Recently a close gay male friend committed suicide. He was HIV-positive for almost 10 years and on medication. Everyone I have spoken to about his death thinks it was because he was HIV-positive, but I don't. I think it was something else. He had just turned 40 years old, which he hated. He had been a partygoer since he was in his late teens, and continued doing the club scene weekly, although he complained a lot about it. He had always used alcohol and drugs on the weekends but began to take large doses of crystal meth and got hooked. He made attempts at rehab, but was unsuccessful.
My friend was found dead from an intentional overdose. He left no note and his death continues to trouble me. I am angry with all his friends, his family, the drugs; the club scene, our view of getting older and I blame myself for not doing more. I have a lot of undirected anger! Can you give me any insights into my friend's behavior and why suicide seemed to be his only solution?
A Response to This Case Study
When any of us are faced with the death of a person with whom we had a close relationship, keeping up your routine and taking the time to grieve are the best hopes for future healing. However, when the life of someone close to us ends due to an act of suicide, the mourning process among the living is often coupled with a sense of puzzlement, guilt and a lack of closure. In attempting to find a solution to this emotional unrest, it is normal to have feelings of anger and to blame others and ourself for this seemingly senseless death. It may be a very human reaction to search in this way for a sense of control over something that seems to be out of our control. However, blame can become random and unfocused and the anger one feels is then used unproductively, resulting in additional emotional unrest.
One way to direct this emotional response is to carefully re-examine all the areas of the person's life, the positive and the negative elements. Without seeking human blame, we sometimes can find answers this way and then can proceed on with our own lives. Many people want to feel we live in a "just world" where there are clear reasons for such seemingly meaningless acts. However the world is not a balanced place, and at some point one may have to accept the fact that whatever caused a suicide may never be known. Let's attempt to break down and examine all you have stated about your friend and his suicide. I cannot write directly about the subject mentioned since I have no access to such personal information. I can only suggest general reasonable assumptions, which are based on prior research. Using psychological theory we can attempt to comprehend why anyone has chosen this direction. In time, you may come to a better understanding of why your friend chose this action or why his past behaviors paved the groundwork for this unfortunate accident.
A Post-Suicide Assessment
Your statement on your friend's suicide does indicate a number of problematic behaviors that would raise "red flags" in any post suicide assessment. Everyone is different and due to human nature no one "sign" is true for all people in despair. In many minds, being HIV-positive has a direct correlation to possible suicidal ideation. People will always look first for the most simple solutions instead of examining the more complex issues and again that maybe due to basic human nature. However, I will focus on all the areas in your friend's life that you have mentioned. Hopefully this will give you a fuller picture on your friend's situation and possibly lessen your pain.
Disease, isolation, substance abuse, mental illness and the sting of rejection can all be interrelated in the role of suicide, creating the groundwork for a sense of hopelessness. However, psychological research continues to point out that most suicides are actually carried out by people who are ambivalent about their suicide. These suicides are not for the most part well planned and the person does not really wish to die. They tend to be impulsive acts and cries for help from people who are in physical or emotional pain and cannot comprehend other solutions at the time.
When anyone is faced with a life-threatening illness, one must place all other issues aside and battle that disease in any way they can. Your friend had continued his fight for ten years; and this in itself can wear out anyone's emotional stability. Hopefully he was taking his medication consistently and staying connected with his medical advisers and conducting himself in a mature and educated manner on all new developments including how medication and HIV can produce depressive effects. Research continues to point this out and it is always encouraged for anyone with HIV or taking HIV medication to seek out psychological intervention. Your statement does not indicate that there were any mental health professionals or social support groups working with your friend but this may have clearly been called for.
Age 40 and Beyond
When we are 20 or 30 or even 35 years old, when speaking of our future it can be stated for most, "my life is ahead of me; and these are my future goals." At about 40 years of age, there can be a different turn to: "this is the time I have left, and this is how I wish to spend it." For your friend who had just turned age 40, aside from his HIV status, how was he going to conduct his life in the time he perceived he had left, what were his short and long-term goals? What were his plans for the future, were they clear, focused, realistic and did he have the capability to follow them through to completion? In addition did he receive the encouragement he needed to keep on these chosen tasks? Employment should be a needed and beneficial part of anyone's structure. However, this was not identified as a problem in your statement. I can only infer that his employment was not an issue or concern at the time.
Your friend had been following what appears to be a rote structure of going to nightclubs for over 20 years and a logical general assessment would find it very hard to comprehend that this had not become boring for him at age 40. This is clearly a judgement call on my part since you stated he "complained a lot about the club scene." What troubled him about the club scene? A natural assumption would be that he was getting older in a club situation dominated by people who are younger and better looking. This can be a very difficult process at any age. Did your friend speak of the club scene in these terms? Was his age a factor? You would have to examine what were the perceived problems your friend was facing.
