Tagged Suicides and Suicide Attempts

How Meghan Markle Has Already Changed the Way We Talk About Suicide

How Meghan Markle Has Already Changed the Way We Talk About Suicide

Meghan’s decision to speak openly about her suicidal thoughts challenges a culture of secrecy that has stopped many people from seeking or offering help.

Credit…Neil Hall/EPA, via Shutterstock

  • March 9, 2021, 10:21 a.m. ET

To many people, suicide is unspeakable. Even mental health professionals sometimes do verbal gymnastics to avoid saying the word.

That’s why Meghan Markle’s decision to talk openly about her suicidal thoughts in her interview with Oprah Winfrey has the potential to change the way we all talk about suicide. By speaking about her experiences, Meghan helped chip away at the stigma that constrains people from disclosing their suicidal thoughts. Her disclosure also educates others about the universality of suicide risk. Nobody is immune, whether they live in a palace or in poverty.

But many people keep suicidal thoughts to themselves, while friends, family and even mental health professionals often don’t ask those in distress if they’re considering suicide. In my work as a psychotherapist and suicidologist, I train mental health professionals and students how to interview people to assess suicide risk. Professionals with decades of experience have told me they don’t dare ask a client with depression or other major risk factors if they’re thinking of suicide.

More than one therapist has told me something like, “I don’t want to give them the idea” or, “If they’re thinking of suicide, they’ll tell me.”

It’s a myth that talking about suicide gives somebody the idea. Research consistently shows that asking somebody about suicide, even several times a day, doesn’t cause or increase suicidal thoughts. Even among children, by the third grade most kids already have a clear sense of what suicide is on their own.

It’s also a myth that most people will admit they’re considering suicide if asked directly. Many people don’t answer honestly because of embarrassment, fears of being hospitalized against their will, fears of being judged, fears that they can’t be helped or a desire not to worry others.

At first, Meghan didn’t speak directly about suicide, either. In her interview with Ms. Winfrey, she described how trapped, maligned and miserable she felt in her royal role, one that she said engendered racist attacks in the media based on her heritage. (Her mother is African-American, and her father is white.)

“I just didn’t see a solution,” she told Ms. Winfrey. “But I knew that if I didn’t say it that I would do it — and I just didn’t want to be alive anymore. And that was a very clear and real and frightening constant thought.”

“I would do it.” That’s what she said — not, “I would kill myself” or “I would end my life.” Simply, “it.” Ms. Winfrey had to say outright, “So, were you thinking of harming yourself? Were you having suicidal thoughts?”

“Yes,” Meghan said, “this was very, very clear.”

Later, we learned just how clear it was. She recalled what she told her husband: “It was like, these are the thoughts that I’m having in the middle of the night that are very clear, and I’m scared, because this is very real. This isn’t some abstract idea. This is methodical, and this is not who I am.”

Meghan said she asked a senior member of the royal family about the possibility of being hospitalized for her mental health problems but said that this person refused in order to protect the family’s image. She said she was too scared to be left alone, worried that she might end her life. So she confided in Prince Harry, who supported her emotionally but didn’t share the extent of her troubles with his family.

“I guess I was ashamed of admitting it to them, and I don’t know whether they’ve had the same feelings or thoughts,” he told Ms. Winfrey. “I have no idea. It’s a very trapping environment that a lot of them are stuck in.”

This is why Meghan’s disclosure is a gift to so many strangers. You don’t have to be royalty to be trapped into silence. According to one 2015 study, almost 10 million American adults had seriously considered suicide during the previous year; a 2019 survey found that almost one in five high school students had such thoughts. Despite the relatively high prevalence of suicidal thoughts, fewer than half of people experiencing them tell a friend or family member. Among those who died by suicide between 2000 and 2017, only about one in three had seen a therapist or psychiatrist in the past year.

Some people may be concerned that Meghan’s disclosures could trigger other vulnerable individuals to view suicide as, to use her word, a “solution.” Indeed, research indicates that knowing someone who died by suicide or who attempted suicide is linked to increased risk of suicide. When a celebrity dies by suicide, suicide rates increase slightly in the month following their death.

Yes, contagion can occur after a suicide, but hope is also contagious.

Hearing stories of people resisting suicidal thoughts without acting on them has been linked to decreases in suicide rates. Perhaps tales of recovery can inspire hope and healing.

The tragedy of the silence around suicide isn’t only that people suffer alone. It’s also that they rarely hear the stories of those who have been suicidal and survived. Research indicates that almost half of people say they know someone who died by suicide. Though this hasn’t been studied, far more people likely know someone who has recovered from suicidal thoughts, since roughly 240 times more people consider suicide in a given year than die by it.

Meghan’s story is one of recovery. Near the end of the interview, she credited her husband with saving her life, because of his willingness to step away from the royal family. By sharing her story, she demonstrates that confiding in a loved one, problem-solving with him and making changes in her life took her off the path to suicide.

By encouraging more openness about suicidal thoughts, like Meghan’s, we can send the message to others that they are not alone, that change is possible and that people do make it out alive. I’m one of those people. I attempted suicide twice in my 20s. For two decades, I kept my story secret from all but a few people. Now I share my story openly as an act of defiance against stigma.

Here are some ways to weaken the walls of silence around suicide:

  • Name it. Ask the question, “Are you having thoughts of suicide?” or “Do you have thoughts of ending your life?” If you are nervous, couch the question: “A lot of people who feel the way you’re describing think of suicide. Do you think of killing yourself?”

  • Frame suicidal thoughts as the mind’s understandable attempt to stop hurting. This can help alleviate shame or embarrassment. For example, you might say, “It makes sense that that’s where your mind goes. We’re biologically wired to avoid pain. But there are other ways to stop the pain, and let’s brainstorm those.” You can empathize with the suicidal wish without validating suicide as an option.

  • Don’t panic. Don’t call 911 unless the person is clearly in danger of acting on suicidal thoughts this instant. Don’t respond with clichés, false encouragement or guilt.

  • Respond with curiosity, not judgment. Ask questions that invite the person to tell their story. “Tell me more.” “What’s happening that’s made you feel so bad?”

  • Connect. Offer emotional support, and help the person find professional help.

There is hope. Most people with suicidal thoughts don’t make an attempt. Of those who make an attempt and survive, most don’t go on to die by suicide. Almost always, life can get better.

As Meghan said: “I’m still standing. My hope for people in the takeaway from this is to know that there’s another side, to know that life is worth living.”

If you are having thoughts of suicide, call the National Suicide Prevention Lifeline at 1-800-273-8255 (TALK) or go to SpeakingOfSuicide.com/resources for a list of additional resources.


Stacey Freedenthal is a psychotherapist and an associate professor at the University of Denver Graduate School of Social Work.

Signs Someone May Be Suicidal

Signs Someone May Be Suicidal

Olivier Douliery/Agence France-Presse — Getty Images

Meghan Markle revealed in her interview with Oprah Winfrey on Sunday that life as a royal had made her suicidal.

If you think someone you know might want to end their life, here’s what to look for →

For Some Teens, It’s Been a Year of Anxiety and Trips to the E.R.

For Some Teens, It’s Been a Year of Anxiety and Trips to the E.R.

During the pandemic, suicidal thinking is up. And families find that hospitals can’t handle adolescents in crisis.

