Environment

The Last Exit

An older Wyoming couple chose to ease their physical – and political – pain through 'united self-deliverance.' In other words, they committed suicide.
At 1:25 p.m. on Jan. 4, Laramie County Sheriff Danny Glick received a letter with a Cheyenne, Wyo. stamp, postmarked the previous day, and immediately had two deputies dispatched to a home on County Road 110A, a few miles west of town.

On the same day, staffers at the Casper Star-Tribune and the Wyoming Tribune-Eagle opened letters bearing the same postmark. Kerry Drake, assistant managing editor at the Star-Tribune, was one of the first to see its contents. The envelope contained a double obituary and a final opinion column penned by Helen Levine, a regular contributor to both newspapers and a personal friend of Drake's.

"I just stared at it, totally disbelieving," he says.
Ethan J. Levine, 50, and Helen G. Levine, 73, died together through united self-deliverance on New Year's Day ... .
Cremation, it read, had already been arranged.
There will be no service. Those who wish to make a contribution in their memory may do so to the National Multiple Sclerosis Society, the American Diabetes Association, the American Heart Association or any wildlife protection organizations.
Around the same time, deputies arrived at the Levine residence, a modest and tidy cream-colored home situated in a neighborhood of small ranchettes and acreages. Following detailed instructions from the letter mailed to the sheriff, they located a key hidden in a magnetic holder stuck to the electricity meter behind the house and used it to unlock a door leading to the garage. Once inside, they discovered a pickup truck still running, its gas tank half full. A hose ran from its exhaust pipe up into a thin crack, stuffed with towels, in the front passenger-side window of a green SUV parked next to it.

Inside were the bodies of a man and a woman, lying down in the back, holding hands, surrounded by pillows and blankets. Deputies also noticed the corpses of two pet cats, one resting between the couple, the other curled at the woman's feet. The Laramie County coroner would later report that carbon monoxide had taken the lives of all four.

In the following days, friends were quoted in the local papers as saying that, despite their shock at the Levines' action, they weren't surprised the well-known and well-liked couple had faced death together. The two were deeply in love, and they'd been heard at various times saying they couldn't live without one another.

"Later on, I realized Ethan and Helen would have planned as much as they possibly could," Drake says. "Still, it was kind of a tough way of finding out. It was a hard loss to accept."

Contrary to popular belief, made-for-TV movies and selective media coverage, people aged 65 and older are more likely to claim their own lives than those of any other demographic. With the recent and notable exception of author Hunter S. Thompson, who was 67 when he died last week in his Woody Creek home of a self-inflicted gunshot wound, many slip by without mention, even in their own obituaries, where the cause of death is often listed only as "a sudden illness."

While they comprise only 12 percent of the population, the elderly account for nearly 18 percent of all suicides in the United States. In 2002, that amounted to an average of 15 suicides per day among those over 65 years old, according to the Centers for Disease Control and Prevention. Older Caucasian men, especially, are at risk: White males over the age of 85 are five times more likely than any other group to commit suicide. And experts believe these statistics are conservative; they do not account for "silent suicide" – seniors who quietly stop taking the medications that may be keeping them alive, self-perpetuate "accidents" or simply quit eating, which can swiftly exact a lethal toll on an already-frail body.

Rarer are double suicides, like that of Ethan and Helen Levine (who don't exactly fit the mold, as Ethan was only 50 at the time of their deaths), but several high-profile cases during the last two years have put the phenomenon somewhat in the spotlight.

On New Year's Eve in 2002, Morris and Estelle Spivack, a Florida couple in their 80s who both suffered debilitating health problems, asked the maintenance man at their Florida condominium to remove the screen from their 17th-story window to improve air flow. Shortly before midnight, the pair stepped from the window and fell to their deaths. They'd left a note with burial instructions, and letters for their lawyer and family members.

In a March 2004 incident that did not end as a New Jersey couple had planned, Norman and Jacqueline Sindlinger, 74 and 72, penned a suicide note and had their mail stopped before lashing themselves together with a TV cable and walking, back-to-back, into the Atlantic Ocean. Jacqueline died of hypothermia, but an officer revived Morris after a fisherman found the pair on the shore.

And last August in Texas, twin 71-year-old sisters, devastated by one sister's recent diagnosis with a terminal illness, died of carbon-monoxide poisoning after sitting overnight in a running car parked in their garage.

