For the first time in my life, I am trendy. Au courant. On the cutting edge.
I have suicide to thank.
My recent collection of short stories, The Incurables, is centered on characters in a small Ohio town who are depressed, anxious, lonely, and suicidal. Reviewers have suggested these protagonists are unfortunate outliers—irrational, strange, grotesque. Far from it. My characters (and, yes, their creator) are, as it turns out, mainstream. We’re fashionable. We’re in the in crowd.
Suicide will never be cool, but it is trending.
From 2000 to 2010, according to statistics issued last year by the American Journal of Preventive Medicine, the suicide rate in the United States jumped 16 percent. For Americans aged 35 to 64, according to a Center for Disease Control report released in May, the increase over the same period was even more pronounced—28 percent. The CDC reported 38,364 suicides in 2010. This is roughly the population of Morgantown, West Virginia, where I live.
Suicide now claims more American lives than automobile accidents. In a 2010 survey conducted by the AARP, one in three adults over the age of 45 reported feeling chronically lonely. In a similar survey ten years earlier, that number was only only one in five.
“The Bridge,” the opening story in The Incurables, depicts a suicide epidemic in which residents of the fictional town of Sherman, Ohio (and, eventually, people from all over the country), hurl themselves off an otherwise unremarkable local bridge. A reviewer called the story “surreal.” In light of recent statistics, however, it seems less surreal than understated.
The recent increase in suicide is ironic because there are more methods than ever to treat depression, a prime risk factor in suicide. From antidepressants to electro-convulsive therapy (ECT), transcranial direct current stimulation (tDCS), transcranial magnetic stimulation (TMS), and deep brain stimulation (DBS), patients have myriad treatment options, if no guarantees. Even Tylenol, as revealed recently by researchers at the University of British Columbia, may be able to lessen existential unease.
We live in paradoxical times. While we have become more connected to each other via the Internet and its virtual communities, we have also become lonelier. In a 2010 survey conducted by the AARP, one in three adults over the age of 45 reported feeling chronically lonely. In a similar survey ten years earlier, that number was only only one in five.
When I wrote The Incurables, I thought I was universalizing my personal experiences of isolation, depression, and suicidal ideation, not speaking for my generation. But at age 47, I am in the middle of that vulnerable 35-to-64 age group—and, evidently, in harmony with it. Regardless of age, however, we Americans are more susceptible to killing ourselves now than at any time in our history. While the causes of our despair—from a moribund economy to persistent and harmful media stereotypes of the mentally ill—are worth examining, two questions persist: Why, despite advances in the treatment of mental illness, do we so often choose death over life, and, more urgently, what options might we have to reverse this disturbing trend?
Of course a struggling economy cannot be the sole reason for our collective death wish. Our wars in Afghanistan and Iraq have also contributed to the higher suicide numbers. In 2012, according to Department of Defense statistics, as many as 349 service members killed themselves—nearly one per day. This represents an increase over 301 suicides in 2011, and 298 in 2010. In 2002, prior to the invasions of Afghanistan and Iraq, the suicide rate among service personnel was below the civilian rate. Now, however, those rates are equal, although the military rate may actually be underreported because of the way the armed forces calculates its statistics. For U.S. military veterans overall, the suicide rate is outright shocking. According to a Department of Veterans Affairs study examining the years 1999 to 2010, a veteran commits suicide every 65 minutes.
My depression represented a profound education on issues of mental health. I wish I could have acquired it another way. Despite improvements in mental health care, the military remains a macho culture in which men and women are often thought weak or cowardly if they admit to feeling mentally unwell. In The Long Walk: A Story of War and the Life That Follows, Iraq vet Brian Castner writes about trying to literally outrun his demons rather than submit to therapy. After I gave a reading from The Incurables at a college, a student there told me about her brother’s futile efforts to convince the military to treat his depression. A suicide attempt followed.
American society as a whole, however, isn’t much better than the military in understanding mental illness. From the over-the-top and unsympathetic portrait of a mental health institution in the 1975 film One Flew Over the Cuckoo’s Nest to Heath Ledger’s 2008 Academy Award-winning but stereotypical portrait of a schizophrenic in The Dark Knight, people who suffer from mental illnesses have seen their conditions demonized and misrepresented in popular entertainment. Because of villainous portraits of the mentally ill such as Ledger’s, the public frequently equates mental illness with violence, although a report published by the Public Health Agency of Canada in 1996 and updated in 2002 refutes this stereotype. Stigma, however, can be a killer. In 2003, the President’s New Commission on Public Health concluded that living with the stigma of mental illness “leads to low self-esteem, isolation, and hopelessness… [P]eople with mental health problems internalize public attitudes and become so embarrassed or ashamed that they often conceal symptoms and fail to seek treatment.”