Lisa, a mother of three in Asheville, N.C., said that months of virtual classes and social isolation had changed her extroverted 13-year-old son “in profound ways I would never have anticipated.”
Lisa, a mother of three in Asheville, N.C., said that months of virtual classes and social isolation had changed her extroverted 13-year-old son “in profound ways I would never have anticipated.”Credit…Jacob Biba for The New York Times
Benedict Carey

  • Published Feb. 23, 2021Updated Feb. 24, 2021, 5:00 a.m. ET

When the pandemic first hit the Bay Area last spring, Ann thought that her son, a 17-year-old senior, was finally on track to finish high school. He had kicked a heavy marijuana habit and was studying in virtual classes while school was closed.

The first wave of stay-at-home orders shut down his usual routines — sports, playing music with friends. But the stability didn’t last.

“The social isolation since then, over all this time, it just got to him,” said Ann, a consultant living in suburban San Francisco. She, like the other parents in this article, asked that her last name be omitted for privacy and to protect her child. “This is a charming, funny kid, also sensitive and anxious,” she said. “He couldn’t find a job; he couldn’t really go out. And he started using marijuana again, and Xanax.”

The teenager’s frustration finally boiled over this month, when he deliberately cut himself.

“We called 911, and he was taken to the emergency room,” his mother said. “But there they just stitched him up and released him.” The doctors sent him home, she said, “with no support, no therapy, nothing.”

Ann and her son are like many families over the last year. Surveys and statistics show that for young people who are anxious by nature, or feeling emotionally fragile already, the pandemic and its isolation have pushed them to the brink. Rates of suicidal thinking and behavior are up by 25 percent or more from similar periods in 2019, according to a just-published analysis of surveys of young patients coming into the emergency room.

For these teenagers, there aren’t many places to turn. They need help, but it’s hard to come up with a psychiatric diagnosis. They are trying to manage a surprise interruption in their lives, a vague loss. And without a diagnosis, reimbursement for therapy is hard to come by. And that is assuming parents know what kind of help is appropriate, and where to find it.

Finally, when a crisis hits, many of these teenagers end up in the local emergency department — the one place desperate families so often go for help.

Many E.R. departments across the country are now seeing a surge in such cases. Through most of 2020, the proportion of pediatric emergency admissions for mental problems, like panic and anxiety, was up by 24 percent for young children and 31 percent for adolescents compared to the previous year, according to a recent report by the Centers for Disease Control and Prevention.

And the local emergency department is frequently unprepared for the added burden. Workers often are not specially trained to manage behavioral problems, and families don’t have many options for where to go next, leaving many of these pandemic-insecure adolescents in limbo at the E.R.

“This is a national crisis we’re facing,” Dr. Rebecca Baum, a developmental pediatrician in Asheville, N.C. “Kids are having to board in the E.R. for days on end, because there are no psychiatric beds available in their entire state, never mind the hospital. And of course, the child or adolescent is lying there and doesn’t understand what’s happening in the E.R., why they’re having to wait there or where they’re going.”

What Adolescents Are Feeling

Most teenagers and young adults have done fine through this pandemic year, provided that their families have stayed healthy and economically stable. They may be irritable or missing their friends, but their support networks have been enough to get them through the pandemic.

For the young people coming undone, however, pandemic life presents unusual challenges, pediatricians say. Most are temperamentally sensitive and after months of being socially cut off from friends and activities, they have much less control over their moods.

“What parents and children are consistently reporting is an increase in all symptoms — a child who was a little anxious before the pandemic became very anxious over this past year,” said Dr. Adiaha I. A. Spinks-Franklin, an associate professor of pediatrics at the Baylor College of Medicine. It is this prolonged stress, Dr. Spinks-Franklin said, that in time blunts the brain’s ability to manage emotions.

Jean, an artist and mother of two living in Hendersonville, N.C., said that her 17-year-old son was doing fine through last spring. But the months of virtual classes and loss of simple social pleasures — hanging out with friends, playing chess — changed him through the fall months.

“Now, he’s become very reclusive, he has mood swings, he cries a lot,” Jean said. “This giant boy, crying — it’s terrible to see.” The young man has had panic attacks, twice followed by a blackout. During one, he fell and injured his face.

Dr. Adiaha I. A. Spinks-Franklin, an associate professor of pediatrics at the Baylor College of Medicine, says it’s the prolonged stress that blunts the brain’s ability to manage emotions.
Dr. Adiaha I. A. Spinks-Franklin, an associate professor of pediatrics at the Baylor College of Medicine, says it’s the prolonged stress that blunts the brain’s ability to manage emotions.Credit…Brett Deering for The New York Times

Lisa, a mother of three in Asheville, said that the months of virtual classes and relative social isolation had changed her extroverted 13-year-old son “in profound ways I would never have anticipated.”

His grades slipped badly, and he began to withdraw. “Next, he was telling us he couldn’t make himself do the work, that he didn’t want to disappoint us all the time, that he was worthless. Worthless.”

These young people do not necessarily qualify for a psychiatric diagnosis, nor are they “traumatized” in the strict sense of having had a life-threatening experience (or the perception of one.) Rather, they are trying to manage an interruption in their normal development, child psychologists say: a sudden and indefinite suspension of almost every routine and social connection, leaving a deep yet vague sense of loss with no single, distinct source.

The result is grief, but grief without a name or a specific cause, an experience some psychologists call “ambiguous loss.” The concept is usually reserved to describe the experience of immigrants, displaced from everything familiar, who shut down emotionally in a new and strange country. Or to describe disaster survivors, who return to neighborhoods that are hollowed out, transformed.

“Everything that used to be familiar and give structure to their lives, and predictability, and normalcy, is gone,” said Sharon Young, a therapist in Hendersonville. “Kids need all these things even more than adults do, and it’s hard for them to feel emotionally safe when they’re no longer there.”

System Overload

The resulting changes in behavior can seem sudden: A bright sixth-grader is found cutting herself; a sweet-natured sophomore takes a swing at a parent or sibling. Parents, frightened, often don’t know where to go for appropriate help. Many don’t have the resources or knowledge to hire a therapist.

Families that land in the emergency departments of their local hospitals often find that the clinics are poorly equipped to handle these incoming cases. The staff is better trained to manage physical trauma than the mental variety, and patients are often sent right back home, without proper evaluation or support. In severe cases, they may linger in the emergency department for days before a bed can be found elsewhere.

In a recent report, a research team led by the C.D.C. found that less than half of the emergency departments in U.S. hospitals had clear policies in place to handle children with behavior problems. Getting to the bottom of any complex behavior issue can takes days of patient observation, at minimum, psychiatrists say. And many emergency departments do not have the on-hand specialists, dedicated space or off-site resources to help do the job well.

For Jean, diagnosing her son has been complicated. He has since developed irritable bowel syndrome. “He has been losing weight, and started smoking pot due to the boredom,” Jean said. “This is all due to the anxiety.”

Nationwide Children’s Hospital in Columbus, Ohio, has an emergency department that is a decent size for a pediatric hospital, with capacity for 62 children or adolescents. But well before the arrival of the coronavirus, the department was straining to handle increasing numbers of patients with behavior problems.

“This was huge problem pre-pandemic,” said Dr. David Axelson, chief of psychiatry and behavioral health at the hospital. “We were seeing a rise in emergency department visits for mental health problems in kids, specifically for suicidal thinking and self-harm. Our emergency department was overwhelmed with it, having to board kids on the medical unit while waiting for psych beds.”

