Will's Choice

by Gail Griffith

  I had been on the phone for the last twenty-four hours trying to speak in person to Dr. Salerian. When we finally connected around 3:00 PM, he had already spoken to the hospital staff and was businesslike and confident in setting a course of action: Will would be transferred back to the Psychiatric Institute of Washington as soon as the hospital team was willing to release him, perhaps as early as Tuesday, and we would go from there. “The Plan” wasn’t exactly swimming in details; it offered little comfort. But I had to admit that we were stumped and didn’t know what else to do.

  Late that afternoon we were visited by the hospital’s chief of psychiatry, Dr. James Griffith, who brought a retinue of psychiatry interns along with him. He seemed knowledgeable and caring, but for parents seeking answers, it seemed we were going over the same old tired ground: “How long has your son been depressed?” “Any history of drug or alcohol abuse?” “Depression in the family?” And so on.

  Dr. Griffith left the room momentarily to take a call, and one of the interns who remained behind to continue the assessment remarked offhandedly, “You’re lucky all your son took was the Remeron. If he’d taken it in combination with his Prozac or Concerta, it would have been much more lethal.”

  “Oh, great!” I uttered sarcastically. This young intern had just done something jaw-droppingly idiotic. With Will present in the room, following the discussion, she had just given him the formula for his next run at suicide. Bob and I exchanged horrified glances.

  The chief psychiatrist stepped back into the room and asked us to leave so he could conduct a private consultation with Will. We repaired to the corridor. As the doctor recounted it, Will admitted to making an earnest attempt to kill himself. “I didn’t want to die,” he confessed, “I just didn’t want to live anymore.” When I heard that I thought: “God, I know that feeling.”

  The psychiatrist asked Will to write down what had led him to attempt suicide. Will completed the task, but what he wrote was an outlandish account of the events as he remembered them from the time he got to the hospital on Sunday until he regained consciousness Monday morning. His written recollection was detached from what he had done and full of oddball characterizations. He began the piece with “On Saturday night I took my pills…all of them. I emptied two bottles of Remeron, a sleeping medicine/antidepressant, onto my bed (probably about 50 or 60 pills) and swallowed them in two handfuls with a sip of Snapple Iced Tea.” His account ended with “And then came the visitors. Wave after wave of disappointed, yet relieved family and friends.”

  Like Will, I too was overwhelmed by the “wave after wave of disappointed, yet relieved family and friends.” Word of our crisis spread quickly. I didn’t discount the innumerable acts of kindness and hopeful wishes channeled in our direction, but we were now the car wreck from which you can’t avert your gaze. I couldn’t explain what happened to us; how could anyone else make sense of it?

  If I knew then what I know now, I would have handled the immediate aftermath of Will’s suicide attempt differently. You are so emotionally raw in this period that you need to husband your resources. Obviously, Will was raw, too. I would recommend that visitors be strictly limited to immediate family—and even then, you should place limits on the amount of time allotted to each visit. There will be time to acknowledge the wellspring of kindness at another time.

  And I also concluded that the best thing you can possibly say to a parent or family member of a child who has survived a suicide attempt is, “How wonderful your child made it! He (or she) survived and now you have a chance to fix the problem.”

  What we needed to do now was turn our attention to the next step, to figuring out the appropriate medical treatment for Will’s depression. This would prove to be a formidable challenge.

  Will’s journal account of his suicide attempt written on March 13 at the request of the doctor treating him at George Washington University Hospital:

  These are the events as I remember them: On Saturday night I took my pills…all of them. I emptied two bottles of Remeron, a sleeping medicine/antidepressant, onto my bed (probably about 50 or 60 pills) and swallowed them in two handfuls with a sip of Snapple Iced Tea. This was definitely an attempt to take my own life, yet I went to bed calm…unfazed by the idea that I was killing myself. I thought about what I had done, not with regret or relief, but rather with a strange indifference, as if it didn’t concern me at all. I do not remember waking up the next morning.

  I was in the hospital, though I did not fully realize it. I was half asleep, half conscious. And half extremely agitated. I can remember hearing doctors yelling at me to stay in my bed or to leave the i.v.’s in my arm, which I was constantly trying to remove. I don’t know why exactly I wanted to leave my bed, but I think I wanted to get my shoes and pants out from under the bed, articles of clothing which my parents did not even bring into the hospital until the next day.

  They did not know exactly what was wrong with me (until they found the suicide notes I had left on my desk) and wanted to do a spinal tap to see if this would give them any clues. I was not going to let this happen. I am in no way a violent or even uncooperative person, but if you were to ask the medical staff at George Washington University Hospital, they would testify that I am at least 95% pit-bull. They sprayed some kind of cleansing fluid on my back to prepare me for the spinal tap. This did not make me happy. I complained that it stung and burned, although I was told later that it was just the cold, which shocked my skin. After several minutes of trying to hold me still so they could clean my back, they realized that there was no possible way that I would be still and calm enough [for them] to actually perform a spinal tap, a procedure which involves very large needles and very still patients.

