“From the outside, we looked like a perfect family. But inside, we were rotting,” confesses Hope Litoff, who made a film about her desperate search to understand why her beautiful, talented and vivacious sister took her own life.

Her new, searing documentary, 32 Pills: My Sister’s Suicide, had its Quebec premiere last month at the Au Contraire Film Festival, in partnership with Chabad Lifeline.

The annual festival, now in its fifth season, seeks to dispel the stereotypes and stigma still associated with mental health issues, says founder Philip Silverberg. Since 2009, Chabad Lifeline has provided intervention and support to anyone affected by addiction, whether substance or behavioural.

Ruth Litoff was 42 when she died of an overdose in December 2008, after a lifetime of battling an illness that no amount of therapy, medication or emotional support could cure. She tried to commit suicide at least 20 times since the age of 16.

The Litoffs were a well-off New York Jewish family and Ruth Litoff, the eldest by three years, and Hope Litoff, were the only two children.

As a child, Ruth Litoff, whom Hope Litoff idolized, was good at everything – school, sports, making friends – but her mood swings were severe. From her early teens, she was into drugs, alcohol and sex. Nothing she achieved was good enough for her, nor were the constant reassurances that she was loved.

“How could anyone be so debilitated, yet so magnificent,” Hope Litoff asks in the film.

Hope Litoff was always the good daughter, but it all became too much and she started drinking at an early age.

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Their mother, a woman who was obsessed with her looks, is portrayed as being constantly overwhelmed, and their father is seen as irresponsible and cold. We are told that after one of her hospitalizations, he said to Ruth Litoff: “Next time, jump.” They both predeceased their daughter.

Family life revolved around Ruth Litoff’s state of mind at any given moment.

She became an art photographer and had a busy social life, while Hope Litoff became a film editor. 32 Pills (her debut film) begins six years after her sister’s death.

A bizarre scene confronted Hope Litoff when she found Ruth Litoff’s body in her Manhattan loft: rows and rows of prescription pill bottles were lined up, but even more startling was how she had created a veritable stage set, with everything beautifully in order.

Hope Litoff, who’s married with two young children, started looking into her sister’s life – going through her voluminous writings, interviewing those who knew her, going over the coroner’s report. But answers were elusive and she began to fear for her kids’ genetic inheritance.

While her undiminished pain and sense of guilt were clear from the outset of the investigation, what she and producer Beth Levison did not expect was that Hope Litoff would break down. After 16 years of sobriety, she started drinking again – heavily – which is hard to watch.

By the film’s end, Hope Litoff finds a measure of serenity, but her recovery continues, the filmmaker said after the screening.

She has been through rehab three times, goes to Alcoholics Anonymous, gets counselling and attends couples therapy.

“I pray to a higher power,” Litoff said. “I live in gratitude each day. I’ve put the trauma of my sister in a different place.”

Although her depiction of their parents is rather harsh, Hope Litoff thinks they did everything they could. “We thought that if Ruth just got the right doctor, the right medication, she would be OK. We were so naive,” she said. “I don’t think we could ever understand. Even the doctors didn’t know.”

She came to realize that doing the film allowed her to “really grieve for the first time.”

“We chose to screen this heartbreaking and honest, yet uplifting, film because of the rawness in its portrayal of the link between addiction and mental health, and how it affects the family,” said Rabbi Benyamin Bresinger, a director of Chabad Lifeline.

32 Pills will be aired on HBO on Dec. 7 and on CBC’s Documentary Channel at a future date.

Chabad Lifeline executive committee member Heleena Wiltzer emphasized that demand for its services, which are administered by professionals, is relentless. Last year, its centre received over 16,000 visits. “No one is turned away, there is no waiting list. Everyone receives immediate attention,” she said.

Services are free of charge, even though the non-profit organization receives no government funding, she said.

Wiltzer announced that an agreement has been reached with the English Montreal School Board to send Chabad Lifeline youth counsellors to Royal West Academy and five alternative schools, to work with students affected by addiction, either personally or in their home, on a weekly basis.