In 400 B.C. a
Greek physician, Hippocrates, is the first to view and treat mental illness as
a disease of ‘disturbed physiology’1 rather
than the result of Godly displeasure. He proposes treatments such as reflective
time alone juxtaposed by physical activities or jobs. In this time period,
family members were the primary care takers for the mentally ill. This trend
continues into the Middle Ages where those mentally ill citizens, who are not
mistaken for witches, are left to the care of their respective relatives. By
1407 the first European mental heath treatment facility is opened in Valencia,
Spain. However, it is not long before massive abuse of mentally ill becomes the
trend in Europe. By the 1600’s isolation of these individuals is in full swing
and they are regularly quartered off into institutions along side criminals and
vagrants. The mentally ill are often kept in chains and shackles, are refused
sunlight or exercise, and in extreme cases, are even kept in darkness with no
clothing or heat. For the next two hundred years, mental health care reforms
appear in such forms as French physician Phillippe Pinel and American activist
Dorothea Dix. In the wake of Dix’s reform success, many expect American mental
health hospitals to cure mental illness. However, when these hospitals become
over-crowded “custodial care supersedes humane treatment”[1]
and the care institutions regress into acceptance of an abusive standard. By the 1900’s Sigmund Freud and Carl Jung
have introduced treatment options of psychoanalytical therapy, and Clifford
Beers publishes a scathing commentary on his personal experiences in a Connecticut
mental institution. Beers continues on to establish the National Committee of
Mental Hygiene (which will later become the National Mental Health Association
as backed by Harry Truman) to further efforts of mental health care
reform. Despite these efforts, the mid
1900’s bring a new bout of ‘treatment’ atrocities. Electro-convulsive therapy,
and electro-shock therapy are introduced to treat schizophrenia. Other patients
are deliberately infected with malaria, lobotomized, or sent into repeated
insulin-induced comas, all under the guise of ‘treatment’. Soon after, the first semi-successful anti-psychotic
drugs are introduced as a treatment method and the world begins its love affair
with medicating mental ailments. Due to a combination of newly available drugs,
peaking numbers of institutionalized patients, and popular literature of the
time (Thomas Szasz writes on how mental illness is a fabrication or myth, Erving
Goffman publishes a critique stating that mentally ill exhibit symptoms in
response to institutionalization, and Ken Kesey’s One Flew Over The Cuckoo’s Nest becomes a major insinuation that
those in mental hospitals are not ill, but simply deviant from the behavioral
norms demanded by American 50’s culture) many patients (who are genuinely ill)
are removed from hospitals. This is successful in a small way, as some patients
excel in local mental health homes. However, the majority of citizens with mental
ailments are left to become homeless. By the 1980’s one third of the homeless
population in the United States is suspected of being mentally ill. Once again,
advocacy groups call for improved care for these citizens. However, it isn’t
long before these sick and homeless are shifted off the streets and into jails.
In 1992 a study stated that about 100,000 mentally ill individuals were
incarcerated. And shockingly, at least a quarter of these individuals proved to
be held without charges while waiting for a bed in a psychiatric hospital to
open…[2]
After a thousand-year-old
ping-pong match between mental health abuse and reform, it is any wonder that
American society has developed a social stigma against mental illnesses? With historical soil fertile with
discrimination, mental diseases occupy an embarrassed and shameful corner of
society. Despite advanced information and research, modern American society
does not view mental illnesses (depression specifically) as legitimate mental
ailments in need of, or deserving of treatment, but rather views them as a
result of a weakness, flaw, or poor life choice of the affected individual. Due
to society’s commitment to reactive behavior over proactive measures, society
treats the results of mental illness (the most extreme result of depression
being suicide) as isolated anomalies instead of the result of over-arching
cultural trends.
