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An Interview with Nancy Rappaport, M.D. on Coming to Terms with a Parent's Suicide

David Van Nuys, Ph.D.

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Nancy Rappaport, MDNancy Rappaport, MD, a Child Psychiatrist, talks with Dr. Van Nuys about her process of coming to terms with her mother's suicide (an event that occurred when Dr. Rappaport was 4 years old) which started when she herself became a mother and concludes 18 years later in the form of a book. She started out writing letters to her absent parent, and later started digging for information to fill out her very incomplete knowledge, incorporating material from her mother's diary and the recollections of her mother's friends and associates. She describes how her understanding of the suicide evolved over time from an initial 'magical thinking' position of believing she had helped to cause it to occur, to her later appreciation of her mother from an adult perspective, and her suspicion that her mother may have had Bipolar Disorder. She offers advice for how adults can help children cope with the sudden suicide of a parent or loved one, including the importance of explaining what has actually happened in a developmentally appropriate manner, and explicitly explaining that the child has not caused this sad event to occur.

David Van Nuys: Welcome to Wise Counsel, a podcast interview series sponsored by Mentalhelp.net, covering topics in mental health, wellness, and psychotherapy. My name is Dr. David Van Nuys. I'm a clinical psychologist and your host.

On today's show, we'll be talking about healing in the wake of suicide with my guest, Dr. Nancy Rappaport. Nancy Rappaport, M.D., is an assistant professor of psychiatry at the Harvard Medical School. She's a board certified child and adolescent psychiatrist. Her research, teaching, and clinical expertise focus on the collaboration between education and psychiatry. She has designed numerous courses for teachers on psychopharmacology, adolescent development, and instructional strategies for disruptive students. Dr. Rappaport has been an attending child and adolescent psychiatrist for the Cambridge, Massachusetts, public schools for more than 18 years.

When Dr. Rappaport was just four years old and the youngest of six children, she lost her mother to suicide. Years later, she investigated her mother's life and the mystery surrounding her death, looking at the past as a way to fortify herself for the future. The culmination of this effort is a powerful new memoir, In Her Wake: A Child Psychiatrist Explores the Mystery of Her Mother's Suicide. In her writing, Dr. Rappaport gives voice to the silent grief that often accompanies painful loss and charts her healing as a mother, doctor, and daughter. She offers her own story as a tribute to the endurance of the human spirit and shows how love lasts longer than death.

Now, here's the interview.

Dr. Nancy Rappaport, welcome to Wise Counsel.

Nancy Rappaport: Wonderful to be here.

David: Well, I'm so happy to have the opportunity to speak with you. I've been reading your book, In Her Wake: A Child Psychiatrist Explores the Mystery of Her Mother's Suicide. It's a very moving and thought provoking account. Your mother killed herself when you were quite young, and you're now an accomplished professional, well along in your career. What prompted you to write this book now, so many years later?

Nancy Rappaport: Well, I'm 50 now, and I was 4 years old, the youngest of six children, when my mother killed herself. And I'm a child psychiatrist. And I started to write letters to my mom when my oldest daughter was born, and I think, often, when we have children, we look to our past to figure out how we want to move ahead with making a profound connection with our own children.

David: Yes.

Nancy Rappaport: And, you know, oftentimes there can be some people referred to as "ghosts in the nurseries," or unsettling things that might have happened. And I would wake up in the middle of the night, and I would start to write letters to my mother, having had minimal amount of information about her growing up and wanting her to know both me as a mother of this new child and also wishing that she was there as a grandmother to know my children. This was back to 19 years ago, and then the process evolved to this book.

David: Yes. Was it a sort of an inner wisdom that was prompting you to do this as a kind of exercise of self healing?

Nancy Rappaport: I like to think it was inner wisdom. Sometimes it was inner torture. It wasn't always a process of linear discovery, and there were many times when I… and again, whenever suicide happens, the answer dies with the person who kills themselves, so you can have a certain level of both persistence and frustration.

