Editor’s Note: We published this story on suicide in middle-aged women two years ago, after a succession of shocking deaths. We are re-running it now because some health professionals are concerned that COVID-19, with all its related hardships, may impact the suicide rate, which is already increasing at an alarming rate, particularly for women in the 45-64 age group.
There was almost no tragedy in recent memory that spiked as much self-examination and pain as the news on June 5, 2018, that Kate Spade, 55, the wealthy, plucky designer of witty handbags and the mother of a 13-year-old daughter, had hung herself, and the subsequent revelation that she had suffered from depression and bipolar disorder for a long time. A few month earlier we had lost 69-year-old Margot Kidder, whose death was later ruled a suicide. And before that, successful film producer Jill Messick, 50, a wife and mother of two, killed herself out of the pain of being unfairly maligned in the Harvey Weinstein scandal. Messick, too, had had a long history of depression—that she valiantly combated—but she seemed, on the surface, to have everything to live for. Yet she took her own her own life (the method has not been revealed).
These stories of women “our” age—45 to 65-plus—who seemed to have everything but took their own lives are as startling as they are, also, on some secret level, comprehensible. In our still patriarchal and youth-oriented culture, it comes as sadness but not surprise that the Centers for Disease Control reports that the largest increase in the number of completed suicides in America is among women aged 45 to 64: a deeply worrisome 45 percent jump in suicides over last 20 years.
Though men, in general, commit more suicides, those in the same age group have shown far less of an increase: 30 percent. Clinical studies have also shown, over recent years, a troubling nearly 50 percent rise in ER visits for drug-related suicide attempts (usually opioid) by middle-aged women.
The Big Jump in Deaths in Our Age Group
The reasons for suicide among middle-aged women are various. Deborah Serani, a New York-based psychologist affiliated with Adelphi University, has spent years helping “dozens and dozens” of women battle suicidal ideation—to the point of calling the police when her patients have indicated they were ready to take their own lives and, in one case, having a patient’s stomach pumped. She has colleagues who have lost patients to suicide. She knew that female depression and suicide intervention would be her life’s work when she was a depressed 19-year-old who came very close to killing herself with her father’s gun; she backed off just in time. A great deal of suicide, especially among the young, is “impulsive”: emotional and tragically impetuous.
Those of us now in our 50s and 60s were the first women who came to young adulthood believing we could ‘have it all.’
“There’s a wide spectrum of reasons that worsening depression and suicide hits middle aged women so hard,” Dr. Serani says. At least 60 percent of suicide victims have major depression. “First of all, those of us now in our 50s and 60s were the first women who came to young adulthood believing we could ‘have it all.’ When you find out it wasn’t quite that neat—your life can’t be that perfect, you’ve ‘fallen short’— that can lead to depression. ‘I’m not happy. I was told a story that didn’t work out for me. I failed.’ Midlife women are also the sandwich generation, having to care for kids (or feeling the loss of purpose when their kids leave them for independent lives) and for aging parents. There’s stress and vulnerability—and the candle can be burning at all ends for them. There’s no one-size-fits-all answer.”
What’s Going On
But there are strong hints. For example, there is a correlation between the estrogen-progesterone changes that come with menopause and increased depression. A 2008 study in Menopause: The Journal of the North American Menopause Society found that “late menopausal transition” was significantly related to depressed mood. Another study found that menopausal women are three times more likely to develop depression than premenopausal women. Going even further, a study of menopausal suicide attempters (as opposed to mere depression sufferers) in Iran in 2012 concluded that “the relationship between the female suicidal attempt and the feminine hormones is [emphasis added] a reality and cannot be renunciated.”
Menopausal women are three times more likely to develop depression than premenopausal women.
A writer named Kathie, a woman in her 50s, recently lost a friend she knew from childhood in such a sudden, awful way that “it was like the ground fell out from under me.” Her friend’s idyllic life—“she had everything; she was happy”—turned to depression severe enough for her to, like Spade and Scott, hang herself with a scarf precisely when she went through the roughest moments of menopause.
Kathie’s friend had had severe postpartum depression (a sign that she was prone to depression) when her child was born 19 years earlier, but it was treated and completely subsided. Yet when she hit menopause, says Kathie, “suddenly, despite amazing professional successes, a fantastic child, a happy marriage, she plunged, almost overnight, into depression again, something she kept secret from most of her friends.
