A clinical psychologist in Palo Alto recommends some reading on the subject:
The still unsurpassed professionally authored book about the diagnosis and treatment of ADHD is Lawrence Diller’s Running on Ritalin: A Physician Reflects on Children, Society, and Performance in a Pill. Diller has no ax to grind and doesn’t hesitate to prescribe stimulant medication when he believes it’s appropriate. But realizing that the “ADHD phenomenon” is extraordinarily complex, he refuses to overgeneralize, insisting that each patient is unique.
A reader in Lakewood, Colorado, shares her story:
I can’t help but share my own family experience: when our youngest daughter started to have anxiety symptoms in 8th grade, the mismanagement of her mental health crisis by the principal (interestingly enough, she was the principal of another school during a year of three suicides, and she let her own anxiety over the experience lead her response to our daughter’s problem), and how our daughter was finally diagnosed with inattentive ADHD and dyslexia.
We were so lucky that our daughter’s psychologist’s own daughter had been diagnosed with ADHD as a teenager, and how she was very aware that my daughter’s struggles to get organized at school (weak executive functioning) were the root of our daughter's anxiety, and not the other way around, as the school administration insisted.
The principal labeled her as suicidal, a description that was strongly disputed by the psychologist. She told us several times to demand from the school to stop doing uninformed, and probably illegal, mental health diagnosis.
We suspected that the interest of the school for labeling our daughter as suicidal was forcing her to leave the school. Even though the principal repeatedly told us and others that she was worried our daughter was suicidal, she never contacted the district Student Services office nor followed the district protocol for at-risk students. That was the unbelievable uninformed, uncaring, and misguided way of a school to deal with a child in a mental health crisis.
The good news was that the psychologist screened our daughter and referred her to the pediatrician and Child Psychology department from a local university, where she was finally diagnosed with ADHD and dyslexia. Since then we have had to deal with the stigma of ADHD diagnosis from some teachers and people in the community, but many others have been helpful.
About a year after diagnosis, my daughter’s anxiety is gone and she is a mature, happy, and confident teenager. Meanwhile, our school district (Jefferson County Public Schools in Colorado) is dealing with its own version of Palo Alto teen suicide crisis. Besides the three suicides at Green Mountain HS in 2002-03, last year Golden High School had three suicides, and since October of this year, another two local high schools have experienced one each—the second one only this week, according to a letter sent to parents of Arvada HS students on Monday. (On their favor, I have to add that the very capable and caring professionals have increased screening and services offered to students in crisis.)
This reader flags another spate of suicides:
The Atlantic has a similar cluster right in its own backyard. Woodson High, a relatively small high school in suburban D.C., experienced six suicides in two years (and depending on who you talk to, at least two more deaths were likely suicides that the family did not want disclosed). The area demographics are similar to Palo Alto, albeit without the glamour of high tech. This is not a Silicon Valley problem by a long shot.
Dr. Diller is an interesting guy. The son of Holocaust survivors, he took the trouble to acquire professional training that was considerably broader than the training that most physicians and other health care professionals receive.
That said, he’s not a psychiatrist and has very little background in any of the other traditional professional mental health disciplines, and his book, as good as it is, doesn’t really address the extremely complicated relationship between ADHD and traditional mental health diagnoses, especially depression. However, his intelligence and curiosity and old-fashioned commitment to treating the whole person (i.e., as opposed to push-button treatment-by-diagnosis) continue to make the book, which was published in 1998, essential reading for any person, lay or professional, who wants to understand and help anyone who suffers from one or more of these conditions.
I guess your thread (that just came to my attention) has been going a long time. Perhaps my response is still of interest. I read Hanna Rosin’s article on the Silicon Valley Suicides with great interest. Until very recently, I lived just a few miles north of Palo Alto. My beloved daughter, a recent Stanford graduate, took her own life in 2002 as a result of an adverse reaction to an SSRI antidepressant.