David: My question about the inner wisdom prompting you to do it and the self healing was more in reference to the idea of writing letters to your mother.

Nancy Rappaport: Oh.

David: That you did when your daughter was about to be born.

Nancy Rappaport: I was trying to forge a continuous bond with my mother. I was trying to figure out how to resurrect her from the dead, so that she could be vibrant with me and probably contribute to my own emerging identity as a mother. I'm not sure if it's inner wisdom that drove me to do that, although maybe, in retrospect, that's the case because it's had such a fulfilling ending. It has been so healing. It was really a drive, a motivation to tell her story as best as I could, and it had an inner momentum to it so that it took me 18 years, but I didn't become totally absorbed in the process.

I'm an assistant professor. I did writing about aggressive kids and the meaning of medication and took detours, raised three children, but I would keep coming back to trying to unravel this mystery. And some people would argue, especially as a child psychiatrist, we all know certain truths about suicide: that, for instance, mental illness and substance abuse are often contributing factors to suicide. But even if you have a relative that may have been depressed or bipolar and ended up dying by suicide, there's still a quality, I think, for survivors, where you're left trying to understand how did this happen.

David: Yes, I can really understand that. My wife just recently lost a good friend to suicide, and she's wrestling with that very question, so I've had a chance to see that process up close. Are you saying that it took you… that you actually worked on the book for 18 years, or more that the journey was spread over 18 years?

Nancy Rappaport: Well, I'd say the journey was a lifetime. The book wasn't originally going to become a book; it was more a personal journey. And then, I would say it was about seven years of where I wanted to take it from being a personal story to figure out ways it could be a teaching tool, and that my readers could learn about my inner journey, not only if they had a suicide in the family, but if they'd had a question about their parents, and now they were adults, and they were coming back and trying to figure it out.

What was my process of uncovering? And how might that be - I don't want to sound self serving - but how might it be inspirational for them? So if they had a parent that was an alcoholic, or they'd been adopted, or there had been some family secrets, what was a way that they could think about asking these kinds of tough questions to the people that survived? And so I have a chapter in the book where I talk to my brothers and sisters, who I'd never talked about in 40 years about - I mean, I'd talked about it in passing, but never in the way that I do and share in the book. And with my father. And that there was this process of not only self investigation, but curiosity with others about helping me come to some understandings.

David: Yes. Now, was it painful for you to write?

Nancy Rappaport: Different times. I didn't want to run over the fact that, when you said that your wife had lost a friend, that my heart goes out to her …

David: Oh, thank you.

Nancy Rappaport: Because I think any time you lose someone to suicide, it's heart wrenching; that we are left with a sense of bereavement and unsettlement, being unsettled. And I'm so glad she has you to try to make sense of it.

David: Yes, thank you.

Nancy Rappaport: So, you had asked me about...?

David: Yes, I was asking if it was painful for you to write this book.

Nancy Rappaport: Actually think that, in a way, the process of writing the book was the gift from the grave that my mother gave to me, because I always said to myself - you know, I've been married, blessed to have a certain level of accomplishment - but I always wanted to write one good book. And I think I did it, and that's so exciting for me - that I could have taken something that was painful, that left me with a sense of, at times, betrayal or abandonment, and was able to find a way of writing a narrative that can both allow the reader to care about my mother, which was certainly a challenge, and to look at these very complicated questions that arise when you have a parent, that you love, having done something that's hard to understand.

And so, the writing - it depended. There were times when the writing… it wasn't just the writing, it was experiencing the emotions that was painful. And then, sometimes, the writing could be healing. But, for example, as the story unfolded, when I'd been writing these letters to the parent void for about five or six years, my mother had a trunk that her best friend had kept for 40 years. And I was able to, and my brothers and sisters, to find out about the contents in it. And in it were pictures of her when she was a little girl, high school graduation diplomas, pictures of my father and my mother, me being held as a baby - a whole richness of material that I'd never had access to - and a novel that she was writing at the time of her death.

