The Survivors Left Behind

One day in June 2018, Jennifer Ashton’00 had filmed a segment for “Good Morning America” as chief medical correspondent for ABC News and completed six hours of appointments in her medical office when she learned about Kate Spade’s suicide. Later while boarding a flight, she received a request from a senior producer of “Good Morning America”: Would she be willing to talk about Kate Spade’s suicide on the next day’s edition?

News of Ms. Spade’s death by suicide had plunged her into a familiar, icy-cold numbness. Typically, Dr. Ashton is not one to shy away from discussing difficult or intimate subjects. The board-certified obstetrician-gynecologist has discussed everything from maternal mortality to menopause to mass shootings on air. However, she was caught off guard by the producer’s request. This topic? It felt unthinkable to discuss, let alone publicly in front of millions of TV viewers.

Just over a year earlier, Dr. Ashton and her two teenage children, Alex and Chloe, suffered a shocking and devastating loss. Her ex-husband, thoracic surgeon Robert C. Ashton Jr., MD, died by suicide at the age of 52, 18 days after his divorce from Dr. Ashton was finalized. Dr. Ashton was blindsided and blamed herself. Her ex-husband did not display any of the classic signs of depression or outward symptoms of other mental health issues that she learned about in medical school. She had seen him three days before his death at their daughter Chloe’s hockey game. They took family photos and had dinner together. Everything seemed normal. How could she miss this? 

Dr. Ashton told her producer that she would need to check with her kids first to get their okay. “I was secretly hoping that they would say, ‘Please don’t do it,’” she says. “Instead, they said, ‘You have to talk about this. You have to use your voice and your platform because so many people are suffering and going through what we’re going through.’” 

She agreed to go on camera on one condition: Dr. Ashton would not speak in her professional capacity as a doctor. She would speak as someone whose life has been affected by suicide. This wasn’t just another news story for her. She wanted to begin to break down the dark stigma that surrounds suicide and the survivors who are left with anger, guilt, blame, and a million what-ifs to sort through. 

Dr. Ashton went on the air the next day and spoke about her family’s experience of losing a loved one and coping with and surviving suicide. Initially, she was worried that the public would judge her. Instead she was blown away by the response she received. “I got tweets, texts, emails, social media mentions, Instagram messages—all of people saying, ‘Finally, someone is speaking for what we’re going through.’ I was just completely shocked by that,” she says.

It wasn’t until then that Dr. Ashton realized that sharing her family’s story could offer solace and community for the many others who have been left behind by a similar unthinkable loss. After all, the stories of other survivors of suicide loss provided tremendous comfort for her and her family as they navigated the grieving and healing process.

Dr. Ashton wanted to continue the dialogue that started that morning on “Good Morning America” about the role conversation and community can play in recovering from the death of a loved one by suicide and the work needed to de-stigmatize mental illness. In May 2019, her book—“Life After Suicide: Finding Courage, Comfort and Community After Unthinkable Loss”—was released, which shares her family’s personal experience as well as stories from other families and mental health experts.

A Ripple Effect

The CDC calls suicide the 10th leading cause of death across all age groups in the United States, and among health care professionals—physicians, dentists, nurses, and other allied health professionals—the suicide rate is higher on average. The suicide rate among doctors is more than double that of the general population, according to a review of 10 years of literature presented at the American Psychiatry Association annual meeting in May 2018. Between 300 and 400 physicians die by suicide each year, a rate of 28 to 40 per 100,000. 

Grieving any death is hard, but the loss left in suicide’s wake is like no other. It’s a different kind of death and grief.

Experts believe the high stress environment and intense care-giving demands, which can lead to physical and emotional fatigue as well as burnout, may contribute to these higher rates. “Many go into this field to be healers and caregivers. Sometimes, even with their best efforts, they can’t necessarily save somebody. That can wear on you over time,” says Jane Bogart, EdD, director of the Center for Student Wellness at the Columbia University Irving Medical Center. Plus, the demanding profession often requires long hours and sacrifice, sometimes of a person’s own well-being. “Neglect of well-being can lead to exhaustion, burnout, and compassion fatigue, and that neglect can prevent physicians from taking the time they need to address these issues and to seek support for mental health concerns.”

But many physicians are reluctant to ask for help. A survey of American surgeons revealed that one in 16 had experienced suicidal ideation in the previous 12 months, but only 26 percent sought psychiatric assistance. The stigma associated with mental illness may discourage doctors from asking for help, and some may fear that a mental health diagnosis could jeopardize their medical license or cause issues with their insurance.