Last March, to address the crowding, Nationwide Children’s opened a new pavilion, a nine-story facility with 54 dedicated beds for observation and for longer-term stays for those with mental challenges. It has taken the pressure off the hospital’s regular emergency department and greatly improved care, Dr. Axelson said.

Over this pandemic year, with the number of admissions for mental health problems up by some 15 percent over previous years, it is hard to imagine what it would have been like without the additional, devoted behavioral clinic, Dr. Axelson said.

Other hospitals from out of state often call, hoping to place a patient in crisis, but there is simply not enough space. “We have to say no,” Dr. Axelson said.

“We had a shaky system of care in pediatric mental health prior to this pandemic, and now we have all these added stressors on it,” said  Dr. Rebecca Baum, a developmental pediatrician in Asheville, N.C.Credit…Jacob Biba for The New York Times

Dr. Rachel Stanley, the chief of emergency medicine at Nationwide, said that most hospitals have far fewer resources. “I worked at a hospital in Michigan for years, and when these kinds of kids come in, everyone dreaded seeing them, because we didn’t feel like we had the tools to help,” she said. “They have to go into a safe room; they can’t be in a shared area. You have to provide a sitter for the child, a staff person to stay with them all the time to make sure they’re not suicidal or homicidal. It could take hours and hours to get social workers involved, and all this time they’re getting worse.”

Anne, the consultant in the Bay Area, said that her son’s visit to the emergency room this month was his third in the past 18 months, each time for issues related to drug withdrawal. On one visit, he was misdiagnosed with psychosis and sent to a locked county psychiatric ward. “That experience itself — locked for days in a ward, with no one telling him why, or how long he’d be there — was the most traumatic thing he’s experienced,” she said.

Like many other parents, she is now looking after an unstable child and wondering where to go next. A drug rehab program may be needed, as well as regular therapy.

Lisa has hired a therapist for her son, a Zoom session every other week. That seems to have helped, she said, but it is too early to tell. And Jean, for the moment, is hoping the infection risk will diminish soon, so her son can get a safe job.

All three parents have become keen observers of their children, more aware of shifting moods. Listening by itself usually helps relieve distress, therapists say. “Trying to educate parents is a routine part of the job,” said Dr. Robert Duffey, a pediatrician in Hendersonville. “And of course we need these kids back in school, so badly.”

But medical professional say that until the health care system finds a way to equip and support emergency departments for what they have become — the first and sometimes last resort — parents will be left to navigate mostly on their own, leaning on others who have managed similar problems.

“Covid has put our system under a microscope in terms of the things that don’t work,” said Dr. Baum, the pediatrician in Asheville. “We had a shaky system of care in pediatric mental health prior to this pandemic, and now we have all these added stressors on it, all these kids coming in for pandemic-related issues. Hospitals everywhere are scrambling to adjust.”

If you are having thoughts of suicide, call the National Suicide Prevention Lifeline at 1-800-273-8255 (TALK). You can find a list of additional resources at SpeakingOfSuicide.com/resources.

For Some Teens, It’s Been a Year of Anxiety and Trips to the E.R.

For Some Teens, It’s Been a Year of Anxiety and Trips to the E.R.

During the pandemic, suicidal thinking is up. And families find that hospitals can’t handle adolescents in crisis.

Lisa, a mother of three in Asheville, N.C., said that months of virtual classes and social isolation had changed her extroverted 13-year-old son “in profound ways I would never have anticipated.”
Lisa, a mother of three in Asheville, N.C., said that months of virtual classes and social isolation had changed her extroverted 13-year-old son “in profound ways I would never have anticipated.”Credit…Jacob Biba for The New York Times
Benedict Carey

  • Feb. 23, 2021, 3:48 p.m. ET

When the pandemic first hit the Bay Area last spring, Ann thought that her son, a 17-year-old senior, was finally on track to finish high school. He had kicked a heavy marijuana habit and was studying in virtual classes while school was closed.

The first wave of stay-at-home orders shut down his usual routines — sports, playing music with friends. But the stability didn’t last.

“The social isolation since then, over all this time, it just got to him,” said Ann, a consultant living in suburban San Francisco. She, like the other parents in this article, asked that her last name be omitted for privacy and to protect her child. “This is a charming, funny kid, also sensitive and anxious,” she said. “He couldn’t find a job; he couldn’t really go out. And he started using marijuana again, and Xanax.”

The teenager’s frustration finally boiled over this month, when he deliberately cut himself.

“We called 911, and he was taken to the emergency room,” his mother said. “But there they just stitched him up and released him.” The doctors sent him home, she said, “with no support, no therapy, nothing.”

Ann and her son are like many families over the last year. Surveys and statistics show that for young people who are anxious by nature, or feeling emotionally fragile already, the pandemic and its isolation have pushed them to the brink. Rates of suicidal thinking and behavior are up by 25 percent or more from similar periods in 2019, according to a just-published analysis of surveys of young patients coming into the emergency room.

For these teenagers, there aren’t many places to turn. They need help, but it’s hard to come up with a psychiatric diagnosis. They are trying to manage a surprise interruption in their lives, a vague loss. And without a diagnosis, reimbursement for therapy is hard to come by. And that is assuming parents know what kind of help is appropriate, and where to find it.

Finally, when a crisis hits, many of these teenagers end up in the local emergency department — the one place desperate families so often go for help.

Many E.R. departments across the country are now seeing a surge in such cases. Through most of 2020, the proportion of pediatric emergency admissions for mental problems, like panic and anxiety, was up by 24 percent for young children and 31 percent for adolescents compared to the previous year, according to a recent report by the Centers for Disease Control and Prevention.

And the local emergency department is frequently unprepared for the added burden. Workers often are not specially trained to manage behavioral problems, and families don’t have many options for where to go next, leaving many of these pandemic-insecure adolescents in limbo at the E.R.

“This is a national crisis we’re facing,” Dr. Rebecca Baum, a developmental pediatrician in Asheville, N.C. “Kids are having to board in the E.R. for days on end, because there are no psychiatric beds available in their entire state, never mind the hospital. And of course, the child or adolescent is lying there and doesn’t understand what’s happening in the E.R., why they’re having to wait there or where they’re going.”

What Adolescents Are Feeling

Most teenagers and young adults have done fine through this pandemic year, provided that their families have stayed healthy and economically stable. They may be irritable or missing their friends, but their support networks have been enough to get them through the pandemic.

For the young people coming undone, however, pandemic life presents unusual challenges, pediatricians say. Most are temperamentally sensitive and after months of being socially cut off from friends and activities, they have much less control over their moods.

“What parents and children are consistently reporting is an increase in all symptoms — a child who was a little anxious before the pandemic became very anxious over this past year,” said Dr. Adiaha I. A. Spinks-Franklin, an associate professor of pediatrics at the Baylor College of Medicine. It is this prolonged stress, Dr. Spinks-Franklin said, that in time blunts the brain’s ability to manage emotions.

Jean, an artist and mother of two living in Hendersonville, N.C., said that her 17-year-old son was doing fine through last spring. But the months of virtual classes and loss of simple social pleasures — hanging out with friends, playing chess — changed him through the fall months.

