‘The pain changes your life’

Rabbi Adam Raskin found himself gazing out onto a sanctuary filled with grieving family members and friends of 16-year old Evan Rosenstock, who had committed suicide, and realized he had an opportunity.

“My priority number one was obviously to comfort the family and pay homage to Evan’s life,” said Raskin of Congregation Har Shalom. He also felt strongly that “this could be my only shot to speak to all these kids – and lots [of them] had to be retracing their steps, rechecking their text messages,” wondering if they could have done anything to help Rosenstock, who died 16 months ago.

Raskin wanted to tell those friends, including Rosenstock’s classmates from Winston Churchill High School in Potomac, “They were wonderful friends. I wanted to kind of lift that burden for them,” and make sure they understood that “there are always people in their lives who love them. No matter how bad things get, there are always loving people, caring people, wonderful people” to turn to.

Suicide is the third leading cause of death among young people between the ages of 10 and 24. It results in approximately 4,600 deaths each year, according to the U.S. Centers for Disease Control and Prevention. Further, according to the CDC, 16 percent of students in ninth through 12th grades seriously considered suicide, 13 percent had devised a plan and 8 percent had actually tried.

In 2011, 4,822 young people between the ages of 15 and 24 committed suicide – that’s 13 deaths a day, one every hour and 49 minutes, according to the American Association of Suicidology in Washington, D.C.

It seems baffling that a person so in the prime of life – ready to leave home, start college or a career, usually free of the burdens of parental responsibilities and mortgages payments – could be so unhappy.

Susan Rosenstock understands now. Her son, a basketball star and friend to all, committed suicide in his sophomore year of high school. His troubles began when an injury to his back resulted in surgery. “That led to depression. He identified as a varsity athlete. Once that hope was given up… .” she said, her voice trailing off.

She watched her son change. He no longer was that “effervescent Evan” that she knew. Physical exams turned up no leads, and Evan began seeing a psychologist. During his fourth week, he began taking celexa for depression. “Week four he took 10 milligrams. Week five, 20 milligrams. Week six, it was 30 milligrams. On visit seven, I went in” and told the psychologist the drug wasn’t working, Rosenstock recalled. Her son “was totally despondent,” she said.

The therapist considered hospitalizing Evan. But he was still going to school, still socializing with friends, so he was considered “functioning.” The Rosenstocks were told to give the medicine more time.

“That was Thursday. He took his life Monday,” said Rosenstock, who attends a twice-monthly Jewish Social Service Agency grief support group.

Rosenstock only recently redid her son’s room, re-examining his many trophies, the replicas of sports stadiums that were placed on tables at his bar mitzvah. She thinks about her 6-foot 3-inch, braces-wearing son all the time.

“The pain, it changes your life,” she said. “That day changed my life forever. I will never be that person again. When we buried Evan, we buried a piece of ourselves, a big piece.”

To Rosenstock, her son, deprived of his beloved basketball, had a mental disease exacerbated by antidepressant medication.

The U.S. Food and Drug Administration has what it calls its black box warning that certain antidepressants – and celexa is on that list – may increase suicidal thinking and behavior in young adults ages 18 to 24.

Young adults who contemplate ending their life have more than just “the blues.” Sadness and even depression are not uncommon at that age. Without the proper coping skills, it can be overwhelming when not invited to the right party, not accepted on a varsity team or dumped by a first love.

Most teens bounce back after a bit. Resilience is the key, explained Wootton High School Principal Michael Doran. He spoke during a parent meeting Sept. 18, shortly after a suicide attempt by a sophomore boy at the start of this school year as well as the suicides of Kira Harrison, who had just graduated this summer and was about to start college, and Ryan Walden, a ninth-grader who died in April.

Scientists believe that such prefrontal lobe brain functions as coping skills, impulsivity and decision making are not fully developed until around the age of 25. Is a teenager who drives more than 100 miles an hour a reckless risk taker or someone curious to learn how fast a car can go? Does a young person who binge drinks or takes illegal drugs have a death wish or just want to be with friends and experience a high without any thought to possible repercussions?