Mental illness
occupies a stained position, on the opposite side of the spectrum than physical
diseases in the minds of many Americans. The contrast in public behavior and
opinion towards physically and mentally ill citizens is astonishing. As cancer,
diabetes, and heart disease have surged through the community at alarming
rates, more and more attention is being given to those suffering from such
ailments. These patients are pitied and sympathized with. Entire families rally
together to support their ailing loved ones, grandchildren fly in from
California, long-held feuds are reconciled over hospital beds. Drastic and
immediate actions are taken by families to dote on, pay respects to, and
comfort sick relatives. There is no doubt in the minds of any that these
individuals need and deserve medical treatment. They are talked about in
hospital hallways in hushed voices. “Poor
thing” or “What a tragedy, it just
isn’t fair”. And thus, they become
victims: victims deserving of consolation from non-profit organizations and in need
of brand-name doctors. Physical illness
is regarded as a misfortune which befalls an individual by no fault of their
own, regardless of if that individual has spent the past 45 years of his life
smoking Newports, lathering herself with baby oil and baking in the sun, or consuming
nothing but high fructose corn syrup, saturated fats and diet coke.
Meanwhile, those
suffering from depression remain socially shamed. Often times, the immediate
families of those suffering from depression are entirely unaware their family
member has any issue whatsoever. This is a direct result of the stigma placed
on mental diseases. Affected individuals are ashamed to seek the help of a
psychiatrist and therefore deny themselves professional care in order to avoid
social branding. Rehabilitation measures are tucked away as embarrassing family
secrets and disguised as extended ‘vacations’.
The community shifts away from depressed members and labels them as
‘weird’, ‘crazy’ or ‘unpredictable’. They are chastised for their inability to
overcome their own ailments in a mind-over-matter wrestling match. Depressed
citizens are often regarded as weak or soft and their condition is almost
always viewed as self inflicted, regardless of if that individual has a history
of victimization by rape or violence, has experienced a significant loss, or
has inordinate amounts of stress and anxiety due to major family
responsibilities.
Institutions
dedicated to the prevention of avoidable mental ailments, such as depression,
are few and far between. There are no facilities in place to teach citizens
methods of coping with extreme emotional distress or overwhelming anxiety, nor
are there programs organized to educate the public about the facts of
depression. Even after an individual
comes forward, seeking treatment for their mental ailment, they are
fast-tracked to a regiment of anti-depressive medication. Despite mounting research proving therapy,
exercise, and even acupuncture to be more effective in treating depression than
prescription medication, the community is continuously denied anxiety-coping
education and alternative depression-management options. This perpetuates the
existence of depression as society is refused the tools to achieve
self-reliance and mental strength, by allowing pharmaceutical companies to
maintain paying customers via shackling drug dependencies. Ironically, the
leading side effect of anti-depressive medication is an increase in thoughts of
suicide; the very thoughts the medication aims to diminish. In a 2009 study,
which compared the effects of antidepressant medication to frequency of
suicidal tendencies, the risk of suicide was seen to double at any fluctuation
of dosage, specifically upon initiation of these drugs. The study concluded, “The
highest risk was associated with initiation, a finding consistent with other
studies, closely followed by periods of dosing changes and discontinuation.
Patients should be closely monitored during these periods.” [3] In a nine year study, concluded in 2010, a
British medical team found that not only did 27% of their medicated test group
(adolescents 10-24) attempt to commit suicide, but the majority of that
percentage attempted to off themselves within the first six months of beginning
medication.[4]
In response to these studies and countless
others like them, The FDA brought forward a new requirement for all anti-depressant
manufacturers in 2003, to “update the existing black box warning on their
products' labeling to include warnings about increased risks of suicidal
thinking and behavior, known as suicidality, in young adults ages 18 to 24
during initial treatment (generally the first one to two months).”[5] Kudos to the FDA, at least they’re honest.
So why do Doctors
keep prescribing 14-year-olds Prozac? Why does Mommy take 6 pills with her
morning coffee? The answer lies in the
American love affair with reactive actions. The fact of the matter is, it’s
more than an affair at this point. American society has developed a serious,
committed, relationship with ‘treating’ and kicked ‘preventing’ to the curb.