David: Oh, my goodness. It must have been such an exciting discovery.

Nancy Rappaport: It was, so that's the thing: there's a back and forth momentum. I would never ask my readers to read 200 pages of lament. There's a part of the exploration that's exhilarating and provides comfort to me and brings my mother alive in a way that I never even… You know, I certainly didn't have a memory of her.

David: Yes.

Nancy Rappaport: And then, the times when you say would be painful is when I would read some of her diary entries, where she was at times very depressed, or when she wrote… There was a three-page "Notes From a Long Distance Mother," and that's fine to write when you're alive, but when you're dead, that takes on a different meaning. So your writing can be both about your demons and trying to exorcise them, and it can also be tremendously meaningful to recognize that there's a way of being able to capture my journey that also provides me with deeper understanding of things that have happened.

David: Yes. I got the impression you really wanted to know why she killed herself. And, so often, children end up blaming themselves. Was that part of what you went through?

Nancy Rappaport: Absolutely. In any suicide, many of us are left thinking is there anything we could have done differently to avert that? And, certainly, as a child psychiatrist, I've spent my life working with teenagers and families to ground them in survival and to recognize that depression's a treatable illness, bipolar's a treatable illness, and we can provide good, caring support that can often avert this kind of disaster.

But as children, we often - now I'm 50, so - we're often the center of our universe, and particularly when you're four years old, there's a developmental idea of magical thinking. And so, there was a quality which, of course, you can look at me now and say, "That's absolutely absurd. How can a child of four years old ever cause something like this?" But children try… partly it's a way to prevent ourselves from feeling helpless. And if you take responsibility, then somehow it means you could have made the outcome different.

David: Well, I seem to recall that you were picking up snippets of information from your father that, in fact, suggested that - and I hope I'm remembering this correctly - that, maybe, there had been a difficult birth or there were other things about the circumstances of your birth that, maybe, he had implied were contributory.

Nancy Rappaport: He was stunned, when I told him that and when he read the draft of my book, that I would have taken away as somehow this was my fault. And yet, if you're a child and you hear… so I have sympathy for my dad because I'm sure that parents do the best. We all do the best we can as parents and try to provide explanations. So he was certainly floored that I would have taken away from the idea that he said "you know, your mother was never the same after you were born," to mean, well, therefore, I must have done something to cause this. But that was the… I did absorb a certain amount of guilt. Had I not been born, would my mother have not been depressed? And, as the story unfolded, you see all the complicated variations that come in, and that's part of what I'm trying to suggest, is that we often, as kids, can build a story about our life and then have opportunities, as we get older, to revisit it and come out with, perhaps, a different personal fable or truth.

David: Yes, it may not relate to other people's understandings of the situation very well.

Nancy Rappaport: Absolutely.

David: Were you able to repair your relationship with your father after what must have really taken him aback?

Nancy Rappaport: Well, he's a terrific dad and has been fiercely loyal to our family and has provided us with so much warmth, love, and tenacity. I know that one of the important parts about how well a child does after a parent's suicide is the surviving parent and whether they can provide stability and good schooling and resources to make sense. And I certainly think my brothers and sisters, in some ways, have not only endured a loss but thrived in having him be as steadfast as he is.

And yet, I think that there is a quality where he had to have - tolerance isn't exactly the right word - but enormous courage for me to come back as a grown adult, a child psychiatrist, and say, "Dad, I'm ready now to hear your story about how you think this unfolded and to move forward publishing my own memoir about a time that must have…" It's 46 years for me, and he's 82 now, and that's got to be enormously difficult to have me come back, and I really admire his ability to…

He said one thing that I mention in the book, that you should never allow the child to define the relationship. And there are ways that I needed to go back and make sense of what happened to my mother, and there were times when I might have distanced myself from my father, and he stayed, communicating to me clearly that he wanted to have a relationship with me. And that's a strong work as a parent. I hope I can do that when my kids come back to ask me something that happened to them when they were four years old.