It was totally unexpected and out of character despite a brief period of mental distress due to insomnia and career upheaval. At the time she died, she was under the care of academic psychiatrists, whom I have now come to believe were a large part of the problem in her death rather than any solution. I know that in at least one of the cases Rosin referred to in her article, the young woman who jumped off an overpass, the victim was also under the care of revered professionals.
It’s my premise that not only the culture of Silicon Valley, but also, almost more importantly, the nature of the remedies that are being proposed in the name of mental health counseling, are to blame in these deaths.
Because I recognized immediately that my daughter’s death was the result of agitated and highly disturbed behavior brought on by medication adjustments in the last days of her life, I became a student of psychopharmacological safety and effectiveness. What I learned was highly disturbing. The FDA is far from a protector; it’s largely the puppet of pharmaceutical industry interests. Psychiatry itself is in the pocket of industry and promotes a highly flawed biomedical model for mental illness that divorces itself almost completely from the trauma and dysfunction that drive most symptoms of mental distress.
I co-founded the website SSRIStories.org, now administered by Julie Wood, who wrote an excellent series of articles (available on RxISK.org) about the significance of what is revealed in that database. I also testified at FDA hearings in 2004 and 2006 and my testimony, along with those of several other victims and survivors, led to a black box warning on antidepressants, which is all too often dismissed a decade later.
While I realize it would be reductionist to say that the suicides going on in Palo Alto are solely the result of adverse reactions to medication—not simply antidepressants, but also stimulants and other treatments that may have been started in childhood—this is still an issue that should be seriously considered. It is no secret that stimulants are now being promoted as a cognitive performance enhancer and Silicon Valley is a prime market for these drugs. [Related discussion in Notes here and here.] But how many people also know that they are a segue to other psychotropic drugs, since stimulants often lead to depression and/or mania? How many children are being labeled “bipolar” or “clinically depressed” because of their response to treatments they are receiving rather than any underlying condition?
As Ms. Rosin so poignantly (though implicitly) points out, these children are not suffering from “brain disease,” but rather some glaring societal and cultural pressures that are inappropriate and damaging. And these children and their parents are not being adequately alerted to the potential for harm of psychiatric drugs. Mental health professionals, least of all, understand that these drugs come with enormous risks of, yes, suicide and self harm, but also chronic dysthymia, sexual dysfunction, sleep disorders etc. etc.
The medications are not helping to alleviate the other broader pressures that exist in the environment (how could pills really do that?!); they are exacerbating those pressures, which is why, in my opinion, the number of suicides continues to grow.
How many of the victims in Silicon Valley were already being treated for mental disorders and how many had labels that are debilitating to live with when it’s the environment that should have the label, not the students? How many were taking medication, which is disabling and harmful over the long term, reducing rather than enhancing coping skills, unless used in a very cautious and short term way?
Mental health counseling, as it is practiced today, is, in so many cases, actually aggravating the problems rather than mitigating them. This is an issue very much worth investigating further for the sake of our next generation.
Thanks to our reader for sharing her personal and impassioned story. Anyone in the psychiatric community or pharmaceutical industry want to provide a different view of medications used to treat depression and other mood disorders? Drop us an email.
Charlotte Hornets point guard Jeremy Lin opened up to his fans in a long and heartfelt Facebook post last week that addressed his experiences dealing with professional and academic pressure, as well as suicides in his high school. Lin wrote that his reflections were prompted by the cover of this month’s Atlantic magazine, “The Silicon Valley Suicides,” a report of how expectations on high school students in the tech mecca could drive them to the brink of a dangerous — and sometimes fatal — depression.
Lin as a freshman sat next to a classmate who committed suicide, as did one of his friends the following year. From his Facebook post:
The pressure to succeed in high school is all too familiar to me. I distinctly remember being a freshman in high school, overwhelmed by the belief that my GPA over the next four years would make or break my life. My daily thought process was that every homework assignment, every project, every test could be the difference. The difference between a great college and a mediocre college. The difference between success and failure. The difference between happiness and misery.
