Yet another distinct voice from the Palo Alto community writes in, a “longtime leader of a free, open-to-the-public Adult ADHD discussion group”:
Thanks to Hanna Rosin for her sensitively written story. When I saw her byline, I knew the piece would not be sensationalized. I live here in Silicon Valley, and I’m very familiar with this phenomenon of academic pressure and teen suicide.
One factor left out of the equation: ADHD. In the parents and the children. ADHD is one of the most inherited traits, almost right up there with height. Most people do not realize the risk for suicide among people with unrecognized or poorly managed ADHD. And here in the Bay Area, we draw these “stimulation seeking” folks from all over the world. Even though many people in this “coveted” school district are educated, sophisticated, and well-heeled, their ignorance about ADHD is astounding.
As the longtime leader of a free, open-to-the-public Adult ADHD discussion group of Palo Alto, I see the fallout every day, among people who were not diagnosed until their 30s, 40s, and even 80s. It is very difficult to find expert care for ADHD here, despite Silicon Valley’s “bookends” of Stanford and UCSF. Don’t go to either of these hallowed institutions expecting to find ADHD expertise. It is shocking.
It is also a fact. Parents who would not hesitate to give a “depressed” child an antidepressant, as if it is the only informed thing to do (in addition to therapy), will cite the Yellow Journalism in The New York Times as proof that ADHD is an invention of Big Pharma. Surely ADHD could not apply to their child. They live in Palo Alto. Their child is above average and gifted, just like them.
Yet they do not realize that a child who acts “depressed” might instead have ADHD. And giving that child an SSRI or other antidepressant could actually exacerbate ADHD symptoms, including ones around impulsiveness. ADHD-related suicides are typically impulsive, based on momentary feelings.
At our local group, we once welcomed a young man who had gone to Paly and had taken antidepressants all the way through for his “depression.” He enjoyed structure and strong support at home and at school. When he went away to college, however, he flopped miserably and was back home by the end of the first semester.
He did not discover that he might have ADHD until he joined some friends in abusing Adderall. While his friends were ready to go party, he was ready to sit down and read. He had focus like he never had. It was that chance “abuse” that led him to discover that he had ADHD, not “depression” (at least not exclusively).
I know that this phenomenon is complex, and Ms. Rosin has painted a vivid picture of the complexity. I would only add another missing detail: Do NOT give your child an antidepressant without a thorough screening for ADHD. And you must get educated before you even consult a mental-health professional, because there are as many biased fiefdoms in the mental-health field as there are in any field, perhaps more.
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.
A tectonic demographic shift is under way. Can the country hold together?
Democracy depends on the consent of the losers. For most of the 20th century, parties and candidates in the United States have competed in elections with the understanding that electoral defeats are neither permanent nor intolerable. The losers could accept the result, adjust their ideas and coalitions, and move on to fight in the next election. Ideas and policies would be contested, sometimes viciously, but however heated the rhetoric got, defeat was not generally equated with political annihilation. The stakes could feel high, but rarely existential. In recent years, however, beginning before the election of Donald Trump and accelerating since, that has changed.
He can’t help but go after women, even when doing so hurts his cause.
On the second day of the impeachment proceedings, President Donald Trump couldn’t control himself on Twitter: He lashed out at Marie Yovanovitch, the former ambassador to Ukraine who was subjected to a smear campaign, and who testified to that effect before the House Intelligence Committee. Trump’s lack of control, in itself, was not unusual. But, for some reason, Trump showed more restraint 24 hours earlier, when William Taylor and George Kent went before the Committee. It was almost as if the president found himself triggered by Yovanovitch, the 61-year-old career diplomat. But why was the president’s response so different to witnesses who were roughly saying the same thing? What was the big difference between Kent and Taylor and Yovanovitch? All three are career diplomats, all three are Ivy League graduates, all three have worked in the State Department, all three are experts in Ukraine. But only one of them is a woman. Could that be why the president singled out Yovanovitch? It is almost as if the president is unable to control his rage against women. It is almost as if the president thinks he can bully women and silence them.
HONG KONG—For months now, I’ve been told that Hong Kong’s protests would end soon. They’ll end when school starts, I heard during the summer. School did start, but the protests wore on, only now I saw high-school students in crisp school uniforms joining the protesters’ ranks. Next, the mask ban of early October was supposed to slow protesters down, but the very first day after that ban, I watched streams of protesters in masks and helmets make their way to their usual haunts on Hong Kong Island.
The government shut down many of the subway lines that day, a practice that has become a de facto curfew, because Hong Kong’s über-efficient subway system is the way most people get around. No matter; the protesters ended up walking, sometimes a lot, and I walked with them, asking some of the same questions I had asked for months: Do you think you will continue protesting? What would it take for you to stop?
A record-setting acqua alta has left much of Venice submerged, following stormy conditions blowing in from the Adriatic Sea.
Yesterday, strong winds and rainstorms pushed water levels in Venice, Italy, to the second-highest levels ever recorded. The high-water mark hit 74 inches (187 centimeters), just short of the record set in 1966. This exceptional acqua alta has flooded businesses and historic structures, sank boats, and been blamed for one death so far.