Is it any wonder
then, with treatment tendencies such as these leading the battle against
depression, that our citizens are losing the will to fight? Suicide statistics in the U.S. are higher
than they have been in a decade (from 29,350 deaths in 2000, to 38,364 deaths
in 2010) and certain pockets of community demographics are being hit the
hardest. As publicized by mainstream media, there have been mounting reports of
recent suicides of young NFL athletes. GamesOver.org, (a non-profit
organization that aims to help NFL players transition from stardom to retired,
daily-life) claims the suicide rate for NFL players is six times the national
average[6], a
rate of roughly 74.4 deaths per 100,000 people (as compared to the 12.4 rate
for America as a whole). Another
suffering demographic, also recently illuminated via increased media attention,
is that of adolescents. The most shocking and worrisome age group to
participate in this trend is middle school students from ages 10-14. The U.S. Center for Disease Control and
Prevention found that the suicide rate for this demographic jumped from 56
deaths in 2003, to 94 deaths in the same age group in 2004; creating nearly a
95% increase within one year.[7]
Society does not like to look at these numbers in
full light, let alone accept responsibility for them. So it doesn’t. Instead,
these numbers are ascribed to isolated events or extenuating circumstances. The
mental instability of the individual is exaggerated and facts are bent in order
to reduce the culpability of cultural trends. The late NFL player Jovan Belcher, became the
most recent of six NFL suicides in the past two years; the last of four in the
past eight months. In this most recent tragedy,
the young man shot and killed his 22-year-old girlfriend before taking his own
life as well. As a result, his actions have been filed and analyzed under
murder-suicide rates; the murder aspects sensationalized, and focus on his
suicide, diminished.[8] In this way, the media has been able to
distance Belcher’s connection to the previous string of NFL suicides. But why
the big cover-up act? The fact is, that
the recent string of NFL suicides is the result of America’s passion for
watching grown men pummel each other every Sunday…and no one wants to admit
it. Since the time of its creation,
players have risked their bodies for football. It is a calculated decision
professional players make. However,
recent evidence has suggested they are also, unwittingly, risking their minds. Recent
studies have shown over twenty NFL players currently suffer (or have suffered,
in the case of the deceased) from chronic traumatic
encephalopathy, a condition that damages the brain’s neurons, induces mainly
“depression, impaired impulse control and cognitive decline”9 (all
three of which combine and often result in suicide) and is generally caused by
severe concussions. A New York Times article comments, “Players who began their
careers knowing the likely costs to their knees and shoulders are only now
learning about the cognitive risks, too. After years of denying or discrediting
evidence of football’s impact on the brain…the N.F.L. is (slowly) addressing
the issue”.[9]
Adolescent suicides also suffer from media-diverted culpability in a
societal attempt to deny a cultural trend. Suicide
rates had steadily decreased in the middle school age group between 1990 and
2003. In response to the 2004 spike in middle school student suicides, blame
was focused on the previously-demanded ‘black box’ warning labels on
anti-depressant medications enforced by the FDA in 2003. An NBC news report
states, “Many psychiatrists have criticized the
warnings, saying they scare people away from effective treatment and may have
contributed to an increase in suicide in recent years.”[10] While this idiotic cycle of media instigation
and public confusion played out, a deeper (darker) trend was all but ignored in
2004. Years later, after society has
caught up and the term ‘cyber bullying’ has been coined, citizens are looking
back and saying, “Mary, what year was it
do you think that all those middle school kids started getting laptops for
Christmas?” or “Goodness,
when did every 12-year-old start carrying a cell phone?” Could it have been 2003? Seems likely. The suicide spike coincides with a cell phone
industry boom and the establishment of a technology generation, a generation
born into a world filled with phenomenon such as social media, sexting and
cyberbullying. A study conducted by PureSight.com, (a website dedicated to
online child safety) supports the likelihood of a technologically-driven,
suicide increase in adolescents, saying, “Middle-school
victims of cyber bulllying are more apt to commit suicide. The AP-MTV survey
found that 8% of cyber bulllying victims (ages 10-18) and 12% of sexting
victims have considered ending their own life, compared to 3% of people (who
consider taking their lives) who have not been cyber bullied and were not
involved in sexting”. [11] With
a shocking 40% of U.S. students victimized by cyber bullying,[12] the
children of the technology generation have a bumpy adolescence ahead of them,
as they have become three to four times more likely to consider taking their
own lives.
In 2004, in the small Massachusetts town of Needham, 19-year-old Greg Gatto
began a 2-year string of four youth-suicides in the quiet suburb. On the same
tragic day Gatto took his life, so did 13-year-old Young-Chul Hong. In 2005
17-year-old Asya Leykin hung herself in her bedroom, and in early 2006
17-year-old Kyle Shapiro took his life as well. I was in 7th grade,
attending a private, Catholic, middle school in Needham the day Gatto and Hong
died. I remember solemn faces and whispers about Gatto’s suspected drug use.