David: Yes. Well, this hunger to understand your mother, to understand why she killed herself, really set you off on a kind of detective story hunt. And you've already pointed to some critical incidents along the way, but maybe you can take us through some of the other - I don't know if highlights is the right word, but that's the only word I can think of.

Nancy Rappaport: I can appreciate that question. Sort of the twists and turns in the pursuit of truth, my truth.

David: Yes. That's it.

Nancy Rappaport: I could sort of walk through sequentially. There was trying to figure out anything about my grandmother on my mother's side, and she's been dead 40 years. There wasn't much information, and it turns out that my first stepmother - because my dad's married twice - but my first stepmother told me that there was a man who was a justice of the peace who had been a confidante of my grandmother. Now, he's 65; at the time, he was 18. And I called him. I can remember I was 45 years old, and I called him, and I said: "Ed, I'm calling because I'm Nancy Rappaport. I'm trying to figure out about my mother, who died 40 years ago." And he said to me, "I've been waiting for this phone call for 40 years."

David: Wow.

Nancy Rappaport: And he went on to tell me detail - and you can always tell in the first beginnings of a conversation whether you've got someone who's got rich material, or if it's going to be vague. And he made my grandmother come alive across time. So that was a twist.

And he gave me information - he said, "Well, your mother's sister drowned when your mother was eight years old," and he knew the town where my mother's sister had drowned. Now, I knew vaguely that I'd had an aunt that drowned as a young child, but I didn't have any details about it. And I was able to pull the article from the records, to get the records, a newspaper article about what had happened to her, and that's in the book.

There was my mother's - the person that she had an affair with, who she ended up leaving my dad to go live with, and that's what precipitated the divorce and the custody case. And he had - it's complicated to explain - but he had been my stepbrother's dad, and so I'd grown up with my stepbrothers from when I was 5 until when I was 17. And so I went to go interview him. He'd sort of been this dark, shadowy figure, and I went to upstate New York to interview him. That was quite an interview. He was remarkably articulate, but it was a complicated interview for me to do.

David: I can imagine.

Nancy Rappaport: Definitely. That's chapter seven. So those are some of the twists and turns, where you're... Oh, and another big one was, of course, the trunk, with my mother's semi-autobiographical novel which is called The End of Freedom. And in it, the main character, who's a mother and is running for governor - and my mom was active in politics at the time - killed herself. So I had a 400-page novel that I'd never known anything about. So there were lots of twists and turns.

David: Yes. And suicide is so painful for families, that there's often a veil of secrecy that descends, sometimes in the name of protecting the child. Did you encounter any barriers such as that as you attempted to find out about the circumstances of your mother's life and death?

Nancy Rappaport: Because I am a child psychiatrist, people might have felt a little more comfortable interviewing with me. Had I come across being overwhelmed with sadness and... even though every time I made a phone call or met someone for an interview, I had to summon my courage because you always have a sense that you were going to discover something that would be hard to integrate.

David: I guess I'm thinking more of when you were a child and growing up, whether there was a veil of secrecy during that period.

Nancy Rappaport: Well, veil of secrecy - I think that more a silent grief that we just never really talked about as children; that there was this major event that happened, which was that my mother had killed herself at the time of the custody battle, and that we had a stepmom and we had three kids, and the fact that my mother's lover had been my stepmom's first husband. We just never really registered that. That was just pass the Cheerios; it didn't really have... So there were multiple layers where we just didn't talk about what does this mean for us as a family.

And sometimes I wonder. In chapter five, when I go back and ask all my brothers and sisters about what their memory was, I wonder: had we had a family therapist, versus me being in individual therapy when I was in seventh grade, whether we would have had a different outcome. I mean, now, the unintended consequence of me having both talked with my brothers and sisters is that our relationship has changed in a wonderful way where I feel closer to them and connected in a way that sometimes, when you don't talk about these unmentionable losses, it can drive a wedge between you.

David: How much of a role do you think this loss in your early childhood played in your becoming a child psychiatrist?