National awareness of the prevalence of suicidality—suicide ideation, suicide plans and attempts, and completed suicide—has increased, but the stigma remains that makes it difficult for those suffering from mental health issues to get help. It also can leave survivors of suicide feeling isolated, which can compound the intense feelings of grief. 

‘I Realized I Could Do This’

Jennifer Ashton’s book, “Life After Suicide,” explores the multiple phases of her life after the death of Robert Ashton, MD, the man who had been her husband for 21 years. The excerpt below details her return to work.

By Jennifer Ashton

On March 22, just under six weeks since Rob’s suicide, I walked into the “Good Morning America” studios. If people thought I looked haggard and imperfect, oh, well. I did, and I was. If they couldn’t get past that scarlet letter on my chest, oh, well. I wasn’t there to be “that woman whose husband killed himself.” I was there to be Dr. Jennifer Ashton, at that time Senior Medical Contributor, and soon to be Chief Medical Correspondent, for the network and for GMA, to discuss the cancer risk of breast implants. And if I got emotional and broke down during my segment, oh, well. I’d try my best not to, but there’s only so much you can control on live TV.

I spent time with Robin Roberts in her dressing room before we went on the air together, and I said yes to her asking if she could say a few personal words to me at the end of our segment. She and I go back more than five years. I trust her, I admire her, and I respect her more than I have words to describe. There’s no one I would rather have had by my side that day. I’d watched in awe as she publicly battled her own life-threatening health issues and wondered at the time where she got the strength. Now I was wondering where I’d find the energy and the fire to lift myself out of my own despair; but there sat Robin, my inspiration for on-air courage and grace under duress, and her presence bolstered me. Cameras rolled. Robin and I talked about the possible link between silicone breast implants and a rare blood cancer.

Then, as the segment ended, Robin said, on the air, “You know, Jen, we’re so glad that you’re back, and our thoughts are with you and your children.”

At that moment I knew that, thanks to all these amazing people around me, and nine years of on-camera muscle memory, I was going to be okay. Choking back my tears, I realized I could do this.

Excerpted from “Life After Suicide” by Jennifer Ashton, MD. Copyright © 2019 by JLA Enterprises Corporation. Reprinted by permission of William Morris, an imprint of HarperCollins Publishers.

Grieving any death is hard, but the loss left in suicide’s wake is like no other. It’s a different kind of death and grief, says Dr. Ashton. It’s a complex and traumatic process that can leave suicide loss survivors with mixed emotions, feelings of guilt and anger, and an acute need to find a reason for why it happened. 

As a doctor, Dr. Ashton was embarrassed that she did not know a lot about suicide. She was unprepared for the physical and emotional trauma. She felt like her family joined a secret society. The shame her family felt combined with the silencing effect of the stigma of mental illness left them unable to share their stories and grief. Dr. Ashton’s instincts told her to work through her complex emotions in private and away from the public eye. “I felt like there was a scarlet letter on my chest,” she says. 

However, the impact of a death by suicide affects more than just the person’s immediate circle of family and friends. A 2018 University of Kentucky study estimated that 135 people are exposed to a single suicide; that’s 6 million people a year. As the rate of suicide increases, more and more people will feel the impact of these sudden losses. 

Yet, the ripple effect can lead to a positive effect too. “As people talk about their experiences, they can sometimes do a lot to reduce stigma. It can be eye opening and also a relief that other people have shared a similar experience,” says Dr. Bogart. For example, in the immediate aftermath of her ex-husband’s death, Dr. Ashton sat in her living room with three friends who have each struggled through a loved one’s suicide. In her book she writes, “I didn’t have to explain anything to them, or defend, or justify, or atone, or edit myself. They’d been where I was. They knew. And they’d survived it. I’d survive it too. I had to, for my children. I just couldn’t imagine how.” 

Post-Traumatic Growth

While sudden and unexpected events like the death of a loved one by suicide can trigger post-traumatic stress, Dr. Ashton also experienced post-traumatic growth, a term she learned from her family’s therapist, Sue Simring, DSW, who has taught at the Columbia School of Social Work. Dr. Simring introduced the term to Dr. Ashton to describe the deeper understanding of self that can follow tragedy. 

“I had gotten through most of my adult life as a real quintessential type A overachiever. I was accustomed to meeting goals, having successes, and avoiding failure,” she says. She majored in art history and graduated from Columbia College in 1991. After completing her pre-med coursework through the Columbia postbac premed program, she enrolled at VP&S in 1996, where she was elected class president all four years of medical school. While completing her rigorous course load, she gave birth to both of her children. In 2016, she received her master’s degree in nutrition from Columbia’s Institute of Human Nutrition.

