As I write, Rosaleen O'Keefe gazes at me from a slightly grainy newspaper photograph. She is beautiful. Shining dark hair frames a soft face and a sensitive mouth, and eyes that seem shadowed by sadness. She is framed against autumn trees, and behind her a grassy road covered in fallen leaves curves out of sight, writes Breda O'Brien
The road that Rosaleen O'Keefe travelled led to her death by suicide. Her son, journalist Darragh O'Keefe, writes bleakly that by the time she died, a concoction of prescribed anti-depressants and sedatives had turned her into a numb, aged and highly suicidal junkie.
No one could read his account of the family's battle to save her life without being moved. For the tens of thousands of family members and friends directly impacted by suicide and attempted suicide in Ireland, of whom I am one, it will have been almost too painful to read.
I am among the blessed ones. Twenty-something years later, the person whom I love is still here. I am grateful every day that I live for that. Yet the experience has also taken its toll. There is a painful story that is only beginning to be told, of the impact that psychic distress and mental illness has on everyone around the sufferer. That is not said with any sense of bitterness, because if my experience taught me anything, it is that I am not fit to stand in judgment on anyone.
A darkness descends on the person that blocks out every chink of light, and every molecule of a person's being becomes focused on ending the pain.
Darragh O'Keefe tells of finding his mother with her throat cut, and holding a wet cloth to the wound while holding her hand until an ambulance arrives. His 14-year-old brother had to cut her down from the banisters where she had hanged herself.
How could any mother subject beloved children to that? One would have to have glimpsed the impenetrable, suffocating darkness that surrounds the suicidal to even begin to understand. Yet no understanding can protect from the rage, the grief, the loss and the utter sense of rejection that being completely unable to help brings with it.
Some months ago, incredulity and anger that a junior Minister with responsibility for mental health could imply that there was no such thing as mental illness, only unhappiness, led to a debate that was frequently impassioned and polarised. I found myself on the pro-psychiatry wing, for this reason.
For many people, psychiatric services are literally life-saving. Yet our psychiatric services are in rag order. Children and adolescents have to wait for years for an appointment. Beds are not available. Community services blithely promised years ago have never materialised.
Darragh O'Keefe says that despite several documented suicide attempts in his house, no social worker or community nurse ever called. That may have been a systems failure, but it is more likely that there is no community nurse specially trained to deal with mental illness anywhere in the area.
People still return to the "community" with no back-up services. In psychiatric hospitals, we still do not have multidisciplinary teams, and doctors often have unbelievable caseloads and waiting lists.
All this might sound as if I believe psychiatry presents a panacea. Far from it. Darragh O'Keefe presents a picture of his mother drugged up to the eyeballs, with no discernible effect except deterioration. It is a scandal how many people in Ireland have been reduced to a zombie-like state by overuse of medication.
He talks about arrogant psychiatrists who will not consider any other form of treatment other than drugs. I have met those psychiatrists. I have also met psychiatrists frustrated to the point of tears at the level of under-resourcing of psychiatric services, which means that the chances of offering anything other than drugs are very low indeed. Far from being arrogant, they are eager to try using promising therapies like dialectical behaviour therapy, but the funding for training and staffing is just not forthcoming.
Recent research in Britain has shown hopeful results from problem-solving therapy where a nurse-therapist makes five visits to the home. What are the chances of that happening here?
People are dying who could be helped. Some people die by suicide because of an impulsive decision, and that is very hard to prevent, but there are many people who, with appropriate support, would never progress to being suicidal, much less dying by suicide.
Yet there are no simple answers. A demand from the public for action is understandable, but we simply do not know enough yet about what causes people to want to die, to formulate fail-safe prevention strategies.
One of Rosaleen O'Keefe's oldest friends said, "It was like she was always looking for something. It was like she had a wanting." Part of the O'Keefe family's grief is that they will never know what that "wanting" was.
Suicide is a complex phenomenon, but I believe there are some people who will ultimately be helped neither by psychiatry nor psychology, although they may find valuable support there. These are the people living with a kind of enormous hole in their souls. Their dilemma is essentially spiritual, a failure to find any credible form of protection from the howling void.
Spirituality provides a connection with something greater than oneself, with forces of love and support beyond the self or one's immediate family and friends. Such spirituality is not necessarily connected to religion, but neither should religion, with its calming rituals and sense of connection to long-lived tradition, be dismissed as a source of meaning.
It may seem banal, but limiting access to paracetamol seems to have lowered suicide rates. Banal, and yet not, because deprived of a means to die, some suicidal people live long enough for a chink of light to enter, that stubbornly refuses to be extinguished by darkness. The intolerable gradually becomes tolerable. In a society increasingly disconnected from higher sources of meaning, are we breeding suicidal despair?
When a person is suicidal, if only they could hear us as we whisper or shout to hold on, that your loss will leave us shattered and broken, that there is hope and darkness can once again be visited with light. If only, if only. Those words torment too many families in Ireland.