One night, about three months after Dana had arrived at Four Winds, there was a meeting of the patients in her unit. Dana, as always, sat in sullen silence, arms folded across her chest. Suddenly everyone in the group turned on her. “We’re sick and tired of you,” they said. “You haven’t done anything since you got here. If you didn’t feel so damn sorry for yourself, maybe you could do something. But since you’re not doing anything, why don’t you leave?” Even her best friend, a patient named Lucy, joined the attack. Dana was stunned, but she kept her head down, saying nothing. After the meeting she spent the night shooting pool in a fury, sending balls flying off the table. “I felt betrayed,” she says. Next morning her favorite nurse cornered her. “I hear they really gave it to you last night—it’s about time,” she said. “You know they’re right.” “No, I don’t,” said Dana. “Yes, you do,” said the nurse. The following day in group therapy when the staff member asked, “Who wants to work today?” Dana raised her hand.
After so many years of carefully constructing defenses to keep the world at bay, opening up was slow, painful, and frightening. “How do I change what I think?” Dana would ask Terry. “Just change it,” he would answer. “How?” “Just act as if you cared about yourself.” “If it’s fake, I’m not going to act it.” “Just give yourself a break. Once in a while don’t talk like that about yourself.” “But that’s acting.” “It’s a first step.” They would end up shouting at each other, and Dana would stalk out of the room. Gradually, however, her armor began to chip away. Both staff and friends tried to support Dana’s efforts. “I still had a sharp tongue, but now every time I swore, even the most timid person would say, ‘I don’t like that.’ If someone said hello and I said, ‘Hey, bitch,’ they’d say, ‘Don’t call me bitch,’ and I’d apologize.”
After many arguments with Terry, Dana even put aside her jeans and T-shirts for corduroys and blouses. The first time she wore them, a young male patient called out, “Well, look at the young lady, don’t she look pretty?” Dana ran to her room and climbed back into her jeans. She told Terry that if she was going to change, people couldn’t tease her. “You can’t program people,” he said. “You have to risk it.” Two days later she tried again. The same boy gave her a wolf whistle. Dana cringed but kept walking.
Dana had never let people get close to her. “I could be friends with someone, but there was always an unspoken agreement that I could get to know them, but they weren’t allowed to get to know me,” she says. Before, when her friends saw that Dana was depressed and asked her what was wrong, she would say “Nothing.” If they persisted, she would swear at them. Now when they asked her what was wrong, Dana would start to say “Nothing” but catch herself and say “I don’t know.” “It was a start,” admits Dana. “After a while they’d say ‘What’s wrong?’ and eventually I’d be able to tell them.”
Dana soon had a true test of her progress when her father came to Four Winds. Although he had often been in New York on business, he had never visited Dana during any of her hospitalizations. They had never talked about her suicide attempts or her therapy. He had phoned her occasionally, but their conversations were so stilted she stopped accepting calls. In the weeks before his visit Dana worked in therapy on being open with her father. In psychodrama the instructor made her and another patient, who played her father, sit back-to-back—“because you two never face each other.” “Dana, how are your grades?” her “father” would say. “Fine,” said Dana. The instructor would stop her, and they would try again. “Dana, how are your grades?” “I’m not doing well.” “Why not?” “’Cause I’m not studying much.” Gradually, Dana was able to be more open about her treatment and her plans for the future. But as the day of her father’s visit approached, she was terrified.
When her father and his wife arrived, Dana gave them a quick tour of Four Winds. “They’d already eaten dinner at the hotel, but they took me to a diner so I could have a hamburger,” she says. “I was very nervous. I had never said a word to my father about my drinking, but I told him I was an alcoholic and I was going to AA five times a week. I told him about my treatment. I told him I had problems getting close to people. I told him about all the things Terry and I were working on, and when I finished, he said, ‘Well, that’s good. I took you to dinner to tell you I’m moving to Japan.’” Dana was crushed, but she kept her composure while they had coffee. After they dropped her off at Four Winds, she rushed down to the smoking room and wept.