Unfortunately, there are very few personal qualities that can be noticed in the environment of the club scene. Growing older with this as your only social outlet and under these restrictions may be very depressing to some. However, to others it is no big deal. Would your friend have felt secure continuing this kind of social life as an older male? Where was your friend to then turn to feel wanted and have a sense of belonging with a dynamic group of people his own age? The only answer is he would then have to take the steps to find alternative outlets that would then push him to interact in new ways. More importantly he would hopefully attempt to do this without the need for drugs and alcohol consumption. Was your friend at this point? You stated he complained about it, but did he have the motivation and determination to change his social direction?
For many individuals, "life starts at 40." It can be a whole second life, where within the time one has left, goals are set and one has a different set of plans and standards of achievement. This time for most people is very different from when they were age 20. The level of wisdom and life experience gained by age 40 is priceless if drug and alcohol abuse have not destroyed one's ability for memory and insight. In addition one does have to take on the responsibility to develop an alternative to a previous pattern if they are unhappy. Was your friend at this point?
The Role of Substance Abuse
You have mentioned your friend's substance abuse in your statement and this jumps up at me as an indicator that needed focused attention. He was openly engaging in very poor health choices that could only encourage possible health risks. Unfortunately there are certain aspects to the "club scene" that seem to encourage this behavior and offer little or no other opportunity for those who choose to remain sober. Dance clubs and bars, gay or straight, are known nesting grounds for indulging in alcohol and drug abuse. In addition basic logic indicates these places are not conducive to socialization and alcohol and drug use help people become more at ease. However, as research has consistently pointed out, many people continue on from alcohol and recreational drug use to harder, more addictive drugs.
Research has strongly indicated that crystal methamphetamine abusers exhibit symptoms that can include violent behavior, anxiety, confusion, and insomnia. More importantly they also can display a number of psychotic features, including paranoia, auditory hallucinations, mood disturbances, and delusions. This paranoia can result in homicidal as well as suicidal thoughts.
For the chronic abuser, which you indicate your friend was, crystal methamphetamine use could lead to psychotic behavior, characterized by intense paranoia, visual and auditory hallucinations, and out of control rages. You do not mention these behaviors in your statement and you may not have been present during his drug use. However, these reactions may have been occurring. I cannot stress how pervasive the research is on these "side effects," coupled with the known depressive state your friend was already experiencing based on his current structure, age and possible HIV medication.
There are several symptoms that occur when a chronic user stops taking the drug. These include severe depression, anxiety, fatigue, paranoia, aggression, and an intense craving for the drug. Why someone becomes addicted and others do not under similar situations is an unanswerable question at this time, although there are many theories. However, for your friend it is clear that at some point the crystal methamphetamine was controlling his behaviors as well as his emotional brain.
Here are some indicators to consider about your friend's situation:
Abusing crystal methamphetamin may have created delusional thinking. This, in addition to a possible depression based on his life structure, age, HIV status and HIV medication may have made him incapable in making logical choices or behaving rationally. You stated that he left no note and this may be an indication of an impulsive act fueled by the crystal methamphetamin use. In-patient clinic placement was possibly indicated for long-term substance abuse treatment.
Substance abuse coupled with HIV medication creates a very problematic situation. It is possible this interaction contributed to your friend's depression and ultimately his suicide. He may have needed to have his behaviors and medication use directly supervised. In addition to medical and psychological intervention, HIV support groups should always be considered.
Possible withdrawal affects of crystal methamphetamin could of in itself been so devastating that this could have created an imposed state of utter hopelessness. I cannot overstate this enough based on the current research. No one can know for certain how an individual will react. In these cases hospitalizing your friend for his own protection may have been needed.
It is very understandable why drugs like crystal methamphetamine are so pervasive in our society. After all, they do change people's mood and behavior rather quickly and usually produce short-term positive results. If you must direct blame for your friend's death, place it productively. Drug and alcohol abuse is a national problem and to redirect some of your anger as an outspoken objector of substance abuse could result in a positive way to vent your frustration at our legal and community education system. Have you considered volunteering your time in crystal methamphetamine and substance abuse education? This would be a more constructive way to deal with the pain and loss you feel at your friend's death, ultimately helping to keep your friends memory alive as you work to educate and redirect others from falling prey to the seduction of crystal methamphetamine and other problematic substances. Good luck.
"Psychologically Speaking" columnist J. Buzz von Ornsteiner, Ph.D. is a New York State-licensed psychologist. He currently works at a New York State correctional facility as a psychotherapist, educator, and behavioral consultant.