Losing a friend to suicide when we both had schizophrenia

This is a composite story, drawn from common experiences shared in the schizophrenia community. It does not depict a real individual.

I am thirty-four. I live in a small apartment in Cleveland with two plants that I have somehow kept alive. I have schizoaffective disorder, bipolar type, diagnosed when I was twenty-three. Last spring, my closest friend in the world — a man named Marcus, who also had schizophrenia — died by suicide. I want to write about that, because almost nobody does, and because the silence around it nearly took me with him.

How we met

Marcus and I met on the unit at a hospital downtown. I was twenty-five and recently re-hospitalised after a manic-psychotic episode. He was twenty-eight, three admissions in. We sat next to each other at a group on coping skills, and afterwards he told me, very quietly, that he thought the worksheets were "patronising garbage." I laughed for the first time in six weeks.

What grew between us over the next six years was not a romance and not exactly a friendship in the way other people use the word. It was something closer to a mutual aid pact. We texted every morning. We called when voices were loud. He drove me to the pharmacy when I could not face the fluorescent lights. I sat with him in the ER for nine hours the night his roommate moved out.

What the numbers actually say

Suicide is the leading cause of premature death in people with schizophrenia. The NIMH estimates that roughly five to ten percent of people with schizophrenia die by suicide, with the highest risk in the first decade after diagnosis and during the months following hospital discharge. A 2017 systematic review in Schizophrenia Bulletin by Hor and Taylor (PMC2951591) put the lifetime risk for completed suicide at around 4.9%. Most of the people I have known who lived with this illness have lost at least one peer.

Knowing the numbers does not make any single death less of a shock. When the call came from Marcus's sister, I sat on my kitchen floor for what I think was about three hours. I do not remember it well.

The particular loneliness of this kind of loss

People who have not lived with serious mental illness sometimes respond to a story like Marcus's in ways that hurt without meaning to. They say "at least he is at peace now." They say "you must have seen it coming." They say, in a tone that is meant to be reassuring, "well, with his diagnosis…" — as if a psychiatric label makes a person's death less of a death.

Inside the community, the response can be different but no less complicated. Some peers I knew went very quiet. A few told me, candidly, that they were scared — because if Marcus, who seemed so steady, could die this way, what did that mean for them? I understood. I was scared too.

The week I almost followed him

About six weeks after the funeral, I stopped sleeping. The voices, which had been mostly background hum for two years, got loud again. The depression that often shadows my schizoaffective episodes settled in like wet wool. One night I sat at the kitchen table with a bottle of my olanzapine and counted the pills.

What stopped me — I want to say something profound, but it was not profound — was that the cat was on my lap, and I did not know who would feed her if I did not get up. I called the 988 Suicide and Crisis Lifeline instead. The counsellor stayed with me on the phone for forty minutes. The next morning I went to my prescriber, told her everything, and she increased my mood stabiliser and added a brief course of an antidepressant that we had used before.

Things that helped me grieve

None of these were original. They are the things grief counsellors and survivors of suicide loss have been recommending for decades. They are listed here because they actually helped, and because reading other people's lists kept me alive.

• A suicide loss survivors group. The American Foundation for Suicide Prevention runs survivor support groups across the US (AFSP directory). Sitting in a room with people who had lost a sibling, a child, a spouse to suicide normalised feelings I had been treating as evidence I was a bad person.
• Telling my prescriber early. Within two weeks of the death I told my psychiatrist exactly what had happened. We made a written safety plan. We agreed to meet weekly for the next two months instead of monthly.
• Removing the means. I gave my mother my pill bottles for two months and let her dose me daily. I felt like a child. It probably saved my life.
• Naming Marcus out loud. Friends were terrified to mention him. I started doing it first, in casual sentences. "Marcus would have hated this song." It made him real again, and it made me less alone.
• One body-based ritual a day. A walk around the block. Cold water on my wrists. A shower. Whatever I could manage. Grief lives in the body and it had to come out somewhere.

Things I wish other people knew

If someone you love has lost a peer with schizophrenia to suicide, please understand a few things. First, the bereaved person is at significantly higher risk of their own suicide attempt for at least a year afterwards. SAMHSA's After a Suicide: A Toolkit for Survivors outlines this clearly. Second, the bereaved person may not look how you expect grief to look. Schizophrenia often comes with flat affect; my face does not always match my insides. Third, just being there matters more than saying the right thing. Marcus's mother sent me a card every month for a year that just said "thinking of you." I still have all of them.

Where I am now

It has been about fourteen months. I have not been hospitalised since Marcus died, which both surprises me and makes me sad — he would have been proud, and would have made fun of me for being proud. I work part-time at a bakery and I am training to be a peer support specialist (see my piece on that path). I take my olanzapine, my lithium, and my walks. I see my psychiatrist every six weeks and a grief counsellor twice a month. The voices are quieter than they have been in years.

I miss him every day. I do not think that part stops. What changes is what I do with the missing. For me, right now, it is this: stay alive, take the medication, answer the phone when another person with this illness is the one calling at 2am. That is what Marcus would have wanted. That is what I am doing.

This article is for educational purposes only and is not medical advice, diagnosis, or treatment. Always consult a qualified mental health professional. If you or someone you know is in crisis, call or text 988 in the US, or your local emergency number.