekend at a time when she was just beginning to
stabilize is still a mystery. My guess is that Karla fooled them, telling them
that she was progressing well enough to be on her own, and that she
would cooperate with an aggressive after-care program which was to
begin on Monday afternoon, two hours after she killed herself. The doctor
from stabilization had a targeted release date of January 17 th, a week
My belief is that, if she remained in-patient for that week and perhaps
even if she would have been released on Monday immediately before her
aftercare program was to begin, she would be alive today.
Here’s my suggestion to you: as a staff, once you decide to release a
patient, add a week. I know there are issues with insurance companies
and, in Karla’s case, the state, but I still say – add a week. Write the
reports in a way that warrants the additional week. Patient care takes
precedence over insurance company policies or state regulations. I’m
going to say that again: patient care takes precedence over insurance
company policies or state regulations. Care trumps policies. That should
be obvious but it is not obvious.
2. My second suggestion is a follow-up to the first. We all know that there is
a big mess in terms of health care, insurance coverage, costs, and who
calls the shots in terms of medical treatment. Add the volatile issue of
malpractice allegations, frivolous lawsuits, legal settlements, jury
judgments, doctor re-settlement and genuine malpractice to an already
out-of-balance system and the mess gets messier. Many of you know
more about these issues than I do, and that controversy is not the point of
this conference. But I have to tell you: I believe that those issues were
determining factors which unduly influenced Karla’s treatment and
premature release. My comment: please fix it quickly. People are dying
because of it.
A principle I learned during the Watergate investigations thirty years ago
applies to this problem. Follow the money. Unfortunately, the bottom line
in this issue is the bottom line. It is ultimately about money. Who gets
how much? How much for the lawyers, the doctors, the insurance
companies, the hospitals, the medical vendors, the drug companies,
alleged victims? It appears to me that the underlying cause of this mess is
the generation and distribution of money. Meanwhile people die because
You may feel as powerless as I do about resolving these tremendous
challenges. I simply encourage you to use whatever influence you have in
whatever arena you’re in to help fix it quickly. As a grieving father, I claim
a voice in the discussion. Patients come before money. Not only in
theory, not only in some ideal world but in this very real world, in daily
practice. There will be no substantial change or progress unless the core
problem is correctly named. I believe the core problem revolves around
the generation and distribution of money. I don’t mean money in general,
like how much do institutions get. I want names and numbers. Follow the
money into insurance companies and name names about where that
money goes. The same with the lawyers and doctors. Who specifically
gets how much? I know there are privacy issues involved. But those
privacy issues don’t outweigh the patient care issues. Frankly, I hope
there is some courageous and talented investigative reporter, ala
Woodward and Bernstein, who is researching that explosive story right
now. As a father who believes his daughter is dead partly because of
these issues, please fix it quickly. And, by the way, Karla’s death is not
3. My third suggestion to the medical community concerns medical records.
Karla was in and out of treatment centers, hospitals, emergency rooms,
clinics, doctors’ offices, and counseling rooms in at least four states and
two countries. I can’t even count the number of psychiatrists and
counselors she saw. Or the number of medications she took.
Part of the problem is that there is no efficient way of sharing medical or
medication history. Karla entered many mental health institutions and
none of them gave any indication that they knew anything about her
medical history. She couldn’t tell them because she was either deeply
depressed or manic at the time. We tried to inform the doctors and nurses
what we knew but, in general, it was hit and miss. In the meantime, she
was simply given whatever medication the current doctor thought best – or
whatever was on hand. And since she moved a lot, she seldom received
long-term care from a single source. And she died because of it.
Just to give you an idea what I am talking about, let me list what I know
were some of her prescriptions. I am not absolutely certain when or in
what order or in what combination she took these pills, but I know she
took: Lithium, Zyprexa, Zoloft, Prozac, Risperdol, Wellbrutin, Valporic
Acid, Xanax, Clonopin, Paxcil, Haldol, Effexor, and Ritalin. There are
probably others as well. She took some of these medications a few
different times and in different combinations, depending on whatever
current doctor she had and where she lived.