That passage reminds me of one of the emails still sitting in our inbox, from a current senior at a high school “situated in the district of St. Louis with the highest median annual income.”
Anything less than perfect is inexcusable. And of course it’s overwhelming. I starting seeing a therapist my sophomore year.
It’s a common joke among my friends about how often we cry. (Though we almost certainly never let the others see.) It feels that a single mistake can end one’s future. I took a lit class sophomore year, and the teacher taught a lesson on cause and effect. She wrote this down: “Cause: You don’t study for your math test. Effect: ? ”
We were to fill in the effect. Most of the students filled out standard answers (You fail the test, your parents get mad, you get detention) but my friends and I, the high-achieving AP students plunked into a required course, differed. Almost uniformly, we wrote, “You fail the test. You get a poor grade in the class. Your GPA lowers. You don't get into college. You work minimum wage the rest of your life.”
This twisted script of cause and effect is rote to us, innate, and unquestionable. A single mistake ruins your life. Academia is horrifically high-stakes to us, and the pressure is awful.
I’m in five AP classes. I’m also on the speech and debate team, and National Honor Society, and president of the school’s a capella club. I love to write, so this November I participated in National Novel Writing Month, and I landed a main role in the spring musical. I sleep less than six hours a night.
I’m not trying to complain, but merely attempting to give context for this: my GPA is a 3.9. I consider this a failure because it is not a 4.0. And even though it’s perfectly understandable because I do take on a lot, it’s still a failure, because, theoretically, getting a 4.0 would have been possible. A friend of mine is president of the speech and debate team, vice president of our National Honor Society, president of our black students coalition, and in 5 AP classes as well. She has a perfect 4.0. Why shouldn't I?
Despite my course load and extracurriculars, I’m actually in a very good place, mentally. I’ve only cried twice this semester, and I feel tentatively optimistic about semester finals. But acceptance decisions for Early Action and Early Decision college applications come out next week and the one after. And my friend—the president of the debate team with a 4.0—broke down in tears last week because she has a B in AP Chemistry. So the stress never really ends.
Thanks to Hanna for writing this article. I haven’t seen many like it. (I did, however, watch the documentary Race to Nowhere last week, which focused similarly.) I hope that in the future, things will change.
Following the two clusters of youth suicides in Palo Alto in recent years, the Centers for Disease Control and Prevention (CDC) and the Substance Abuse and Mental Health Services Administration have sent a five-person team to conduct an epidemiological assessment, the San Jose Mercury News reports.
More from the Mercury News:
The assessment will survey the extent of the health problem and track trends, as well as identify risk and protective factors, in coming up with recommendations for prevention. [...] Students and other community members have already taken numerous steps to support teens to discourage them from harming themselves. Schools are starting later so that students can get more sleep. Gunn High School students created a student support group. New fencing rims the Caltrain tracks. The school district and city have offered sessions on parenting and mental health issues. And counseling services have been expanded.
I am a 2012 Paly graduate, currently studying at Washington University in St. Louis. I’ve read Hanna Rosin’s “The Silicon Valley Suicides” four times now, but it feels like a hundred. The story is honest and true, and Rosin provides a clear overview of what has happened in Palo Alto, but it offers little that is new, at least not for someone who lived it. Rosin’s insights into Suniya Luthar’s research and the parallels between high achieving and underachieving inner-city and affluent kids are interesting and welcome, but ultimately the article provides a bird’s eye view of a community that deserves much more than that.
Here’s more from another reader, Jeremy Neff:
I grew up in Palo Alto, down the street from where the Blanchards live. I graduated from Gunn in 2012 and now I am a senior at George Washington University. Like everyone who went to Gunn when I did, I have powerful memories and emotions pertaining to the suicides of my peers. Below is my personal experience with suicide and a few current thoughts I have on the matter.
