The landscape of my life has been dotted with suicides: a high school classmate soon after graduation, fathers of two friends from childhood, an exchange student with whom I chatted during cross-campus bus rides in college, a psychiatry professor and a medical school classmate.
One that really hurt was the suicide of my role model -- a man several years my senior who embodied all the traits that I hoped I might have in a medical career.
Family and friends mourned in every instance. Death was more painful than if illness or an accident had been the cause. We expressed surprise and wondered if there were anything we might have done to avert the various tragedies. Then we moved on, perhaps seeking understanding in privacy.
The suicide earlier this month of Robin Williams is especially troubling. In comedic roles, stand-up riffs and deeply serious films such as "Awakenings" and "The Fisher King," he totally engaged us. He surely had the means to obtain the best in psychiatric evaluation and therapy yet, in his final days, depression overwhelmed him.
No less upsetting are the suicides last month of two boys, ages 16 and 18, who were in state custody in the juvenile facility at Dandridge, Tenn. Details have been sparse. We do know that one boy had repeatedly been placed on suicide watches.
Each death represents the loss of decades of life expectancy and possible chances for diverse accomplishments. Various investigations regarding the circumstances of each death are underway. A public accounting of these deaths is imperative, especially to determine the availability and quality of mental health services for the two boys and all children in state custody.
In each instance of suicide we can imagine a sense of helplessness and isolation in the face of utter despair. A cherished goal may have become permanently unattainable. Alcohol may have clouded judgment and eroded hope for alternative solutions to complex problems at hand. Perhaps there is no longer strength to battle the challenge of an addiction or deal with intractable pain.
Too many critical losses -- job termination, deaths of loved ones, failed marriage or financial collapse -- may have occurred close together. Prior brain injury such as repeated concussion in collision sports or military service may have hampered judgment. A child sequestered in state custody, far removed from any semblance of home and family, will be especially vulnerable to malignant despair.
Almost 49,000 Americans took their lives last year. Half used firearms. Emergency rooms treated more than 750,000 patients for self-inflicted injury in the same interval. Suicide ranks 10th among causes of mortality in the U.S. and one-third in the age group of 12- to 19-years old.
What can you and I do to lessen this mortality?
We can bring depression out of the shadows and remove any stigma for seeking help. This means forthright discussions about the causes, recognition and therapy for depression.
We can educate ourselves on the topic of depression. I found a fresh perspective in "The Depths: the Evolutionary Origin of the Depression Epidemic" by Jonathan Rottenberg.
We can publicize and make counseling services easily accessible in schools, workplaces, and community centers.
Services of psychiatrists and clinical psychologists must be a part of all health insurance plans.
For disadvantaged persons we must have readily available, publicly supported clinics for self-referral or referral by social service and law enforcement agencies.
For incarcerated persons of all ages, but most especially children, psychiatric services must be available with no bureaucratic hurdles. Too often persons with underlying mental illness end up in the criminal justice system with no prospect of appropriate diagnosis and therapy for their situations. This and the preceding recommendation will cost money -- tax dollars. The investment is morally necessary.
Each of us may find ourselves confronted by a friend, relative or neighbor who is hurting. Our personal involvement at this point can be lifesaving.
Contact Clif Cleaveland at firstname.lastname@example.org.