WEBVTT 00:00:00.000 --> 00:00:01.000 Hi there. A warning before we get started. Today’s episode is about suicide and includes references to sexual abuse. If you, or someone you know, is thinking about suicide, please call the National Suicide Prevention Lifeline at 1-800-273-TALK. 00:00:01.000 --> 00:00:02.000 [MUSIC FADES IN] 00:00:02.000 --> 00:00:03.000 This is “In Conversation,” from “Apple News.” I’m Shumita Basu. Today, why it’s so hard to assess suicide risk in children, and what parents should know. 00:00:03.000 --> 00:00:04.000 [MUSIC FADES OUT] 00:00:04.000 --> 00:00:05.000 On April 14th of 2021, Andrew Solomon attended a funeral with his twelve-year-old son, George. 00:00:05.000 --> 00:00:06.000 I had thought that he might be upset by the idea of attending a funeral, but he was actually glad to have been asked. And I think it gave him some feeling of completion or closure to have been asked. 00:00:06.000 --> 00:00:07.000 [MELANCHOLIC MUSIC FADES IN] 00:00:07.000 --> 00:00:08.000 The funeral was for a boy named Trevor Matthews, who George had gone to school with. 00:00:08.000 --> 00:00:09.000 And this was a very beautiful funeral. It was very high church. There was spectacular music. And we listened to these evocations of Trevor and all the things he had accomplished and all of the good that he'd done in the world and just felt how much frustrated and broken love there was in the room for somebody who was now gone. 00:00:09.000 --> 00:00:10.000 Trevor died by suicide. He jumped off the roof of his family’s apartment building in New York City, just a few months after his twelfth birthday. At the end of the funeral service, Andrew’s son George and a few of his classmates were some of the last to file out. As they passed Trevor’s mother, she stopped the boys, she took off the large, dark sunglasses she had been wearing, revealing her red eyes, and she said to them… 00:00:10.000 --> 00:00:11.000 I want you boys to promise me, to promise me that you will talk with one another, with your parents, even with a doctor, with a teacher about what is going on inside your head through this difficult time. She said, because I don't want to ever come to another funeral like this one. 00:00:11.000 --> 00:00:12.000 Andrew Solomon is a professor of clinical medical psychology at Columbia University. He’s written about depression, and parenting. And in his latest piece in the "New Yorker," he writes about his son’s classmate, Trevor, and the overall rise in youth suicide. 00:00:12.000 --> 00:00:13.000 Children's mental health is in peril. It was in peril before the pandemic. It was getting worse. It continues to get worse. The rates of suicide continue to go up. Somebody needed to step in. And I happened, really through knowing this one family, and then through having a background in writing about depression, and having suffered, not from suicidality, but from quite severe depression myself at one point, I thought I'm probably as well qualified as anyone to try to tackle this. 00:00:13.000 --> 00:00:14.000 In 2020, according to the CDC, suicide was the second leading cause of death for young adults ages 15 to 24, making it as common a cause of death as car crashes. Andrew explains that youth suicide is such a painful topic, most people find it hard to acknowledge the depths of the problem, much less how to address it. It’s an emotional and academic blind spot. Thinking of it that way can help explain how an affluent, well-educated, and loving couple in Manhattan, people who had resources and access to mental healthcare, were still unable to avoid losing their son Trevor to suicide. 00:00:14.000 --> 00:00:15.000 [MUSIC FADES OUT] 00:00:15.000 --> 00:00:16.000 Trevor was an unbelievably bright child. He was far and away the brightest child in the class that my son was in. He was reading advanced, adult books when he was very young. He was a very asynchronous child, which is to say that he was intellectually super ahead of his age and emotionally at age level or in some instances behind. He was a child who expressed himself aggressively much of the time, and who would push back, and other children were in some instances traumatized by being in a class with Trevor because he could be so aggressive. But he also did things, I mean, he would stand up for people and come out for people and do things for people. And his parents are immensely articulate, even wise. And I think that they spent a long time trying to find the right context for Trevor. One in which he could thrive and prosper. He left the school he had attended with my son. He went on to another school, then he was entering middle school. And in the system he was in, that involved going to get another new school. And so, he was going to schools and he didn't have a chance to meet anyone face to face. He was online most of the time. So, he was experiencing a sort of terrible isolation and his parents, I think, were deeply sad about that. 00:00:16.000 --> 00:00:17.000 There was a summer camp, right. That Trevor had gone to, had made friends at. It was later revealed that a long-time counselor at that camp had been abusing the children, some of the children. Can you talk a little bit about how that experience