One drizzling night in early 2011, I sat in the lonely darkness of my home and wondered why I had to keep living. I was 16. I thought about how easy it would be to not do anymore homework, to not have to worry about whether I was cool, to not have to struggle to succeed in any of my passions, to not have to deal with any conflict, loneliness, or sadness.
It was 1 a.m., past my usual bedtime, and I was exhausted but still I couldn't sleep. I wanted a long rest. I didn’t think about how much my family loved me or about how my friends would cry years later when Facebook said it was my birthday or how everyone that knew me would feel unshakably sad at even the slightest mention of suicide.
Instead, I wondered how J.P. did it. I wondered if I could do it. I wondered if I had the strange courage one needed to walk two blocks to the tracks and let Caltrain sweep them away.
J.P. lived a block down the street from me. When I was 11, he came over for my older brother’s birthday and laughed when I made jokes about how nerdy my brother was. He was absolutely my favorite of my brother’s friends.
His suicide was also part of the reason I opened my front door and walked down to the crossing that night. I don’t know what I would have done if a train had come. Would I have remembered that killing myself would ruin my parents’ lives and hurt so many people? Or would I have made an impulsive leap and given up the mysterious struggle that awaited me in the rest of my life?
I stood in the shadows by the tracks for half an hour before I realized that Caltrain doesn’t run past midnight on weekdays. I didn’t tell anyone for five years, especially not my mother.
Looking back, it is hard to fully understand what drew me so close to tragedy. Certainly I had struggled with depression in the past, and had taken medication until I was 14. But I wasn’t struggling with depression in high school. Perhaps it was the feelings of inadequacy that come from being surrounded by brilliant and impressive people that drove me to consider suicide. But I definitely thought I was at least a little brilliant and impressive to some people, so that couldn’t be it. Mostly, I think I just thought nothing was worth living for.
Years later, at the ripe old age of 21, I look around me and see how I can matter in the world. I see how I can inspire someone, tell a story the world needs to hear, heal a community, bring ease or comfort to people who deserve it, or even just show one person that they are absolutely and without question beautiful and loved. But at the time, everything was just a selfish chore to help me succeed in the future.
For me, high school felt like a time to prepare so I could matter later. But that's wrong and unhealthy. My friends died and I could have too. It is wrong to think that being 16 is any less of a reason to tell a story, to heal a wound, or to make someone feel loved. And it is unhealthy when 2000 students at Gunn are doing great things like that every day, but feel selfish and unfulfilled because at the end of the day their accomplishments are going on a college app where all the beauty of their passions is reduced to a vain attempt to “be the best” and go to a selective college.
If you asked me what should be done, we could talk for hours. But I think most of it comes down to perspective and mental health. If only students fully understood how different the rest of the country was than Palo Alto, I think they would have monumentally less fear about succeeding and monumentally more optimism about how they could use their abilities to matter in the world. And if everyone had the same attitude about mental health as they did about physical health (such as having six-month mental health check-ups and getting easily excused for mental sick days), I think students would both have better mental health in the first place and feel less of a stigma when it came to reaching out for mental health care.
But as the article seems to conclude, it is impossible to be certain what might make a difference or why someone might find so much solace in death. I still don’t know why I walked down to the tracks that night, and I don’t think I ever will.
Just as concerts return, a new film reveals the cynicism and cultural rot that led to one of the most notorious shows ever.
We’re halfway through the first summer of full-capacity crowds at American arenas and nightclubs after pandemic-induced hibernation. Have you attended a glorious, mythmaking concert to mark the occasion? Perhaps Foo Fighters reopening Madison Square Garden gave you chills, or maybe you air-tromboned to the band Chicago at New Jersey’s first big comeback show (NJ.com’s review: “Enjoyment came in many forms Thursday night”).
Why is so much American bureaucracy left to average citizens?
Not long ago, a New York City data analyst who had been laid off shortly after the pandemic hit told me she had filed for unemployment-insurance payments and then spent the next six months calling, emailing, and using social media to try to figure out why the state’s Labor Department would not send her the money she was owed.
