November of the Soul

by George Howe Colt

  None of this explains a single suicide, of course, but it describes the background against which young people choose to live or die. “What we’re doing is looking at a rising suicide rate and trying to determine what is different now from twenty-five years ago,” psychologist Pamela Cantor told me at the height of the adolescent suicide “epidemic.” “You can point to the rising divorce rate. You can point to increased mobility. You can point to two-career families. And therefore that’s what gets blamed. I think they are responsible, but maybe they’re not. It may just be correlation because you can also point to the fact that the weather has gotten colder.” She smiled wryly. “I’m not being facetious. We just don’t know what the answers are.”

  In 1971, teaching a psychology course at Boston University, Cantor asked her class how many had seriously considered suicide. All but two students raised their hands. Cantor had been studying suicide ever since. Her private practice consisted primarily of young women, many of whom had attempted or threatened suicide. Cantor had traveled the country speaking to students, teachers, and clinicians about adolescent suicide. She had been president of the American Association of Suicidology and chair of the National Committee for Youth Suicide Prevention. Over the years she had been asked hundreds of times why the rate was rising, and in a voice filled with concern and urgency, she had tried to answer that question.

  When I spoke with her, Cantor expressed her concern not only as a psychologist but as the working mother in a high-achieving, two-career family in a wealthy Boston suburb. She fretted about her own parenting; as a therapist she had vast knowledge of its hazards and, as a parent, of its rewards. She was keenly aware of how different her children’s world was from the world she knew growing up on Long Island in the fifties, with Debbie Reynolds and June Allyson for role models. “There’s no safe place anymore,” she told me. “When I was young, our safe place used to be larger than just our home. I could gain mastery over my world by going to the village to get a loaf of bread, by going out for a tuna fish sandwich, by walking to and from school. I could take the train into New York City and stroll up and down Fifth Avenue. I had a great sense of freedom and autonomy without any real threat of danger. Today, when we get out of the car, we lock it; when we get in the car, we look in the backseat. We look under the car before we get in. One Sunday I left the kitchen window open. My husband and children were home. I went to see a friend, and when I came home, I found that a man had climbed through the window and wandered through the house and nobody ever saw him. We keep the window locked now. It’s ridiculous. And sad. And this is not only part of my life but part of my children’s. Surely it affects their attitude and their well-being. Does it lead to suicide? I don’t know.

  “The suicide literature is very frustrating. I feel that frustration when I speak to parents because I will go through the list of things that have been pointed to as factors, and I always come up feeling empty because when you’re all through, it really doesn’t help you determine what to do and what not to do. Yet people want the answer, and I don’t blame them—I want it, too. That is why this subject is so frightening for parents, because you can’t say, ‘If you do a, b, and c, you will protect your children from suicide, and if you do d, e, and f, you will lead them down the path of self-destruction.’ The bottom line seems to me that if a person likes himself, he won’t kill himself. But how do you get children to like themselves? What do you do? And even if you do everything you think you’re supposed to do and you give them love and a sense of security and a feeling that you care, some kids still don’t like themselves. And some kids who do like themselves go through periods when they don’t. One evening my daughter told me she didn’t like being herself because she wasn’t popular. But she has lots of friends. How seriously do you take it? When do you listen? When don’t you listen? When do you do something? You have to follow your instincts, and I guess all I’m saying is that the best you can do is give children two parents who genuinely love them.” She sat back in her chair and shrugged.

  In the years since I spoke with Pam Cantor, the adolescent suicide rate has dropped—from a high of 13.8 in 1994 to 9.9 in 2002. If the reasons for the three-decade rise are murky, the reasons for the recent decline are hardly less so. One of the most frequently cited reasons for the increase was the greater exposure of adolescents to drugs and alcohol, yet there has been no clear decline in drug or alcohol use by young people over the last decade. Others have pointed to the falling rate of firearm use among high school students following the 1994 Brady Bill, which required federally licensed firearms dealers to run a background check and receive authorization from a national database before making a sale. Yet the proportion of suicides by firearm remained unchanged between 1988 and 1999, and a comparison of states that did and did not pass the Brady Bill statutes showed no effect on the proportion of firearm suicides, except in elderly men. Many therapists attribute the decrease in adolescent suicide to the extraordinary increase in antidepressants prescribed for adolescents; between 1987 and 1996, the annual rate of antidepressant use more than tripled among those age six to nineteen in the United States. Indeed, studies have shown that adolescent suicide rates have dropped in those countries where the use of antidepressants has increased. Yet clinical trials have found that antidepressants have had little effect on reducing depression in adolescents and may, in fact, cause suicidal behavior in a tiny minority of pediatric patients, a phenomenon to be discussed in part four. The declining rate in the 1990s may have been due, in part, to increased public awareness of depression and of the warning signs of suicide. Or it may have been due to the booming economy during that decade; over the century, one of the few steadfast correlates has been that the suicide rate rises as the economy falls. A few researchers just throw up their hands and remind us that the suicide rate has always been subject to inexplicable cycles, dips, and blips.