“Now, he’s become very reclusive, he has mood swings, he cries a lot,” Jean said. “This giant boy, crying — it’s terrible to see.” The young man has had panic attacks, twice followed by a blackout. During one, he fell and injured his face.

Dr. Adiaha I. A. Spinks-Franklin, an associate professor of pediatrics at the Baylor College of Medicine, says it’s the prolonged stress that blunts the brain’s ability to manage emotions.
Dr. Adiaha I. A. Spinks-Franklin, an associate professor of pediatrics at the Baylor College of Medicine, says it’s the prolonged stress that blunts the brain’s ability to manage emotions.Credit…Brett Deering for The New York Times

Lisa, a mother of three in Asheville, said that the months of virtual classes and relative social isolation had changed her extroverted 13-year-old son “in profound ways I would never have anticipated.”

His grades slipped badly, and he began to withdraw. “Next, he was telling us he couldn’t make himself do the work, that he didn’t want to disappoint us all the time, that he was worthless. Worthless.”

These young people do not necessarily qualify for a psychiatric diagnosis, nor are they “traumatized” in the strict sense of having had a life-threatening experience (or the perception of one.) Rather, they are trying to manage an interruption in their normal development, child psychologists say: a sudden and indefinite suspension of almost every routine and social connection, leaving a deep yet vague sense of loss with no single, distinct source.

The result is grief, but grief without a name or a specific cause, an experience some psychologists call “ambiguous loss.” The concept is usually reserved to describe the experience of immigrants, displaced from everything familiar, who shut down emotionally in a new and strange country. Or to describe disaster survivors, who return to neighborhoods that are hollowed out, transformed.

“Everything that used to be familiar and give structure to their lives, and predictability, and normalcy, is gone,” said Sharon Young, a therapist in Hendersonville. “Kids need all these things even more than adults do, and it’s hard for them to feel emotionally safe when they’re no longer there.”

System Overload

The resulting changes in behavior can seem sudden: A bright sixth-grader is found cutting herself; a sweet-natured sophomore takes a swing at a parent or sibling. Parents, frightened, often don’t know where to go for appropriate help. Many don’t have the resources or knowledge to hire a therapist.

Families that land in the emergency departments of their local hospitals often find that the clinics are poorly equipped to handle these incoming cases. The staff is better trained to manage physical trauma than the mental variety, and patients are often sent right back home, without proper evaluation or support. In severe cases, they may linger in the emergency department for days before a bed can be found elsewhere.

In a recent report, a research team led by the C.D.C. found that less than half of the emergency departments in U.S. hospitals had clear policies in place to handle children with behavior problems. Getting to the bottom of any complex behavior issue can takes days of patient observation, at minimum, psychiatrists say. And many emergency departments do not have the on-hand specialists, dedicated space or off-site resources to help do the job well.

For Jean, diagnosing her son has been complicated. He has since developed irritable bowel syndrome. “He has been losing weight, and started smoking pot due to the boredom,” Jean said. “This is all due to the anxiety.”

Nationwide Children’s Hospital in Columbus, Ohio, has an emergency department that is a decent size for a pediatric hospital, with capacity for 62 children or adolescents. But well before the arrival of the coronavirus, the department was straining to handle increasing numbers of patients with behavior problems.

“This was huge problem pre-pandemic,” said Dr. David Axelson, chief of psychiatry and behavioral health at the hospital. “We were seeing a rise in emergency department visits for mental health problems in kids, specifically for suicidal thinking and self-harm. Our emergency department was overwhelmed with it, having to board kids on the medical unit while waiting for psych beds.”

Last March, to address the crowding, Nationwide Children’s opened a new pavilion, a nine-story facility with 54 dedicated beds for observation and for longer-term stays for those with mental challenges. It has taken the pressure off the hospital’s regular emergency department and greatly improved care, Dr. Axelson said.

Over this pandemic year, with the number of admissions for mental health problems up by some 15 percent over previous years, it is hard to imagine what it would have been like without the additional, devoted behavioral clinic, Dr. Axelson said.

Other hospitals from out of state often call, hoping to place a patient in crisis, but there is simply not enough space. “We have to say no,” Dr. Axelson said.

“We had a shaky system of care in pediatric mental health prior to this pandemic, and now we have all these added stressors on it,” said  Dr. Rebecca Baum, a developmental pediatrician in Asheville, N.C.Credit…Jacob Biba for The New York Times

Dr. Rachel Stanley, the chief of emergency medicine at Nationwide, said that most hospitals have far fewer resources. “I worked at a hospital in Michigan for years, and when these kinds of kids come in, everyone dreaded seeing them, because we didn’t feel like we had the tools to help,” she said. “They have to go into a safe room; they can’t be in a shared area. You have to provide a sitter for the child, a staff person to stay with them all the time to make sure they’re not suicidal or homicidal. It could take hours and hours to get social workers involved, and all this time they’re getting worse.”

Anne, the consultant in the Bay Area, said that her son’s visit to the emergency room this month was his third in the past 18 months, each time for issues related to drug withdrawal. On one visit, he was misdiagnosed with psychosis and sent to a locked county psychiatric ward. “That experience itself — locked for days in a ward, with no one telling him why, or how long he’d be there — was the most traumatic thing he’s experienced,” she said.

Like many other parents, she is now looking after an unstable child and wondering where to go next. A drug rehab program may be needed, as well as regular therapy.

Lisa has hired a therapist for her son, a Zoom session every other week. That seems to have helped, she said, but it is too early to tell. And Jean, for the moment, is hoping the infection risk will diminish soon, so her son can get a safe job.

All three parents have become keen observers of their children, more aware of shifting moods. Listening by itself usually helps relieve distress, therapists say. “Trying to educate parents is a routine part of the job,” said Dr. Robert Duffey, a pediatrician in Hendersonville. “And of course we need these kids back in school, so badly.”

But medical professional say that until the health care system finds a way to equip and support emergency departments for what they have become — the first and sometimes last resort — parents will be left to navigate mostly on their own, leaning on others who have managed similar problems.

“Covid has put our system under a microscope in terms of the things that don’t work,” said Dr. Baum, the pediatrician in Asheville. “We had a shaky system of care in pediatric mental health prior to this pandemic, and now we have all these added stressors on it, all these kids coming in for pandemic-related issues. Hospitals everywhere are scrambling to adjust.”

If you are having thoughts of suicide, call the National Suicide Prevention Lifeline at 1-800-273-8255 (TALK). You can find a list of additional resources at SpeakingOfSuicide.com/resources.

How to Help When Adolescents Have Suicidal Thoughts

Credit…Grace J Kim

The Checkup

How to Help When Adolescents Have Suicidal Thoughts

Even when rates of suicidal ideation increase, there are ways to keep kids safe.

Credit…Grace J Kim

  • Feb. 6, 2021, 5:00 a.m. ET

With some evidence suggesting that more adolescents have been reporting suicidal thoughts during the pandemic, experts and parents are looking for ways to help.

One issue is that the Centers for Disease Control and Prevention has not yet compiled and released statistics on suicide deaths, so it’s not clear whether the problem is worse than usual. But there are questions about whether suicide risks are increasing — especially in particular communities, like the Black and brown populations that have been hit hardest by the pandemic.

Even during normal times, many mental health problems tend to emerge in adolescence, and young people in this group are particularly vulnerable to social isolation. In Las Vegas, an increase in the number of student suicides during the pandemic spurred the superintendent’s recent decision to reopen schools.