A mother in Philadelphia living below the poverty line told me about her struggle to maintain government aid. Disabled herself and caring for a disabled daughter, she had not gotten all of her stimulus checks and, because she does not regularly file taxes or use a computer, needed help from a legal-aid group to make sure she would get the newly expanded child-tax-credit payments.
Getting COVID-19 when you’re vaccinated isn’t the same as getting COVID-19 when you’re unvaccinated.
A new dichotomy has begun dogging the pandemic discourse. With the rise of the über-transmissible Delta variant, experts are saying you’re either going to get vaccinated, or going to get the coronavirus.
For some people—a decent number of us, actually—it’s going to be both.
Post-vaccination infections, or breakthroughs, might occasionally turn symptomatic, but they aren’t shameful or aberrant. They also aren’t proof that the shots are failing. These cases are, on average, gentler and less symptomatic; faster-resolving, with less virus lingering—and, it appears, less likely to pass the pathogen on. The immunity offered by vaccines works in iterations and gradations, not absolutes. It does not make a person completely impervious to infection. It also does not evaporate when a few microbes breach a body’s barriers. A breakthrough, despite what it might seem, does not cause our defenses to crumble or even break; it does not erase the protection that’s already been built. Rather than setting up fragile and penetrable shields, vaccines reinforce the defenses we already have,so that we can encounter the virus safely and potentially build further upon that protection.
Just as striking as the officers’ testimony today is GOP lawmakers’ refusal to engage with it.
All along the hallways of the Capitol complex today, members of the Capitol Police stared at their phones and nearby TV screens. Four of their fellow officers were testifying before Congress for the first time about the treatment they’d endured on January 6. They described being beaten with metal flagpoles, sprayed in the eyes with wasp repellent, and shocked with their own Tasers. One of the men cried while he spoke; a colleague patted his back. Their hands shook as they took careful sips of water.
This morning’s testimony was the first time Americans have heard such a vivid and agonizing account from the front lines of the attack—the officers’ growing panic as the mob surrounded them, how the rioters called them “traitors” and threatened to kill them with their own guns, the realization that they might die right there on the marble steps of the Capitol. But just as striking as the officers’ testimony is Republican lawmakers’ refusal to engage with it. The GOP response has been to minimize or even scoff at what occurred.
In 1955, just past daybreak, a Chevrolet truck pulled up to an unmarked building. A 14-year-old child was in the back.
This article was published online on July 22, 2021.
The dentist was a few minutes late, so I waited by the barn, listening to a northern mockingbird in the cypress trees. His tires kicked up dust when he turned off Drew Ruleville Road and headed across the bayou toward his house. He got out of his truck still wearing his scrubs and, with a smile, extended his hand: “Jeff Andrews.”
The gravel crunched under his feet as he walked to the barn, which is long and narrow with sliding doors in the middle. Its walls are made of cypress boards, weathered gray, and it overlooks a swimming pool behind a white columned house. Jeff Andrews rolled up the garage door he’d installed.
Our eyes adjusted to the darkness of the barn where Emmett Till was tortured by a group of grown men. Christmas decorations leaned against one wall. Within reach sat a lawn mower and a Johnson 9.9-horsepower outboard motor. Dirt covered the spot where Till was beaten, and where investigators believe he was killed. Andrews thinks he was strung from the ceiling, to make the beating easier. The truth is, nobody knows exactly what happened in the barn, and any evidence is long gone. Andrews pointed to the central rafter.
Gather friends and feed them, laugh in the face of calamity, and cut out all the things––people, jobs, body parts––that no longer serve you.
“The only thing a uterus is good for after a certain point is causing pain and killing you. Why are we even talking about this?” Nora jams a fork into her chopped chicken salad, the one she insisted I order as well. “If your doctor says it needs to come out, yank it out.” Nora speaks her mind the way others breathe: an involuntary reflex, not a choice. (Obviously, all dialogue here, including my own, is recorded from the distortion field of memory.)
