BRATTLEBORO — I'll always remember that late afternoon I spent sitting across from a bright and talented young man in a psychiatric hospital's group room. Half of his face was boyishly handsome. The other half was scarred from a car crash that no one called an accident.
He politely answered my questions about music and books, but we both knew I was there to keep my eyes on him while his psychiatrist, therapist, and terrified parents discussed his requests behind closed doors.
He steered the conversation back to what he had asked for. He wanted his belt back so he could walk without holding his pants up. He wanted his shoelaces back so he could stop shuffling down the hallways in untied boots. He wanted a few minutes of privacy.
Since his parents had admitted him - after his third attempt to take his life - a staff person was added to each shift with one assignment: Watch this boy. He slept; someone watched. He dressed; someone watched. He sat on the toilet; someone watched.
Yet even with the constant vigil, he reported progress. The new meds made him feel better. He made friends on the ward. He felt safe for the first time in a long time. He warned that the constant watching put his recovery at risk. He said he would never completely fit in with the others if he couldn't let go of his pants or tie his shoes.
The meeting ran long. A different staff person took my place. I drove home through dark Vermont woods. I likely kissed my infant daughter goodnight and read while my wife fell asleep by my side.
The treatment team and the parents granted the young man's request. He had worked hard and earned their trust. They returned his belt and his shoelaces and told the staff to perform random but frequent room checks.
Around 11 o'clock that night, just when I would have been turning off my reading lamp, this bright and talented young man took his hard-won freedom and a brief moment of privacy, and he hung himself. Friends slept in the surrounding rooms. Highly trained staff stood around the corner.
* * *
I think of this young man as my oldest child walks down high-school hallways made quieter by one fewer voice. A bright and talented young woman in the next grade shot herself at home over a long weekend.
My wife works as a student assistance professional in the local schools. She gets notified when there is trouble or crisis, so we found out about this tragedy shortly after it happened. Details were sketchy. We didn't know if our daughter knew this young woman, but we knew some of her friends had played sports with her, so we sat my daughter down to talk about what had happened. With today's electronic grapevine, she already knew.
According to the National Center for Injury Prevention and Control, the top three causes of death for people between the ages of 15 and 24 are accidental injuries, homicide, and then suicide.
In 2007 (the last year that statistics are available), more than 4,000 teenagers and young adults killed themselves. They left behind thousands of parents, siblings, aunts, uncles, grandparents, and friends who might ask themselves for the rest of their lives, “Is there something I could have done differently? Is there something I could have done?”
A distraught staff member at the psychiatric hospital asked a similar question. The hospital's chief executive officer reminded us, “Sometimes, depression is a terminal illness.”
* * *
I wanted to find statistics on how many people tell someone they're going to commit suicide before they do it. I've heard the number is low, but I can't back up this claim. According to some experts, only one in six people leaves a suicide note. Maybe the pain of living becomes so great that the focus narrows to the task at hand.
There are some common signs that a teenager might be thinking about taking his or her life. They include changes in eating or sleeping habits, neglect of personal appearance, persistent boredom, and/or a decline in the quality of schoolwork.
In other words, a suicidal teenager might start looking like a teenager.
When we sat my daughter down to talk, she wanted to know specific details. We told her we wouldn't share them if we knew.
Instead, we told her we loved her more than she might ever understand. We spoke of the family a few miles away now suffering a pain we couldn't begin to comprehend. We reminded her that she was young, and she still lacked perspective and the ability to rationally process decisions when under stress.
We assured her that someone would break her heart someday. She would make what she would think were catastrophic mistakes. She might feel horrible about herself.
All of this was to be expected, we said, and we would be there for her when it happened. We spoke about families we knew who suffered terrible loss but still continued on. We explained how important it was to tell an adult if she was worried about a friend, or if she felt really terrible herself.
When I worked at that psychiatric hospital, my oldest child was an infant. I didn't really think of myself as a parent then. I couldn't picture that young man's parent's pain. Now it is all I can think about. And the parents aren't at fault. Friends often don't know what is going on.
Depression can be a terminal illness. Some people never want to be stopped.
But the living need to talk about suicide. It might be all we can do.