The fantasy of perfection: student suicide and the lies that cause it

There is a corridor of collective hysteria in this country. It is the stretch of land between the 101 and 280 freeways, starting in San Francisco and moving south, eventually ending when the latter turns into 680 and intersects with 101 due east of downtown San Jose.

For the billions of people who know nothing about northern California, I’ve marked the area for convenience.

A corridor in the San Francisco Peninsula that contains many high-pressure prep schools.
A corridor in the San Francisco Peninsula that contains many high-pressure prep schools.

This isn’t exact, but this post deals with places that are within two miles of either side.

The feature “Campus Suicide and the Pressure of Perfection” by Julie Scelfo in the New York Times is excellent. Halfway through, I was not at all surprised to learn that Kathryn DeWitt, the centerpiece of the story, is from this area.

Ms. DeWitt is younger than me, but we both lived through a different Gunn High School suicide cluster around the time we graduated. This is an excellent piece about the two clusters– which are very rare but happened twice at the same school within five years of each other. Student suicide is so commonplace that I’ve never had a conversation about California’s high speed rail project with someone my age without a detour into “will they build it so that kids won’t be able to jump in front of it?”

Student suicide is a classic social problem. It’s complex. There are a ton of institutions that may play a part. Norms are established about academic performance and image are difficult to change. If any part of the system is poisonous, it can undermine everything else. School, peers, parents, media, society, politics, money, sanity- all play a part in the problem, and all have to be addressed to create a real solution.

The prep school culture in the Bay Area isn’t unique. But it is unusually concentrated and reinforcing. It’s a high concentration of wealthy adults, often from immigrant backgrounds and low economic standing. Their kids are expected to make similar progress in their own lives. The high population means not one but many schools that mesh together to create a social scene where failure means weakness and worthlessness. Harker, Crystal Springs, Castilleja, Bellarmine, Pinewood, Woodside Priory, Sacred Heart. Then there’s all the larger Catholic schools; St. Francis, St. Ignatius, and so on. Then there’s the public schools like Aragon (where Ms. DeWitt went), Gunn, Palo Alto High. All the public schools have a substantial honors track that’s insular and indistinguishable from the private prep schools.

Anyone who’s not in the culture would find the whole apparatus absurd. It is, and you should.

William Deresiewicz, former Yale faculty and current polemicist against the narrowness of mind that selective schools of all levels create, points out that elite schools that fail their students when you look away from the resume-building:

Look beneath the façade of seamless well-adjustment, and what you often find are toxic levels of fear, anxiety, and depression, of emptiness and aimlessness and isolation. A large-scale survey of college freshmen recently found that self-reports of emotional well-being have fallen to their lowest level in the study’s 25-year history. (“Don’t Send Your Kid to the Ivy League“, The New Republic, July 2014)

Suicide clusters at elite high schools and universities should not be a surprise. These institutions have taken the regular level of stigma in society and piles on. Not only is mental illness stigmatized, as it is everywhere, but a million different forms of imperfection are as well. All the contributing factors to suicidal ideation are turned into overdrive. As all three of the stories I’ve linked to concur, students think they are isolated in their unhappiness. It’s a lie that’s allowed to persist. In Scelfo’s profile, it’s the college counselor who breaks through the illusion. People are messed up. There’s a culture supposedly based on intellect and critical thinking that frequently uses neither. And people are dying because of that.

What everyone loses in a suicide

Sulome Anderson’s feature last week, “How Patient Suicide Affects Psychiatrists” is a great inversion of a big social problem. Most features on suicide and mental illness (including the great The Cost of Not Caring series by USA Today) tend to focus on the individual who committed suicide and the impact on their family and community. Anderson did quality journalism to create this feature, which helps humanize doctors who naturally become the bad guys in some of these cases.

Personally, last year someone I knew tried to end their life- I had talked to them the a few hours prior to the attempt, having a short conversation about family relations that turned out to be much more important in hindsight (they wanted to know if I had special insight on why I have a good relationship with my parents, and they had the opposite. I wasn’t helpful, though I tried to be). When I visited this person the following day, they were still attempting to die in the confines of the hospital room. Never have I seen desperation more fully realized. It’s profoundly disturbing, and the feature gets across that this sentiment crosses all lines of profession or experience. You don’t become truly adjusted to suicidal people in your life, even if you chose psychiatry as a profession.

Personally, I thought that my history of mental illness would help deal with this experience. I’ve never been particularly suicidal, but my choice to be an activist and socialize within the community has put me into contact with many people who are open about their past with suicide. Turns out that was all (I suppose) wistful thinking. It’s horrible to witness, even in the context I had, where I had some time to mentally prep.

This feature helped develop a three-dimensional picture of the tragedy, which I wish was available with all social problems. Everyone loses someone in a suicide, and we each lose a part of ourselves when someone we know personally attempts or completes it. And yes, as Anderson comes to- sometimes there is nothing that can be done. Zero suicides is an ideal to strive towards, but no free society can ever attain it.