Simultaneous suicide is controversial. While all accounts reviewed for this story referred to the Levines as a progressive and caring couple, the American Association of Suicidology reports that suicide pacts are "mutual arrangements between two people who kill themselves at the same time, and are rare. They are not simply the act of loving individuals who do not wish to be separated. Research shows that most pacts involve an individual who is coercive and another who is extremely dependent."

Double suicides among the elderly are "very rare," confirms Yeates Conwell, co-director of the Center for the Study and Prevention of Suicide at the University of Rochester in New York and an expert in the field of late-life suicide.

"It happens, but it's unusual, in part because the typical context for a late-life suicide is a bereaved person, someone who is isolated, who has lost connections or supports and become very depressed or physically ill, so they've been cut off from others in their home by their psychological or physical state."

One of the factors that distinguishes elderly suicide victims from any other age group is their sheer determination to end their lives. In general, older people have fewer prior suicide attempts and use deadlier means than younger individuals.

For all ages combined, there is an estimated one suicide for every 25 attempts. Among those aged 15 to 24 years, that number drops to one suicide per every 100 to 200 attempts. But over the age of 65, one in every four attempters completes the task, with guns accounting for nearly three-quarters of the deaths.

"Research suggests that somebody who is older, particularly a widower, who decides he is going to kill himself will do it," says Beverly Thurber, executive director of the Suicide Resource Center for Larimer County, which gives presentations on depression and suicide warning signs to groups of seniors. "He will use a very lethal method, and he will go through with it."

Perhaps unsurprisingly, depression is the leading indicator precipitating senior suicide. Other causes – intense physical pain, onset of illness, loneliness or loss of a spouse – have also been linked, but beyond these broad symptoms, the phenomenon is notoriously difficult to study, says Carolyn Turvey, a University of Iowa researcher who has authored several reports on the subject.

"It's a low base rate: 11 [suicides] per 100,000 in the general population, and maybe 35 to 45 per 100,000 among the elderly," she says. "If you wanted to do a longitudinal study, you'd have to study 100,000 people. And the problem with doing case-controlled studies is that the people who have committed suicide are dead – you can't interview them – and interviewing relatives after the fact is fraught, although [researchers] do that."

Even classic suicide harbingers become cloudy when dealing with senior citizens. Typical warning signs like loss of appetite, changing sleep patterns, disinterest in activities one used to enjoy, even recurring thoughts of death or dying, to some degree, are often part of the normal aging process, making it difficult to distinguish clinical depression from "sadness over aging," Turvey says.

"Many seniors are dealing with life events that cause grief," Thurber adds, "and not just deaths of family or friends, but also losing things like financial independence, physical health, the ability to drive and be independent in that way.

"There are a lot of things you mourn as you get older, and sometimes that is just normal grief, and sometimes that can actually develop into depression. It's hard sometimes to tell the difference."

Many physicians fail to see the difference, as well. Studies show that a majority of seniors who commit suicide have visited their doctor at least once in the month preceding their death.

"The reality is that primary care clinicians don't have the time to spend with depressed people, and older people, in particular, may take more time to get to the psychological underpinnings of their distress, so the problem is compounded," Conwell explains.

Add to that a certain inherent stoicism in many elderly adults who've lived through world wars and a Depression – and were raised during an era when psychiatric medications were reserved for only those pegged as truly insane.

"As a general rule, seniors are less likely to see depression as an illness; this is the generation that sometimes thinks you should just be able to 'get over it' ... to 'pull yourself up by your bootstraps,'" Thurber points out. "This is a World War II generation that is incredibly strong, but it may make people less apt to seek help."

Conwell believes this stigma can also skew caregivers' and younger family members' views of elderly suicide, creating an illusion that the death was inevitable or rational.

"It seems to me that the way we manage our grief for the loss of an older person is more likely to understand it as a self-determined act, because we want to see our elders that way," he continues. "We don't want to deal with the subject, and it can be a version of ageism – one that is driven by our own social, cultural and personal needs to see our parents as capable people."

As a massive generation of baby boomers stands at the threshold of senior citizenship, Conwell stresses the importance of addressing "very aggressively, from a public health perspective" the potential for a worsening problem.

On the surface, Ethan and Helen Levine did not fit the archetypal case study for suicide.

