When Jamie Neal was home on medical leave from Williams College in early 2010, her parents were going to great lengths to try to protect her.
"I knew she was suicidal," says Jamie's mother, Debbie Neal. "My husband and I decided we would do everything to keep her alive."
Several months earlier, in August 2009, the Duxbury resident had made a suicide attempt that left her in a coma for several days.
"The last few months before she died, I had her sleep in my bed next to me," Debbie Neal explains. "And every single day, I asked her on a [scale of] 1 to 10 how she felt and was she suicidal. And she would tell me that she was a 5 and that she wasn’t suicidal."
In March of 2010, the 21-year-old killed herself in the family's home. Suicide had become her desperate attempt to escape a complex web of pain and trauma: not only mental illness, but sexual assault and drug addiction — a dark journey in a life filled with so much promise.
Like many other survivors of suicide, the Neals recall a loved one who was outwardly happy — even, in Jamie's case, "outrageously fun." She had a ready smile.
"Jamie was always, always smiling," Debbie Neal says. "It kind of defined who she was. She loved other people who were struggling. And she was very kind, and she had a beautiful heart."
There were some signs early on that Jamie might have mental health issues. A nursery school teacher noticed the normally cheerful, outgoing girl would sometimes withdraw into a sad state. And the straight-A student was a perfectionist in everything she did.
"That perfectionism drove her and motivated her," says Jamie's brother, Abe Neal. "On the other hand, I don’t want to say it necessarily did her in. But it was very difficult for her. You would find her at four in the morning editing some minor paper for an English class. And she was also very hard on herself as things started going downhill with herself."
If someone said something disparaging to her, her family says, she would replay it over and over in her head and wear herself down. She was eventually treated for bipolar disorder.
Piecing Together The Puzzle
Jamie's father, Bob Neal, scans a collage of photos of Jamie, trying to determine when his daughter started seriously struggling.
"This is 2000. This is Ireland. I can see joy in her face. I look at this, which is 2008, that's a mask. And you can see it — her smile is formed differently," he explains.
A couple years before that picture was taken, the Neals had learned about a painful secret Jamie had been keeping. She revealed she had been raped when she was 16. She would never give details. She blamed herself, as if it were a failure because she had been drinking at the time. Her parents now had an explanation for other things going on in Jamie's life.
"She did get involved with drugs, which was a shock at the time because she was so happy," her father recalls. "But in retrospect, it’s the mental illness and then rape on top of that that really just did her in."
Research has found sexual assault — even without preexisting mental illness — increases the risk of suicide. Survivors are also more likely to abuse alcohol and drugs to self medicate.
"This is a very hard topic to talk about, just because there is shame attached to it, there's stigma attached to it," Bob Neal says. "But this kind of self-medication shouldn't be treated as a moral issue. It's a medical issue."
Shortly after Jamie Neal started her freshman year at Williams, the stand-out student and athlete took leave and started a string of inpatient drug treatment programs. Her parents say a man she met at one of them introduced her to opiates.
By the next fall, though, she was sober and doing better overall, so she returned to Williams. Her family says she got great support at the college. She saw a campus psychiatrist and received extra attention and care from one particular dean. But she ended up being removed from the basketball team roster because of a long-standing injury, which added to her depression. Her addiction remained a struggle.
Her parents point out Williams couldn't possibly provide mental health care comprehensive enough for Jamie. And then, she reported she was raped again — not at school, but allegedly by someone she met through a 12-step program. She called her parents to take her home and went on medical leave after completing a year and a half of school.
Still, her mother says, the family remained optimistic.
"She was so competitive that she was the definition of somebody who could win over all odds. That's who she seemed to be. But in retrospect, inside she wasn't," Debbie Neal reflects.
Fragmented Mental Health Care
Jamie entered more drug treatment programs. She was seeing a psychiatrist in Boston and a therapist closer to home. But her parents say the care wasn't coordinated.
"So at the time when in therapy she was getting into some difficult discussions about her trauma, the prescribers were backing off on her medication, specifically Lithium, which with someone with bipolar is standard," Bob Neal says. "It's fragmentation of care, and that is a recipe for disaster."
In the course of Jamie's long history of mental health care, her parents and brother say they were distressed to come across some psychiatrists who refused to treat her because her case was considered too difficult or high-risk. The Neals say they'd like to see a system of care for people who are suicidal that's something like hospice in terms of its coordination — with a team including a doctor, social worker and even volunteers working together to monitor, treat and support the person.
Jamie improved again though. Her parents thought she was better than ever. She was taking courses at Harvard Extension School and planning to go back to Williams. And they dropped their guard a bit, leaving her alone on occasion — including a brief time on the day in March 2010 that the 21-year-old ended up taking her life.
The Neals say they wish they knew then that as in many cases of suicide, Jamie likely seemed happier because she had made a plan to die.
"When I think about Jamie, I think she died of a mental illness," Debbie Neal reflects. "I think she fought really, really hard her entire life. But I do believe she died of a brain disease."
The Neals say though they wanted their daughter's pain to end, they know suicide is never the answer. They hope through wider education to reduce stigma, and better coordination and parity in mental health care, fewer families will suffer the same kind of loss.
Bob and Debbie Neal have spoken about their daughter, Jamie, and the issue of suicide at community meetings and church gatherings. Writing and talking about their daughter and what led up to her death has brought them some measure of comfort. Listen to a portion of Bob Neal’s writing below, and read their presentations here and here.
Resources: You can reach the National Suicide Prevention Lifeline at 1-800-273-TALK (8255) and the Samaritans Statewide Hotline at 1-877-870-HOPE (4673)