affected Trevor and how his parents came to know about it? 00:00:17.000 --> 00:00:18.000 The counselor in question, Dylan Stultz, had been at the camp for many years, and one of the children wrote home a letter at the beginning of one summer and said, "Sports are great. Everything's terrific. Dylan touched my penis. Aside from that, everything was terrific." And his parents immediately called the camp, and the camp immediately let go that counselor. I didn’t ask for, and I don't have the exact details of, what it was that he had done to Trevor, but it was an enormous, enormous trauma and the kind of trauma that often pushes people over the edge. In the larger research I did about child suicide, nothing predicted more strongly than sexual or other forms of abuse, but particularly sexual abuse. 00:00:18.000 --> 00:00:19.000 You describe Trevor's parents, Angela and Billy, as having done so many things. Clearly, they wanted some kind of help for their child. Maybe they didn't know exactly what kind of help. But can you talk a little bit about some of their attempts over the years? What kind of guidance did they seek? What did they seek for Trevor? 00:00:19.000 --> 00:00:20.000 I would begin by saying that the cliche, which has some basis in reality, is that children who commit suicide often do so because they come from households in which they have been badly abused and have felt unloved. Trevor was a beloved child. His parents adored him and wanted to do everything they possibly could for him. They had taken him to a variety of therapists. They took him to therapists before he revealed the news about having been abused. They had him interacting with a therapist afterward. At one point, they had him hospitalized in an involuntary psychiatric commitment, which was very, very difficult for everybody who was involved. I think they did everything there was to do. 00:00:20.000 --> 00:00:21.000 Were there any conversations that Trevor's parents recounted to you that really stood out to them, that gave them some insight into what was going on with their child, within his mind? Depressive thoughts, or even suicidal ideation? 00:00:21.000 --> 00:00:22.000 Yes. Trevor had talked about suicide a lot, and that was really what spurred his parents to take all of the action that they took in the period before he died. And they had said to him that they wouldn't judge him for anything he thought, or anything he felt, or anything he said. They just wanted him to be open with them. And there were moments when Trevor was with his parents and he said, "I'm having thoughts." And that meant, I'm having suicidal thoughts. And his parents were very vigilant and stayed very much on top of things. And then with a lot of treatment, he seemed to be getting better and they began to relax a little bit. And as he seemed to be getting better, perhaps he was getting better, but he was an impulsive person. He was impulsive in his interactions with other children all along, and at some point, impulsively he made the decision to end his life without any immediate warning. It's not as though at that point, he was in a terrible welter of depression and was constantly talking about suicide and they just didn't pay attention. And he was at home with his parents. They thought he was doing homework at the moment that he died. 00:00:22.000 --> 00:00:23.000 Yeah. Tell me a little more, if you can, on what happened on the day that Trevor died? 00:00:23.000 --> 00:00:24.000 Well, Trevor had gone out and he had bought some candy. He had bought some Jolly Ranchers and he had bought a big bag of them and then was gonna break up the bag and sell the candies individually at school, which he was rather proud of as an operation. And when he told his parents that he'd done that, his mother said, “You really can't go out shopping for things by yourself. And you can't have the Jolly Ranchers.” That was, I guess, a day before he died or two days before. On the day, Trevor did his therapy with his doctor, the psychiatrist said that Trevor was no longer a suicide risk, that there was zero risk of his ending his life at that point. 00:00:24.000 --> 00:00:25.000 This was virtual therapy or? 00:00:25.000 --> 00:00:26.000 This was virtual therapy. So, we were in the thick of the pandemic. And Trevor asked for the Jolly Ranchers back from his mother. She said, “No," she said, "I'm sorry, but you really need to learn the lesson that you can't just go and do these things.” They were all sitting together. Trevor went back to his room to do his homework. Trevor's father, who was working from home, went into the dining room to work on his computer. Trevor's mother was with his sister trying to pick out leotards for her ballet classes. And Billy looked up and saw Trevor standing in the hallway, looking at the mail, which seemed slightly odd, but not terribly odd. And the next thing they knew, it was a few minutes later, the doorman was pounding on their door and ringing their bell to tell them that Trevor had jumped from the roof. 00:00:26.000 --> 00:00:27.000 What was the conversation like with your son, with George, when you told him what had happened with Trevor? 