Clearly, there needs to be some easily accessible system which allows for
quick retrieval of these vital medical records. The privacy issues must be
resolved in favor of appropriate accessibility. Today the technology for
record storage and retrieval is surely available. I’m not sure who to direct
this to but someone please find a way to make this improvement happen.
There are many Karlas still out there. And they too die because of it.
4. My fourth suggestion concerns all medical health workers in whatever role
you have. Even when Karla was most manic, psychotic, depressive and
catatonic, she reacted personally and deeply to the people who treated
her. She would tell us that “the counselor is a jerk but the nurse is
wonderful”, or “I like my psychiatrist this time but the social worker is
This is just a reminder; you know it already. Your personal feelings about
your patients can not be hidden. They will read you even when they are
psychotic. If you don’t love them, they will know it. I suspect that many
mentally ill people are more sensitive and accurate about these emotions
than the normal population. If you are having a bad day, they will know it,
regardless of how well you can conceal it from others. If you resent
particular patients, they will know it. Since their illness is both mental and
emotional, their emotional reaction to their care givers is more vital to their
recovery than a patient with a broken leg or even cancer.
The challenge of being genuinely caring and loving all day, every day
when your patients suffer from a mental disorder is overwhelming. I
admire and respect you for putting yourself in that position. I am simply
reminding you how important it is, from a patient’s perspective. And a
I now turn to the religious community with a few observations based on my
experience with Karla.
1. It is commonplace today to distinguish between religion and spirituality.
The implication is that many people are not religious, that is connected
with a particular denomination, but they are spiritual, that is, they believe
in some kind of God and attempt to contact that God periodically. Frankly,
I think that distinction is overrated. In other words, I believe there are
many people who claim to be spiritual but who, for all practical purposes,
offer little evidence of a prayer life or a significant spiritual impact on their
Karla was not like that. She was very spiritual, even though she drifted in
and out of adherence to her Catholic denominational roots. She was
always fascinated by Eastern religious beliefs and practices. Her use of
yoga was much more than an exercise program. She also seriously
considered converting to Judaism, initially attracted through her extensive
Holocaust studies but then also through her relationships with Jewish
leaders in Tulsa and Stillwater. She would also regularly come back to
Catholicism, primarily drawn by the sacraments, especially the Eucharist.
For a while, she attended daily Mass. While in treatment during the ten
days before she died, she kept a journal. Much of the journal contains her
commentary on the Gospel of St. Matthew, as well as daily letters to God,
in which she expressed her state of mind in the form of prayers, with an
emphasis on the feminine side of God.
Karla was deeply spiritual.
Here’s the hard part for religious leaders: the way she expressed this
deep spirituality was not always clear or consistent. She was a seeker,
exploring many possible ways of living and expressing her evolving
beliefs. She sought counsel from many priests, ministers, rabbis, and
even a teacher of transcendental meditation. She was skeptical of pat
answers, religious formula responses, and attempts to convince her of
some dogma or doctrine.
The problem for us religious leaders is that we generally have a preferred
way of expressing our beliefs. We tend to move people into religious
verbiage that corresponds to our language, whether that is biblical
language or doctrinal language. Karla was much more interested in the
spiritual experience itself and if she sensed that someone was promoting
a prescribed and limited way of expressing this experience, she quickly
lost patience with that conversation and that person. When she was
manic, this impatience was magnified.
The caution to religious leaders is to be very careful, especially when
dealing with people with a mental disorder. Do not be sidetracked by the
way people express their faith questions or opinions. During her
depression and her mania, Karla lost her ability to think and speak clearly.
Her spiritual life suffered from the same lack of clarity and at times she
sounded extremely bizarre. My suggestion is to listen closely and to stay
in contact with the person.
