Will's Choice

by Gail Griffith

  You were my first real love and I’ll always love you no matter what. I really hope you’re doing well. And I hope more than anything that you’re not just putting on your pretending to be better thing. Because that only hurts you and the people around you who love you. You have so much potential (I know how we all hate that speech.) Please think of all the possibilities you have. When things get rough (which they will) try to remember that everything will work out for the best in the end.

  On a lighter note, I’m at camp right now. I’m doing really well. I haven’t had any major relapses lately. The end of the school year was brutal, but it’s over now so it’s all good. How’s everything in Montana? When are you coming back? Take your time there! I really hope you’ve figured out a lot of things for yourself. Write me back (if you’re allowed).

  Good luck with everything…

  Love always,

  Megan

  Early August. Nearly six weeks after Bob’s and my disastrous weekend visit with Will, he had not communicated with either of us in writing. I wrote in exasperation:

  August 4, 2001

  Will-o, you-doo-doo-head,

  You can see by my salutation that I’m still really ticked-off about your lack of letter writing. Five weeks—and not a single note. Maybe something will come on Monday. Or maybe you just want to stay in Sun Clan for the rest of your life.

  I was in Austin, Texas this week. I don’t know if you heard, but Austin has had a run on over 100 degree-days like you wouldn’t believe. It was 107 degrees on Thursday. Totally unreal. It felt like we were in Kuwait without the camels. Fancy air-conditioned hotels, big cream-colored Mercedes and desert palm trees.

  We’re all really excited about coming to Montana soon. Sometimes I miss you so much that it brings me to a standstill in the middle of the sidewalk, people walking by me all around. I think about the way you used to giggle when you were little and how much fun you are when you’re feeling well.

  Max is here in Washington with his band, “Walken.” They played a very loud gig in Baltimore earlier today at a place called “Ottobar.” Right now they’ve all gone off to China Café for some cheap eats—just as you’d expect.

  I love you,

  Mom

  Megan’s letter to Will from Camp Betsey Cox, Vermont, August 6, 2001:

  Dear Will,

  I was surprised and very happy with your letter. You really sound like you’re doing better and that’s great. It seems like you’re starting to really get your shit together and I’m really happy for you. I’m so, so glad that even though it’s hard right now you’re sticking with it. I’m so proud of you.

  About us getting back together…I don’t think there’s been anything that I’ve thought about more in my entire life. Ideally, being with you would be wonderful. If we really could have an open and honest relationship all we’d need was the picket fence and yellow lab. I just don’t think we could pick it back up and have everything be perfect. Especially since we’re so far apart. If we ever want “us” to work again it will take a lot of work from both of us that can’t really be done through the mail.

  For the time being, it would probably be best if we just kept it as friends. I would like to try again when you’re home for good. (That doesn’t mean you should try to leave early…I’m not going anywhere.) I just need stability and I don’t think I’m ready to handle an intense, long distance relationship. Another thing to consider is the fact that you’re probably going to go through some dramatic changes. I don’t want us to be together while you’re gone and have you change your mind and then feel bad about telling me etc. etc.

  I think it would be best for both of us to wait before jumping back into this. We need to be face to face and work it all out that way. And everything has to be subject to a change to a more healthy way of living. (Hmmm, I don’t know if that makes any sense outside my head…) Because things can’t go back to the way they were. Judging from what you said, you agree about that.

  Sorry if this letter is disjointed…let me paint the scene where I am…I’m in the infirmary for the sixth consecutive day with bronchitis and strep throat. The camp herbalist is convinced it’s tuberculosis—it’s not; she’s kind of crazy. Anyway, the lone male counselor lives in the room next to mine and I can hear some animal rummaging around in the mess that is his room. I am very afraid to open the door, as I anticipate being attacked by a large rat. So that’s why I am distracted…. sorry about the tangent.

  Stepping back from everything, I still love you. But now I feel more in need to protect myself from potentially traumatic situations and that’s why I’m waiting. Don’t think that I’m saying this just to get you off my back—I mean it all.

  Please keep in touch. I want to know how your school is, what classes you’re taking, etc. I also heard through the grapevine that you’re stuck in Moon (??) phase because you won’t write your parents. Will, Will, Will. Is that really a fight worth fighting? Your parents might be a little weird sometimes (they all are) and you’re probably pissed at them for sending you there, but they love you a lot and only want the best. It would be more productive if you told them all the issues you have with them because at least then you could try to improve your relationship. (Sorry, more unsolicited advice. Ha-ha.)

  Again, I’m so happy for you. Keep working and fighting. I’m sorry that you’re still depressed, but eventually you will feel better if you keep working at it. I hope everything is going well. Have you learned how to horseback ride? Are there even horses? Write me soon.

  Love always,

  Megan

  P.S. And for the love of God, write to your mother.

  Letter from Will from Marion, Montana, mid-August 2001:

  Mom…

  Hi. Sorry about the lack of writing and such. Bears ate my hands. I had to wait for them to grow back.

