No One Wants to Help Suicidal Kids, and I Was One
In honor of the book I’m working on, here's some of my personal story...
The relentless push towards evidence-based tools in psychiatry ignores a problem. It’s a big one, and the reason I’m writing a book. The problem is that there is a ton of social pressure telling clinicians not to risk helping people like who need it, with evidence-based tools. This pressure is so intense that it could make diamonds out of coal. We have every reason not to help. If you help really sick people, it puts your career in jeopardy. And that is too high-stakes for most physicians.
Our society has made a deal with the devil–abandon people suffering from suicidal ideation, so as to not have to think about it ourselves. We have created a cult of abdication of duty. We reliably scapegoat those who cross this particular river Styx. The helpers are not to be helped. Helping really sick people places a huge burden on psychiatrists, and we don’t help them with this burden. In this way, we are able to decry suicidality, and stand against death and sorrow, without the risk of contaminating ourselves by standing too close to it. What if it were a Catching Thing, we seem to be saying to ourselves? Try telling someone you’re a psychiatrist on a first date. (I have. The only person that would marry me was another psychiatrist.)
In my substack, I write as the pseudonymous narrator O. Scott Muir, M.D.—a playful nod to the late author David Foster Wallace and his character in the posthumus book The Pale King, who he named David Wallace. The reason I have that slightly absurd character, for the purposes of narration, and the reason David Foster Wallace is not the one writing this chapter, are in fact the same: suicide is a beast. It killed DFW, and I don’t use my actual name online freely anymore because of the consequences of being a doctor that takes care of suicidal kids and adults. Yep, I get stalked.
Yes, it’s creepy. No, this piece isn’t about that.1
I haven’t told this story to anybody in its entirety. Maybe one or two people have heard it, ever. In fact, other than my psychiatrist, mom, wife and editor, very few people even know the truth of this next statement:
Among the people who struggled with suicidal ideation as a child is… me.
The public does know that this is an academic topic for me. I’m the co-editor of Adolescent Suicide and Self-Injury: Mentalizing Theory and Treatment.
It’s an academic book, a guide to psychotherapy for suicidal youth (and families) using a modality— mentalization-based treatment, MBT. MBT is (frustratingly) left out of most American discussions of what might help suicidal people. What most people don’t know is that I didn’t pull that academic book together only because of abstract curiosity. I have a personal interest in the topic. The following is a bit about my “why”:
I remember watching TV when I was younger, and one of the really common shows for me to watch was Behind the Music. It was the VH1 show which was the only reason that I ever watched VH1. There was always a moment in every one of these identically structured biopics about Vanilla Ice or Milli Vanilli, and in that moment, the artist would talk about how things got so bad, at their lowest, they “even thought about suicide.”
This always struck me as absurd. The reason it was absurd to me, however, is a bit dark. I had a really hard time imagining someone only thinking about suicide once. In my childhood, I thought about suicide constantly. As far as I know, I have been thinking about suicide since about the age of four, when my mother reports that I first came to her and said “Mom, I hate myself and wanna kill myself.”
From that point on, suicidal ideation was a relatively constant companion. I wasn’t always depressed. I wasn’t always in the pits of despair. But it was a frequent occurrence. Sometimes, the thoughts were more casual. “I wonder what it would be like to…” Sometimes it was more urgent—like finding my hands around my neck at age 6 until I passed out. As a pediatric subspecialist, I would later learn that anyone who holds their breath too long will pass out, but later be fine. Sometimes, though, my suicidality was really frightening, like when I was 16 and drove at 72 miles an hour towards a telephone pole. This crash was averted by the paroxysmal “squeak squeal woooooonk squeal” of a police siren, after which I pulled over, and broke down in tears while the officer talked to me about the dangers of unsafe driving. I was breaking down because what was unsafe was my own mind, not the speed of my red Chevy Cavalier. I realized then that I had to talk to my mom about it, because I had a ticket from a cop for “speeding”.
This led to my mom making a frantic series of phone calls. My original visit was with a psychiatrist who gave me Zoloft. I woke up the next morning shaking on the floor and for the next two weeks was an utter maniac. I later learned that this was an episode of mania. The reason I had all those suicidal thoughts and brutal black paroxysmal lows was–I had bipolar disorder.
Furthermore, it was likely my mother had those genetics on her family’s side. This was determined after virtually every member of my family was enrolled in a study at the National Institutes of Mental Health. We found that a number of members of my family had had some pretty significant problems with psychiatric illness, including my grandfather, who died at the end of the noose when my father was five years old. I only recognized, literally on the day my father died, that he must’ve had post traumatic stress disorder as a result of his mother’s instructions to cut his father‘s body down from the beam upon which his corpse was hung. This beam was in the basement of the house in which he grew up. He wouldn’t move out of that house until he went to college at age 18. The trauma was ever-present. Thinking back on this now, I realize that my Dad spent a lot of time in the basement of the house in which I grew up, mostly drinking.
This family history was my inheritance. My mom struggled. My older sister, Alison Muir, died a few years back of an opiate overdose on the floor of her bathroom.
