Translator: Raissa Mendes Reviewer: Ellen Maloney
Hello.
It's a privilege to be here today to speak with you
about suicide in young people;
an enormous public health problem
that hasn't receive the serious attention that it deserves.
My goal today is not just to capture your attention about the problem,
not just to really sound the alarm but to encourage you
to take this problem seriously, and hopefully to act accordingly.
When I was asked to describe myself for this talk,
I chose three words.
The first was "physician," the second was "psychiatrist,"
and the third was "advocate."
Most of us don't come by our passions by accident,
and I suppose I'm no different.
So let me tell you a little bit about me.
I don't think it's an accident
that I am the first and only physician in my family.
I am quite confident
that the death of my brother Paul when I was about eight years old
was a powerful influence on my choice of medicine as a career,
and also, on my abiding interest in wanting to do something
to protect the lives of young people.
I chose originally to train in pediatrics,
and my plan was to train subsequently
and subspecialize in hematology/oncology,
then devote myself to caring for young people with cancer.
I'd always been interested in psychiatry,
but somehow, never took it seriously as a career direction.
Largely because I think I considered it
- and I was worried that other people might think it -
a frivolous way to make a living.
In a way, I was afraid of being thought a dilettante,
with a tweed coat and a pipe.
But it really took another powerful personal experience
for me to see my interest and preoccupations
come together into what I believe, for me, has being a "calling."
I was fortunate enough to train in pediatrics in Philadelphia,
the same city
that a close friend of mine from medical school
had won a very prestigious spot
in another training program in medicine.
This fellow was bright,
dedicated, and ambitious.
Both of us understood that adolescence and young adulthood
were really the period of maximal risk when it comes
to the onset of mental illness and addictions.
But neither of us really thought that mental illness
would interfere with the trajectory of either of our careers.
Unfortunately, our lack of awareness, or cluelessness so to speak,
didn't prevent my friend from developing the sort of crushing depression
that I had read about and sometimes seen on the wards,
but really never expected could undermine
the life of a person of value
like my friend.
The good news is that my friend survived.
He recovered.
He went on to have a successful life and a successful career in medicine.
The good news for me
was that this experience forced me
to confront some of my own prejudices.
I realized that I was not unlike many other people,
and not unlike many of my colleagues in medicine
in that I tended to think about mental illness truly
as having more to do with some sort of personal failing or character flaw,
than I thought about it as a real illness, like asthma, or cancer, or diabetes.
Let me tell you a little bit about suicide.
Suicide is among the ten leading causes of death
across the life span and across the world,
but its impact is particularly profound in adolescence and young adulthood,
where it's the second leading cause of death in the United States.
Only accidents kill more young people.
And if you look around this audience,
it's probably the second leading cause of death in this audience.
In 2013, nearly 4,900 people between the ages of 15 and 25
killed themselves.
That represents almost 20% of all the deaths in that age group.
That's three times the number of deaths
in that age group than deaths due to cancer.
And what's even more shocking is if you add together all of the deaths
due to cancer, deaths due to cardiovascular disease,
death due to diabetes,
death due to respiratory illnesses like asthma and cystic fibrosis,
deaths from pneumonia, influenza, and meningitis, and HIV,
and you add them all together,
more people die by suicide in that age group.
If you find that shocking, I think that's probably a good thing,
because one of my goals today is to capture your attention.
Perhaps another story will help do that as well.
I want to talk to you for a moment about a remarkable young man
by the name of Kevin Hines.
When Kevin was 19,
after several weeks
of really severe depression and distorted thinking,
he left his house in San Francisco and began walking towards
the Golden Gate Bridge intent that he would kill himself.
Like most people who kill themselves, Kevin suffered
from a major mental illness, in his case it was bipolar disorder.
And also, like acutely suicidal individuals, Kevin was ambivalent.
He went back and forth about wanting to live and wanting to die.
