There were four of them growing up in Atlanta, four girls close in age, the daughters of an Episcopal priest and his wife. The girls played together, fought like mad, made up, laughed a lot, vacationed at Folly, went off to college, married and had children.

Where to get help

If you are in crisis or worried about a loved one, help is available.Dial 2-1-1 or 744-HELP any time for crisis intervention or community resources. Or go to Trident United Way’s confidential online chat service at 414-2350 for the Charleston Dorchester Mental Health Center. This offers a 24/7 emergency-response team and a variety of mental health services. Call 1-800-273-TALK (8255) to reach the National Suicide Prevention Lifeline.Call the Survivors of Suicide grief support group at 566-7183.On the WebFor tips on helping someone who is suicidal, go to mental/suicide_ prevention.htm.Go to www.charleston for the Charleston Dorchester Mental Health Center.Go to for the Berkeley Community Mental Health Center.Go to the Suicide Prevention Research Center at to the American Foundation for Suicide Prevention at

Caroline Ball, the baby, loved to paint and draw and dance ballet. She and her sister, Sarah, sang in the church choir. Theirs was, in so many ways, an ideal childhood.

By the numbers

The national suicide rate in 2010, the most recent data available, was the highest it’s been in 15 years. Some experts attribute that in part to the economic downturn.90 percent of people who die by suicide have a diagnosable and treatable psychiatric disorder at the time of their death.Suicide is the 10th leading cause of death for all ages.The rates are highest among those ages 45-54 years old.Suicide rates among men are four times higher than among women. The overall suicide rate historically has risen and fallen in connection with the economy, especially among people of prime working ages.Women attempt suicide three times as often as men.A person dies by suicide about every 14 minutes in the United States.For more, go online to ViolencePrevention/suicide/index.html.Centers for Disease Control and Prevention, National Institute of Mental Health

Yet, today Sarah Ball Damewood and one sister are all who remain with their father in a family robbed of its pieces by physical and mental illness. In 2009, they lost their mother to complications from a stroke.

Surviving the holidays with grief

Coping with the loss of a loved one can intensify as holidays near. Planning can help: Decide what you can handle this holiday season and let family and friends know.Visit with family or friends. Be with the people YOU enjoy.Express your emotions. If you need to cry, do so. Allow people to comfort you. They need to feel they are helping.Talk with a therapist and go to a support group.Communicate with other survivors. They have gone through what you are experiencing. Let people know that it’s OK to reminisce if you want to talk about your loved one. Examine your holiday priorities. For instance, don’t send out cards if it is too difficult.Keep a grief journal for venting.Create a memorial fund in your loved one’s name.Do something special for someone else.Don’t be afraid to have fun. Laughter and joy are not disrespectful to the person you have, Open to Hope,

In 2010, they lost the oldest of the four sisters to breast cancer. She was just 54.

And this year, they lost Caroline, the youngest daughter. They lost Caroline to herself, to the emptiness she had yet to fill.

Nationwide, deaths by suicide have reached their highest rate in 15 years, leaving thousands of families like theirs to cope this holiday season with the emotional havoc left behind.

The descent

A tall and beautiful brunette, Caroline went to nursing school and excelled in a Kershaw hospital’s post anesthesia care unit. She married and had two children.

On the exterior, she seemed outgoing and vibrant.

But Sarah recalls watching her little sister struggle to feel happiness, for herself and for others. Sarah felt that Caroline saw her sisters’ marriages as perfect, although they weren’t, and her own as flawed. She saw other people’s successes as her own failures.

And she was terrified of being alone.

Caroline long dealt with anxiety and depression. Yet, like many millions, she controlled them with medication and therapy.

Then, as 2009 set in, she faced the hormonal seesaw of menopause. Her children grew into young adults, leaving an empty nest and a void where once she was so needed as Mom. She faced the deaths of her mother and her oldest sister. Her marriage deteriorated.

And her anxiety disorder worsened. She became intensely needy and emotional. She would grip onto someone with an emotional intensity that could turn people off, even her sisters.

She began to write notes to herself, notes of encouragement, as if writing them down would make them real.

I am a good mother. I am a successful nurse. God loves me.

I will get better.

Sarah, a local clinical research coordinator who works with psychiatric drug trials, along with her other sister and their father, grew more and more worried.

Caroline seemed to have no sense of herself, of what made her valuable to the world, of what made her Caroline.

Then, Caroline was diagnosed with borderline personality disorder, a mental illness that can manifest in a severely distorted self-image, typically one that is inherently worthless and flawed. Death by suicide and self-harm are common among its victims.