00:00:27.000 --> 00:00:28.000 I was out shopping for groceries for dinner and my phone rang, and I saw that it was the mother of one of George's friends, and I thought, "Well, I'll call her back," and she didn't leave a message. And then as I was in the parking lot, putting groceries into the car, the phone rang again, and it was the mother of another one of George's friends from school. And I thought, "Well, I'll call her back, too." And then I suddenly thought that's very strange that they both called me so close together. And so, I called one of them back and I got the news. And I drove home thinking, what is gonna be the calm, cool, collected way that we're gonna present George with this information. And I walked in and my husband was making dinner. And he looked at me when I came in and said, did something happen? And… 00:00:28.000 --> 00:00:29.000 He could see it on your face already. 00:00:29.000 --> 00:00:30.000 He could see it on my face immediately. And I said, "Yes." And he said, "What happened?" And I told him, and he burst into tears. And George came running out of the room where he had been playing a computer game, I think, and came in and said, "What is it? What is it, what happened? What happened? Did something bad happen?" So, all thoughts of a cool collected way of responding disappeared. And so, we told George what had happened and George said, "But why, why would he do something like that?" And he was crying and crying. And he said, "I wasn't always that nice to Trevor. Maybe, maybe I had to do with it in some way." And I said, George, you didn't do anything that caused this and you couldn't do anything to have prevented it. It's just a terrible, sad, tragic thing that's happened. And George was really, I mean, he was deeply, deeply grieving for Trevor. Not because Trevor had been his best friend, but he had known Trevor, you know, since kindergarten. And I think the idea, even for children, it's the idea for adults, but even for children, the idea that someone has been in that much pain and you didn't see it and you didn't know, and you didn't respond to it. There's a terrible feeling of neglect and sadness and guilt that goes with all of that. And I think George, even at the age of 12, was processing all of those complex emotions. 00:00:30.000 --> 00:00:31.000 For you as a parent, but also as an expert in psychology and issues of depression, how prepared did you feel for that conversation with your son that day? 00:00:31.000 --> 00:00:32.000 Nothing in my long experience had prepared me to have that discussion with George that day. The mother of one of his friends said when we spoke a few days later, she said their childhood ended on Tuesday. And that was the feeling I had. I had the feeling that George, with whom I had been reading stories at bedtime. And not that George hadn't also had his difficulties and his challenges and all of the things that children have, and we'd gone through plenty ourselves, but nothing on that scale. And I felt like you can describe what depression is. You can say that depression is an illness. You can emphasize that there are treatments for it. But in the end, in a case like this, you have to acknowledge here was a child who was receiving treatment, who had adoring, loving, supportive parents, who had enormous academic success at school, who had everything going for him and still, this was the way that his life ended. And at this early in age, and, when I talked to George about it, I think it was the awakening of the understanding of that. 00:00:32.000 --> 00:00:33.000 Trevor’s story sent Andrew down a path to better understand youth suicide. He’s now working on a book that expands on his "New Yorker" article. 00:00:33.000 --> 00:00:34.000 It will cover the experience of children from five to twenty-five, because five is the youngest age at which anyone dies by suicide. And 25 is the age at which I think the brain is fairly fully developed. But in that gap, that five to twenty-give gap, and Trevor at the age of 12 fell squarely in the middle of it, children are incredibly vulnerable for reasons that can be quite different from the reasons why adults are vulnerable. 00:00:34.000 --> 00:00:35.000 Andrew has been speaking with other families who have lost children to suicide, as well as people who attempted suicide as a child and survived. And he’s also been looking at the data. Which shows a disturbing trend. 00:00:35.000 --> 00:00:36.000 The rate of suicide has been steadily increasing, really for a long time, probably at least since the 1950s, but certainly over the last decade. And the age of suicide gets to be younger and younger. I mean, I was shocked in the research I did when I came across the story of a girl who hanged herself with her jump rope at the age of five. And I thought when I was five, I didn't think I even understood what life and death meant. I wouldn't, no matter how I'd felt, it wouldn't have been available to me as an idea. So, the rates are going up and the age is coming down. Now, the age for a lot of things is coming down. The age of puberty is coming down and it's come down significantly. There are various other ways in which at the age of consciousness is coming down. But I think here, particularly, we have a new generation for whom this is an acute danger. And if you have a child who you even think is basically fine, but having a rough time, it's time to put the prescription medications in a safe and to keep an eye on your child, and to put the kitchen knives where they aren't so readily accessible. I think nobody really believes that his or her child is capable of this until it happens. And then when it happens, the shock is enormous. 