  The recent decline in the adolescent suicide rate, however, serves as a reminder that while even one adolescent suicide is too many, the vast majority of American teenagers maneuver through adolescence without killing themselves. In 2002, for instance, 40,496,000 of 40,500,000 adolescents chose not to commit suicide. Although suicide is the third leading cause of death among adolescents, young people have the lowest suicide rate of any age group. While most people wonder why so many adolescents kill themselves, some clinicians suggest that we have the question backward. Why don’t more adolescents kill themselves? And why do so many consider it and then back away? Psychiatrist Robert Litman, who has studied suicide for nearly half a century, talks about something he calls “the suicide zone.” He believes that suicide-vulnerable individuals move in and out of periods of suicidal risk—sometimes for brief periods, sometimes for moderate or long periods—as their life circumstances fluctuate. But of all those people who enter that zone, few actually kill themselves. “For every hundred people at high risk,” he says, “only three or four will actually commit suicide over the next couple of years.”

  For that to happen, says Litman, a multitude of things must occur. “It’s like a slot machine,” he says. “You can win a million dollars on a slot machine in Las Vegas, but to do that, six sevens have to line up on your machine. In a sense it’s the same with suicide.” Those spinning sevens represent all the biological, psychological, and sociological variables that are associated with suicide—depression, broken family, serotonin dysfunction, triggering event, and so on. “In order to commit suicide, a lot of things have to fall together at once, and a lot of other things have to not happen at once,” says Litman. “There’s a certain random element determining the specific time of any suicide and, often, whether it happens or not.”

  In Litman’s slot machine metaphor, suicide is conceptualized as an exceedingly rare event that requires everything to be in alignment for it to take place—a sort of perverse, malevolent music of the spheres. “It’s as if you need to have six strikes against you,” Litman says. “And we’re all walking around with one or two or three str
ikes. Then you get into a big crisis and you have four strikes. But to get to all six takes some really bad luck.”

  III

  BRIAN

  BRIAN HART WAS the kind of young man who would have been prized by the classmates who scorned Justin Spoonhour. Handsome, athletic, and outgoing, Brian was as much in the thick of things as Justin was isolated and alone. Brian grew up in a large, loving family in Bedford Hills, an upper-middle-class community halfway between Putnam Valley and New York City. As hard as Justin tried to be different, Brian tried hard to be one of the guys, but he could never succeed to his satisfaction. He grew up with one large strike against him, one that ultimately set him apart every bit as much as Justin Spoonhour.

  Family photographs seem to cover every surface of Patrick and Mary Hart’s modest home: grade school portraits, graduation pictures, baptisms, first communions, birthdays, weddings, Thanksgivings, Christmases, and St. Patrick’s Days. “The Rogues’ Gallery,” Pat and Mary call it. When they come downstairs in the morning or go up to bed at night, they are surrounded by the smiling faces of their children. Home and family are important to the Harts. Pat grew up less than a mile from this house, on the estate where his father was superintendent. When Pat was sixteen, his father died, and Pat had to go to work to support his mother and two younger siblings. Mary grew up on Long Island, but the family was broken up during the Depression when her father lost his job. After living with various aunts for two years, Mary was reunited with her family in Mount Kisco. Pat and Mary met in the eighth grade but didn’t date until junior year. Pat played basketball and baseball; Mary was prom queen. In their graduation portraits, which hang side by side at the top of the stairs, they look serene, Mary ravishingly beautiful, Pat confident and strong. Their heads are cocked, gazing up and off to the right, looking, as the photographer no doubt intended, toward the future.

  Four years after graduating, Pat and Mary were married. During the next four years they had five children, the last two, twins. Pat got up long before dawn for his job as a milkman, then went to night school for his college degree. After working as an officer for the local Teamsters union, he became a federal labor mediator. Mary raised the family and did volunteer work. Seven years after the twins were born, agreeing that they had never had time to truly savor raising a child because they were always busy caring for the next, Pat and Mary decided to have one more child—“the last hurrah,” as Mary says. “The gang” was thrilled with the news. When the Harts drove up to church on Easter Sunday in their nine-seater Pontiac, they leaned out of every window. “Guess what!” they yelled. “We’re going to have another baby!”

  As an infant, Brian was like an only child with seven doting parents. Each morning when Mary woke, she never knew in whose room Brian would be: the first child to wake would lift Brian from his crib, take him to his or her own bed, and feed him his bottle. As soon as the children got home from school, they would drop their books and run through the house looking for their baby brother. Brian was the little prince of the family. If he wanted anything, he was given it; if he was hurt in any way, there was hysteria; if there was an activity, he was included. But gradually his brothers and sisters went off to college or to jobs, and by the time he was twelve, Brian was the only child left at home.