  It’s been hard to write. Very busy. Very tired/confused. Doing pretty well, all things considered. Feeling a little bit better. Possibly due to recent meds. Also, possibly due to recent viewing of Bambi.

  Got my camera. Taking some pictures but haven’t gotten any back yet. I’ll probably get my Phase 3 on Monday. Just need to wrestle one crocodile/lawnmower. Slay the school dragon, save the fair maiden.

  So I’ll talk to you all soon. Say hi to everybody. They claim there’s a whole assload of mail for me today. I’m on the edge of my seat. I miss you all.

  Love,

  Will

  Note to Will from his stepfather, Jack Brady, Washington, D.C., August 2001:

  Will—

  Here’s some insight [about bears] from my bike group—

  Love,

  Jack

  MEMO:

  Subject: Bear Alert

  The Montana State Department of Fish and Wildlife is advising hikers, hunters, fishermen and residents to take extra precautions and be on alert for bears while in Glacier National Park area this summer. They advise people to wear noise-producing devices such as little bells on their clothing to alert but not startle the bears unexpectedly. They also advise you to carry pepper spray in case of an encounter with a bear. It is also a good idea to watch for signs of bear activity.

  People should be able to recognize the difference between black bear and grizzly bear droppings. Black bear droppings are smaller and contain berries and possibly squirrel fur. Grizzly bear droppings have bells in them and smell like pepper spray.

  Over time Will began to settle into Montana Academy, although he continued to voice resentment about our decision to place him there. True to his nature, he was well liked by other students, his doctors, and his teachers. I took it as a good sign when he decided to run for a seat on the student council, but he played it down.

  “We get to go off campus to that diner by McGregor Lake once a week for the meetings and they’ve got a bunch of candy there I can buy with my allowance.”

  Not exactly a proclamation of grand ambition, but it was a step.

  I have to believe that after three or four m
onths, Will opened up a minimalist dialogue with his doctor and counselors that provided the underpinnings of therapeutic change, but he retained a distrust of the process and held in contempt other kids in the program who he believed manipulated the process.

  From Will’s journal, July/August 2001:

  I guess what amazes me most (or what I wonder about or whatever) is how much dignity people are willing to give up to get out of there. Or integrity. That’s probably why I don’t talk. I see all these kids saying all they can hoping it’ll get a ticket home. I don’t want that I guess. I want to get home and all, but I don’t want to be like Aaron or whatever. He seems so forced and phony. I don’t want to lie my way out of here. And I think it’s possible, but it almost seems like nobody here even bothers trying it. So maybe it isn’t. It seems like kids here don’t try to lie intentionally. They just start lying to themselves and it seems like all of the sudden they start believing it and telling it to everyone and then they go home and are comforted by the fact that no one was here to see it (except their parents, they don’t even matter, they changed our diapers.) So they can just snap right out of it when they get home and no one there will even know that they ever changed. I guess Mark did it honestly. But even he didn’t do it completely honest. I want to get out of here without even thinking about lying to Greg and Charles and Malinak. I just want to do it straight out. I don’t want to put out a separate personality for when I’m in group or therapy or just talking to them.

  I guess I have an advantage over everyone else though. Because honestly, I don’t even care about clans or getting out because I always have the turning 18 thing to fall back on. Maybe that’s why everyone else is so multi-sided. Aaron really irritates me in that sense. I find it so hard to believe that within a matter of weeks (days/hours?) he could go from: “I think that drugs will always be a part of my life,” to being totally clean FOREVER. And he just seems too conceited about it (and everything else). Like by switching he’s suddenly better than all of us. Now he no longer has to look anybody in the eye. He’s one of those people who will leave here in December and I won’t have to see again. It’s not like those people don’t exist in the real world. But they are sure as hell easier to ignore.

  The biggest therapeutic challenge in Will’s case was finding appropriate medication to treat his depression. For most students at Montana Academy who suffered from depression, you could trace the seeds of their illness back to dysfunctional home environments or emotional or physical abuse or stunted maturity, any one of which could seriously hinder a child’s ability to succeed. The external strife in these teenagers’ circumstances triggered their depression. In large measure the formula for their recovery consisted of providing appropriate behavioral therapy, retooling their coping skills, and boosting their ability to handle the outside circumstances. But the roots of Will’s depression were largely biological and not the result of the collapse of the family, abuse, or an inability to succeed in his environment. It would take more than skilled therapy to treat his depression.

  Will had been taking antidepressant medication since December 2000 without any appreciable relief. When he reached Montana Academy in May, his psychiatrist, Dennis Malinak, initially stuck with the same drug regimen: a combination of Prozac and Remeron. But by June, Dennis decided Will ought to be evincing more relief than we were seeing. He decided, and we agreed, to taper Will’s dosage of Prozac and begin to introduce newer, more targeted antidepressants, either Effexor or Celexa.

  Will’s frustration with the medication was evident in his letters home, and in our weekly phone conversations. He started to wonder aloud if he was ever going to get better. By midsummer, Dennis confided that he too was frustrated. He expected to see Will improving gradually, but none of the pharmacological interventions were working. Bob, Dennis, and I discussed the possibility of ECT (electroconvulsive therapy), if the situation did not improve soon. Dennis broached the subject with Will; Will had no objections. He said he had “nothing to lose.”