00:00:36.000 --> 00:00:37.000 One thing that that brings me to is the idea of assessing suicide risk in children before it happens. And you write about just really how difficult it is to do that accurately. 00:00:37.000 --> 00:00:38.000 Well, some children have manifested real signs of depression from a very young age and have required the kind of attention that will be from psychologists. And you know that they're struggling and you see what a hard time they have, and you spend their whole lives trying to fix it and make it better. But a lot of the time, child suicide occurs apparently out of the blue. Impulsivity is one of the primary predictors of suicidality in children, and that's what makes child suicide so particularly terrifying. And we all want to believe that love is an adequate medicine to keep people from killing themselves. And love helps a lot. You're much less likely to do that if you've grown up in a loving household than if you've grown up in an abusive household, but love is actually not sufficient to prevent it. And part of the reason that I was so engaged by, and pained by, the story of Trevor and his family, is that he couldn't have been more loved. He couldn't have been more loved, and nonetheless, he went in this direction. 00:00:38.000 --> 00:00:39.000 What are some of the signs, if there are any, that indicate that a child might be at risk? I'm just imagining parents listening to this right now and thinking, "Gosh, what should I be looking out for?" 00:00:39.000 --> 00:00:40.000 It's important to look at whether the child is able to form social relationships with other children or with adults. It's important to look at whether the child tends to be honest. It's important to look at bullying. Suicide is highly correlated with bullying. But startlingly, it is as much correlated with bullying for the bully as for the person who is bullied. Both of those people are in very severe risk groups. And it's important to know whether your child is impulsive or whether your child pulls back from taking extreme actions when those are available to them. Those are all things to look for. And I'm perhaps speaking New York cliches, but if your child seems to be having a rough time in any way, find a therapist that your child can trust and who understands this area, or sometimes find, you know, a priest or a minister whom your child can trust or find somebody outside the family. Because there are a lot of things children won't say to the family. And also try to educate children, not to tattle on one another, but to say when there's something that worries them because of the children who go on to die by suicide only about at 60 or 70% of them have ever told anyone that they were even thinking this. And of that 60 or 70%, half have told only a peer. But the other thing that parents can do is actually to talk about the idea of suicide with children who don't appear to be suicidal, because there are quite a lot of children who, if you say to them, Have you ever thought of harming yourself? Have you ever thought of ending your own life? Will actually say, "Well, sometimes I do." Children you would never have expected to hear that from, and the old idea that somehow asking children that question is gonna push them towards suicide is now entirely discredited. 00:00:40.000 --> 00:00:41.000 [MELANCHOLIC MUSIC FADES IN] 00:00:41.000 --> 00:00:42.000 Andrew says, this is what was on Trevor’s mother’s mind at the funeral when she pulled George and the other boys aside and told them to promise to always talk to adults and to each other. 00:00:42.000 --> 00:00:43.000 She said, “It's true that I've lost my son.” She said, “But it's true that you've all lost your friend,” she said, “and that counts for a lot too.” 00:00:43.000 --> 00:00:44.000 Andrew warns that suicidality in young people can be contagious. Studies show that young people who know a peer who died by suicide are at an increased risk for suicide for a full two years after, even if they didn’t know that child very well. 00:00:44.000 --> 00:00:45.000 Because the idea has become accessible to them. And it seems like an option in a way that it previously didn't seem like an option. Particularly with the rising information that's available on the internet. 00:00:45.000 --> 00:00:46.000 Even with this information being more accessible to kids, adults remain largely unaware about the signs of depression and suicidality in children. Andrew says it’s something that he himself did not see clearly in Trevor. 