“We don’t have the data to know the relationship of suicidality in children and youth and the Covid epidemic,” said Dr. Cynthia Pfeffer, a professor of psychiatry at Weill Cornell Medical Center who has worked extensively on grieving and bereavement in children and adolescents. “The tremendous stress for families might make a child feel like they need to get out, or feel depressed.”

During the early months of the pandemic, there may have been some sense of common purpose — the kind of spirit that can increase people’s resilience after a disaster. In a research letter published on the JAMA network in late January, researchers compared internet searches related to suicide during the two months before and four months after March of 2020, when the United States declared a national pandemic emergency. Searches using the term “suicide” went down significantly in the 18 weeks after the emergency was declared, compared with what was predicted.

In a new study in the journal Pediatrics, researchers looked at the results of more than 9,000 suicide screenings that had been performed on 11- to 21-year-olds who had visited a pediatric emergency department in Texas. Everyone coming in, for any reason, was asked to complete a questionnaire which asked, among other things, about suicidal thoughts or suicide attempts in the recent past.

The researchers compared the responses from the first seven months of 2019 with those from the same months in 2020. They wanted to see if there was evidence of more suicide-related thoughts and behaviors between March and July of 2020 as the pandemic took hold. Ryan Hill, an assistant professor of pediatrics at Baylor College of Medicine who was first author on the study, said that his team expected that while in January and February, the pandemic would not have been on people’s minds, “we expected to see some differences later — and we did see some, but they were not consistent.”

Dr. Hill and his team found higher rates of suicidal thoughts in some, but not all, months of 2020. “In March and July, the rate of ideation was substantially higher than in 2019,” Dr. Hill said. “Something’s going on — we interpret it as due to the pandemic, though other things were going on in 2020.”

Dr. Christine Moutier, the chief medical officer at the American Foundation for Suicide Prevention, emphasized that even when rates of suicidal ideation increase, suicide rates do not have to rise.

“I think it is terrific that there is more universal screening going on; it represents an opportunity to employ some of the evidence-based strategies that we know can help,” she said.

In a comment published in JAMA Psychiatry last October, Dr. Moutier wrote about how important it is to prioritize suicide prevention during the pandemic. She included several strategies for health care providers, communities, government, and also friends and family to do just that, with some designed to improve social connections by taking advantage of technologies for virtual check-ins and visits. Her foundation also recently released a statement on what parents can do to protect children’s mental health during remote learning.

“Now more than any other time is a time for parents, for any adults who work with adolescents and youth, to be paying attention to the well-being of all adolescents,” Dr. Moutier said. “It’s really a time to be checking in.”

Parents should think about the different ways adolescents might respond to stress, said Dr. Rebecca Leeb, a health scientist at the Centers for Disease Control and Prevention who led a team on emotional well-being and mental health in the pandemic. Perhaps they are withdrawing and sleeping more; eating more or less; or trying drugs, alcohol or tobacco.

Parents can encourage their teenagers to get out of the house and to use the right safety measures — masks, hand-washing, distancing — so that they can spend time outside with friends. She emphasized that “social interaction” is important, whether that’s “exercise or drawing or hiking or taking the dog for a walk.” Kids take cues from their parents, she added, so adults should do those things as well.

It’s also important to make sure that your own mental health is taken care of before you “jump in and start checking in on your kid’s mental health,” Dr. Moutier said. Find moments to relax and laugh, she said, and make sure to talk about how you’re maintaining your own wellness and resilience, so that you can acknowledge and model the importance of those coping strategies for your kids.

Checking in with your kids might also give them an opportunity to open up, said Dr. Moutier, which, for many families, is something that they used to do in the car.

“Our children will feel loved and cared for if we’re practicing that kind of dialogue,” she said. “Do not shy away from asking the deeper, harder questions.” Dr. Moutier recommended being curious about your teenager’s world, asking things like, “How is that situation at school affecting you and your friends?”

Laura Anthony, a child psychologist at Children’s Hospital Colorado and an associate professor at the University of Colorado School of Medicine, said that one common mistake that even she sometimes makes is trying to solve a child’s problems. “What I need to do is just listen,” she said.

She works as the co-leader of the hospital’s youth action board, and teenagers with mental health histories compiled suggestions about how they would like their parents to help. One suggestion: Don’t assume that your kids are struggling all the time, Dr. Anthony said. Instead, consider questions like, “What’s taking up your head space?” Or, “What are you grateful for?”

[Click here for more of the Children’s Hospital Colorado teenagers’ advice on helping teens through the pandemic.]

Another suggestion: Parents should not discipline kids by taking away their phones. “Our teens say, this is not the time for a lot of punishment, you need to give us encouragement, help us have fun,” Dr. Anthony said, “and taking away the phone is really like taking away a lifeline.”

We need better data on mental health, Dr. Leeb said, and on well-being and quality of life. “We are learning a great deal,” she said. “I personally am hopeful for the future,” adding that she’s had several discussions with her children (who are 11, 15 and almost 18) about what the future looks like.

Ask teenagers, “How is this time affecting you?” Dr. Moutier said, and if they are experiencing any kind of struggle. And make it clear that no challenges are insurmountable, she said, “those are really important words for parents to say.”

Giving kids a sense of agency is also vital, said Dr. Sarah Vinson, an associate professor of psychiatry and pediatrics at Morehouse School of Medicine. “Think how kids can be part of the solution,” she said, whether that’s encouraging them to do volunteer work, or helping them understand that concrete steps, like wearing masks, can play a vital role in “reclaiming our day-to-day lives from this pandemic.”

If you’re concerned that your child is depressed or anxious, or if an adolescent talks about feeling overwhelmed, Dr. Anthony suggested asking directly, “Are you having any thoughts of suicide?” You don’t need to ask them every day, but if you’re having any concerns, you should definitely ask.

“Help is out there and it works,” Dr. Anthony said, pointing to the increased availability of virtual mental health services. “Suicidality is partly not being able to see the future,” she said. “If we can change that, we can see remarkable changes.”

Much as the hardships of the Great Depression and World War II forged what is known as “the Greatest Generation,” she said the challenges of the pandemic could strengthen today’s young people.

“I think we are going to have a generation of really remarkably resilient kids and teens who grow up to be really remarkable human beings as adults.”

If you are having thoughts of suicide, call the National Suicide Prevention Lifeline at 1-800-273-8255 (TALK). You can find a list of additional resources at SpeakingOfSuicide.com/resources.

Doctors, Facing Burnout, Turn to Self-Care

Dr. Michelle Thompson, a family medicine physician in Ohio, had to convert to seeing her patients via telemedicine overnight.
Dr. Michelle Thompson, a family medicine physician in Ohio, had to convert to seeing her patients via telemedicine overnight.Credit…Dustin Franz for The New York Times

Doctors, Facing Burnout, Turn to Self-Care

A growing number of programs aim to help doctors, nurses and medical students who are struggling with mental health issues during the pandemic.

Dr. Michelle Thompson, a family medicine physician in Ohio, had to convert to seeing her patients via telemedicine overnight.Credit…Dustin Franz for The New York Times

  • Jan. 26, 2021, 5:00 a.m. ET

Dr. Michelle Thompson knows a lot about self-care. A family medicine physician in Vienna, Ohio, she specializes in lifestyle and integrative care, using both conventional and alternative therapies to help her patients heal. She also teaches medical personnel how to prevent and treat burnout.