  Electroconvulsive therapy’s application to adolescents is controversial, although the small sample of teens that have been treated with ECT experienced the same beneficial results as adults.1 If we were forced to consider ECT as a last resort, we were inclined to give it a chance. Dennis, Bob, and I agreed that ECT would be a last-ditch option.

  Few medical issues are as controversial as the use of antidepressant drugs to treat teenagers and children—and few health care issues have the potential to arouse public hysteria.

  The issue grabbed the public’s attention in the summer of 2003 after the British Medicines and Healthcare Products Regulatory Agency (the U.K.’s equivalent of the U.S. Food and Drug Administration [FDA]) reviewed a rash of anecdotal evidence linking the drug Paxil to a surge in suicidal thinking and suicidal behavior among teens. The British government sounded the alarm, urging practitioners against prescribing Paxil for patients less than eighteen years of age.

  The FDA, hoping to buy time for a more detailed review of the data, issued a public advisory in October 2003 designed to signal caution. The FDA’s first advisory on the subject read in part:

  FDA notes, to date, that the data do not clearly establish an association between the use of these drugs and increased suicidal thoughts or actions by pediatric patients. Nevertheless, it is not possible at this point to rule out an increased risk of these adverse events for any of these drugs.2

  The FDA’s statement troubled me. It was alarmingly ambiguous. How could the government agency whose stated mission makes it “responsible for advancing the public health by helping the public get the accurate, science-based information they need to use medicines and foods to improve their health,”3 think this clarified the issue or helped parents struggling to understand a complex medical debate that held life-threatening consequences for our children?

  I wrote an op-ed piece for the Washington Post, criticizing the FDA, the medical establishment, and the media for failing to provide clear guidance to families whose children were in crisis and fueling the public’s fear and mistrust of pharmaceutical interventions.

  The FDA’s October advisory conceded that the government needed further study of the clinical data on the drugs’ efficacy and risks and offered, “As we recognize that this is a serious illness, we need a better understanding of how to use the products we have.”4

  Isn’t it obvious, I argued: “Depression isn’t just a serious illness. It’s a life-threatening illness, and it’s disheartening to think that so little has been done so far to sort out the confusion over remedies for our children’s suffering.”5

  Shortly thereafter, I was invited to serve as the “patient representative” on the advisory panel convened in February 2004 to look at the risks of antidepressants in pediatric populations. The FDA hoped my background as an “educated consumer”—as opposed to a medical practitioner—and my sensitivities as a parent of a child with depression would add a unique perspective to the panel’s composition.

  In late 2003, the British government took the unprecedented step of banning the use of all SSRIs, except Prozac, for treatment of patients under the age of eighteen. Now everyone was panicking and the FDA was challenged to present a clear mission for the upcoming advisory panel.

  Specifically, the advisory panel was asked to consider a spate of alarming reports transmitted to the FDA’s Office of Drug Safety about serious side effects exhibited by children prescribed certain SSRIs, the newer, allegedly safer and more targeted SSRIs. The drugs being scrutinized by the FDA included Zoloft, Celexa, Paxil, Effexor, Remeron, and Serzone, as well as Prozac.

  The FDA’s advisory panel was asked to consider whether the United States should follow the British lead and ban or curtail the use of antidepressants in treating young people, or wait until the data could be thoroughly analyzed by an independent panel of experts at Columbia University who were tasked with doing a blind study of previous clinical trials conducted by the drugs’ manufacturers.

  In advance
of the FDA meeting, members of the advisory panel were asked to review volumes of technical data. I spent days poring over analyses of clinical trial data (most of it far too complex for anyone without background in science or medicine). Nonetheless, I searched through the materials for the answer to the one question that bothered me most of all: Is there evidence to show that the drugs we used to treat Will’s depression prompted him to attempt suicide?

  February 2, 2004: the daylong FDA hearing was emotionally white-hot. Some sixty families lined up to testify in the ballroom of a Bethesda, Maryland, hotel, packed with media, government officials, and interested parties. The families hoisted placards with photos of dead children and offered personal vignettes of tragedy and loss, arguing they and their families were victimized by a heartless and greedy pharmaceutical industry, an inept and ill-informed medical community, and government agencies and lawmakers who place the interests of drug companies ahead of their obligation to protect public health and safety.

  Some of the families’ grievances were backed up by testimony from sympathetic doctors and trial lawyers who laid blame squarely on the FDA, charging the government agency with negligence for inadequately safeguarding our children from the adverse effects of antidepressants, and with malfeasance for basing decisions on data provided by the pharmaceutical industry. They claimed the drug companies altered or dismissed negative findings in the drugs’ preapproval trials.

  Presenters also attacked doctors for being seduced by the promotional tactics of drug companies whose marketing representatives urge them to prescribe newer drugs, the side effects of which have not been fully documented in pediatric patients, or for handing out drug samples without fully understanding the drugs’ risks.