  Luckily, about that time my stepbrother found the notes, which I left behind explaining my actions. They came to the conclusion that by no coincidence were my two full bottles of sleeping pills entirely empty. I had definitely overdosed, and I had definitely done it on purpose. I’m not sure what time all of these events took place, although I imagine it was mid to late Sunday afternoon, as my mom did not find me until about ten o’clock Sunday morning.

  When they realized that I was clearly suffering from a drug overdose they came up with one solution: charcoal. Now, there are few aspects of this whole experience which I remember as clearly as the charcoal, simply because swallowing twenty ounces of liquid charcoal is not easily forgotten. I later learned that charcoal is common in cases of drug/alcohol overdoses and accidental poisonings. As one might imagine, gagging down cup after cup of liquid charcoal is not the high point of anyone’s day, least not an unsuccessful 17-year-old suicidal boy’s. So it goes without saying that I was not terribly pleased about this.

  Realizing that they would be hard-pressed to get me to take in the charcoal myself, they tried to pipe it into me through tubes in my nose. This turned out to be extremely painful, and Lord knows I would not stand for that. I was in no mood to tolerate any kind of pain and therefore was forced to get the charcoal down on my own.

  There are few things quite like swallowing nearly a liter of liquid about as thick as tar and probably quite similar in taste. To this very moment, nearly two full days later, I am afraid to move my bowels for fear of shitting charcoal briquettes.

  I got through one cup, spitting out much of the liquid into a small bucket held by the nurse, then a second cup, and half of a third to make up for what I left in the bucket. It was one of the single-most unpleasant experiences of my life and I feel extremely lucky that I was only half conscious throughout it.

  With the charcoal in place to settle my stomach and hopefully absorb the excesses of the Remeron, they moved on to questioning if there was any kind of permanent damage to my brain. They gave me a CAT-scan, something which has always interested me, but which I can’t describe here simply because I remember practically none of it.

  All of the events, which I have just described, occurred in what seemed to me like a very short period of time and are still very
fuzzy in my mind. I was filled in on most all of the details the next day. I was expected to stay under for about three days, starting on Sunday night. I woke up at 9 a.m. Monday morning. Pretty fucking tough if you ask me, but then again, who did?

  When I woke up, I found my arms held down in restraints to the sides of the bed, a precaution, which was taken to keep me from removing the i.v.’s and needles from various parts of my body. I imagine it was also a precaution against leaving the doctors open for me to hit, which seems extremely out of character, but not all together impossible, considering my mental state.

  I also awoke to find my penis painfully attached to a tube, which led to a thick plastic bag. This, I was told, was to enable doctors to take a urine sample without me even being conscious to give one. Oh, the technology! I was about as happy as one might expect a suicidal boy to be when he wakes up to find a tube attached to his penis.

  When the nurse who had been assigned to sit with me as I slept noticed that I had woken-up, she offered to remove my arm restraints, to allow me to get up to wash my face. She would have let me get up to use the bathroom, but as she said, I was “all hooked up” and could feel free to “let it go.” I found peeing into a tube while lying in bed extremely uncomfortable and declined to do so. When she realized this (apparently the lack of visible urine traveling through the tube into the bag) she offered to remove the tube, although [she] admitted that it would be uncomfortable, translation: painful.

  I agreed to this since I really did have to pee quite badly. In describing this process as uncomfortable, that nurse had never been more 100 percent correct in her entire life. In fact, it was so uncomfortable that I might go as far as describing it as REALLY FUCKING PAINFUL. The moment she removed the tube, I was so surprised by the pain that I was almost tempted to scream, “Jesus Fucking Christ, why don’t you just cut it off Goddamnit?” but thought better of it since she literally had my balls in her hands.

  And then came the visitors. Wave after wave of disappointed, yet relieved family and friends.

  Consultation Record

  The George Washington University Hospital

  Psychiatry Attending: Dr. James Griffith

  Date: 03-13-01; 9:00 AM

  Patient Interviewed. He made a low/moderate risk, but low-rescue suicide attempt, intending to die. He has a partially treated major depressive disorder and his suicide attempt represents more his fatigue in living with chronic emotional pain than a wish to die.

  I recount the events of those two days and I am traumatized all over again. I sit staring in front of the computer screen, biting my nails and rocking back and forth methodically. The rocking is unconscious, self-pacifying; I drift into it without being aware of it initially. I associate it with bouts of depression, and I have seen it in others—that strange hyperkinetic motion that flags us as mentally ill.

  Writing this story is like writing from the bottom of a well. I am struggling to bring these recollections, these insights, to light, but more often than not, dredging the memories is like swimming through black ooze. And any attempts to array them in a rational chronology or place them in the context of medicine and healing is, well…downright depressing.

  I am no stranger to mental illness. I have battled severe depression all of my adult life. It is a chronic illness, not unlike diabetes or hypertension. In theory my approach has been: You deal with it and you move on. Although, if you were to ask me if it’s really that simple, in the midst of a bout of depression, your question would elicit an ugly response. I hate the illness not just because of how it makes me feel, but because of who I am when I become depressed.