Her husband and best friend were doing everything they could, making appointments with specialists, and those specialists identified her condition as menopausal depression. But it all happened so quickly! When I got the call that she had killed herself, I couldn’t believe it. This was a beautiful woman who always smiled; people loved her—but menopause hit her like a ton of bricks. What happened to my friend makes me want to shout: ‘We have to de-stigmatize menopause!’ Women don’t want to admit we’re going through it because, these days, we have to work with 30 year olds. But we can’t afford to be silent about menopause anymore; my friend’s suicide is proof.”
Maura, a 55-year-old sufferer of severe depression who has had suicidal ideations, agrees, from first-hand experience. She writes: “I have had PTSD from a violent rape at 27 with attendant depression and anxiety for at least 27 years. However, the last 11 years, after a severe back injury, and the past five to six years, have been the most difficult with suicidal ideation. Definitely perimenopause and menopause contributed—my psychiatrist said that both of them raised my anxiety levels and made it more difficult for me to manage triggers.” The other factor, for Maura, was “becoming ‘the invisible woman’ in my 50s.” But, she adds, “I have the best mental health care providers. I have really good friends. I know depression; it’s ruthless. But I know how to get through.”
It’s Hard Out There
Menopause aside, at the risk of defying politically correct anti-ageism and Age Boldly positivity, growing older can feel damn hard for women in this culture. Feature film director and Columbia University professor of graduate film studies Katherine Dieckmann, 56, has thought long and hard about why so many of her female friends are depressed at this age. “We think, I can’t use my ‘woman tricks’ anymore because I’m invisible to the world.” There’s Maura’s term, repeated! “And to be invisible means to be discounted.
‘We have to de-stigmatize menopause! My friend’s suicide is proof.’
At 50 or so you have to re-interpret your whole being, and that is exhausting. ‘If a man smiles at me on the street, does that mean he thinks I’m an old lady?’ I’m not depressed now: making a movie, <span”>Strange Weather, in which a midlife woman, Holly Hunter, wears jeans, has adventures, and is sexual helped correct that. We have to fight to be honest about who we still are and not give in to thinking ‘Oh, I’m considered pathetic and trying-too-hard now unless I dress in sensible shoes, a cardigan, and a quilted purse.’ Screw that!” Note: Next Tribe, of course, shares this mission
But there’s also career-dwindle depression. A friend of mine—I’ll call her Joanna—is extremely depressed. She successfully battled cancer (and with humor!), but that was easier. People understood the physical illness she was up against and supported her heroism. The severe depression she is dealing with now, seeing career options fritter away in a field she’d once mastered but that has been overhauled by for-the-young digitalization, makes her feel like “Holy shit! It was all for nothing! I’m supposed to be ‘comfortable’ now, reaping the ‘rewards,’ not struggling like this!”
Dr. Dean Parker, a clinical psychologist in Dix Hills, New York, who has treated hundreds of patients of both genders in his long career, says that, no matter how much he tries to work up positivity in some of his midlife women patients—especially those who have just ended relationships—it can be an uphill climb. What sticks in his mind are the “beyond disheartening” results of a 2014 study sponsored by A. Vogel, an herbal supplement company that produces menopause remedies. Of the 2,000 women over age 45 surveyed about their feelings on aging, more than half felt they’d been “left on the shelf” and have been “judged negatively because of their age.”
That’s pretty grim, and it certainly beats the drum for serious attention—but it’s not unsurmountable. A prescient and very thorough 2011 blog post that Dr. Serani wrote addresses female midlife depression and suicide: how to see signs of depression in yourself and the possibility of suicide in your friends and how to ameliorate and treat both.
Inside the Mind
In the immediate aftermath of Kate Spade’s (and Anthony Bourdain’s) shocking suicides, I asked midlife women whose depression might have veered into suicide ideation to send me descriptions of their lives, and here is what some of them said. A well-published and eloquent writer in her 60s: “My first depressions came in my 20s and 30s.” Loss of lovers, memories of childhood sexual abuse by a relative led to “the constant thrum of anxiety in my bloodstream. My inner landscape [felt] devastated by a nuclear bomb. My body refused all pleasure, beginning with food and people. Suicide ideation somewhat. Hijacked sleep. I was beyond tears.” Seeing a therapist helped. A good relationship helped. Then, in her 40s, 20 years ago—menopause-time—“a work disappointment shifted me into what I recognized in my body and mind was the beginning of another depression. By then, there were antidepressants. I got myself to a psychopharmacologist and after a little tinkering, found Zoloft. The difference it made in my life continues to be profound. The net held.”