The following day she and her father met with Terry for a therapy session. Terry told her father some of the reasons Dana felt she couldn’t relate to him. Her father nodded thoughtfully, and when Terry had finished, he admitted that it was difficult for him to talk about feelings because he hadn’t been brought up to do so. “But you two need to talk to each other,” said Terry. “Do you think you could try?” “Sure, we can try,” said Mr. Evans.
As she walked her father to his car, Dana said, “There’s something else you don’t know.” She rolled up her sleeves and showed him her arms, crisscrossed with scars. “I used to cut myself,” she said. “Oh,” he said. “Well, thank you for telling me.” There was an awkward silence, and Dana said she had better get back to the group. They said good-bye, and Dana went inside.
“It could have been worse,” Dana says now. “I was worried he’d just say ‘I’ve had it with you.’ And though he didn’t say ‘Please get well,’ he never said ‘I don’t care about you.’ For him that was something—that he said we’d try.”
That spring Dana continued to open up. In therapy, as she and her mother began to talk about her mother’s work, about her boyfriends, about Dana’s leg, and about the divorce, they became more understanding of each other’s struggles. At AA meetings Dana began to take an active role, making the coffee, setting up chairs, participating in discussions. “I was actually letting a few people get to know me a little bit,” says Dana. “It was terrifying. I had never trusted anybody. I always thought if I told someone something, they’d print it in the local paper. Terry told me I had to risk it.” Dana and Lucy became even closer. “I would tell her something that I thought would be embarrassing, and she would say, ‘Oh, I did that, too.’” In April, Dana was scheduled to have major surgery to replace her kneecap. She was so afraid the operation would fail that she couldn’t talk about it in group. But a few nights before the operation Dana went to Lucy and said, “I’m terrified.” It was the first time she had ever admitted to anyone that she could be frightened. On the eve of the operation Lucy stayed up all night with her.
Dana spent three weeks in a hospital in Manhattan. She thought that while she was away, they would forget about her at Four Winds, but Terry called her every day. A staff social worker visited her three times a week. Every so often the unit nurse would call on the ward phone, and the patients would take turns talking to her. One day a friend from the ward walked into her room. “What are you doing here?” asked Dana. Then Nan, the head nurse, entered, followed by Lucy. They wheeled Dana down to the solarium. “There were fifteen people out there!” says Dana. “Half the unit! I couldn’t believe it. It was great! I figured I wouldn’t see those people for three weeks. They didn’t tell me they were coming down. They’d posted a sign-up sheet—‘Sign up if you want to see Dana’—so no one forced them to go.” She smiles. “More people wanted to go, but there wasn’t enough room.”
In May 1984, two months after Brian Hart’s death, Dana was discharged from Four Winds.
VI
“USE THE ENCLOSED
ORDER FORM TO ACT
IMMEDIATELY. YOU COULD
SAVE A LIFE”
ON A SPRING MORNING two years after Justin Spoonhour’s death, George Cohen walked into a social studies classroom at White Plains High School carrying a slide projector and a tape recorder. Setting them on a desk, he pulled a white screen down from the row of furled maps above the blackboard. The bell rang. While Cohen set up his projector, a stream of tenth graders flooded the room. H
e observed them for a moment before asking for quiet. Cohen, a middle-aged man, was dressed in a brown tweed jacket and striped tie, but his mop of dark, curly hair, pudgy face, and ready grin gave him a rumpled, informal look. “I’ve asked your teacher to let me come in and talk to you today,” he said. “I’m here for two reasons. The first reason is that the problem of teenage suicide has grown tremendously. Three times as many kids kill themselves today as when I was in high school. The second reason is that everyone in this room can do something about it.”
