A Suicide Epidemic among American Youth

So, American young people are undergoing a mental health crisis. That is, their mental health is declining and they are becoming increasingly likely to commit suicide. We do not know what is causing the problem.

Worse yet, we know what to do about it, or at least Dr. Richard Friedman does, but we are not actively treating depressed and anxious young people.

Friedman explains the problem:

Teenagers and young adults in the United States are being ravaged by a mental health crisis — and we are doing nothing about it. As of 2017, statistics show that an alarming number of them are suffering from depression and dying by suicide. In fact, suicide is now the second leading cause of death among young people, surpassed only by accidents.

After declining for nearly two decades, the suicide rate among Americans ages 10 to 24 jumped 56 percent between 2007 and 2017, according to data from the Centers for Disease Control and Prevention. And for the first time the gender gap in suicide has narrowed: Though the numbers of suicides are greater in males, the rates of suicide for female youths increased by 12.7 percent each year, compared with 7.1 percent for male youths.

At the same time, the rate of teen depression shot up 63 percent, an alarming but not surprising trend given the link between suicide and depression: In 2017, 13 percent of teens reported at least one episode of depression in the past year, compared with 8 percent of teens in 2007, according to the National Survey on Drug Use and Health.

Roughly speaking, the spike in depression and suicides corresponds with the Obama presidency. Could it be that our “hope and change” president brought despair to our hallowed land. Surely, Obama did not enhance national pride. Apologizing for America does not enhance pride. And, Obama did not stand tall and proud on the world stage. He cowered weakly and ineffectually, covering it all with a gloss of optimism.

As any serious scientist will respond now, I am merely presenting correlation. This does not necessarily entail causation.

If we understand that the cure for depression is pride, not hope, we can also ask whether America’s educational establishment is teaching children to be proud of the country. Or are they telling them that America is an organized criminal conspiracy, that their parents are bigoted thieves and knaves, that they did not earn what they have but were granted it as a privilege, and that they ought rightly to give it over for redistribution.

Is this message, seemingly the essence of what is being taught in American schools, more or less likely to make children depressed?

While we are in an inveighing mood, what is the psychological fallout of the latest idiot fad, namely teaching children that they can choose their own gender identity. And that they are all gender fluid and that they must choose their pronouns. We have already said a few words about the negative psychological consequences of forcing children and even adults to ignore biological reality and mutilating the language.

And besides, how can you plan for your future when you doubt your sex? Gender roles are inscribed in the social coding we follow when we chart our path through life. When our cultural revolutionaries deprives us of our bearings, we are lost. And we are more likely, I posit, as an hypothesis, to become depressed, to suffer anomie.

Friedman does not indulge such speculations. He is a psychiatrist and therefore addresses the mental health aspect of the problem. 

How is it possible that so many of our young people are suffering from depression and killing themselves when we know perfectly well how to treat this illness? If thousands of teens were dying from a new infectious disease or a heart ailment, there would be a public outcry and a national call to action.

For my part, and possessing information that is not as good as his, I would suggest that we do not know perfectly well how to treat suicidal depression. Cognitive therapy has shown some promise, but how many of today’s therapists prefer to feel their patients pain and shower them with empathy. Feeling the pain of someone who is suicidal does not, it would appear, provide an off ramp from such thoughts.

Besides, what does it mean to feel empathy for someone who feels so worthless that he wants to commit suicide? What does it mean to feel empathy for someone who does not know what to do to overcome his depressive thoughts? Does it mean, as the term suggests, that the therapist should feel depressed and suicidal, not knowing what to do?

And besides, if therapists excel in mothering their patients, doesn’t that feel like an offer of pity and pathos… just what these children do not need. I find Friedman’s pronunciamento about our perfect knowledge of how to treat these things to be… dare I say… overly optimistic. I hope I am wrong, but I suspect that if treatment were so effective young people would be flocking to it. If young people feel demeaned by therapists who want to mother them, then that would tell us why they are avoiding treatment.

One notes, in passing, that this blog has often shown considerable skepticism about therapy. In some cases I have addressed the public pronouncements of therapists themselves. In other cases I have highlighted the psychobabble offered by advice columnists and former therapy patients. 

Is it not possible that depressed young people read this swill and conclude that they should not waste their time looking for a good therapist?

I would conclude that therapists would do better to get over their addiction to empathy and reconsider the way they present themselves in public.

For his part Friedman seems to believe that one part of the problem might be that anti-depressants have not been getting very good press. And the FDA has warned that they are capable, by themselves, of producing suicidal thoughts and actions. He wonders whether these warnings discouraged people from using these drugs, though he does not ask whether there is any truth to the warning. 

And he does not ask whether the drugs were oversold to a gullible public, oversold as a panacea and oversold as something that could radically alter who you were. Could it be that the relentless hype about SSRIs allowed people to believe that they could solve their psychosocial problems by taking a pill? And that this discouraged them from undertaking the other activities, like aerobic conditioning, that could have had a salutary effect on their distress.

Friedman explains:

It is legitimate (though controversial) to ask whether the Food and Drug Administration’s “black box” warning for antidepressants back in 2004 — which said the drugs could cause suicidal thoughts and actions in some children and teenagers — discouraged the use of these drugs and unwittingly helped fuel the rise in teen depression. Within two years of the F.D.A. advisory, antidepressant use dropped by 31 percent in teens and 24 percent in young adults. Although antidepressant use recovered somewhat after 2008, it has remained below levels that would have been expected based on prescribing patterns before the warnings appeared.

Of course, if antidepressant usage recovered after 2008 that would seem to disprove the point, which the doctor noted above, namely that suicide rates spiked after 2007.

As for knowing what to do, Friedman is far more optimistic than I about the effectiveness of treatment. But, he seems to believe that we just need a new dose of optimism. I am not at all opposed to optimism, but rejiggering the mind is surely not enough. What would happen if the problem is the lack of pride, the lack of pride in our country, in our families, in our communities, the lack of pride in our achievements… produced by the relentless assault on the nation and its leaders.

Anyway, I will give Friedman the last word:

The good news is that we don’t have to wait for all the answers to know what to do. We know that various psychotherapies and medication are highly effective in treating depression. We just need to do a better job of identifying, reaching out to and providing resources for at-risk youths.