  One Saturday morning in October of his seventh-grade year, Brian was playing with friends in the next-door neighbor’s backyard. Though Brian had never been allowed to play with toy guns, they were using the friend’s BB rifle. By accident one of the boys fired a shot that hit another in the eye. Brian was close enough to hear the splat. Pat, hearing screams, went to the door in time to see the other children, terrified, fleeing the scene, followed by Brian, one arm around the injured boy, whose eye was streaming blood. When Brian returned from walking the boy home, he went into the backyard where the boy had been shot and gathered up the bloodstained leaves from the ground. At the brook behind his house he knelt and carefully washed the blood from each leaf.

  Though Brian didn’t talk about the incident, his parents could tell it bothered him. He began to have problems concentrating in school. His teachers said that while most of the time Brian was bright, eager, and responsive, at times he was withdrawn, almost “out of it.” (In the elections at the end of the year, his classmates would vote Brian Most Popular and also Most Moody.) They suggested he get professional help. Although reluctant—Brian’s therapy would be a family first—the Harts found a respected young psychiatrist named Eugene Kornhaber, who began seeing Brian once a week. Brian was initially resentful, but he grew reconciled to being in therapy and would joke to his family and friends about his “shrink.”

  Brian seemed to be getting along well until the following year when the Harts’ beagle, Kelly, died. Kelly was kept tied to the clothesline on a running leash, and the Hart children had been told never to let her loose because the commuter railroad tracks ran behind the house. But Brian occasionally took Kelly across the tracks to play on the hill. One day while Kelly was crossing the tracks, a train approached. Brian called her, but Kelly panicked and ran in front of the train. The train hit her, and Brian saw Kelly tossed between the cars. After the train passed, Brian heard a weak bark and ran to Kelly just as another train approached from the opposite direction. He darted in front of the engine, grabbed Kelly from the tracks, and jumped off the embankment. Brian rushed her to the house—he could hear her bones grind as she moved—but she died within the hour. Brian buried her in the backyard. That night Brian couldn’t stop crying. He was sure that he had led Kelly to her death.

  Though he rarely talked about them, these two incidents would haunt Brian throughout his life. Years later doctors would point to them as crucial traumas in his development. Because the injured boy, who had to get a glass eye, was on the Harts’ property when he was hit by the BB, the Harts were involved in a lawsuit that wasn’t settled until Brian was seventeen. In eleventh grade, Brian wrote an essay in which he described the guilt he felt over Kelly’s death. Sometimes when he walked into the backyard, he could still hear her howling in pain.

  After Kelly’s death, Brian’s ups and downs became more pronounced. When Brian was up, his determination, exuberance, and sense of humor were infectious. He was extraordinarily handsome, with sandy hair, blue-green eyes, and a wide grin. Girls developed instant crushes on him, teachers were reminded of why they had gone into teaching, and friends’ parents wondered why their sons couldn’t be as charming as Brian Hart. “With Brian, nothing was halfway,” says his mother. “He didn’t do anything gradually, he’d jump right in, feetfirst.” When Brian took up jogging, he immediately started running five miles a day—and won two medals for ten-kilometer races. When he became interested in cooking, he tested recipes on his parents and made plans to write a cookbook. When he became interested in girls in eighth grade, he fell in love at least once a week. When Brian was up, he believed anything was possible. Watching a TV show in which a New York Giants football player discussed the upcoming season with pessimism, Brian composed a four-page letter to the Giants’ administration, telling them a player with that attitude shouldn’t be on the team—a person should never give up.

  At times, however, Brian was remote and morose. “Sometimes he was afraid to be alone. He’d walk out with me—not with me but behind me, like a puppy, afraid to let me out of his sight,” says Mary, who had been elected town clerk. “Sometimes he would call the office and ask me to come home and talk to him. I’d drop everything and rush home, and then he wouldn’t talk.” When his parents asked him what was wrong, he would say, “I’m just low.” At night when he went upstairs and his parents, sitting in the living room, looked up, Brian demanded, “What are you staring at?” After an eighth-grade basketball game, Brian’s father kidded him about a play in which the player he was guarding had cut around him to score a basket. Brian was silent for a moment, then said quietly, “Dad, you shouldn’t criticize me.” Pat was taken aback but realized that Brian just wasn’t the type to be teased. When Br
ian asked his mother not to come to his games, she was saddened that he might be embarrassed by her presence—the Harts had always attended their children’s activities—but she agreed. “If this was the only way he could function, without our being too close, that was all right,” she says.