00:00:46.000 --> 00:00:47.000 Trevor could be very sweet and loving, but he was also very reactive and he could be very tough on other children. I understand that aggression very differently now than I did then. And I wish I had encouraged George to be his friend and to help him instead of doing what I did, which was to say, you know, "Okay, just deal with Trevor as best you can at school, and on the weekends, that's not one of the people we're going to see." And I wish we hadn't all been so afraid of Trevor, but we were. We were afraid of Trevor I, the other parents at the school, many of the people who interacted with him. 00:00:47.000 --> 00:00:48.000 Trevor’s mother told Andrew that the many mental health professionals who worked with Trevor, for a long time, didn’t bring up words like ‘depression’ or ‘anxiety.’ But, in retrospect, it’s clear to Andrew that’s a big part of what was going on. 00:00:48.000 --> 00:00:49.000 Well, depression really manifests in two kinds of symptoms. It manifests in internalizing symptoms, which are sadness, withdrawal, disconnection, failure to take care of yourself and so on and so forth. And in externalizing symptoms, which are aggression and argument. Often depressed children present not as depressed, but as angry. If your child has emotions that seem extreme or behaviors that seem extreme, those can be a sign. I had thought when Trevor was at school with George and he caused trouble with some of the other boys, I had always thought Trevor had kind of a mean streak. And after this happened, I thought, no, that was his way of expressing the pain that he was in. And so, I think the idea that depressed children are necessarily gonna look depressed in the conventional ways that we think of adults as looking depressed is not valid. If you have a child who's acting out and who's engaged in extreme behavior, that child tends to meet, not with sympathy, but with discipline. And in fact, those children should be met with compassion. You know, it's not that much fun to be a bully. It's not that much fun to be overbearing in your interactions with other children. It doesn't make you popular to be explosively angry for very little reason. Those are all qualities that point toward what I, as I said, this externalizing depression. 00:00:49.000 --> 00:00:50.000 But it sounds to me from what you've written about that a lot of mental health professionals who work with children, miss those other signs that could be pointing toward depression. 00:00:50.000 --> 00:00:51.000 One of the things that is completely shocking is that there is a terrible dearth of child psychologists and psychiatrists in this country. Children who have really serious depression are often therefore missed, or even if the parents think there's something wrong, they can't get help. There's more help concentrated in major cities. But if you are in a rural part of the country where you don't have ready access to therapies and supports you have to figure an awful lot of it out by yourself. And you have to, at some point say, "Okay, my child keeps getting in trouble. Maybe that's because he's suffering." And part of the reason I wrote the article and part of the reason that I'm working on a book is because I think it's so terribly important that we tell these stories, so that people have some idea where to begin and what to look for. People tend to think, "Oh, my child is sort of disturbed, but the teenage years are hard." I mean, I can't tell you how many people I've spoken to who've said, "Yeah, he didn't seem to be doing that well, but the teenage years are hard." And the teenage years are hard. I mean, I’m the father of two teenagers, and they're having a hard time in various ways that are just endemic, I think, to the age they are. But you have to be open to the question of, is it more than just the teenage years are hard? Are the teenage years so hard that this person isn't going to get through them? 00:00:51.000 --> 00:00:52.000 And also, is it particularly hard to get through your teenage years right now during a pandemic? I don't know how this has been measured or if it's been measured, but has the pandemic affected youth mental health in a particularly hard way? Particularly suicides. 00:00:52.000 --> 00:00:53.000 Youth mental health has plummeted. There are a lot of children who, even before the pandemic, were talking about the idea of global warming, the sense that the world was being destroyed, the question of whether they would be able to have a life anything like the life they were growing up in, all of that was difficult. And then in the pandemic, you had two things that were very difficult for children. The first was that they were essentially cut off from their peers. And then you layer on top of that, the fact that many children lost someone who mattered to them to the illness. And the fact that many children were in households in which there were catastrophic financial consequences to the closing down of various kinds of work. And they had to leave the homes that they had thought they were safe in. All of it adds up to a crisis. There's no question that children are, have been in a terrible place. 00:00:53.000 --> 00:00:54.000 I mean, aside from the peculiarities around the pandemic so much has been said about social media, how young people are interacting with each other on social media, how they send out to the world signals about who they are and what they want the world to of know about them on social media. Do you see social media as having an outsized role here? It makes a very small mention actually in your piece, smaller than some people 00:00:54.000 --> 00:00:55.000 might expect. 