Will's Choice

by Gail Griffith

  Will’s Choice

  A Suicidal Teen, a Desperate Mother, and a Chronicle of Recovery

  Gail Griffith

  For my mother, Duff Witman Griffith,

  who never knew a day of depression.

  She lived her life expecting wonderful things

  to come her way. And, for the most part, they did.

  Contents

  Foreword by Dr. David Shaffer

  Prologue

  1 The Bears Downstairs

  2 Pulled from the Wreckage

  3 Tunnel Vision

  4 Like Mother, Like Son

  5 Lethal Secrets

  6 Broken Hearts, Deep Wounds

  7 Lost Horizon Ranch

  8 California Rocket Fuel

  9 Calamity and Clarity

  10 Time, Sweet Time

  Epilogue: In Will’s Own Words

  Megan’s Biography

  Organizational Resources for Families of Depressed Teens

  Suggested Reading and References

  Endnotes

  Acknowledgments

  About the Author

  Praise

  Copyright

  About the Publisher

  FOREWORD

  As a psychiatrist, I have been studying the problem of “teen suicide” and its various manifestations—suicidal thoughts, suicide attempts, and, much less commonly, completed suicide—for nearly thirty-five years. My work has required me to read academic papers and books, and to evaluate innumerable statistical tables, looking for flaws and merit. But while an analysis of dry facts, such as age, sex, ethnicity, previous psychiatric illness, and family history, leads clinicians to an infinitely greater understanding of who commits suicide, statistics can only do so much; they don’t uncover the why. Even personal accounts of depression or experience with suicide don’t tell the whole story.

  In Will’s Choice, I found an especially helpful account that complemented my clinical experiences in an important way. It is written so graphically and is so unencumbered by interpretation that I found myself quoting it to a research colleague as if it were a case I actually knew. But beyond its clarity as a case study, this narrative offers a special window into the world of the sufferer. Even the most diligent and curious clinicians rarely see how our patients are perceived by others; our information is always learned through the filter of the patient’s own limitations and biases. With Will’s Choice I was given an irresistible look behind the scenes. It was almost as if Griffith were bringing the whole family into my office.

  In writing the story of her son, Griffith takes on the role of the investigator trying to fathom Will’s perception of his own situation as well as what led him to consider suicide. We see Griffith galvanizing her family to obtain help for her son. She takes us with her while she vividly, often generously (always politely), and, above all, without rancor or polemic, recounts Will’s (and her family’s) experience with various doctors, therapists, hospitals, and schools. A depression sufferer herself, Griffith was stimulated to find out more. She researched exhaustively, and spoke to experts on adolescent depression and suicide. She joined the National Alliance for the Mentally Ill (NAMI) and the American Foundation for Suicide Prevention and was invited to serve on the FDA committee that reviewed the risks and benefits of SSRI antidepressants.

  So Will’s Choice does more than recount the tale of a sick boy and summarize facts on youth suicide. It paints a picture of a vigorous, intellectually involved American family confronting a problem with determination and energy. They epitomize the healthiest way of coping with a problem—mastering it. Most interestingly, the book draws liberally from the work of two stunningly gifted writers—Will himself and his girlfriend, Megan. Both allowed Gail Griffith access to their journals. Megan’s account of her own unusual behavior is unsurpassed, and I, for one, plan to quote it in my lectures to students. Will’s diatribe over whether to submit to his parents’ and their agents’ wishes to stay for more treatment or to follow his instincts and bolt from his therapeutic school perfectly conveys the land of youthful indignation and makes the reader cheer for the hero.

  Will’s answer to “Why?” was “I just didn’t want to be here anymore.” End of case? I doubt it. We cannot will our own death through indifference. Fortunately, death requires a formidable injury or effort. By uncovering the thoughts and feelings that led to Will’s actions, Gail Griffith, Will, and their entire family, have turned Will’s choice into a gift for us all.

  —David Shaffer, F.R.C.P., F.R.C. Psych.

  Irving Philips Professor of Psychiatry

  Columbia University

  PROLOGUE

  These days my dreams are unnerving flights of fancy, laced with anxiety: my children are always small—somewhere between two and six years old; they are always troubled—there are tears—and they are beset by myriad tiny agonies.

  In one dream, a toy block wagon, with primary-colored wooden shapes designed to teach my eldest son, Max, the fundamentals of building, has rolled down a driveway, spilling a chaotic configuration of blocks all over hot asphalt. In another, Max is having a hard time coming to terms with a pillowcase that does not match the Marimekko animal-print bedsheets and he morphs into a clump of Play-Doh while I search hysterically for the matching pillowcase.

  In my dreams, my younger son, Will, is sobbing over something he has lost. In my most recent dream, missing were the miniature Spanish doubloons that come with the Lego pirate ship—those tiny gold rounds every parent knows will vanish before the child’s next birthday—or, worse yet, turn up in the kid’s nose.