She was admitted to a psychiatric hospital, beginning a period of trying different mental health facilities and various drug regimens to find the best one for her.

Caroline would improve for a short time. Then, she would descend into that emptiness again.

It frustrated everyone.

“It was her perception, her reality. She couldn’t believe that all of these people loved her,” Sarah recalls.

The sisters and their father tried to fill Caroline’s intense insecurity with compliments and assurance that they loved her deeply. But they also began to wonder: Are we enabling her fears?

“That intense emotion will suck you dry,” Sarah says.

Sarah struggled to balance helping Caroline, trying to fill her emptiness with praise and encouragement, while also keeping enough emotional distance that she could raise her children, work and maintain her marriage.

“It was so frustrating that she couldn’t see her talent and her beauty and the potential in her future. But we couldn’t live her life for her,” Sarah says. “The best thing we could do was to get her back on her feet.”

Then last summer, Caroline attempted suicide.

She came to Charleston to stay briefly with their father, who at almost 90 remained in good health and was living in a local retirement community.

With his ready and gentle smile, the Rev. John Ball long had gifts for pastoral care. He had dealt with loss and loved his youngest daughter dearly.

He cared for Caroline’s needs; she helped to care for his.

Maybe giving something back to another person, feeling valued and needed in that way, would help her.

Caroline tried. She went to her doctor and took her medication. Everyone held out hope.

Any time now, Caroline would fill the emptiness inside.

Please help her

That morning, the Sunday before Thanksgiving, Sarah went to Holy Trinity Episcopal, her home church. She prayed for Caroline:

“Please help her to find you.”

The church’s youth group has a tradition of selling goods just before Thanksgiving to raise money for missions.

After the service, Sarah bought lunch and headed to her father’s apartment with it.

When she arrived, Caroline still looked gaunt and fearful. But she had been on a new medication for a week.

Sarah tried to encourage her, tried to bolster her spirits, tried to keep her from wallowing in her fears and insecurities.

It was Caroline’s last supper.

A few hours later, she would find God, just not in the way Sarah had imagined in her prayer.

The loss

When Sarah answered the phone several hours later, her father was so hysterical that at first she thought he was laughing. She’d never heard such a flood of grief and terror.

When she hung up the phone, she screamed: “Caroline killed herself!” and sped the 3-minute drive from her home to her father’s apartment where Caroline had hanged herself. With immense love and indescribable horror, Sarah tried to revive her sister.

But Caroline was gone, taking the emptiness with her.

And leaving more behind.

Left behind

Sarah and her father both believe that Caroline is in heaven now.

“The carnage is left behind,” Sarah says.

The worst is imagining her father’s pain. Caroline causing their father such suffering infuriates Sarah more than her own grief.

“My heart broke into four pieces,” Sarah recalls. “One piece for the pain that led her to do that. One for my pain. One for my dad seeing his baby like that. And one for her children.”

Then come the haunting doubts, the what if I ...

When Sarah brought lunch that afternoon, she had tried to encourage her sister, to boost her spirits, to urge her to be strong.

Were those the wrong things to say?

What if she had listened more, expressed more understanding, held Caroline’s hand? What if she had stayed with her when Caroline said goodbye?

But when Sarah looks beyond her grief, she knows that they all showed Caroline they loved her — and tried to help her.

“She was just so emotionally exhausted. She had been trying for so long. I feel like she had already died in a lot of ways,” Sarah says. “She wasn’t Caroline.”

And her father, a rock of faith, reminds Sarah that her little sister, her big sister and their mother are all in heaven praying for them.

Season of family

For Christmas, Sarah bought Caroline’s daughter, her godchild, a handmade silver necklace with pretty blue stones. When she showed it to Caroline just a few weeks ago, Caroline had smiled, certain her daughter would love it.

After Caroline’s death, Sarah carefully wrapped the necklace and wrote a note to Caroline’s daughter: I’m giving this to you from your mom.

She worries about her sister’s two children, who are in their early and mid-20s. Both live in other areas of the state. Sarah wants to be there for them if they ever want to know more.

And despite the pain Caroline’s death has caused, Sarah is thankful that at least her family knew something was terribly wrong.

“I don’t want Caroline’s death to be in vain,” Sarah says.

That’s why she decided to share her story. She hopes it encourages those considering suicide to seek help no matter how desperate they feel. She hopes it defuses the stigma surrounding deaths like Caroline’s.

And she especially hopes it helps others spending this holiday season with the grief and anger left behind by the one person who truly knew why. She wants them to know they aren’t alone.

Reach Jennifer Hawes at 937-5563 or follow her at