  Depression is the great medical misnomer of our epoch. Too often, the illness carries a mystique propagated by the misguided notion that those who suffer are touched with artistic gifts above and beyond those bestowed on the rest of the population. The illness is cloaked in a veneer of undeserved glamour.

  I have spoken to friends—musicians, artists, and writers—about their depression. Some lean into it unflinchingly; “My mental anguish is my gift,” or “I create through my emotional suffering.” Maybe for them. Not for me. If my depression is a gift, I want to return it. The illness dismisses me from the ranks of the living, and rather than reaching an apotheosis through it, I become incapacitated, immobilized. I become a useless shell.

  According to historians, Winston Churchill referred to his depression as “the black dog,” but he drew on his moods for profound oratorical inspiration and painting. Comedians Robin Williams and Jonathan Winters both battle depression but consider the illness a wellspring for their electric humor. Writers, painters, politicians, and poets—the list is legion with famous people who contend with depression.4

  Does the public benefit from reading or hearing accounts of celebrity depressions? Perhaps it serves to make the illness more visible, and thus the public is more comfortable discussing depression, but I do not think so. By attributing the illness to celebrities, we tend to instill it with a whiff of magic so far off the mark, it does everyone a disservice.

  More typically, depression hits mainstream folks living ordinary lives. Depression is capable of incapacitating the plumber, the school-teacher, and the banker and those among us who are least able to cope: the working poor, single mothers, the physically or mentally disabled, and the elderly. And if you take into account the legions of drug-or alcohol-addicted individuals, driven to addiction as a means to quell serious depression, you have to include in the tally the homeless and the destitute who live on the street, or in state institutions and prisons, much like the mentally ill of a century ago.

  In an August 2004 interview, the director of the National Institute of Mental Health stated that clinical depression is the number one medical cause of worker disability for workers between the ages of fifteen and forty-four.5 That’s a staggering fact. Very few Americans realize that there are almost twice as many suicides as homicides in our country.6 I have been open and forthcoming about my own bouts with major depression. Mental illness is still regarded with superstition and shame, and that disturbs me profoundly. By being up front about depression, I aim, in small measure, to counter the stereotypes of the mentally ill. For depression to be recognized and treated as the bona fide illness it is, it must be destigmatized.

  I understand depression. And I even understand suicidal depression and the hypnotic trick suicidal fantasies play on a depressed brain; I have suffered their blandishment myself. But suicide is not a choice made by a healthy person. Suicide is where the mind goes when the brain chemistry is altered to the point of nihilistic fatalism. Depression is a suicide illness.

  Forty years ago, the medical community assumed that adolescents were too young to suffer from depression; a teen suicide was an anomaly, an act so far off the charts that it was seldom reported and often covered up by the family. Is teen depression and teen suicide more common today than it was in the middle of the twentieth century or have we simply become more adept at recognizing the signs?

  Dr. Kay Redfield Jamison’s comprehensive study of suicide, Night Falls Fast: Understanding Suicide, suggests that because the average age of the onset of puberty has dropped sharply over the last several decades, it is possible that “the age at which depression first occurs has also decreased.”7 But maybe our society’s changing dynamics play a part as well.

  In a provocative book, Liberation’s Children: Parents and Kids in a Postmodern Age, social critic Kay Hymowitz argues that we live in a culture devoid of moral clarity, leaving children yearning for deep connections to family and traditional values. She argues that two powerful forces distinguish our generation from that of our children: absentee parents and a “sexualized and glitzy media-driven marketplace.”8 Could these factors lead to an increase in the incidence of teen depression?

  A 2004 Rand Corporation study published in the journal Pediatrics (funded by the National Institute of Child Health and Human Development) demonstrated empirically that watching sex on TV “predicts and may
hasten adolescent sexual initiation”9—the first time a teen experiences intercourse. By their measurements, two-thirds of all television programming contains sexual content and the study suggests that

  reducing the amount of sexual content in entertainment programming, reducing adolescent exposure to this content, or increasing references to and depictions of possible negative consequences of sexual activity could appreciably delay the initiation of coital and noncoital activities.10

  You would have to be an alien to be surprised by these findings. What is surprising, however, is that the study showed that even though intercourse among adolescents is commonplace, the majority of the teens wish they had waited longer to have sex. The study concludes: “[This] suggests that sex is occurring before youths are prepared for its consequences.”

  Today more American children are raised in families with two working parents than in any time in our history. Often the necessity of having two wage earners leaves parents with no choice. But some social critics suggest that we—in particular, women—are beholden to measures of success that value what we achieve in the workplace over the family and home.

  Around the country, often the first question you get is, “What do you do?”—the benchmark of your contribution to society. I never hear anyone respond, either male or female, “I am raising a family.” Are kids suffering because of these changed dynamics? Hard to argue that they have no impact.

  And you would have to be living in a remote corner of the planet to miss the rapid changes in technology and marketing that aim an increasingly dumbed-down, sexed-up media to young people, with all of its superficial absolutes.