But despite what she recommends to others, taking care of her own emotional well-being hasn’t been easy during the pandemic.

When the pandemic hit in March, Dr. Thompson, 46, who is also chair of medicine for the University of Pittsburgh Medical Center Horizon regional health service, was seeing about 25 patients a day in her office, whom she had to convert to seeing via telemedicine “overnight,” she said.

In April, she joined an eight-week online mind-body skills program run by Dr. James S. Gordon, founder and executive director of The Center for Mind-Body Medicine, which since its founding in 1991 has trained nearly a thousand health care professionals in various self-care measures that they can use in their practices. Dr. Gordon, a psychiatrist, started the skills group earlier this year to help doctors and other health care workers cope with the extra demands and psychological suffering the pandemic has brought. The program included weekly Zoom calls with others on the front lines, along with meditative exercises like drawing pictures, visualizations and guided imagery.

“It allowed me two hours a week to check in with myself and share my experience with other health care professionals who could relate to the overwhelm and intensity of the pandemic,” Dr. Thompson said. “I never realized the power of group support.”

Physician burnout has long been a serious concern in the medical community, with roughly 400 doctors dying by suicide each year in the United States. The issue of pandemic burnout among physicians came to the forefront in the early months of the pandemic following the death of Dr. Lorna M. Breen, who supervised the emergency department at New York-Presbyterian Allen Hospital in Manhattan. Dr. Breen, who had been sick with Covid but working remotely, was later admitted to a psychiatric ward for 10 days. Fearing the professional repercussions of her mental health treatment, she took her own life in April.

“She was overwhelmed with the volume of death and dying, and she could not keep up,” said her brother-in-law, Corey Feist, a lawyer in Charlottesville, Va. “The industry needs a big cultural change.”

Mr. Feist and his wife, Jennifer Feist, Dr. Breen’s sister, have since co-founded the Dr. Lorna Breen Heroes’ Foundation, a nonprofit dedicated to protecting the emotional well-being of health care workers. The Feists also worked with politicians and a cross section of health care industry experts to develop the Dr. Lorna Breen Health Care Provider Protection Act, which aims to reduce and prevent burnout, mental and behavioral health conditions and suicide among health care professionals.

Dr. Thompson teaches medical personnel how to prevent burnout, but learning how to take care of herself during the pandemic has been a challenge.
Dr. Thompson teaches medical personnel how to prevent burnout, but learning how to take care of herself during the pandemic has been a challenge.Credit…Dustin Franz for The New York Times

An October poll of 862 emergency physicians nationwide from the American College of Emergency Physicians and Morning Consult found that 87 percent felt more stressed since the onset of Covid-19, with 72 percent experiencing a greater degree of professional burnout. Concerns about family, friends and their own health were among their chief concerns, along with financial and job security and a lack of personal protective equipment. Yet consistent with a longstanding stigma surrounding physician mental health, 45 percent weren’t comfortable seeking mental health treatment, citing concerns about workplace stigma and fear of professional reprisal.

The American Psychiatric Association, the American Medical Association and other professional groups, have formal statements against punishing doctors who seek mental health treatment. The Americans With Disabilities Act, which prohibits discrimination based on disability, including psychiatric disability, applies to professional licensing bodies. Still, the stigma persists.

A growing number of organizations and programs have taken up the charge to help doctors, nurses, residents, interns and medical students who are struggling with mental health issues.

Columbia University, for example, created CopeColumbia for employees of Columbia University Irving Medical Center. Another program called #FirstRespondersFirst, from the Harvard T.H. Chan School of Public Health, Thrive Global, and the CAA Foundation, recently unveiled its new mental health initiative, designed to provide support to health care workers in the United States and abroad. The Frontline Workers Counseling Project includes some 500 volunteer therapists in the San Francisco Bay Area, while the Physician Support Line, started in late March, is a free, national support line of some 700 volunteer psychiatrists who provide peer support.

A Body Mind Skills group helped Dr. Thompson to take time out for her own needs.Credit…Dustin Franz for The New York Times

“Part of the healing for me is helping other people,” said Dr. Lois Kroplick, a psychiatrist in private practice in Pomona, N.Y., who co-ran a weekly support group for psychiatrists and psychologists at Garnet Health Medical Center, in Middletown, N.Y., and volunteered with the Physician Support Line. During this same period, Dr. Kroplick lost her first grandchild and mother-in-law. “The best way to cope with my own grief was to help others,” she said.

Doctors recognize the growing need for mental health help for others, and for themselves. And as the infection rate continues to climb, many health care workers feel torn between their duty to help patients while also caring for themselves.

Elizabeth M. Goldberg is an associate professor of emergency medicine at Brown University, in Providence, and an emergency room physician. “In March and April there was this sense that you choose either your patients or yourself and it was your expectation to be there,” said Dr. Goldberg, 38, who has three young children. “Many of us wanted to be there, but I did experience fear and anxiety about going to work.”

She attended a free support group for health care workers, which she had never done before. “It was great hearing other people share similar experiences I had of not sleeping well and worrying about our family’s health and talking openly about our anxiety and fear of contracting the illness,” she said.

Kathleen S. Isaac, 32, clinical assistant professor at NYU Langone Health who is also in private practice in New York, created a weekly support group in June for her residents. But not many doctors showed up. Part of that she attributes to time constraints and demanding schedules, but also that many were simply trying to be stoic and power through.

“Asking for help is less stigmatized in the psychological community, but sometimes I think there’s a sense of ‘I’m fine, I know what I’m doing,’” she said. “There’s such a culture of perfectionism, and it’s so competitive that people want to present their best self. It’s harder to admit they’re struggling.”

This applies in her own life, too. She talks to friends and colleagues, exercises, goes to therapy and admits to binge-watching the sitcom “That’s So Raven” to help her unwind.

As for Dr. Thompson, she credits the Body Mind Skills group with helping her change her own self-care routine, checking in with herself hourly. “I ask myself, ‘What do I need? How am I caring for myself in this moment? Do I need a cup of tea? Should I implement some mind-body medicine?’” she said.

This might include soft belly breathing, dancing, mindful eating or just heading outside to get a breath of fresh air. “Maybe I just need to use the restroom and need to make time for simple basic self-care needs,” she said.

“This has been the hardest time of my life, and I am super grounded and really well balanced,” she added. “I am doing OK, but it is constant work and making sure I’m staying aware of my own self.”

A Wintry Tale of Deliverance

Living With Cancer

A Wintry Tale of Deliverance

The George Saunders story “Tenth of December” poses a question that absorbs many patients and caregivers: Can we save ourselves or each other from suffering?

Credit…Alexey Karamanov/Getty Images

  • Dec. 22, 2020, 5:00 a.m. ET

When I learn, as I did a few days ago, of a cherished member of my cancer support group going into hospice, I find myself alienated from holiday cheer, as many do this year. Rather than reading a holiday story like “A Christmas Carol,” I open instead George Saunders’ short story “Tenth of December.” In it, a man who dreads end-of-life cancer connects with a boy who has been bullied in school. Through their interaction, the tale poses a question that absorbs many patients and caregivers. Can we — how can we — save ourselves or each other from suffering?

