It seems like a fitting bookend to follow my last post, which discussed a documentary about a teen who killed himself a few months after he went off his mood stabilizers, with one about a documentary suggesting that meds – not the lack of them – are to blame for suicidal thoughts and actions.
The film Prescription: Suicide?, which a medication-critical reader was kind enough to send me, profiles families whose children killed themselves or experienced suicidal thoughts after they began taking SSRI antidepressants.
Before I discuss this second film, though, I want to highlight a study that caught my attention last week in which researchers interviewed teenagers about their prior suicide attempts. News headlines tend to trumpet a study’s most dramatic findings, and many of these declared that in this study, kids were found to have attempted suicide as young as 9.
Upsetting as the concept is, I have to say I was not surprised, after the research I’ve done on child mental health. But the fact that this was headline news highlights just how resistant people are to the idea that children would really want to kill themselves – and would actually try it.
Indeed, as I was in the middle of writing this post, I noticed a comment on another column I’d written that disputed the need to treat kids with meds by declaring that children are “a lot more innocent and simpler” than diagnostic criteria for childhood mental illness allow. Imagine what this person would say about kids wanting to die. (In fact, a large body of research shows not only that children can, of course, not only suffer from mental illness, but that they can be suicidal, too).
Parents, I suspect, are likely to be even more resistant than the general public when it comes to accepting their own children would want to die. Studies show that parents tend to underestimate the severity and extent of symptoms for internalizing disorders like depression and anxiety. As for accepting that the child you created and raised with such effort and sacrifice is not just anxious or depressed but actually wants to obliterate himself…well, I can only imagine how deeply painful this would be.
Hence the appeal of films like Prescription: Suicide?, which heavily intimates, though it doesn’t explicitly argue, that SSRIs plant suicidal thoughts and behaviors in the minds (or would that be brains?) of kids who otherwise would have had no such urges.
This, of course, is the idea at the heart of the FDA’s black-box warnings on antidepressants, which went into effect in 2004 for teens and a few years later was expanded to include young adults under 25. More recently, the agency has also warned about the possibility for antiepileptic drugs, which are often used as mood stabilizers, to increase the risk of suicidal thoughts and actions.
Prescription: Suicide? was made in 2005, shortly after the FDA black box warnings provoked a major controversy over the use of antidepressants in kids. But, to me, although it poses a fascinating and disturbing question that is still generating ample scientific research, the film lacks the intellectual rigor that would have made it a truly effective. Large-scale studies can tell us whether antidepressants increase the risk of suicide or not, but they don’t answer the question of whether in any particular case they were a sole, or even a partial cause of a child’s death.
Tell that, of course, to a grieving parent. “12-year-old girls just don’t kill themselves,” a says a grieving male voice, presumably the father of a 12-year-old girl who killed herself while taking a small dose of Zoloft for generalized anxiety.
I felt heartless, but as I watched this scene, I couldn’t keep from thinking, “The thing is, they do kill themselves. I’ve been a depressed 12-year-old girl, and I know what they’re capable of. Look at the statistics.”
The film somewhat elides the issue of whether the teens it interviews really believe that the suicidal thoughts or actions are drug-imposed. It also doesn’t ask them to distinguish clearly between non-suicidal self-injury and suicidal actions.
I believe hearing from young people themselves is important, or I wouldn’t be writing this blog or have written a book on the topic. So I appreciate the attempt by the makers of Prescription: Suicide? to include teens’ perspectives.
But I also believe in asking tough questions, which means asking people to defend their perspectives. Prescription: Suicide doesn’t do that. It takes the parents and kids’ opinions at face value. If parents can be in denial about the true depths of their children’s misery, so, too, can kids themselves airbrush the past. To declare “a drug made me do it” is to absolve oneself of the shame that goes along with being suicidal, and with acting on it.
Indeed, the new study I cited earlier was conducted to see how closely 18 and 19-year-olds’ accounts of past suicide attempts line up with in-the-moment assessments of their depressive symptoms at the time of those reported attempts.
The study wanted to see how accurate retrospective reports are because asking kids to report recent attempts is prone to some kids overreporting, in a bid for attention, and some underreporting, because they are ashamed or worry about researchers contacting their parents.
So imagine when it’s not just a matter of researchers possibly contacting one’s parents, but of openly confessing to them one’s wish to die. Young children may not have the emotional sophistication to keep such a secret from their mothers and fathers, but teens do. And the kids in Prescription: Suicide? were all 12 or older, old enough to begin to hide their true feelings.
Such was the conclusion of Evan Perry’s former psychologist in Boy, Interrupted, the documentary I blogged about last week. “Evan may have gotten to the point where he got really just better at masking it externally,” she told Evan’s parents, the filmmakers as they tried to understand why he seemed to have improved in the years leading up to his suicide. “But internally it was a lot of suffering. And this was just the beginning. I mean, it started when he was much younger, and it wasn’t going away.”