One of the most moving correspondences I have had has been with comedian, writer, and TV producer Bari Alyse Rudin, who is 48. When she was three years old, her beautiful 29-year-old mother, seemingly out of the blue, took her husband’s pistol, pointed it at her own head, and blew her brains out while Bari and her two little siblings were getting ready for preschool in the adjacent bedroom of the family’s Brooklyn house. Out of shame and terror, Bari and her family eventually told others she had died of cancer. Years later, Bari’s brother tried so hard to hang himself (but narrowly failed, being in a long coma for a long time after) that a permanent rope scar braced his neck. In 2015, he succeeded in killing himself, the same year their father died of natural causes.
We cannot not talk about feeling ‘invisible’ or career-gut-punched.
A family history of depression and suicide this intense is hard to beat. And Bari has tried to beat it, with everything in her. Bari was a straight A student and president of her high school class in leafy, affluent Connecticut, “and then I put together a great career in TV and comedy”—massively competitive fields requiring humor! Objectively, she says she did plenty right, but she never felt that “rightness.” She finds that to be universal with everyone who experiences severe depression.
Bari has battled suicidal ideation and severe depression—it comes, it goes, it comes it goes—all her life. Last year she was so depressed she couldn’t comb her long, luxuriant hair, so she hacked it all off. She tells me that looking at the planets in the sky with her son, who wants to be an astrophysicist, helps and that she is absolutely determined “to make a clean slate for my children and give them a happy childhood.” She’s enormously grateful that, so far at least, she has succeeded. “Putting them and their needs first and knowing that they deserve a happy and healthy mom has helped me seek help every time I hit another low or see myself slipping. I want my children to have great lives.” When deep depression recurs, “I try to tell myself that the one thing going through it so many times has taught me is that every single time I have come out of it. I have to keep reminding myself of that!”
Bari is an active volunteer for the American Foundation for Suicide Prevention, and I heartily recommend going to this worthy group’s website.
She is heroic, as are all the midlife women battling depression linked, remotely or less so, to suicide ideation. We cannot not <span”>talk about these subjects: menopause; feeling “invisible” or career-gut-punched; feeling that your psychological pain seems less sympathy-worthy to friends than, say, cancer; feeling that you are living on the dark planet of grief that money and success cannot touch.
Here, of course, is the all-important number: If you need emotional support or are in crisis, call the National Suicide Prevention Lifeline at 1-800-273-8255.
Let’s hope we don’t hear of any more Kate Spades for a very long time. But let’s be grateful to her family that her tragedy has prompted this essential conversation.
Sidebar: “Get Help.” Not as Easy as It Seems
In the aftermath of the suicides of Kate Spade and Anthony Bourdain, many news outlets and social media posts implored those with suicidal thoughts to “get help.” For Aviva Rosenthal, 49, of Sacramento, California, that seems like facile advice. She has had thoughts of suicide (but assures me now that she’s fine). Her story is heartbreaking and full of challenges. She has Asperger’s and multiple sclerosis and is wheelchair bound. Her son has been recently diagnosed with Asperger’s, as well. In her youth, she had two friends who hanged themselves.
The impossibly high price of psychiatry in today’s economy is where she places much blame.
“‘Get help?’ hmm. This really isn’t as easy as it seems,” she says. “In my desperation to stay alive, I’ve always been forthcoming about my issues but unable to afford most therapy. I don’t respond well to medication—all antidepressants cause severe migraines, and anti-anxiety meds, ironically, bring on acute depression—so talk [therapy] is it for me.” The impossibly high price of psychiatry in today’s economy is where she places much blame. She says that in order to get subsidized therapy for her son and herself, she banged on every door, filled out every form possible.
Here, in her words, is how she sees the issue:
“At best would receive a few months of sub-par therapy that would then disappear. This is why I smile bitterly when yet another person commits suicide, and everyone says, ‘Why didn’t they get help?’ My God—do you really think we didn’t try?
I’ve given [my son] every one of my coping skills. Go outside. Draw and write every day. Talk about it. Give yourself goals and pleasures to look forward to. I’ve learned five languages, simply because I’m depressed and it’s a good distraction. And above all [emphasis added and black-humor alert:] recall that you can always kill yourself tomorrow [not today].”
When I learned of Anthony Bourdain’s death, the pain of loss was quickly replaced by anger. He was a fighter, someone who’d always been open about his demons. If he could give up, what was there to stop me? And what were the rest of us schlubs going to do without this fighter in our world?
Yes, the system is fucked up beyond repair. But you can still take care of yourself, practice kindness to others, especially those you know are vulnerable, even if they’re doing a great job of pretending otherwise. There have been days when a chance smile from a stranger was all that kept me from slipping into despair. Talk and write about it, a lot, even if it’s unpleasant and makes people sick of you. More than ever, we need to know we’re not alone.”
A version of this article was originally published in June 2018.