People with late-stage disease or those loving people with late-stage disease may find this story especially heartening. It analyzes not only our anxieties about physical deterioration but also how we might lay them to rest.

Tenth of December” begins with the ostracized boy, Robin, trekking to a frozen pond to vanquish make-believe enemies who torture him with the sorts of barbs launched by his classmates: “Wow, we didn’t even know Robin could be a boy’s name.” Undaunted, Robin imagines rescuing a girl he admires from being kidnapped by his assailants, though he realizes “The twerpy thing was, you never really got to save anyone.” He had failed to save a dying raccoon and “He didn’t do well with sad. There had perchance been some pre-weeping, by him, in the woods.”

Robin’s fantasies are interrupted by the sight of a coat left on a bench and then, in the distance, of a skinny, bald man in pajamas who looked “Like an Auschwitz dude or sad confused grandpa.” The boy determines to deliver the coat because “had not Jesus said, Blessed are those who help those who cannot help themselves but are too mental, doddering, or have a disability?”

While Robin embarks on “a real rescue,” Don Eber is resolving to freeze to death in order to spare his wife and children his “future debasement.” Disease or chemotherapy has begun to scramble his words and Eber dreads the degeneration that reduced his beloved stepfather to a rail-thin, verbally abusive brute. Determined instead to do what a good father does — “Eases the burdens of those he loves” — Eber prays, “Let me do it cling. / Clean. / Cleanly.”

Both the boy and the man want to be heroic, though soon their roles reverse. After Robin falls through the ice and manages to pull himself only partly out, Eber drags him free. “The kid’s shivers made his shivers look like nothing. Kid seemed to be holding a jackhammer.” Noticing his coat on the ice, at the edge of the black water, Eber slides on his belly to snag it, strips off the boy’s freezing clothes, and then peels off his own pajamas, boots and socks to dress Robin, who slowly regains consciousness.

The exposed man and boy quaking in the killing cold bring to mind Lear and his fool on the stormy heath: unaccommodated, forked animals. With the exchange of the coat, their scene evokes William Butler Yeats’s definition of an aged man as “a paltry thing, / A tattered coat upon a stick.” On the brink of catastrophe, Robin and Eber are poised to expire, although Robin manages to gather Eber’s coat “like some sort of encumbering royal train” and high-tail it home where he will summon help.

Left alone and hallucinating, Eber remembers dressing his sleepy kids, recalls that because of insurance he has not left a note, and senses the misery he will inflict by “offing himself two weeks before Christmas,” his wife’s favorite holiday. “Tenth of December” opts for “Let me do it cling” over and against “Let me do it cleanly.” For abandoned in the snow, dying in his underwear, blue-skinned Eber comprehends the cruelty of his earlier attempt to commit suicide. Recognizing the interconnectedness of his life with others, he realizes that it is not his sole possession to give away.

Both Robin and Eber have botched their initial missions. However, they end up saving each other, not despite but because of their failures. When Eber is finally brought in from the cold, his response to Robin’s apology for fleeing the scene — “You did perfect. I’m here. Who did that?” — comforts them both: “Can’t console anyone if not around?” Eventually Eber remembers that in precious moments his dying stepfather preserved his identity through small acts of kindness: “I’ll try to be like him,” he decides.

Eber accepts the future deterioration dictated by his disease. “Why should those he loved not lift and bend and feed and wipe him, when he would gladly do the same for them. He’d been afraid to be lessened by the lifting and bending and feeding and wiping, and was still afraid of that, and yet, at the same time, now saw that there would be many drops of happy — of good fellowship — ahead, and those drops of fellowship were not — had never been — his to withheld. / Withhold.”

Sometimes we know — or a person we love knows — that a decline toward death has become inevitable. Under these circumstances, it is an acknowledgment of our reciprocity to be lifted or lift, to be fed or feed, to be wiped or wipe. Not our strengths but our weaknesses inspire and intensify the mutuality that sustain us. When we cannot save ourselves or each other from suffering, sharing it can become a saving grace. This is a poignant insight these days when the pandemic has limited our capacity to share suffering.

Like Charles Dickens, George Saunders illuminates the mystic deliverance of our dependence on each other and celebrates the generosity to which erring people cling. Like William Butler Yeats, he suggests that we become more than “A tattered coat upon a stick” only when “Soul claps its hands” and learns to “sing and louder sing / For every tatter in our mortal dress.” By instructing us to rejoice in every drop of affection bestowed upon our torn or sore mortal bodies, his story blesses its readers, each and every one.

Frequent Moves During Childhood May Be Bad for Health

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Credit

Changing residences frequently in childhood may be bad for your health.

Using Danish government health data, researchers cataloged various adverse events — suicides or suicide attempts, violent criminality, mental illness, substance abuse, psychiatric diagnoses and premature death — in 1,475,030 Danes born from 1991 to 1997. Then they correlated these problems with the number of times each person had moved before age 15.

They followed the group through their early 40s and found that the likelihood of every one of those adverse outcomes tended to rise the more someone moved in childhood. Contrary to the researchers’ expectations, the associations persisted in both lower and higher socioeconomic groups.

The study, in the American Journal of Preventive Medicine, controlled for age, sex, parental age, degree of urbanization and history of mental illness in a parent or sibling. Although these factors had some influence, the separate effect of moving was still apparent: the more moves, the greater the number of psychosocial problems.

“We don’t want to create blame, where people start saying, ‘If only we hadn’t moved…’” said the lead author, Roger T. Webb, an associate professor in epidemiology at the University of Manchester in England. “We can’t say that there is a causal relationship” between moving and negative outcomes.

“The main thing is to understand how this group of young people can be so adversely affected across so many aspects of their lives,” he said.

Overcoming the Shame of a Suicide Attempt

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Credit Jordin Isip

I don’t remember much about the first time I tried to kill myself, 21 years ago, because any time the memory popped up I deleted it from my mind like an unflattering photo on Facebook. Despite being open and public about my second attempt, in 2006, which I revealed in a memoir about my alcoholism, I’ve never told anyone else about that first one – not my partner of 25 years, my therapist of 10 years, family, nor friends – until now.

Here’s what I remember about that first time, in 1995. I felt hopeless, that my 27 years of life were done (27!). I’d come home drunk from a glamorous Manhattan book event, which I had organized as the publicist. The wattage of successful artists in literature, fashion and theater was blinding. I felt like a failure, that I would never be more than the hired help, that my own dreams were just thin air. When I came home and poured another drink and remembered the leftover painkillers in my medicine cabinet – prescribed for a sprained ankle earned by a drunken fall — I thought, “Why not?”

My attempt was impulsive, not premeditated. Had it been successful, I’d classify it as suicidal manslaughter. I climbed into the antique wrought iron bed I shared with my partner and passed out. The next morning, I woke up next to him and he was none the wiser. I got up in a daze and went to work feeling like I was moving under water, so heavy was my triple hangover from booze, pills and shame. I kept moving, kept drinking (I was blind then to the cause and effect of booze and depression) and kept silent.

My silence nearly killed me. Eleven years later, I tried again. I had been fantasizing about suicide every day for months. I was more hopeless. I was drunker. That time I did it with sleeping pills I’d been taking to prevent me from drinking as much at night. Booze, pills, suicide attempts: it was all one big happy “Valley of the Dolls” family. That time I took the pills in the morning after my partner left for work, and I didn’t wake up on my own. My partner found me in that antique bed when he came home from work. The jig was up, and my winding path to recovery began.