We are all humans with flaws and we are not omnipotent. There is only so much we can do for those we love. All we can do is our best.

Involuntary commitment: it needs to be on the table

There is a great, blunt editorial by a man named Tom Zoellner published, “Reforms shouldn’t protect ‘Big Mental Health“. Though the issue is contentious in the mental health community and among those living with mental illness, Zoellner is absolutely right: involuntary commitment could save lives if it could be used more. This is both in more public situations (mass shooters with obvious symptoms and warning signs), and to save the lives of individuals who will otherwise kill themselves.

Charles Krauthammer is wrong about most things (he’s just a more intellectual-sounding Rush Limbaugh), but his experience as a psychiatrist and his work with mania is extensive and undeniable. Thus even in a column where most of his logic is shaky, like this work after Newtown, his point on mental illness is correct. Several social problems persist due to inadequate resources to treat those who suffer from psychosis, major depression, and mania. And if involuntary commitment was a possible option in more states and situations, some prominent shootings would likely not have happened. Jared Loughner and Seung-Hui Cho (the Virginia Tech shooter) had plenty of warning signs that teachers and friends recognized, but this didn’t filter up to the relevant authorities, and even then their hands can be tied by personal rights and privacy.

This is a balancing act, which is par for the course with mental health. People shouldn’t be locked away like in the days of the massive mental facilities, but they shouldn’t be left to rot when they reach the point where they can’t help themselves. People should be entitled to their privacy and autonomy, but there are times when an imminent threat exists, towards self-harm or harm of others. People should be treated with empathy, but should recognize that involuntary commitment can be an expression of that empathy. The heartless thing is to nothing when nothing is not the best option.

The opening point of the oped, that Republicans currently have a better understanding of what needs to be changed than Democrats do, is correct. Though given the Republican interest in reducing healthcare spending, that basic good idea shouldn’t mean they get the keys on overhauling the system. It points to a need to look at American mental health policy and figure out what works and what does not. Zoellner is right that services may have no track record of success. It’s true that services are redundant and mismanaged- I’ve volunteered at the county level and it’s a complete mess. Even experienced people are finding new groups and services year after year they didn’t know about. The uniting factor is that most of these places get government grants and subsidies; transparency about where this money goes and whether it is overlapping is key.

There are two ways to look at mental illness, where neither is full right nor wrong. One is that anyone with a diagnosis is incapable of living independently and needs to be locked up. The other is that someone with a diagnosis should be given full privacy and any suicidal or dangerous statements shouldn’t be communicated to relevant authorities. It’s key to see involuntary commitment as a tool that shouldn’t be used carelessly (like in the past), but it shouldn’t be ruled out entirely. There have been points where I was in a dangerous place, and the last thing I wanted was a culture of silence where nobody felt obligated to get me more direct help.

Holding your two selves together

BipolarColor
Image by Andrew Mackay.

Growing up, I was diagnosed with anxiety at an early age. From age seven onward therapy was a regular aspect of my life- it was just another after school activity. Some kids went off to learn viola, I went to a biofeedback room to learn how I could control the fear and unease that ruled my life.

That was the diagnosis up until just before I turned fifteen- anxiety. General anxiety, social anxiety, separation anxiety. It was something, a vague combination of all the ways one can feel out of place and time. There were constants. To this day I hate calling people on the phone, which dates as far back as I can remember. But it was in flux. Maybe some of this was obsessive-compulsive disorder (a psychiatrist theory). Or just a weird adolescence. Perhaps I suffered the same fate as many ‘gifted’ children- a dysfunction around others, even those I had a lot in common with.

The lay of the land changed when the moods formed a pattern and my problems found a name. Ever since, life has been about reconciling old issues with newer ones. What is anxiety to me? Where does it fit now? Is it fully independent of bipolar, its own sovereign disorder- or perhaps that they feed each other in a cycle much like the steady sin wave that governs my mood swings and struggles with the extremes of bipolar disorder.

Anxiety, as it stands shortly before I turn twenty-four, is a symptom. A special sort of symptom, fed by hypomania followed by depression. It is the metaphorical headache that comes with reconciling two wildly different, but very real persons. After engaging in stupid or dangerous things while manic, my depressive self must deal with the social ostracism and humiliation. I’ve heard classmates and friends telling me they prefer the funny, hypersocial me- the same one I fear and hope never reappears. Each cycle one self creates commitments, strange friendships, debts monetary and not- then the other self must sift through them. A constant reminder of behavior that is both at times shameful and bizarre. Why did my depressive self let all this crap pile up? Why did my hypomanic self blow all that money?

To me, bipolar disorder is not just the two selves with little in common. It’s the attempt to be sinew, and connect the various fractions into a coherent self. It’s difficult and demanding- and gives me great anxiety. But anxiety is not a standalone issue- it is the water gushing from the crack on the dam. You can buy all the buckets you can find, and gather the water to keep it from flooding what lies below- but the water will never stop. The crack needs to be fixed. Thoreau spoke that “There are a thousand hacking at the branches of evil to one who is striking at the root”. Day-to-day maintenance is so overwhelming that in the past I could rarely ponder “why am I anxious?”