They were happily married ("I don't think I've ever known a couple who loved each other more than they did," one friend told the Star-Tribune. "They were soulmates."), engaged socially, had family – including Helen's two daughters from a previous marriage – scattered throughout the U.S., and staked broad-ranging interests in the community.

Ethan, a Wyoming native who attended theater school in London after college, retired from managing a shopping mall in Cheyenne and worked as a marketing consultant. He served on numerous local boards and civic organizations, including the editorial board of the Tribune-Eagle.

Helen held a master's degree in communication and worked for 12 years as a public information officer for the Wyoming Department of Health, spending much of her spare time volunteering for the elderly and people with disabilities. Because of her experiences, Wyoming Gov. Dave Freudenthal appointed her to the Wyoming Senior Services Board. Ethan and Helen worked together at a community radio station when they first moved to Cheyenne from Detroit, and they remained active in politics.

But a closer look reveals red flags – ironically, many of them not even under-the-radar, but rather manifested publicly in Helen Levine's newspaper columns.

During the past year, she'd written several pieces focused on depression and physical pain, and she defended the work of Dr. Jack Kevorkian, who was arrested and imprisoned after facilitating several euthanasia cases in Michigan. And she declared her support of an old friend from Detroit, a quadriplegic confined to a respirator, who'd long desired to end his life and had finally found a physician willing to assist.

Helen and her husband were struggling with pain of their own: In addition to chronic heart disease, Helen had recently fractured her hip and was facing the prospect of back surgery, while Ethan battled multiple sclerosis and diabetes.

In March 2004, she described her hip discomfort as "off that 1-10 scale."

The next month, she again addressed physical agony: "[W]hen pain reaches a staggering proportion it would not be uncommon to end the pain once and for all. And I can understand that. The quality of life has been lost, not to be recovered, and who is to say that isn't a good reason for someone to take action."

Helen also admitted to feeling depressed and having suicidal thoughts while living with her first husband in Detroit, but wrote that she'd "sought help."

"And that is so important when dealing with suicidal feelings; have someone to talk to," she advised.

In addition to physical ailments, the pair professed their concern over the Iraq war and certain Bush administration policies, especially those they believe had a negative impact on seniors, such as the privatization of Social Security and the Medicare bill, which Helen deemed "flawed."

"Helen and Ethan were deeply troubled by the results of the presidential election," says Kerry Drake.

In her December 2004 column, Helen, a lifelong Democrat who counted Harry Truman as a hero, wrote, "In all my years, I have never seen such a display of arrogance, subterfuge and just plain flat-out lying. The dirtiest of politics infested this election and will probably set the standard for future elections. ... Frankly, I have little faith left in our electoral system."

Most of these themes were also present in various letters the couple left behind for their loved ones. It was largely for these reasons, Ethan and Helen wrote, that they made their fateful decision and began planning the  details months ago.

"We know what we feel and why we have made this choice. We also know that our decision may not be met with the same understanding by you. All we can ask is for you to respect our choice and understand this was something we both felt so strongly about," the couple wrote in a letter to friends.

Ethan and Helen Levine's meticulous planning was evident when deputies searched their home on Jan. 4. Everything inside the house was in order – lights turned off, master bed neatly made – as, it appears, were the Levines' affairs: Their attorney later told authorities that the couple had reviewed their will prior to embarking on a camping trip through the western U.S., according to police reports.

The Levines left easily accessible documents – from messages for friends and family, to notes for the sheriff and a funeral director – on their personal computers. The only thing officers noted amiss in the house were two drinking glasses, with liquid still in them, on the living-room coffee table. In Helen's office, deputies found two books, Final Exit and Double Exit, both pro-euthanasia and "how-to" manuals of sorts. Perhaps most prominent, however, was a framed 8" x 10" wedding photo of the couple, placed next to a small flower vase in the center of the kitchen table.

In an August Star-Tribune column that seemed to foreshadow the path the couple would take on New Year's Day, Helen appeared to justify – or at least, explain – their decision, and she concluded the piece with a quote that could be construed as either ominous or oddly comforting, depending on viewpoint.

"Whether we find ourselves slipping away from natural causes, or taking the moment and make our own way, I remember the advice of Dylan Thomas: 'Do not go gentle into that good night, Old age should burn and rave at close of day; Rage, rage against the dying of the light.'"
Bethany Kohoutek is the editor of the Rocky Mountain Bullhorn, a newsweekly in Fort Collins, Colo.
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