Why bother talking about the first one? Now that I’ve been sober for almost eight years and my artistic dreams are coming true, the secret made me feel like a house rebuilt on a foundation still riddled with termites. I knew I would have to own the attempt eventually, so when the Centers for Disease Control and Prevention recently released a report that suicides had surged to the highest levels in 30 years, I knew it was time for me to come clean. With two attempts on my score card, I forever remain in a suicide high risk group. According to the Harvard T.H. Chan School of Public Health, a history of suicide attempt is one of the strongest risk factors for suicide, and the American Foundation for Suicide Prevention reports that approximately 40 percent of those who have died by suicide have made a previous suicide attempt at some point in their lives. I don’t want the third time to be the charm.

The further away from that first attempt, the deeper the secret grew and the less real it became. I didn’t really do that. I didn’t think a few painkillers would kill me. I didn’t mean it. But I did do it and I did mean it. I’m mortified by that. It was reckless, rash, stupid, selfish, pathetic.

As a recovering alcoholic I know that admitting to my behavior and owning my story is the only way it can no longer own me. I’m not ashamed of being an alcoholic, but I’m still ashamed of trying to kill myself, even though I know I did it under the temporary insanity of alcohol. According to the A.F.S.P., approximately 30 percent of those who die by suicide have blood alcohol levels in the range of intoxication at the time of their deaths.

After my second attempt, I went to rehab and then to sober meetings. The focus quickly shifted from my suicide attempt to my alcoholism, and rightfully so. Once my alcoholism was treated, the depression lifted. It was alcohol that brought on my depression and thoughts of suicide, and ultimately twice gave me the courage to try it. Since I’ve been sober, I no longer suffer from depression, do not take antidepressants and no longer think about killing myself.

I’m fortunate to live in New York City, where there are almost as many sober meetings as there are bars. These are peer-led meetings of alcoholics helping other alcoholics, free of judgment and condescension. These meetings keep me sober, hence nonsuicidal.

But what about the nonalcoholics and nonaddicts who’ve attempted suicide? Where are their meetings? I could find only a few peer-led suicide attempt survivor support groups via Google, and none in New York City. When I called the National Suicide Hotline requesting local suicide attempt survivor support groups, the operator suggested just one option: a Safe Place Meeting hosted by the Samaritans, a suicide prevention network. But those meetings are for those who have lost loved ones to suicide, and they have no meetings for attempt survivors.

I admitted my second suicide attempt because I was found out, and had to. But shame kept me quiet about my first attempt. I admit it now, and I throw out a call for other closeted suicide attempt survivors to do the same: Own it, and find – or create — a safe group where you can talk about it.

Today I own my story, so that my story doesn’t kill me.

Jamie Brickhouse is the author of “Dangerous When Wet: A Memoir of Booze, Sex, and My Mother.

Opening Up About Depression

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Credit Arianna Vairo

I have slogged through a number of difficult situations in recent months, among them the ongoing crises of my elderly parents’ illnesses and the suicide of a friend. I never lost my appetite nor burst into tears, and I didn’t suffer from any of the other typical symptoms of depression. Maybe I was more irritable than usual, a bit more prone to snap. And yes, I buried myself in my work. But I didn’t think I’d tripped down into the rabbit hole of depression.

You would think I would have been more self-aware, both personally and professionally. As a health journalist, I have often used my own stories to write about difficult-to-discuss medical conditions, includinglearning I had testicular cancer at age 26 and my misdiagnosis with H.I.V./AIDS — back when it was a death sentence. But I had never written about suffering from depression, even though it’s plagued me since I first put pen to paper, at age 11, when I started keeping a diary.

Still, I’m far from alone. At least six million men in the United States suffer from depression, according to the National Institute of Mental Health. The true number is likely to be even higher, said Dr. Matthew Rudorfer, the institute’s associate director for treatment research, since men are less likely than women to report classic symptoms like low mood, sadness or crying, so they often go undiagnosed. Men, he told me, more often demonstrate “externalizing” symptoms like irritability, anger and aggressiveness, substance and alcohol abuse, risk-taking behaviors and “workaholism.”

Oh, that macho thing: Men don’t get depressed; they just work, drink and compete harder. Andrew Solomon, author of the pathbreaking memoir about depression, “Noonday Demon,” told me that ridiculous attitude is part of the mind-set that guys should “cover up our moods with militarism or athleticism.”

So why speak up now? If there was a specific catalyst, it would be the death of my friend (his family asked me not to disclose his real name), a personal trainer who, one August morning, worked out his regular clients — and then went home and killed himself with a single gunshot to the head.

Even with 20/20 hindsight I never would have guessed he was at risk for serious depression, let alone suicide. Just three days before his death, alive with excitement, he’d talked with me about buying his first house and applying for a management role at the health club. Still, as one of his closer friends told me later, “You never know where depression lives.”

Most people, even those who know me well, don’t see my depression. I’m a “high-functioning” depressive, for sure, and perhaps an artful one, too, obscuring its symptoms with a mix of medication, talk therapy, exercise and knowing when to close the door on the world. And unlike my surgical scars (thank you, cancer), those left by depression are invisible.

I wonder, had I talked with my friend about my own struggle, if he might have said, “Me, too.” Indulging in some magical thinking, I imagine he would be alive today if we had shared our stories.

It’s encouraging that new studies are refuting previous ones that showed women to be twice as likely as men to experience depression. For example, a 2013 University of Michigan study concluded, “when alternative and traditional symptoms are combined, sex disparities in the prevalence of depression are eliminated.” In other words, men and women may be equally at risk.

The first step in recognizing depression in men is diagnosing it properly, which means establishing accurate criteria — and making sure mental health practitioners know what to look for. The second step, which may be even more difficult, is getting men to speak up about it.

Which leads back to my own silence. One reason I’ve been unable to talk about my condition until now is that, as the Cymbalta ad says, “depression hurts.” When I first heard that tagline I rolled my eyes, but I’ve since come to appreciate the copywriter’s genius. Imagine suffering from a bad flu, the kind that seems to have poisoned your blood, physically incapacitating you. For me, depression can feel like the worst flu ever, with no end in sight. It is tough to talk about when you’re in that much pain.

And then there’s the stigma. As much as I understand that illness is illness, whether mental or physical, and that there is a greater openness about depression now than a generation ago, I feel shame.

My own encounters with stigma have been profound. I once dated a fellow who dumped me unceremoniously when he found out I took Lexapro, an antidepressant. Before the Affordable Care Act became law, I was rejected for health insurance — not because of my cancer history, but because of my medication history. Having sought help, I was penalized. “It doesn’t make any sense,” my primary care doctor said to me.

So I have decided to be more truthful. Last fall, when I needed to beg off from a commitment, I didn’t fabricate some physical ailment, as I had in the past. Instead, I emailed: “The depression I’m suffering from right now makes it difficult for me to be there as promised. I’m sorry.”

Depression need not be the loneliest fight, as Mr. Solomon has so well characterized it. But if I don’t tell you, you can never really know me — or help. Now I can appreciate it when friends ask me how I’m feeling (but not in that dreadful way: “How. Are. You?”). And I appreciate those who offer: “Is there anything I can do?”

Steven Petrow, a regular contributor to Well, lives in Hillsborough, N.C.