  In the dreams, Will is inconsolable, as if the toy coins or a missing stuffed bear were all that connected him to his world: the loss of these totems wrecks his sense of wonder, dispatching his innocence somewhere beyond grasp.

  Like toxic exhaust from a faulty tailpipe, these dreams vaporize into the atmosphere. Predawn I awaken with a headache from inhaling imaginary particles.

  It is now over three years since my son Will’s suicide attempt. On Sunday, March 11, 2001, he took an overdose of antidepressants, which nearly killed him. I knew that day that my life’s course changed irrevocably and that our family would be defined by the event.

  Two years later, I decided to lay bare our experience and Will’s struggle with major depression, because nothing in the therapeutic literature about teens or teen depression prepared us for the battle we waged against this illness.

  This is the story of our journey—a mother and a son—as we struggled to regain equilibrium after a cataclysmic descent into a suicidal depression. It is a story for families who are trying to keep their children from the same terrible abyss, who are challenged by limited resources and poor therapeutic solutions.

  Will’s Choice offers a candid assessment of what we learned—what we should have watched for, what we missed, what we could have done to prevent Will’s suicide attempt, what we did in the aftermath of his attempt, and where we go from here.

  Moreover, this is a story of hope: our child survived a suicide attempt and a crippling bout of depression. Although the specter of Will’s illness is never wholly obliterated, for now we are back on level ground.

  During the autumn of 2000, when it was first evident that Will was depressed, I found it was hard to imagine a more unlikely candidate for the illness. He was popular and athletic; he received good grades and was well liked by his teachers, and he was the easygoing, youngest child in a family who lavished him with love and attention.

  He was in his junior year at a Washington, D.C., parochial high school; he had a delightful new girlfriend, Megan, a sophomore at a nearby public school. But what no one realized—not Megan’s family, and certainly not ours—was how deeply depressed the two of them were. Neither Will nor Megan
was on solid ground as their relationship began in the fall of 2000; their separate descents into depression began months earlier.

  For adolescents the desire to bond with peers and experience intimacies on a new level is so powerful that it is not uncommon for kids caught in emotional maelstroms to be drawn to one another—to seek each other out and wrap themselves up in each other’s dysfunction. The stunted relationship becomes a cocoon of pathology and pain, both comforting and hurtful.

  Megan was a “cutter” she routinely took a sharp edge to her skin until she drew blood, opening up scabs, scoring new ones, and collecting scars up and down her arms. Will became so incapacitated by major depression that he decided to take his own life.

  It is evident now that during their brief relationship, both Megan and Will had some inkling they were in serious straits, individually and collectively. Each implored the other to get help, talk to parents, take the medication. But in the end, depression deposited them on isolated islands of despair, and separately, independent of an advance signal to each other, they made a run at suicide in the winter of 2001.

  How do you explain the suicidal impulses of a child? We give our children life; we think we know everything about them. And why shouldn’t we? We tell them what to think and do from the moment they are born. So it comes as a shock to learn that our children have secret lives—and that their secrets may be deadly.

  When I undertook to write a book about teen depression, I implored first Will, then Megan to let me tell their stories. Each of us knew I was asking for more than stories: I was asking them to share their secrets and perhaps to revisit recollections too recent to be free from their potential to bruise.

  Will was reticent initially; the notion of dredging up recent past was not only painful, it was embarrassing. Megan, whose recovery was swifter and surer, was enthusiastic about disclosing her experience; she had spent a good deal of time analyzing what had happened to her and was eager to write about it.

  What I discovered is that both were more apt at telling their stories than I was. So with their permission, I included vast amounts of their own accounts of depression and recovery: Will’s journal entries covering his two hospitalizations, his suicide attempt, and the time he spent in a residential treatment program in Montana appear throughout the book; Megan’s wrenching and emotionally charged account of her cutting is explored chronologically, as the relationship between the two teens builds and ebbs. I am enormously proud of them for being brave enough to reflect upon and write about that time in their lives.

  Teen depression is a national scourge. According to the American Association of Suicidology, one young American (under the age of twenty-four) commits suicide every two hours. Will’s story, Megan’s story, have positive outcomes. Our families are fortunate. But we are painfully aware the outcomes could have been otherwise.

  Roughly two thousand American teenagers between ages thirteen and eighteen attempt suicide every day. That is a staggering statistic for a society that, on the surface, has so much to offer its children. Thankfully, suicide rates for teens began falling in the mid-1990s, presumably because of the widespread use of antidepressant medications. Even so, suicide is the third leading cause of death among young people between the ages of fifteen and twenty-four, roughly four thousand of whom will die by their own hand this year alone.

  In 1999 the United States Surgeon General issued a report stating that 3.5 million American teens suffered from depression. Yet, a shocking eighty to ninety percent of adolescents suffering from clinical depression go undiagnosed and untreated. If left untreated, depression can lead to suicide.

