All This Darkness Past

Just more than five years after the surprising death by suicide of University of Pennsylvania first-year student Madison Holleran, I traveled to Philadelphia to address family doctors on the epidemic that her demise reflects. I told them about Madison, shared the publication of her story by her parents (who wanted to create greater awareness) and quoted from Madison’s suicide letter that stated, in part, “I thought how unpleasant it is to be locked out, and I thought how it is worse perhaps to be locked in … I love you all … I’m sorry. I love you.”

The loss of Madison, a rising track star and young woman who to most seemed to, proverbially, “have it all,” gave notoriety to the term “Penn Face,” which reflects the pressure students feel to “be normal” and to fit in. Penn Face and similar titles at other schools belie the façade many young people present to others, including those closest, in order to look strong, self-assured and successful.

Also belying that norm is a survey of first-year college students conducted by The Jed Foundation, Partnership for Drug-Free Kids and the Jordan Porco Foundation. The data revealed that the majority of these young people feel unprepared emotionally, “defined by the organizations as the ability to take care of oneself, adapt to new environments, control negative emotions or behavior and build positive relationships” for the trials and tribulations of college.

They report the following.

•  60 percent of students wish they had gotten more help with the emotional preparation for college.

• 45 percent felt that “it seems like everyone has college figured out but me.”

•  51 percent found it difficult at times to get emotional support at college when they needed it.

JED also reported, “A survey of 14,584 faculty and staff members and 51,294 undergraduate students in 100+ U.S. colleges and universities found that more than half don’t feel adequately prepared to recognize, approach or recommend support services to students experiencing psychological distress, including depression, anxiety, and thoughts of suicide.”

To make matters worse, the National Survey of College Counseling Centers stated in 2014 that 94 percent of counseling directors say they’ve seen an increase of students with severe psychological disturbances. Many schools struggle to meet demand.

An era of senseless tragedies has begrudgingly brought to the fore issues of mental health and the fragility that often lies beneath the surface of sometimes highly functioning, seemingly “normal” people.

But what is normal, anyway?

Too often, society views mental health as a matter of polar opposites: well and unwell. The problem with this equation is, as with physical health, mental health considerations are much more granular. For example, while we may consider ourselves to be in good health despite a scratch, rash or stomachache, so, too, might we consider ourselves emotionally stable despite a reactionary depression, a spate of anxiety or a nagging doubt about our aptitude for success.

Normative emotionality is a fluid rather than static construct. Many, if not most, individuals trace movement on the continuum of mental health in fairly small arcs, not deviating too widely from our core. Yet for some those arcs are more pronounced and may require intervention and treatment.

And therein lies the boogeyman.

When we build into the equation a foreboding stereotype that seeking help signals weakness or worse, we discourage legitimate mental health care in a way that would be unimaginable with physical illness or injury, disease or defect.

Perhaps nowhere is the problem more vexing than among America’s cohort of adolescents. Both because of a long-running shortage of mental health professionals treating youth and because, according to the National Alliance on Mental Illness(NAMI), mental health issues typically strike early, “half of all mental illness emerges by the age of 14 and three quarters by age 24.”

Stephen E. Brock, Ph.D., NCSP, president of the National Association of School Psychologists, a collaborating organization at the Center for Adolescent Research and Education (CARE), says 13-20 percent of children suffer from mental illness and points to a sharp rise – 24 percent between 2007 and 2010 – of inpatient admissions.

While not all such disturbances end in suicide, the CDC reports that it is the second leading cause of death for youth between the ages of 10 and 24, resulting in more than 4,600 lives lost each year.

In a TIME magazine 2017 cover story, “Teen Anxiety and Depression: Why the Kids Are Not Alright,” Susanna Schrobsdorff states, “Adolescents today have a reputation for being more fragile, less resilient and more overwhelmed than their parents were when they were growing up. Sometimes they’re called spoiled or coddled or helicoptered. But a closer look paints a far more heartbreaking portrait of why young people are suffering.”

Indeed.

The article continues, “In 2015, about 3 million teens ages 12 to 17 had had at least one major depressive episode in the past year, according to the Department of Health and Human Services. More than 2 million report experiencing depression that impairs their daily function. About 30% of girls and 20% of boys–totaling 6.3 million teens–have had an anxiety disorder, according to data from the National Institute of Mental Health.”

Schrobsdorff shares the stories of two teens who may very well represent the tip of the iceberg.

“Josh, who did not want his real name published, is a high school sophomore in Maine who says he remembers how his parents began checking on him after the Sandy Hook shooting that killed 20 children and six adults. Despite their vigilance, he says, they’re largely unaware of the pain he’s been in. ‘They’re both heterosexual cis people, so they wouldn’t know that I’m bisexual. They wouldn’t know that I cut, that I use red wine, that I’ve attempted suicide,’ he says. ‘They think I’m a normal kid, but I’m not.’”

“The first time Faith-Ann Bishop cut herself, she was in eighth grade. It was 2 in the morning, and as her parents slept, she sat on the edge of the tub at her home outside Bangor, Maine, with a metal clip from a pen in her hand. Then she sliced into the soft skin near her ribs. There was blood–and a sense of deep relief. ‘It makes the world very quiet for a few seconds,’ says Faith-Ann. ‘For a while I didn’t want to stop, because it was my only coping mechanism. I hadn’t learned any other way.’”

There is no doubt that America faces an unprecedented crisis when it comes to youth mental health and suicides.

That’s where you come in. Whether a peer, parent, teacher, coach, physician, mental health professional, neighbor, faith-based mentor or passerby, everyone has a role to play in protecting youth.

What does that mean?

1.  Look for symptoms of depression.

2.  Know about treatment options.

3.  Understand the grieving process and the impact of cumulative grief.

4.  Promote protective factors.

5.  Communicate finite periods of distress.

Let’s take those one at a time.

Well-known signs of depression and suicidal ideation include the following.

·  Talking about suicide

·  Making statements about feeling hopeless, helpless, or worthless

·  A deepening depression

·  Preoccupation with death

·  Taking unnecessary risks or exhibiting self-destructive behavior

·  Out of character behavior

· A loss of interest in the things one cares about

·  Visiting or calling people one cares about

·  Making arrangements; setting one’s affairs in order

·  Giving prized possessions away

Good news can be found in the fact that depression is treatable!

Depression may be related to brain chemicals and thus medication can be effective, perhaps especially newer classes of drugs such as SSRIs (Selective Serotonin Reuptake Inhibitors) and SNRIs (Serotonin and Norepinephrine Reuptake Inhibitors). Most effective treatments generally involve a combination of therapy and medication.

For parents especially, other important action steps include not being afraid to talk to your child, learning about the risk factors and warning signs, acting immediately to get help and tightening the circle of care that surrounds their child.

While the grieving process and its duration are different for each individual, some of the steps, or stages, include denial, anger, bargaining, depression and, for some, acceptance.

So what keeps kids safe? According to the Search Institute, such things as good relationships with other youth, willingness to seek adult help when needed, lack of access to suicidal means (such as guns), easy access to mental health care, religiosity, school environments that encourage help-seeking and promote health, family cohesion and stability, coping and problem-solving skills, a sense of self-worth and impulse control, positive connections to school, extracurricular participation and academic success.

Perhaps most critical is helping young people to build resiliency (the ability to handle adverse childhood events,) and to understand that how they feel in the moment of despair is not how they will always feel – something a lack of life experiences makes challenging.

Yet, for most, it is true. There will come a time when all the darkness will pass.