The Choice of Life

We were stymied by the staggering inadequacies of our managed-care system, and we discovered that our best hope for helping Will was to become at least as well informed as the therapists treating him. For any family in the thick of a crisis, it is a lot to handle.

Teen suicide is now a public health crisis. In the years since Will's suicide attempt, I have watched it rip through families and lamented the paucity of ready solutions. Roughly 2,000 American teens between the ages of 13 and 18 attempt suicide every day. That's a stunning statistic for a society that, on the surface, has so much to offer children.

In 1999 the U. S. Surgeon General issued a report stating that 3.5 million teenagers suffered from depression. Yet 80 to 90 percent of depressed adolescents go undiagnosed and untreated. And if left untreated, depression can lead to suicide.

Stealth Candidates

When depression strikes a teenager, it often shows up in a confusing set of symptoms that are difficult to distinguish from normal adolescent behavior -- moodiness, irritability, irregular sleep patterns, drug or alcohol use, difficulties at school.

But there is another, less common but more troubling pattern of teen suicides, which occurs more often, but not exclusively, in adolescent boys. I call these the "stealth" candidates for suicide -- the kids who appear to be doing just fine, even very well. It's the type of kid my son Will appeared to be.

How often have we seen media reports of the "star athlete" or "president of the student council" or the kid voted "most likely to succeed" -- the teenager with everything going for him -- who comes home on a Saturday night, loads a gun and shoots himself? If there is a suicide note, it is vague in the extreme: "Sorry for the inconvenience." Or "I just couldn't handle stuff anymore."

This type of kid typically closets emotions while aiming at goals and self-imposed standards that are impossibly high or prompted by perceived expectations of their parents. They are loath to disappoint family and friends.

In our pressure-cooker society, how do we convince our children that nothing is as important as their health and well-being?

The first stop on the road to diagnosis is often the family pediatrician or managed care gatekeeper. Few are expert in diagnosing and treating adolescent depression.

If you are lucky enough to locate a competent therapist or psychiatrist to treat a teen (no mean feat), you need to become educated about the therapeutic options for your child and weigh the risks vs. the benefits of antidepressant medication.

As I talk with friends and families of depressed teenagers, I have concluded that parents are ill-equipped to steer their children through the rugged terrain of mental illness. Worse, we have so little confidence in our judgment that our anxiety over doing the "right thing" often results in doing nothing at all.

Sometimes families of troubled teens refuse to accept the overwhelming evidence pointing to a teenager with depression when it is right in front of them. Abusing drugs and/or alcohol, risky sexual behavior, truancy, petty larceny, self-mutilation (including "cutting" and eating disorders) -- each one of these behaviors is in its own way a cry for help. Two or more together should make alarm bells go off.