This present period of stability is incredible. It far surpasses the most raucous fun of hypomania, and it is the most treasured possession I have. It has allowed me to understand symptoms from a new perspective- the major cause is being controlled, so what still bothers me?

And anxiety is still there. I don’t like calling even close friends on the phone, or knocking on a stranger’s door. The anxiety is less widespread and reminds me more of my pre-bipolar past, talking with a soft-spoken psychologist and trying to control my breathing and body temperature with biofeedback. This is what remains, once the anxiety of reconciliation is kept to a dull roar. Like the tremor in my right hand from lithium, it’s okay that it exists. I can handle it. I’m okay.

Coming out…as living with a mental illness

In a perfect follow-up to my earlier post on mental illness and stigma, Al Jazeera America has posted a lovely feature about Elyn Saks, a distinguished legal scholar who “came out” as schizophrenic in 2007.

I think her story helps demonstrate a parallel between combating stigma about mental illness and combating stigma about being LGBT. Friday’s celebrity news was dominated by Ellen Page coming out as lesbian. The more people that are open and public about their sexuality, the easier it becomes for those who are still tentative about coming out. Saks, by deciding to emerge as a genius academic living with a serious mental condition, sends a clear message. Having bipolar disorder, or schizophrenia, or major depression isn’t a personal failing, and it doesn’t guarantee a life of missed opportunity. There is power in her story, where she went ahead with her dreams despite pleas to choose a less ambitious career.

There are many traits that can isolate us- being LGBT, having a religious or political philosophy at odds with our family or community, and yes, living with mental illness. The reason I choose to live openly as a bipolar is that I’ve come to learn that I am not alone. There are other people like me, hundreds of thousands in the United States. When Saks and those like her talk about their experience in public, it helps to show that the struggle you are having is not unique.

And that it’s not something to ever be ashamed of.

 

Understanding what mental illness is and is not

I’ve been featured twice recently in articles about the Affordable Care Act and its impact on mental healthcare- first by the Peninsula Press, and subsequently by Generation Progress, which is an offshoot of the Center for American Progress think tank. This wasn’t by accident- I approached the author of the first article, Maya Horowitz, during a county meeting on mental health. What prompted me is the serious lack of literacy in regards to what people with mental disorders are like and the challenges they face. The ACA is a good legislative step by eliminating these disorders from disqualifying individuals from quality insurance, nevertheless there still is societal stigma.

A place I return to time and time again is the largest bipolar community on reddit.com. To some extent, in a non-medical sense I’m already somewhat of an expert. Living with bipolar disorder for almost nine years now, I see my own early struggles in new people that show up. In the pre-ACA era there was what I described to the Peninsula Press as “a climate of fear.” Consequently most people stayed in the closet, and avoided disclosing their status to co-workers. It was dangerous to let insurance companies know too much about your chronic condition, and embarrassing to disclose in a social setting.

Polls show that a third of Americans think prayer alone can overcome serious mental illness. People who openly talk about their struggles will inevitably get condescending suggestions to ditch their medication in favor of alternative remedies, yoga, or positive thinking. Many can improve their mood with exercise, sunlight, and improved diet; but scientifically it is clear that medication is the primary answer for people with severe major depression:

The magnitude of benefit of antidepressant medication compared with placebo increases with severity of depression symptoms, and may be minimal or nonexistent, on average, in patients with mild or moderate symptoms. For patients with very severe depression, the benefit of medications over placebo is substantial. (2010 study, source)

The public by and large does not understand major depression, or bipolar disorder, or schizophrenia are, how they present, are diagnosed, and are treated. This lack of tangible knowledge leads to one of the most offensive aspects of mental health in America.

That the media and special interest groups are lumping all violent behavior with mental illness, and erasing any distinction between violent individuals, those with mental disorders, and violent individuals with mental disorders.

A large portion of mass shootings lead to a blame game, and mental illness is always brought up as a hand-wave answer for why such things happen. This is reinforced by scary news features, along with TV and film portrayals of sadistic, insane villains. However, the link to violence is an illusion. Terrible crimes are committed routinely by people with no trace of mental illness; the more blame lumped onto mental health, the less vigilant people are about other at-risk groups.

Indeed several mass shooters had serious mental issues, but they also had warning signs that should have been picked up on. More stigmatization keeps people from seeking treatment, and leading to risky and destructive behavior.

The reason I volunteered to go on the record is because there need to be more voices with experience, even though it’s always awkward to talk about mental illness in public. Anti-stigma campaigns are being formulated and launched- my county now has a unified campaign with quality materials. One way I look at the 21st century is how there are a shrinking number of acceptance prejudices. In many ways those with mental health are not treated with the same empathy and respect as others. They should.