Nancy Rappaport: It's always a complicated question because what I want people to know when I'm taking care of them as teenagers - and I work mostly in public sector at a teen health center in Cambridge - is I want my patients to stay alive because I want them alive, and it's not because I couldn't save my mother, I want to save them. It's because of the value of who they are. And, at the same time, I'm sure that I was drawn to psychiatry on some level, also, because of the role having a caring therapist played in my life and hoping to do that in other people's lives.

David: You mentioned that caring therapist when you were in the seventh grade. How did that come about? Were there some kinds of symptoms that you were showing at that point in your life?

Nancy Rappaport: Sure. Well, I work now in a school-based health center, and I'm sure I would have been picked up by a school counselor. I was a smart kid, hopefully, and that wasn't a problem, academics, but I was - I can confess this on radio - I was stealing things. I was stealing all sorts of things, which some British psychoanalyst, Winnicott, would say that teenagers steal when they want to find love.

David: Yes.

Nancy Rappaport: And I think that I thought I could invent. So that was one thing that was a tip off. And then the other was, at a certain point when my dad and my stepmother in seventh grade were starting to move towards divorce, I had decided to run away from home. And my bright idea about where to run away from home was to run away to the school auditorium, and I spent the night in the school auditorium.

And it was after that, that my stepmother and my father decided it might be useful for me to talk with a therapist. And it was helpful because, as we talked about, I carried an enormous sense of guilt that I somehow could have prevented my mother from taking a fatal overdose. And this therapist was particularly helpful, and something I certainly try to do with my patients when they have complicated things happen to them, is he helped me understand that it wasn't my responsibility, and that this was tragic and, in its own way, unexplainable. And that allowed me to get back on track.

David: That's wonderful. We can see that that relationship with that therapist was, certainly, probably formative in your career choice. And I read that your current sense of mission was strongly influenced by your experience as a science teacher in Harlem.

Nancy Rappaport: Oh, yes.

David: Between college and medical school. Tell us something about that.

Nancy Rappaport: Well, certainly. I'm the director of school programs at Cambridge Health Alliance, and I work with teachers and administrators who I have so much respect for, for being in the front lines. And that was probably one of the harder jobs I had, although I loved it, being a preschool to third grade teacher.

And what I had thought when I initially was a teacher is I'll open up a pediatric clinic and probably come back to Harlem. Of course, I stayed in Boston. But what I came to appreciate when I was teaching was that many times, at least in the United States, we often have the basic needs met for our children - that's not completely true. But that there's other challenges that kids face: a parent that's an alcoholic, deaf. But those kinds of challenges I found myself being intrinsically drawn to, both the vibrancy of kids.

And that's why I ended up being in schools and working in a school-based health center, is that I wanted to work with the community trying to support kids and provide them with the momentum and stamina to stay engaged when, frankly, kids' behavior sometimes can be bewildering or unsettling. And I wanted to say, well, let's think about together how we can support kids who may be hurting and showing their hurt in ways that can be scarier.

David: Well, given your work in the school system, I note that you also teach in the med school at Harvard. And so I'm wondering, what is it that you're teaching?

Nancy Rappaport: I teach Harvard undergraduates. I actually teach a course in the freshman seminar on psychiatry and memoirs, so that's a really terrific course. I read some parts of my memoir. They got to hear it before anybody else did. And then I pull articles that are sort of academic articles that may describe different disorders, bipolar depression, and then we also interview patients who will talk about their experience with mental illness. So that's meant to recruit people and ignite them with the excitement of being a therapist. And then I work with child psychiatry, people who are training to become adult residents, so adult psychiatrists and child psychiatrists. This might be more information than you want, but…

David: No, no. I'm quite interested.

Nancy Rappaport: With adult psychiatrists, I'm trying to teach them about normal and abnormal development in children. And then, with the child psychiatry residents, I'm teaching them about working with schools. So that's the range of teaching. I love to teach. That's what I was hoping my book would be, is not pedantic, but a way of engaging the reader and saying child psychiatry, how the mind works, this is tremendously interesting.

