I tweeted earlier this week that I can’t get the PBS documentary Boy Interrupted out of my head, and that’s still true several days and a second viewing later.
The documentary retraces the life, psychiatric illness and eventual suicide of Evan Perry, medicated from age 7 and diagnosed with bipolar disorder age 10. At 15, Evan killed himself by jumping out the window of the bedroom he shared with his little brother. He had been stabilized on lithium for years, but tapered off the drug a few months before he died.
The film represents an attempt of Evan Perry’s filmmaker parents to fathom the unfathomable – why their son decided, finally, to take his own life.
I found the film, which came out in 2009, arresting and poignant in many ways, but for the purposes of this post, I’ll focus on the role medication plays in Evan’s story. The film suggests that at least in Evan’s case psychiatric drugs were necessary – but not sufficient. And that was true in more than one sense.
Lithium, though it played an important role in giving Evan a few happy and successful years, was only part of a carefully constructed scaffolding of friends, family, therapy and school support that the film credits with managing to prolong and enhance Evan’s short life.
This was, after all, a child who threatened suicide from age 5, who was, in the words of several people who knew him, obsessed with death from a young age, who demonstrated in front of his mother how he would hang himself.
He was seeing a psychiatrist and taking Prozac by age 7. In fifth grade, he climbed on the roof of his elementary school and threatened to jump, after which he was committed to an inpatient facility and put on several other drugs. The doctors finally settled on lithium to even out the mood swings of bipolar disorder, his eventual diagnosis.
Medication was necessary but not sufficient in a second sense, too. Ultimately, although Evan was medicated from a young age, neither this intervention, or any of the others was enough to save him.
After tapering off lithium, he sunk again into the sullenness and depression that had characterized so much of his childhood. His parents had made an appointment with his psychiatrist to increase his dosage. But he killed himself two days before he could see the doctor.
It’s easy to think, as I noticed myself doing, if only. If only he could have seen the doctor a little earlier, then maybe he’d still be alive and this film would never have to have been made at all.
His psychiatrist has a powerful rejoinder to that idea. “He would have gone off his medication,” he tells Evan’s parents in one scene. “All these kids do. They all go off them.”
It’s not entirely clear if by “all these kids,” the doctor is talking about kids with bipolar disorder in particular or children in general who take psychiatric medications. For those with bipolar disorder, hypomania can be sufficiently attractive to make mood stabilizing medication seem constricting and loathsome.
But there are many motivators for what doctors call “non-adherence.” For teenagers, going off medication can be an act of rebellion, self-assertion and identity-seeking. Many psychiatrists I’ve interviewed have reported teens’ non-adherence as a common phenomenon, even one to be expected in their line of work.
There’s quite a lot to say about young people’s rebellions against medication, and I hope to discuss more in future posts. In Boy Interrupted, we learn that Evan had very much wanted to be off lithium, even though, apparently, the risks were made quite clear to him. He complained to his parents and psychiatrist that the drug made his throat dry, that it made made him tired. His older half-brother said he noticed Evan seeming slow and dazed, mostly likely because of the lithium, his brother thought.
Evan’s mother says he desperately wanted not to be sick. Mostly, he wanted not to be different from his friends and peers – and medication, one can only assume, marked him as different. Even though his friends didn’t seem to know he was taking meds, it would have been a daily, private reminder he didn’t care for.
But other than these limited reasons, we have few clues how Evan really felt about the drugs itself – what they represented to him and why he wanted to try going without them. There’s only a scene of Evan’s psychiatrist reading aloud his notes, in which Evan reported feeling better as he tapered off the drugs. “He seemed so fine,” the doctor recalled.
The mystery is in keeping with the spirit that surrounds the film, the eternal question that family and friends are always left asking when someone takes his or her own life: Why?
Even having heard Evan proclaim since kindergarten that he wanted to die, his family will never comprehend quite what was running through his head the night he jumped.
A suicide note, which the film unflinchingly displays, contains no mention of his medication. But a shot of the air shaft below provides a subtle, haunting evocation of what he may have experienced.
At night, it was far too dark to see what lay at the bottom of the air shaft. Like his paternal uncle, who committed suicide at age 21 and who told his then-fiancee he was “in a hole,” Evan must have felt trapped. Isn’t that so often the best explanation we can find for suicide? The sixth “thing to die for” in Evan’s suicide note read, simply: “What’s the point?” Literally plunging into the darkness must have felt fitting, and inevitable.
image credit: mnapoleon/Flickr