Cohen began his program with a sixteen-minute slide show describing the extent of teenage suicide, the warning signs of depression, and how to help in a crisis. As the slides progressed, some of the students watched intently. One girl took notes as furiously as she chewed her gum. Others were less attentive—a girl whispered to a friend at the next desk, a boy studied his history book, a girl fished a compact from her purse and began meticulously to apply eye shadow. Gradually, however, the whispering stopped; the boy looked up from his homework, the girl abandoned her makeup. Soon the only sound in the room was the voice of the narrator and the click of the slide projector.
The slide show offered some basic information about suicide and its prevention. Suicides rarely happen out of the blue; experts say four of five people who kill themselves leave clues to their plans. Some clues are behavioral—giving away prized possessions, for example. If someone gives his watch or music collection to a friend, he may be trying to say good-bye. Other clues are verbal. When someone says “You won’t be seeing me around anymore” or “The world would be better off without me,” he may be thinking of suicide.
Although there are few precise indications of when a depressed adolescent will turn to suicide, there are signs that suggest when an adolescent is experiencing depression severe enough to warrant concern: sudden changes in behavior (for instance, when someone who takes great pride in his appearance neglects himself); dramatic changes in appetite; sudden weight gain or loss; sleeping difficulties (insomnia or a desire to sleep all the time); poor performance in school; trouble concentrating; unexplained lethargy or fatigue; loss of interest in friends, hobbies, or social activities; increased drug or alcohol use; constant feelings of worthlessness or self-hatred; excessive risk-taking; a philosophical preoccupation with death, dying, or suicide.
When the slide show was over, Cohen paced in front of the class. “After seeing this, what feelings are you left with?” he asked. “Sad,” said a girl sitting in the front row. Cohen nodded. “How many of you have known someone who has thought about or attempted suicide?” Eleven of twenty students raised their hands. “What was it like?” he asked. “It was scary,” said another girl. “You’d worry about her every minute, wondering whether or not she would do it.” Another girl added, “It was confusing because it seemed like she had everything she wanted. I couldn’t understand why she would want to do that.” Cohen turned to the girl who had been putting on makeup. “Did you know her?” he asked. “What was it like for you?” The girl looked up. “I didn’t believe her,” she said. “Why?” asked Cohen. “Because she came right out and said she was going to do it.” Heads nodded agreement. “That’s the toughest part—knowing whether they really mean it or not,” said a boy in the back who had seemed to sleep through the film. “They may just be trying to get attention,” someone murmured. Cohen looked up. “Sometimes people will joke about it—‘Man, I’m gonna kill myself,’” he said. “But it’s important to ask, ‘Are you serious?’” Too often, he told them, out of uneasiness or fear, a friend may laugh off a plea or ignore a clue. And one of the biggest myths about suicide is that people who talk about it won’t do it. “It’s very important to take them seriously.”
Cohen had an easygoing, cheerful manner, and he quickly established a rapport with the students. He always asked a student his name; the next time that student raised his hand, Cohen remembered it. “What do you say to someone who has told you he’s thinking of killing himself?” Cohen asked the class. “I’d say, ‘Let’s go get help,’” suggested one boy. “I’d ask why,” said a girl. “That’s good,” said Cohen. “Depressed people feel hopeless, and one of the things they need most is someone to listen.” A girl with hoop earrings said, “I would tell her that I care about her.” Cohen nodded. “Yes, it’s important to let them know that you care,” he said. “And there’s something else I’d like you to tell them. I’d like you to tell them, ‘Don’t do it.’ Sometimes people have made their decision, but they need to hear someone who cares say no.
“What if a friend makes you promise to keep a secret, and then he tells you he’s going to kill himself? What do you do?” After a moment of silence a young man spoke up: “I’d tell somebody and get help anyway. If that person is a true friend, you’d care enough to want to keep him around.” Another boy nodded. “It’s someone’s life,” he said. “You keep a secret when it’s about a boyfriend or a girlfriend, but not when it’s someone’s life.” Some of the kids worried that breaking a promise might anger their friend, but they nodded agreement when Cohen said, “It’s better to have a live angry friend than a dead one.”