And even though I'm talking about absolutely one of the more significant losses in my life, I did have - I don't want to pathologize me - but my defense was being intellectual, being curious. So if I talk about my mother's affair, I'll go back and try to make that more vivid by looking at what's our understanding about why affairs happen. Or if it's about divorce, what can you expect with children when they come from a family of divorce? So I'm trying to take these examples that happened in my life and use it as an opportunity to deepen our understanding about human behavior.

David: And I think your book succeeds at that.

Nancy Rappaport: Thank you.

David: So I hope people listening will hear that it has this sort of dual aspect. I was interested: in your book, you say you would have encouraged your mother to take lithium, and at the same time, you also say that, as a psychiatrist, you're not particularly eager to write prescriptions. How do you see the role of medication in dealing with depression and other psychological disorders?

Nancy Rappaport: Appreciate. That's such a good question, and I want to answer it in two ways. One is I'm cautious to diagnose my mother because I never interviewed her. Just like I wouldn't diagnose a celebrity if I'd never interviewed them, even if I got lots of information. But sometimes when I was reading her writing and hearing from different people that I interviewed, I had thought it was possible that she had bipolar disorder. And with bipolar disorder, if you take lithium, you're eight times less likely to kill yourself. So that's why I'm saying, gee, if she had bipolar, in a heartbeat I would have prescribed it to her.

And then, when I'm talking about being - tentative isn't the right word - but taking the decision to give medication very seriously, every time that I write a prescription, I think to myself, would this be something I would do for a family member? Because even though - and I tell this to my patients - even though I'm a child psychiatrist, we want to be measured about giving medication. And when you're thinking about medications with children, it can be a complicated decision process trying to figure out which part of this difficulty that this child is facing is because of trauma that may have happened early on in their life, or is it that there's a biological component which really will be improved by medication?

So that's where I'm talking about when I make that decision. That's huge because, when you weigh in and say… You have a child that has - let's just say for example - attention deficit disorder, and I'm going to give them a stimulant. And maybe also, though, there's been really tough traumatic kinds of things that have happened. People have been hitting each other a lot in the family. It could be that both things are happening at the same time, which is sometimes the case. But you don't want to mistakenly have a false sense of confidence that you've treated the problem when what really needs to happen is that you need to address the fact that this is a frightened child who can't concentrate because they're so afraid of what's going to happen next.

David: Good point. What advice do you have for listeners who might be survivors of suicide loss, but haven't yet come to terms with what happened?

Nancy Rappaport: The reason that's such a good question is that I… there's so many books out there that are self-help books - read this and I'll tell you how to solve it. And my book is offered as a way to connect with the reader, so that if you are someone who has survived the loss of suicide that you don't feel so alone and so isolated. So, not to say that my feelings mirror yours, but that my sorrow and my grief I'm sharing with them, in a way, to let them know that they're not alone.

And I did not use the kinds of support systems that are throughout the country, but certainly have been very useful to people, so I'd want to let them know about the American Foundation of Suicide Prevention, which has support groups for those survivors of suicide. And some people have found that enormously useful. There are walks that are called "Out of Darkness" and then the American Association of Suicidology and Samaritans. So that there is an infrastructure within our country where we have tried to mobilize to provide support for people.

But not everybody is going to say they need to see a therapist because of this, although I think it's important, particularly if you are finding yourself not being able to function, to look for professional support to help move through that time. And I would also say, there are some people who repression happens, and they just move on, and they say, "I don't want to deal with this." And I have tremendous respect that everybody has their own timetable, and there's no right way to make sense of this or to move through it.

David: Okay. Do you have any sense of how parents might guide kids through the sudden loss of a loved one? Maybe, especially, if that loss was due to suicide?

Nancy Rappaport: There are certain steps that I would think are important. The first is that you want to give developmentally appropriate information. So the kind of information that you say to, say, a child that's under 6 years old versus a child who's 6 to 12 versus 12 to 18, it's going to be framed differently.