So as he walked with his thoughts racing,
towards the bridge,
he resolved that even if one person interrupted him,
tried to help,
or even asked how he was doing, he would not make the jump.
But nobody did stop him.
As he paced back and forth on the walkway of the bridge,
finally, someone did tap him on the shoulder.
Kevin turned, tears running down his face,
and saw a woman with a camera,
who very politely asked him to take her picture on the bridge.
(Laughter)
Kevin is a nice guy, and he, politely,
took this woman's picture,
handed her back the camera, and now convinced that nobody cared,
he threw himself over the rail, headlong.
As Kevin started to fall,
he immediately realized that he didn't want to die.
And he also realized that all of the problems,
all of the pain that felt so insurmountable
really was solvable
with one painful exception.
And that was that he was probably falling to his death.
Kevin is not alone
in terms of jumping off the Golden Gate Bridge.
Over 1,200 people have killed themselves since the bridge opened in 1937.
But Kevin isn't one of them.
Kevin's a rarity.
He's one of a handful of people who survived that jump
to actually come and tell us about it.
And as he fell,
he prayed for God to save him;
righted himself in the air, and miraculously,
he is a very powerful advocate for suicide prevention
in the United States.
So what about the woman, right?
It would be very easy to think, "What a rotten person!"
She didn't care about poor Kevin.
But I don't think that would be correct, and I don't think it would be fair.
I think that woman was a lot like me with my depressed friend.
And I think she's a lot like many of us
when it comes to the problem of suicide.
Maybe she was preoccupied,
not paying proper attention.
Maybe she didn't really grasp the seriousness
of the situation in front of her.
And maybe she just didn't know what to do.
Today,
I want to invite you to join me and people like Kevin
in taking the issue of suicide in young people seriously.
What would that mean?
What would that look like?
The first thing is that I will invite you to begin
to think about yourself as an advocate.
What do advocates do?
Well, Proverbs 31:8 calls us
to speak up for those who can't speak for themselves;
for the needy, for the destitute.
And to judge their situation fairly.
What would that mean here?
We know that the vast majority of people who kill themselves
suffered from mental illness, or addiction, or both.
We also know that areas that have better access
to mental health and health services,
in those areas, the risk of completed suicide is lower.
So if we're serious about the problem,
we need to be advocates for better access
to mental health and addiction services,
and for better services.
If we're serious about better services,
we need to be advocates for more and better research,
because we don't know nearly enough about preventing suicide in young people.
What else?
I think it's critically important that we approach this problem
with a sense of hope - and I believe it's realistic hope –
and positive expectations.
Nihilism didn't get us the polio vaccine,
and it's clearly not helpful to us
when we think about this problem of suicide.
If anything, it's clearly a detriment.
Look around, think about it for a minute.
I want you to think about this next year.
What would be an acceptable number of suicides in young people?
What would be an acceptable number of suicides
in the folks and people
like the folks who are in this audience today?
If you're like me, you come to the same conclusion,
which is: it's zero.
And that our tolerance for suicide in young people
should be a zero tolerance.
What else does it mean to be an advocate?
Well, part of being an advocate means
that we need to challenge ourselves and others by asking questions,
and sometimes, uncomfortable questions.
Here are a few for you to think about today.
The first:
how can we help many of our colleagues in general medicine
and workers in emergency departments
to begin to think more about mental illness,
and addictions,
and psychiatric crisis
as opportunities to save a life?
More than simply some sort of petty annoyance, or distraction
from the work of what we'd like to think about as "real medicine."
Next question:
how can we ensure that our societal investment
in preventing suicide is at least comparable
to the investment that we make in a variety of disorders
that have far less in the way of public health impact?
And then finally,
we're here today on The Ohio State University campus,
so it seems to me an appropriate question
IS what would the Big Ten be like
if these great universities cared more
about which of the campuses competed more,
for which campus would be the first one to be suicide free
than which campus had the best football team?
What would that be like?
Think about it for a moment.
Thank you for your attention here today.
(Applause)