Being no different from our enemies has not been the aspiration of previous presidents, nor of our military.
President Donald Trump has exercised his authority to intervene in three cases involving war crimes, on the side of the alleged war criminals. He pardoned one serviceman who was convicted of heinous crimes, and another awaiting trial for heinous crimes. He also reversed the demotion of a Navy SEAL convicted of taking trophy pictures with an enemy corpse. All were brought to justice by their fellow servicemen and women; each prosecution relied on testimony from servicemen in the same units who witnessed the war crimes and reported them to military superiors.
This makes Trump the first commander in chief in memory to pardon American servicemen for violent crimes committed in uniform. The justification can be found in a statement Trump made to NBC News in 2016: “You have to play the game the way they are playing the game.” That is, the U.S. should operate the way terrorists operate.
The GOP will not be a great or good party until those who lead it straighten their backbone.
The first day of public hearings into the impeachment inquiry of President Donald Trump included an explosive revelation. William B. Taylor Jr., the senior American diplomat in Ukraine, tied Trump even more directly than we previously knew to the effort to pressure Ukraine to probe his political opponent.
But as damaging as Taylor’s testimony proved, it was merely another massive boulder in the avalanche of evidence against the president. We are well beyond the point that any disinterested person can deny that the president abused his power and acted in a corrupt manner, in ways the American founders explicitly warned against.
That the president acted the way he did should surprise exactly no one, given his disordered personality and Nietzschean ethic, his pathological lying and brutishness and bullying, and his history of personal and professional depravity. The president is a deeply damaged human being—and therefore a deeply dangerous president.
I first met him 21 years ago, and now our relationship is the subject of a new movie. He’s never been more revered—or more misunderstood.
A long time ago, a man of resourceful and relentless kindness saw something in me that I didn’t see in myself. He trusted me when I thought I was untrustworthy, and took an interest in me that went beyond my initial interest in him. He was the first person I ever wrote about who became my friend, and our friendship endured until he died. Now a movie has been made from the story I wrote about him, which is to say “inspired by” the story I wrote about him, which is to say that in the movie my name is Lloyd Vogel and I get into a fistfight with my father at my sister’s wedding.
I did not get into a fistfight with my father at my sister’s wedding. My sister didn’t have a wedding. And yet the movie, called A Beautiful Day in the Neighborhood, seems like a culmination of the gifts that Fred Rogers gave me and all of us, gifts that fit the definition of grace because they feel, at least in my case, undeserved.
As age factors more urgently in politics, a simple test could evaluate who remains fit for office.
Remember these numbers. You’ll be asked about them at the end of the test: 70, 73, 76, and 78.
These are the ages of the leading candidates in the 2020 presidential election: Elizabeth Warren, Donald Trump, Joe Biden, and Bernie Sanders, respectively. In most any other line of work, people in their eighth decade are usually retired. For most of human history—and still in most of the world today—people of this age were usually dead.
Last month, Jimmy Carter, the 95-year-old former U.S. president, said that the office requires a person “to be very flexible with [one’s] mind,” and that by age 80 he wouldn’t have felt able to do the job. He joined the growing ranks of those suggesting they would support an upper age limit for the office, either for purposes of breaking up the gerontocracy or to ensure a person has the physical and cognitive capacity. “You have to be able to go from one subject to another and concentrate on each one adequately and then put them together in a comprehensive way,” Carter said.
Nothing in Marie Yovanovitch’s testimony had directly added to the Democrats’ case for removal. Then the president stepped in.
As they present their findings to the public, House Democrats may find it easier to let President Donald Trump build the case for impeachment himself.
The testimony that Marie Yovanovitch, the former ambassador to Ukraine, delivered to Congress this morning was perhaps as politically damaging to Trump as anything presented during the first day of House impeachment hearings, on Wednesday. In a quiet but firm voice, she described how “a smear campaign” orchestrated by the president’s allies led to her abrupt dismissal as ambassador, and how “the color drained from my face” when she read a transcript of Trump bashing her in a phone call with Ukraine’s new president, Volodymyr Zelensky. “It sounded like a threat,” Yovanovitch said, referring to the president’s comment that she would “go through some things.”
Warren supporters tend to like Pete Buttigieg just fine. Bernie supporters? Not so much.
Politically speaking, Marie Herring, a 49-year-old supporter of Elizabeth Warren, and John Thomas Grindle, a 36-year-old Bernie Sanders fan, have a lot in common.
Both Iowans want Medicare for All, student-debt cancellation, and a government that taxes the heck out of billionaires. Neither harbors ill will toward the other lefty firebrand in the race. But the two voters feel very differently about one 2020 Democrat: South Bend, Indiana, Mayor Pete Buttigieg.
“Definitely, I like him,” Herring told me. “He’s a rising star.”
To Grindle, though, Buttigieg is just “another corporate puppet.”
For the past several months, the trio of Warren, Sanders, and former Vice President Joe Biden has been leading the polls in the state with the first-in-the-nation caucuses. But over the past few weeks, 37-year-old Buttigieg has been gaining ground: The most recent surveys of Iowa voters have shown the Indiana Democrat at or near the top of the pack of primary candidates.