So with the youngest children, sometimes they just need to know concrete information, so it would be very confusing if you use a euphemism like "he went to heaven," or "he went on vacation," because then they're going to be terrified the next time you go on vacation. And you really have to be concrete that your daddy or mommy isn't here anymore and has died, and his heart doesn't work and his lungs don't work, so that they get concretely what it means to them.

When you get to the older ages, like the 6 to 12-year-olds, they may be very focused on what actually happened and what it means for them. So you want to be able to think together about how much information you want to give. I would strongly recommend never to lie about it. It will come back to haunt you. If you just say daddy had a heart attack, when he actually drove into a tree, that's going to come back to really be corrosive. And kids can feel betrayed now, not only by the parent who killed themselves, but they'll begin to feel they can't trust explanations that people give to them.

And then with teenagers, they may look indifferent when you're talking with them and don't… I would really encourage parents not to read too much into that. The central thing, which goes back to what I was talking about, it's really important to let people know that nothing they said or did caused their parent to suicide. So the fight that happened right before dinner, that's not what caused it. Usually there is mental illness that's been involved, either depression or bipolar, sometimes substance abuse, sometimes a level of impulsivity and hopelessness. And it's that combination of factors, so you really want to help them understand that.

David: Well, these are helpful guidelines, so thank you for those. Losing your mother at such a young age was a major life challenge. Now look at you - you're a psychiatrist; you're teaching at Harvard. Looking back, what got you through?

Nancy Rappaport: Well, certainly there were what I call "other mothers" in my life, so there were strong female presence, teachers that really cared about me. There was a caretaker who had been - she wasn't really a nanny. That's not exactly the right word because she was so important in my life. Bea was her name. I write about her in the book, and she was devoted to our family, and that made a huge difference. Having a strong dad was helpful. Having a therapist when I got older, seventh to twelfth grade, made a big difference. Being in a really good school system was huge. And also with any of us, I think the power of narrative, the ability to write a story about what happens to your life, whether you choose to write it down or not. But to bring some understanding of how an event's unfolded can be enormously healing. And now - my husband wouldn't want me to say - I've been married for 24 years, and I have a terrific husband, three kids, and that's been something so valuable to me. To be able to have my own family be strong and vibrant is tremendously healing.

David: Well, your family will be happy to hear that if they get a chance to hear this.

Nancy Rappaport: Yes.

David: I can't get my family to listen to any of these shows.

Nancy Rappaport: I know. They're like, "Enough already, Mom. Move on."

David: Right. Are you at all tempted to try to see if you could get your mother's novel published?

Nancy Rappaport: I wish I could say it was the most spectacular gem ever. And I did make sure to give it to my brothers and sisters when I got it. It has aspects, and there are parts that I share of her writing that I culled from the novel and from her journals that I think she was a really strong writer, very compelling. She needed to stick around so that she could have edited this because there are digressions that go back and forth.

Although, again, that's what's so interesting. There were parts about the whole political process that… I probably skimmed some of War and Peace, so I'm not the best… But my sister Martha really enjoyed those parts because she was a Minnesota politician. So she loved all the aspects of trying to figure out how to get enough electoral votes and the duplicity that was going on in the politics in the novel, where I thought, "Oh, gee, this is going on and on."

So that said, I haven't gone forward to see anything about publication of it, but it was fascinating for me, and that's what I talk about in chapter three: to take a look at what am I supposed to pull away from this as a daughter who wants a good story, as a daughter who wants to be proud of her mom, and as a writer?

David: And I have to think that, genetically, you received a gift from her, as well - that writerly part of you. That some of that came through her.

Nancy Rappaport: Again, it was stunning coincidences that I didn't know about. I didn't realize that she had gone back, when she had four children in 1956, to go get a master's degree in English.

David: Wow.

Nancy Rappaport: And I found that out in the trunk. And I had definitely not known that she was trying to write a novel when she died. So that whole aspect of the fact that we were both writing and that we had this shared connection was pretty stunning.