Cohen asked the students to whom they would turn for help, and the students named the school nurse, school counselor, and school social workers. Cohen mentioned the two school psychologists; not one of the students had heard of them or knew where their offices were. When Cohen suggested parents, the kids chuckled and shook their heads. “They’d just get hysterical,” said one girl. “What would they say?” asked Cohen. A girl sitting in back affected a high, shrill voice: “Oh, my baby wouldn’t do that.” The class burst into laughter. “Yes, you may get a lot of denial,” said Cohen, “but it’s a good idea to talk to the parents because they have the responsibility.” Cohen also suggested the local suicide hotline. He passed out a list of warning signs and resource numbers and asked if there were any more questions. “Thank you for letting me talk to you,” said Cohen. “If anyone wants to talk more, let me or your teacher know.” The bell rang, chairs scraped on linoleum, and the students rushed out to their next class.
Two or three times a week Cohen, a human relations specialist with the White Plains Public Schools, brought his projector to classrooms, auditoriums, church basements, and libraries throughout Westchester County to talk to teenagers, teachers, social workers, and parents about suicide. His thirty-nine-minute program, designed to fit into a high school period, was sponsored by the Westchester County Mental Health Association Interagency Task Force on Adolescent Depression and Suicide, of which Cohen was chairperson. The group’s imposing name belied the modesty of its operation. It was formed in 1979 after two suicides and five attempts in five months at the same high school in Chappaqua left Westchester County health professionals realizing how little they knew about the subject. The Task Force, an unpaid volunteer group of teachers, counselors, and therapists, began meeting regularly. Although Westchester had one of the largest mental health budgets per capita of any county in the nation, it had no specific suicide prevention program directed at adolescents. In the fall of 1982 the Task Force began offering this program, free of charge, to high schools in the county. While some schools welcomed the program, the Task Force met resistance from administrators who believed that talking about suicide would only encourage a youngster to commit it. Others felt that suicide prevention was not the school’s responsibility; it was a family matter. Others feared that if students were exposed to the program, teachers and counselors would be overwhelmed with students wanting to talk about their troubles. Some said there was simply no need for the program; in their school, suicide was not a problem.
In 1984, as the “Westchester suicides” made headlines, demand for the program soared. Many of the schools that had been reluctant were suddenly eager. As far as Cohen knew, none of the students who had seen the program had completed suicide. “But even if a youngster went out and killed himself after seeing it,” he told me, “I wouldn’t back away from the program because I know a lot
of youngsters are getting help because of it.” After almost every program, while he was putting away the projector, a student would approach Cohen to tell him about a friend she was worried about or about her own suicidal thoughts. “One night at ten I got a call from a girl who had seen the program in class. She said, ‘I have a friend in the next room who wrote a note that says she’s going to kill herself.’ I told her to keep her friend there, and I was able to get over and talk to the kid and get her into the hospital. Today, I see that kid walking around the streets of White Plains, and I feel terrific. Without the program I’m not sure her friend would have known what to do.”
While Cohen’s presentation may seem tame, it would have been unthinkable fifteen years earlier. At that time, although there were three hundred suicide prevention centers across the country, there were no programs aimed at younger people. Prevention was geared toward adults, whose rate was highest. In a 1969 article on reducing adolescent suicide, recommendations made by suicide “experts” ranged from the suggestion that students be “encouraged to participate in extracurricular activities” to increasing “the relevance of education to the modern world.” No one broached the idea of actually educating teenagers about suicide—that, it was assumed, would be too dangerous. Many schools prohibited talking about suicide in any context; the only mention of it might occur in English class when the students read Hamlet or Hemingway. If a student completed suicide, teachers were expressly forbidden by school administrators to discuss it with students. It was simply not a school matter; these were “crazy kids”—they must be, or why would they kill themselves?
November of the Soul Page 17