My depression represented a profound education on issues of mental health. I wish I could have acquired it another way.
My major depressive episode began in the summer of 2003. Among its causes, I suspect, were the recent deaths of my maternal grandparents, with whom I was close, and my father’s diagnosis with what would prove fatal kidney cancer.
A pill doesn’t make the world better. If we’re lucky, it only makes it seem better. There were other factors as well. As a former Peace Corps Volunteer who worked with Guatemalan farmers on soil conservation in the early 1990s, I was (and am) profoundly concerned about the impact of global warming, especially on poorer countries. I was (and am) worried I would be sending my daughters into an apocalyptic future of scorching temperatures, crop failures, and potentially violent competition over diminishing natural resources. I believed (and believe) in employing non-military approaches to conflict resolution. President George W. Bush’s “you’re either with us or against us” approach to international relations felt alarming and unsettling. I lived in Guatemala toward the end of its 36-year civil war. The Guatemalan military had a similar “with us or against us” philosophy—and it destroyed anyone merely suspected of being against it.
All of this contributed to my feelings of isolation and hopelessness. The transition from these feelings to depression was quick. So, too, was the transition from depression to despair. By the fall of 2003, I felt an anguish so profound that suicide seemed the only way to quell it.
I was lucky to survive.
There are, of course, biochemical causes of depression. Chemical imbalances in the brain can make a person vulnerable to depression and therefore suicide. But no treatment—10 percent of Americans over the age of 12 are now taking an antidepressant—can eradicate war or global warming or unemployment or any of the other environmental components of our misery.
A pill doesn’t make the world better. If we’re lucky, it only makes it seem better.
Writing fiction requires an author to imagine the lives of other people. If my experience with depression was the impulse that led to The Incurables, that impulse alone could not have sustained a collection with dozens of characters struggling to stay sane in a world grown hostile to mental wellbeing. My stories are colored by the men and women I met in my journey back to health, principally in the psych ward of a New York City hospital where I spent three months.
In “Classmates,” two of the characters attempt suicide 15 years after their graduation when their conception of themselves as men prevent them from seeking help for their depression. In the title story, a male porn actor who has contracted herpes and is experiencing impotence tries to kill himself, but is saved—and ends up having the chance to save someone else. The protagonist of “Afterwards,” Perkins, is driven to psychosis by the failure of his business and the dire place the world threatens to become. In what he perceives as an act of mercy, he kills his wife and two children. He survives to face the vitriol of everyone in his hometown, save a sympathetic childhood friend.
I would never have wished the experiences I needed to write The Incurables on anyone. But having endured them, I wanted to redeem them in words.
I have no magic prescription for loneliness or depression or hopelessness over what the world is and may become. I have, however, developed strategies to ease the harshest manifestation of these emotions in myself.
Rather than despair over inaction on global warming, for example, I ride my bike, contribute to green causes, vote for green candidates (rare as they are in coal-fired West Virginia). Will my actions affect a measurable change? I don’t know. But I know I will change more by acting than by succumbing to hopelessness.
The “with us or against us” approach to foreign policy has persisted, even after George W. Bush left office. President Obama could have promoted nonviolent conflict resolution at his 2009 Nobel acceptance speech, but chose instead to talk up our country’s toughness, and proceeded to increase the number of drone strikes. Instead of becoming despondent over our country’s bellicosity, however, I draw on my experiences in Guatemala and speak to my students and my children about constructive, cooperative, and nonviolent engagement with the world.
As important as it is to connect with people across oceans, it is equally crucial to connect with people next door. The strongest communities remain those we create by coming together in the same space, by eating the same food and breathing the same air, by seeing each other’s faces and shaking each other’s hands. In our communities, we should always be prepared to offer help. And, just as important, we should never be afraid to ask for it.
This is a notion I found myself returning to frequently in The Incurables. My characters have the best chance of surviving their despair if there is someone nearby, friend or stranger, to whom they can turn. At the end of “The Bridge,” when John Lewis, the 65-year-old sheriff charged with stopping the suicide epidemic, seems poised instead to surrender to its spell, CeeCee, the 19-year-old sorority president who has been working with him to end the madness, offers him her hand.
The human touch is an old remedy. But it’s often the best cure.