00:00:55.000 --> 00:00:56.000 There is a lawyer based in Seattle, Matt Bergman, who is working and has now over 40 cases that are filed against social media companies, claiming that the algorithms on social media, which are designed to keep the children online for as long as possible, keep them online and drive them toward dangerous content, and that that dangerous content is at least partially responsible for those children's choice to end their lives. And I think that that's an opening area, and he's someone who previously worked on asbestos claims. And he said it's really very much the same thing. He said, you have these huge corporate entities that are involved in producing something that they know is dangerous and they choose to go on doing it anyway. Children on social media always see their friends lives idealized. And even if they are themselves putting idealized pictures of themselves up and know that their description of themselves on social media is not accurate, they believe, much of the time, that what they're seeing of other children is accurate. And some of the time, actually, what they're seeing is their own exclusion. When I was in high school, I was not a super popular kid and there were some parties I wasn't invited to, and I sort of vaguely knew they were happening, but I wasn't that engaged with it. When you get to a certain age now, you look on social media and you see everyone else having fun at a party you weren't asked to the sense of exclusion and isolation is terrible. 00:00:56.000 --> 00:00:57.000 Do you have any advice for parents on how to talk about suicide with their child? 00:00:57.000 --> 00:00:58.000 For many, many children, the idea that you don't have to hold secrets makes a huge difference. There's someone, again, whom I interviewed more recently, I interviewed both the mother and the daughter. And the mother was very shocked when her daughter made a suicide attempt and they were sitting in the emergency room together waiting for her daughter to get treatment. And she said, "How do you feel now?" And her daughter said, "I feel so relieved." And her mother said, "Relieved?" And she said, "Now you know." And she had no other way to tell her mother than to make the actual attempt. Fortunately, she recovered, but that was the conversation. And so, if your children feel that you can handle this information and that you won't say, "That's totally crazy, what are you talking about?" And that you won't say the thing that everyone says that's so destructive, which is, "But you have so many reasons to be happy, but you have this, but you have that. Here are all of the ways in which things are good in your life." That erases the emotional experience the child is actually having. What you need to do is not to erase that experience, but to say, "Tell me more, how did that feel? Have you felt that way for a long time? Did anything happen that started this?" And so, it's the ability to have these conversations with your children and not have them feel judged. I guess that's really the thing. To say to them, this happens a lot. It happens to lots of children. If it happens to you, we're here to help and we don't judge you in any way for it. 00:00:58.000 --> 00:00:59.000 How does it feel to you to have written this story to have spent so much time with obviously something that hits so close to home? 00:00:59.000 --> 00:01:00.000 Look, it's terrifying to be writing about child and adolescent suicide as the father of two adolescents. I mean, and if anything is going to make you paranoid, that's it. And I feel like I'm constantly trying to make sure that my children are all right and to take their temperature, and that their friends are all right, and that my niece is all right, and that other people who are in my sphere are all right. It's crushingly sad. But when I looked at a family who had all of the connections and capacities that the Matthews family did, and who struggled so hard to find really good care for Trevor, I thought what happens to everyone else who doesn't have the access that they had, if even they couldn't find it, then what are we to do? And I thought, I know what we have to do is to make the information more broadly available, and you make it more broadly available in part just by putting the stories out there so that people don't feel so alone. 00:01:00.000 --> 00:01:01.000 [MUSIC FADES IN] 00:01:01.000 --> 00:01:02.000 Well, Andrew, thank you for writing this piece. It's beautifully written and clearly written with such love, and care and is really a moving read. Thank you. Thank you for your time 00:01:02.000 --> 00:01:03.000 Thank you so much. A pleasure to be here. 00:01:03.000 --> 00:01:04.000 You can read Andrew Solomon’s article for "The New Yorker" on "Apple News." You can find a link on our show notes page. And if you or someone you know is thinking about suicide, please call the National Suicide Prevention Lifeline at 1-800-273-TALK (that’s, 1-800-273-8255) or text TALK to 741741. 00:01:04.000 --> 00:01:05.000 [MUSIC FADES OUT]