It was unclear whether this overdose was intentional or not. But it was surprising, inasmuch as she had already attempted suicide, leading to an ICU admission for a liver transplant. The liver transplant never ended up needing to happen. I was always pretty sure she was going to kill herself on purpose, not by accident. Suicide is a big deal. Of family secrets, it casts a remarkably long shadow. I’m never going to know what happened at the end of my sister’s life. Trying to figure it out would only lead to misery.
I was lucky enough (which so many are not, I now recognize) to get help that was pretty good. My mom, Vita West Muir, who began her working life as a medical editor, has for the past 40-odd years worked as a music promoter and not-for-profit Executive Director. In her Rolodex, she’s got a bunch of jazz musicians. It’s an actual literal Rolodex. The kind with paper cards. One of those paper cards had the number of Denny Zeitlin, MD. I’ve actually never referred to him with the doctoral letters before this writing. In addition to being Dr. Zeitlin, Denny, as I knew him, is a remarkably gifted jazz piano player, and both my mother and I were devotees of the jazz piano trio as a musical format. Denny is among the most gifted players and band leaders in that format, but he’s also faculty at UCSF in the department of psychiatry. Like so many parents, what most people do when they have a psychiatric crisis to deal with is they think of who in their life they can talk to about it. If they’re especially lucky, it’s someone who has any idea at all what to do. Dr. Zeitlin picked up the phone from my mom because he had played at the jazz festival she ran previously.
By the time I was 20 years old, and four years after my initial diagnosis with whatever-her-name-was that was the initial psychiatrist, Frank Ninavagi, M.D. at Yale made the definitive diagnosis of bipolar disorder. This was towards the end of my junior year at Amherst College, and frankly, much of my time there had been a struggle. I had made a fortunate decision very early on to never drink or use drugs. I still haven’t had a drink. Or used a recreational drug. This is not the easiest decision for a teenager in his first few years of college. But, as the doc at the NIMH research study I was later enrolled in said, “That was a very good decision, you would be dead otherwise.” She may have been reinforcing positive health behaviors. I also think she was correct.
Towards the end of my junior year, I had already been forced to take two extensions on finals I couldn’t finish because of depression. It was really hard to know what to do. I was taking medication every single day. But there was one key element left out of the medical process of informed consent: if you take medicine for a psychiatric illness, it should work. You should actually feel better. If it doesn’t work, you need to be prescribed a new one. Though I had taken medication for years, and frankly a lot of it (Depakote in the beginning, and more subsequently) it didn’t help. My episodes continued unabated. Though I had listened to the doctors about the risks of side effects, I didn’t have a sense of what it would feel like to get better until many years later, and no one seemed to be talking with me about this.
I wanted to die. I wanted it a lot. I thought about it all the time. I finally told my mom, and she told Dr. Zeitlin, and his advice was practical: find the best research hospital near you, find a study going on where they’re researching the problem your kid has, and enroll your kid in that study. Pronto.
I lived in Connecticut at the time, and the proximal hospital with a strong research program around bipolar disorder was Columbia University at the New York State Psychiatric Institute. There was a study running, led by Ramin Parsey, M.D., that I was suitable for. I would get free treatment for six months as part of the study. And, as Dr. Zeitlin explained to my mom, they’re going to refer Owen to someone good afterwards. They’re not “gonna let a study patient drop.”
I first read David Foster Wallace while I was in that hospital. They actually hospitalized me for the study evaluation in the summer between my junior and senior year of college, the same year in his life that David Foster Wallace would later place the action of the fiction The Pale King. The eponymous semi-lead character in that book, David Wallace, took that year off to go work at the IRS processing center in Peoria, Illinois. At that time in my life, Infinite Jest was a new book. It was really long. And, it turns out that psychiatric hospitalization, particularly when you’re not actually that cripplingly ill at the time, but instead need to get a series of tests done for a study, is really boring. So having a nice long book by an engaging author like David Foster Wallace was a great way to pass the time. This was the year 1999. Notably, psychiatric hospitals, to this day, are more or less still in the 90s. No phones, no computers, no internet. It’s just you and a book and maybe other patients to talk to you. I didn’t know it then, of course, but I had treatment with some of the stars of the field, including receiving a lumbar puncture at age 20 from J. John Mann, M.D. I subsequently received six months of care from Dr. Maria Oquendo, who was among the most prominent researchers in suicide and bipolar disorder. She ran the general psychiatry residency program at Columbia (which chose not to interview me when I applied there for my future medical residency. Not that I’m sore about that or anything). She was the president of the American Psychiatric Association. She’s submitted a panel at SXSW with my colleague Dr. David Mou about working with suicidal patients just this past year (2022). It’s kind of bizarre to think that the person who came up with the suicide rating scale I was evaluated with was the same person I saw for that problem, but that’s the case. I suspect that many of the patients I’ve seen, some of whom have since become mental health professionals, and even MDs thereafter, think of me in much the same way.
To be continued…
My stalker reads the Substack. I am going to address this issue to her for a minute: I have asked you not to stalk me. I’m putting this, again, in writing. Do not subscribe to the Substack. You’ve been blocked already. Continuing to harass someone after they have blocked you, and told you to stop in writing, and via legal council, is stalking.