The boys were so far apart in age, no one thought to make a connection between
the two, and each death was treated as an isolated tragedy. When Asya killed
herself, there were mutterings of boy-troubles, how she had been incapable of
handling the rejection of a failed, teen-age fling, how girls at that age are, “You know…like that”. The generalization insulted her memory. However, when Kyle killed himself only
6-months later, the town began to realize there was something dark running
through the community. They were no longer able to deny the pattern developing
around the town’s students. Keith O’Brien writes on the topic, “…until the fourth suicide, residents here say, there always seemed to be a
reason to turn away from the problem… With Shapiro’s death, everything changed.
“You reach a point where you can’t ignore the problem anymore, and you have to
say that it’s not a one-time thing. It’s a problem,” says Needham High School
senior Maddie Gifford. “And so, after the fourth suicide, students wanted to
see something happen. They needed a reaction from the community, the administration,
someone to acknowledge and address the problem.”[13] And
thus, it was the students themselves that stopped the “He was high on Marijuana” whispers and forced the creation of the
Needham Coalition of Suicide Prevention.
By time I entered Needham Public High School, this task force was in
full swing. In collaboration with students, teachers, and guidance counselors,
the coalition had determined that Needham students carried inordinately high
levels of stress and anxiety in direct connection with above-average parental
and societal pressure to succeed academically. This pressure was perpetuated by
a looming “keeping-up-with-the-Joneses’ vibe, especially in regard to higher
education. In Needham, its not a question of if you are going to college, its where you are going to college. The term ‘helicopter-parent’ was
introduced for those guardians who hovered above their child’s every academic
move, in an extreme attempt to ensure their child’s college acceptance to a
brand-name university. The school taught
stress-management in health class. Students were given excused class absences
to speak with school guidance councilors; it was an impressive, positive
response. O’Brien notes, “Alan Holmlund, director of the suicide prevention
program at the Massachusetts Department of Public Health, has seen towns react
to suicides but has never seen a group quite like this one before. “They could
very well be a model for other towns,” he says”[14] Unfortunately, Holmlund may have spoke too
soon as, in 2009 the popular Needham High School graduate, Jason Roberts hung
himself only a few months into his college career. While this most recent Needham, teen suicide
was tragic, the town’s reaction was admirable. Gone were the days of substance
abuse accusations, teen-hormone explanations, and concealed information. The school system assembled the students,
told them exactly what had happened, offered grief counseling to anyone in
need, and most importantly, acknowledged the connection with previous suicides
by recommending and encouraging various stress-management resources.
Here is evidence of one community that refuses to treat suicides caused by
societal trends, as anomalies. Let’s hope the rest of the U.S. follows suit and
roots out underlying suicide and depression causes, before the national suicide
rate continues to climb.
[3]
Valuck RJ, Orton HD, Libby AM.
"Europe PubMed Central." Antidepressant Discontinuation and Risk
of Suicide Attempt: A Retrospective, Nested... The Journal of Clinical
Psychiatry, n.d. Web. 16 Dec. 2012
[4]
Sebastian Schneeweiss, MD, ScD.
"Comparative Safety of Antidepressant Agents for Children and Adolescents
Regarding Suicidal Acts." US National Library of Medicine National
Institutes of Health. NCBI, n.d. Web.
[5]
"Antidepressant Use in Children,
Adolescents, and Adults." FDA. US Department of Health and Human
Services, n.d. Web. 16 Dec. 2012
[6]
"AFSP: Facts and Figures." American
Foundation for Suicide Prevention. N.p., n.d. Web. 16 Dec. 2012.
[7]
Services, Msnbc.com News. "CDC:
Suicide Rate Jumps for Kids, Young Adults." Msnbc.com. Msnbc
Digital Network, 06 Sept. 2007. Web. 16 Dec. 2012.
[8]
Fantz, Ashley. "NFL Player's
Murder-suicide Moves Us to Ask Why." CNN. Cable News Network, 03
Dec. 2012. Web. 16 Dec. 2012.
[9]
Schwarz, Alan. "N.F.L. Players
Shaken by Duerson's Suicide Message." The New York Times. The New
York Times, 21 Feb. 2011. Web. 16 Dec. 2012.
[10]
See footnote 7
[12]
see footnote 11
[14]
see footnote 13
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