Be patient. Working as a spiritual advisor to a mentally ill person calls for
a different set of skills than normal spiritual direction. I know this not only
because of Karla but because I am presently a spiritual director for a bi-
polar person. Be patient with the phone calls, the changes in mood, the
shifting focus, the inconsistency, the lack of what we could expect in terms
of steady progress in the spiritual journey, and the baffling symptoms of
the mental disorder itself. Obviously, make sure they have a professional
counselor. But some people, including Karla, want a spiritual guide as
well. When you accept this role, expect a greater commitment of your
time and energy and expect this relationship to be very personal as well
as professional. On the other hand, if you establish such a relationship, it
can be very rewarding for you and deeply appreciated by the other
2. My second suggestion to the religious community is very delicate.
Sometimes people judge even when they aren’t aware of it. Ultimately,
Karla shot herself because she suffered from bi-polar illness. Many
illnesses kill people – cancer, diabetes, heart disease all take their grizzly
toll on millions of victims who leave more millions of people grieving. The
causal connection between these diseases and death is obvious. If
someone dies of cancer, there is immediate understanding that this loss
has a clear reason. With suicide, that connection is not always assumed.
There is the suspicion that suicide is not the drastic end of an illness but a
freely chosen act of a guilty self-murderer. The implication is that the
diseased person goes to her grave tarnished, deserving some punishment
because she is not really a victim but a criminal.
Even for people who do not accept this rigid judgment of a “suicider” there
often remains some suspicion. I heard it between the lines of some of the
sympathy messages people shared during Karla’s wake and in some of
the notes people sent us. People didn’t mean any harm and they certainly
were not blunt or overtly condemnatory. But occasionally I heard it. A
suicide raises questions that a heart attack doesn’t. “Karla was
responsible for her death”, they think. I become the father of a young
woman who unfairly forced this grief on me, and therefore they
sympathize with me. Most of the time this accusation is subtle and
unintended, but it is there. If she had died of cystic fibrosis, there would
be no such suspicion.
Religious leaders are in a position to help erase that suspicion. But first,
we must examine ourselves closely. It wasn’t too long ago that the
Catholic church officially refused to celebrate a funeral or bury a suicide
victim. I suspect that some people still think in terms of suicide as a
mortal sin of despair. To others, it reflects a lack of faith, implying that
more faith would prevent suicide. Everyone eventually dies but for some
people, perhaps even for some religious leaders, dying by suicide is at
least tainted by moral guilt.
We religious leaders need to examine ourselves honestly and closely to
discover if any vestige of guilt lingers in our reaction to suicide. If there is,
then please take whatever steps you need to take to eliminate that
suspicion of guilt. After that, then preach, teach or lead your parish or
congregation to greater awareness, understanding and acceptance of
mental illness and suicide. Help people, perhaps one by one, to eradicate
the negative judgment about suicide. Suicide is the terrible consequence
of a serious mental disorder, not a freely chosen act of a fully functioning
child of God.
My formal presentation ends not with my words, but with Karla’s. The card you
received includes Karla’s serenity prayer. She wrote the second verse to this
beautiful prayer a few years ago and prayed it daily. You will also note that the
card has a website address. Kevin and a friend created this site which contains
a number of items about our family, Kevin’s eulogy at the wake service, a
presentation he gave at the Shiloh Methodist Mental Health conference in
January and a copy of my talk here this morning. There is also a place where
you can light a candle in memory of Karla. Please light a candle; it is source of
consolation for all of us and it adds consoling colors and twine to our family
tapestry. Thank you.
Pray with me now Karla’s serenity prayer:
God, grant me the serenity
To accept the things
I cannot change,
Courage to change the things I can,
And wisdom to know the difference.
Show me the trace of you in everyone I know.
Gently turn my gaze back home,
Toward simplicity, grace, and gratitude.
Remind me that we are all
Imperfect, holy and free.
Open me to know and embrace your peace.