David: She was pretty young, wasn't she, when she died?

Nancy Rappaport: Thirty-four years old, 16 years younger than me.

David: Yes. Well, as we begin to wind down here, I wonder if you have any thoughts on how we, as a society, can break through the stigma around the subject of suicide and make it less of a taboo.

Nancy Rappaport: Well, first of all, just the opportunity to talk with you today is tremendously useful because many times people are afraid to talk about suicide. They think if they talk about it that either it's somehow contagious, or that they may say something wrong and inadvertently prompt someone to feel more suicidal. So being able to say this is a tragedy that happened and to also… Before the stigma of suicide, we're getting better around the stigma of mental illness, but people feel tremendously damaged, sometimes, when they have a mental illness and they need help, much more than they would, say, if they had diabetes. They'd go straight ahead and go have their blood sugar checked and take insulin. And yet, oftentimes, people will have suffered for a long time before they say "you know what, I'm in over my head."

So the first thing I would want is for people to recognize that if they have a family history of depression or bipolar, that there may be a certain vulnerability, and that they want to be familiar with what those symptoms are, so that if things start to happen, that they can get treatment. And to communicate that mental illness is a treatable condition, and they shouldn't have to face it alone. So, that said, because that will help decrease suicide.

And I would say, also, that there are the 1-800-273- -- oh, gosh, 1000, the lifeline number - that we can get support for if someone needs immediate help. So what you want to do when someone's suicidal is to create a pause, to create a chance for them to be reflective about what happened. For instance, as a society, having… Ideally, if we had guns being much more difficult to access, that would decrease the suicide rate overnight, because 65% of suicides are caused by guns, and they're only 1% of the attempt.

David: Well, that's a good place for us to wrap it up. Dr. Nancy Rappaport, thanks so much for being my guest today on Wise Counsel.

Nancy Rappaport: I so appreciate it.

David: I hope you found this conversation with Dr. Nancy Rappaport informative and inspiring. As you heard me mention in the interview, her book is more than a memoir. It's also filled with useful insights about depression, suicide, and coping with loss.

Also, Dr. Rappaport wanted me to correct the number of the National Suicide Hotline which, under the pressure of the moment, she recited incorrectly. The correct number is 1-800-273-TALK.

You've been listening to Wise Counsel, a podcast interview series sponsored by Mentalhelp.net. If you found today's show interesting, we encourage you to visit Mentalhelp.net, where you can add a comment or question to this show's web page, view other shows in the series, or simply page through the site, which is full of interesting mental health and wellness content. Access the show's page and show archive information via the podcast box on the Mentalhelp.net home page.

If you like Wise Counsel, you might also like ShrinkRapRadio, my other interview podcast series, which is available online at www.shrinkrapradio.com.. Until next time, this is Dr. David Van Nuys, and you've been listening to Wise Counsel.

 

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About Nancy Rappaport, MD

Nancy Rappaport, MDNancy Rappaport, MD is an assistant professor of psychiatry at Harvard Medical School. She is a board certified child and adolescent psychiatrist; her research, teaching and clinical expertise focus on the collaboration between education and psychiatry. She has designed numerous courses for teachers on psychopharmacology, adolescent development, and instructional strategies for disruptive students. Dr. Rappaport has been an attending child and adolescent psychiatrist for the Cambridge, Massachusetts public schools for more than 18 years.

When Dr. Rappaport was just four years old and the youngest of six children, she lost her mother to suicide. Years later, she investigated her mother's life and the mysteries surrounding her death, looking at the past as a way to fortify herself for the future. The culmination of this effort is a powerful new memoir, "In Her Wake: A Child Psychiatrist Explores the Mystery of Her Mother's Suicide" (Basic Books, 2009). In her writing Dr. Rappaport gives voice to the silent grief that often accompanies painful loss and charts her healing as a mother, doctor and daughter. She offers her own story as a tribute to the endurance of the human spirit, and shows how love lasts longer than death.