“But the uterus …” I say, spearing a slice of egg. “It’s so …”
“Yes. Don’t roll your eyes.”
“I’m not rolling my eyes.” She leans in. “I’m trying to get you to face a, well, it’s not even a hard truth. It’s an easy one. Promise me the minute you leave this lunch you’ll pick up the phone and schedule the hysterectomy today. Not tomorrow. Today.”
In the United States, this pandemic could be almost over by now. The reasons it’s still going are pretty clear.
In the United States, this pandemic could’ve been over by now, and certainly would’ve been by Labor Day. If the pace of vaccination through the summer had been anything like the pace in April and May, the country would be nearing herd immunity. With most adults immunized, new and more infectious coronavirus variants would have nowhere to spread. Life could return nearly to normal.
Experts list many reasons for the vaccine slump, but one big reason stands out: vaccine resistance among conservative, evangelical, and rural Americans. Pro-Trump America has decided that vaccine refusal is a statement of identity and a test of loyalty.
In April, people in counties that Joe Biden won in 2020 were two points more likely to be fully vaccinated than people in counties that Donald Trump won: 22.8 percent were fully vaccinated in Biden counties; 20.6 percent were fully vaccinated in Trump counties. By early July, the vaccination gap had widened to almost 12 points: 46.7 percent were fully vaccinated in Biden counties, 35 percent in Trump counties. When pollsters ask about vaccine intentions, they record a 30-point gap: 88 percent of Democrats, but only 54 percent of Republicans, want to be vaccinated as soon as possible. All told, Trump support predicts a state’s vaccine refusal better than average income or education level.
They’re not all anti-vaxxers, and treating them as such is making things worse.
Last week, CDC Director Rochelle Walensky said that COVID-19 is “becoming a pandemic of the unvaccinated.” President Joe Biden said much the same shortly after. They are technically correct. Even against the fast-spreading Delta variant, the vaccines remain highly effective, and people who haven’t received them are falling sick far more often than those who have. But their vulnerability to COVID-19 is the only thing that unvaccinated people universally share. They are disparate in almost every way that matters, including why they haven’t yet been vaccinated and what it might take to persuade them. “‘The unvaccinated’ are not a monolith of defectors,” Rhea Boyd, a pediatrician and public-health advocate in the San Francisco Bay Area, tweeted on Saturday.
Persistent hype around mRNA vaccine technology is now distracting us from other ways to end the pandemic.
At the end of January, reports that yet another COVID-19 vaccine had succeeded in its clinical trials—this one offering about 70 percent protection—were front-page news in the United States, and occasioned push alerts on millions of phones. But when the Maryland-based biotech firm Novavax announced its latest stunning trial results last week, and an efficacy rate of more than 90 percent even against coronavirus variants, the response from the same media outlets was muted in comparison. The difference, of course, was the timing: With three vaccines already authorized for emergency use by the U.S. Food and Drug Administration, the nation is “awash in other shots” already, as the The New York Times put it.
The once-dynamic state is closing the door on economic opportunity.
Behold California, colossus of the West Coast: the most populous American state; the world’s fifth-largest economy; and arguably the most culturally influential, exporting Google searches and Instagram feeds and iPhones and Teslas and Netflix Originals and kimchi quesadillas. This place inspires awe. If I close my eyes I can see silhouettes of Joshua trees against a desert sunrise; seals playing in La Jolla’s craggy coves of sun-spangled, emerald seawater; fog rolling over the rugged Sonoma County coast at sunset into primeval groves of redwoods that John Steinbeck called “ambassadors from another time.”
This landscape is bejeweled with engineering feats: the California Aqueduct; the Golden Gate Bridge; and the ribbon of Pacific Coast Highway that stretches south of Monterey, clings to the cliffs of Big Sur, and descends the kelp-strewn Central Coast, where William Hearst built his Xanadu on a hillside where his zebras still graze. No dreamscape better inspires dreamers. Millions still immigrate to my beloved home to improve both their prospects and ours.