  So why is it so hard to diagnose? When depression strikes a teenager, it often shows up in a confusing set of symptoms that are hard to distinguish from “normal” adolescent behavior—moodiness, irritability, irregular sleep patterns, drug or alcohol use, difficulties at school. Few teenagers reveal their depression to family or friends.

  Many teenagers who obtain help are inadequately informed about treatment options and pharmacological choices. Parents of depressed teens are often left to ferret out information about treatment on their own. What you soon discover is that quality mental health care for teenagers is either unavailable on a consistent basis or prohibitively expensive.

  Often a parent’s first stop is the family pediatrician or managed care gatekeeper—few of whom are expert in diagnosing and treating depression. In addition to finding a competent therapist or psychiatrist to treat a teen (no mean feat), parents need to become educated about the drugs available to treat depression.

  Over the last two decades, parents have been flooded with “how-to” and self-help literature and advice dispensed via popular culture. I sense parents today have less faith in their own instincts about their children than our parents did.

  Too many theorists compete for the hearts and minds (and pocketbooks) of the family members who know their children best. Treatment theories abound, but in reality child and adolescent psychiatry is in its infancy. Only during the last two decades has the field begun to move away from its embrace of psychoanalysis and into a more evidence-based methodological approach to the study of the developing brain and behavior. “Pop-psychology” offers a confusing and sometimes dangerous cacophony of viewpoints and solutions to complex and variable sets of personal problems. The knowledge and certainty with which our parents and grandparents raised us are undermined and often derided for lacking the most up-to-date medical or therapeutic insights.

  The conflicting advice of “experts” leaves many of us feeling ungrounded and insecure about our child-rearing abilities. We risk becoming a debilitated, groping, second-guessing group of caregivers, stripped to the bone with worry and fear that our decisions won’t be the “right” ones for our children. We need to regain the ability to trust our own instincts. No one on the planet knows your child as well as you do. Trust in that knowledge, trust your instincts, and fight like hell for your child’s well-being.

  In the aftermath of Will’s suicide attempt, our family and a set of clinicians came together to try to analyze what went wrong. We began a wrenching process to determine the next course of action—a treatment plan for Will that at a minimum might safeguard against another suicide attempt and at best might conquer his depression.

  As we grappled with the situation, we learned a lot about our son and a lot about the limited treatment options for teen depression. We immersed ourselves in the controversy over the growing use of antidepressant medications to treat teenage patients, and weighed the advantages and drawbacks of outpatient versus residential treatment programs. We unearthed the staggering inadequacies of our managed-care system and we discovered that our best hope for helping Will was to become as well as or better informed than the therapists treating him about treatment options. For a family in the thick of a hemorrhagic crisis, it is a lot to handle.

  I have watched this public health crisis rip through families and lamented the paucity of ready solutions. I also regret what it is doing to our children—not just to the teens who are ill but to their peers, struggling to understand an illness that still inspires secrecy and shame. A young person sucked into the downward spiral of a friend’s depression or, worse yet, the suicide of a peer, is dealt a brutal blow; it zaps their innocence and occludes their sense of wonder and of possibilities for the future. And I have learned that depression does not need to kill its young victims, but adolescents, whose lives too often hang in the balance between reason and risk, should not be left alone to make that choice.

  In June 2001, shortly after Will was admitted to a residential treatment program for adolescents in Montana, we met face-to-face for the first time with the psychiatrist assigned to treat him. Dr. Dennis Malinak, a bright, warm, engaging parent of two sons, had seen Will every day for the previous eight weeks.

  Dennis began our conversation by asking us to characterize our son as a young child, preadolescence. He was looking for a word or phrase to describe Will’s personality,
something that could be used as a baseline against which we measured his depression. Instantly and without the slightest hesitation, I offered, “Will was joyous.”

  Will’s father nodded in affirmation. I repeated the pronouncement again: “He was joyous.” The second time was more a lament than a statement of fact.

  As Dennis absorbed this bit of information, his expression changed from matter-of-fact to bafflement—so profound was the dissonance between the adolescent he was treating and the person we knew to be our son.

  If we had said “Will was kind of quiet” or “fearful of strangers” or “intense” or “difficult,” Dennis could have paired our characterization with the mute and emotionally raw kid he saw each day. But “joyous” was so far out of alignment that even we had trouble harkening back to the ease and pleasure we enjoyed as parents raising Will.

  I am sure most parents of troubled children have shared a similar moment in the confines of a doctor’s office or over the dinner table, as they scratched their heads in wonder and asked, “What on earth went wrong?”

  What I do know is that over the course of a year and a half, from the onset of his depression to a near-fatal suicide attempt to a residential treatment program, Will lost his innocence and with it the ability to experience joy—or any other emotion beyond the prison of his mental anguish. We watched and held our breath as he struggled to gain back what we all want for our children: a sense of life’s possibilities and hope for the future.

  Will, and Megan too, traversed a mental inferno most people only experience through books and movies, but in the end, they both emerged from depression intact and optimistic, with more than their fair share of insight and self-awareness.