“When Rob killed himself out of the blue, with no signs that we learn about in medical school, not only was I in shock and devastated for my family’s loss, but, for me, I had to come to terms head-on with what I perceived as flaws, weakness, and failure—all the things that I had tried to avoid my whole life,” she says. Dr. Ashton felt that speaking about her imperfect life and how vulnerable she felt after her ex-husband’s death by suicide would challenge the very essence of who she believed she was.

Dr. Ashton has been open about the vital role therapy has played in her family’s healing. Dr. Ashton, Alex, and Chloe were gathered in Dr. Simring’s office less than 24 hours after Dr. Rob Ashton’s death. “The little bit of my brain that was functioning normally knew that this was a psychological emergency, no different than a medical emergency. I wasn’t about to wing it with myself or my children,” she says. Through therapy, she learned to set aside her perfectionist’s myth and her aversion to vulnerability and emerged a changed person. She describes feeling like a plate shattered into a million pieces that has been put back together, with all the glue and broken seams visible on the surface. Still, she was intact. 

The experience recast Dr. Ashton’s relationship with her patients too. “Ironically, I feel like that’s part of what makes me a good doctor and that’s part of what makes my patients feel comfortable. When they feel weak, I’m always strong for them,” she says. “Going through this tragedy and trauma, they knew what happened to me and my family. They saw me when I was weak and vulnerable. It has opened up a level of understanding and compassion for both of us that didn’t exist before.” As Dr. Ashton opened up to her patients about some of her struggles, her patients were able to relate to her and they, in turn, shared more with her, ultimately allowing Dr. Ashton to better address their health concerns. 

Life After Suicide

When Dr. Ashton was deciding whether to speak on “Good Morning America” that day in 2018, her children helped her realize that silence was not an option. After all, during their grieving process, she met and heard from people who shared with her and her family their experiences of recovering from the trauma of suicide. She realized that tragedy could be a communal experience. As she writes in her book, “If I kept on hiding and stayed silent, wouldn’t I essentially be turning my back on a chance to help some of those people and participating in, maybe even condoning, the same stigma that Alex and Chloe and I found so offensive and unfair?”

“Talking about mental health or suicidality and destigmatizing those topics as much as possible is something that needs constant chipping away at, and there’s been tremendous progress,” says Dr. Bogart. “For Dr. Ashton to come forward is impactful because she’s a very visible person. I remember watching her on TV around the time Kate Spade and Anthony Bourdain died by suicide and it brought a lot of recognition to the issue.” 

Dr. Ashton’s book, “Life After Suicide,” is part memoir and part researched guide. Dr. Ashton hopes it will trigger a much-needed discussion about mental health and bring some comfort to those grieving in silence, who may feel alone in the aftermath of a loved one’s suicide, and who are struggling to make sense of their loss. In addition to her personal account, Dr. Ashton includes the latest insights from researchers and health professionals to help normalize the process of recovery. “The book is really to show people that they can live through the most horrific loss and tragedy” and experience post-traumatic growth, she says. “I also want to show people that it’s okay to try to find happiness and peace and healing after this. And it doesn’t mean that you’re not still missing their loved one.”

Dr. Ashton realized that sharing her family’s story could offer solace and community for the many others who have been left behind by a similar unthinkable loss.

In the book, Dr. Ashton also shares stories from others who have been affected by suicide, including Melissa Rivers, who lost her father to suicide when she was roughly the same age as Dr. Ashton’s children. “She’s obviously funny like her mother but it was the first time she really opened up extensively about how her life has been since her dad’s suicide,” says Dr. Ashton. These stories provided Dr. Ashton with a roadmap for navigating the challenges she and her family faced and preparing for those they would encounter in the future and she hopes it can be a similar guide for readers. Connecting with other families helped her reframe her grief and find a path forward. 

Dr. Ashton also launched a podcast to continue to explore the aftermath of suicide and offer insight on how to thrive. She interviews suicide loss survivors such as Ms. Rivers and Talinda Bennington, the wife of Chester Bennington, the former lead singer of Linkin Park, plus mental health experts and others who have healed from traumatic experiences, such as Robin Roberts and Sheryl Sandberg.

Mostly, Dr. Ashton hopes to shed a greater spotlight on the growing epidemic of suicide in the United States and the millions of people left behind each year to grieve and cope with devastating loss. She also continues to raise awareness of the need to speak loudly about mental health, not just in hushed tones. 

“We have to safeguard our mental health no differently than we do our cardiovascular health,” she says.