Dr. Elizabeth Ballard, a postdoctoral fellow at the National Institutes of Health in Bethesda, said that while scientists have a long way to go to understand the brain and depression, there is even more to learn about the teen brain. Studies concerning adult suicide don’t necessarily pertain to adolescents, she said.

“Your emotional brain comes on line before decision making and planning,” said Ballard. The brain of someone in their early-to-mid-20s is “a perfect storm, with very strong emotions and not a lot of coping skills to deal with those emotions.”

Drugs are available to help a suicidal person. Studies funded by NIH are looking into infusing a medication designed to help sea sickness and, separately, using ketamine, a street drug that so far has shown positive results but for only short periods of time, said Dr. Carlos Zarate, chief of the division of intermural research programs at NIH.

Sleep studies also are being reviewed. Zarate noted that depressed patients wake often for brief periods between midnight and 4 a.m., he said.

In scans on children, NIH researchers noticed that the parts of the brain involved in basic functions mature first, including those involved in processing information from the senses and controlling movement. The parts of the brain responsible for more “top-down” control, like impulsivity and planning ahead – the hallmarks of adult behavior – are among the last to mature, according to an NIH pamphlet, The Teen Brain Still Under Construction.

Most young people weather these brain changes. Supportive words from a family member, teacher or other adult are needed for those who cannot. During the recent meeting at Wootton High School, Doran said he works to make sure all his students understand, “When anyone commits suicide, they are wrong. It’s irreversible. It’s final. There are no do-overs.”

If a young person is sleeping more, expresses hopelessness, has lost interest in hobbies and friends, uses alcohol or drugs or exhibits intense mood swings, it’s important to “have that talk,” Doran said. Ask if the teen is thinking about dying, said Doran and a panel of mental health experts who answered questions during the 90-minute meeting.

Other warning signs include a drop in grades, changes in eating habits and appearance, complaints of headaches and stomach aches and the offering of prized possessions to friends.

Lisa Horowitz, a clinical psychologist at NIH, worked with a team to seek clues on how to recognize a person who is contemplating suicide. The team developed four questions that Horowitz believes everyone between the ages of 10 and 21 entering a hospital emergency room should be asked. The ASQ – Ask Suicide-screening Questions – is a tool that could greatly reduce the number of suicides by reaching an adolescent before it’s too late, Horowitz said.

“The main take home is, ask people. Ninety percent of suicide attempts go unaware by parents,” she said.

“There is a myth that if you ask questions, you will be putting suicidal thoughts into a person’s head,” she continued. “Our whole emphasis is on the asking,” she said, adding that 17 percent of high school students have had serious thoughts of suicide. “That is more than 3 million” people.

“It’s happening all over. It happens in rural areas. It happens in cities.”

The four questions in the ASQ are: (1) In the past few weeks, have you wished you were dead? (2) In the past few weeks, have you felt that you or your family would be better off if you were dead? (3) In the past week, have you been having thoughts about killing yourself? And (4) Have you ever tried to kill yourself?

“The tool actually takes less than two minutes to administer,” but the results can be life-saving, she said.

For teens needing help, most schools have a psychologist. There are hot lines, crisis centers and private therapists that stand ready to help, like the Montgomery County Hotline’s Suicide Prevention Lifeline.

Some families turn to their Judaism for help. At Washington Hebrew Congregation, for example, they have held film screenings and hosted discussion forums with JSSA “to hopefully make the barriers less high” for people to come forward and seek assistance, said Senior Rabbi M. Bruce Lustig.

“We need to deal with the issues of mental illness, depression, substance abuse – fertile ground that creates opportunities for suicide. Also, we need to work on the idea of acceptance of these problems. Mental illness is as real and prevalent as other illnesses. We need to take any stigma away, so hopefully we can help.”

When a congregant does commit suicide, Lustig said the funeral ritual at his synagogue is no different than for any other death. “Any loss has its uniqueness. Whether it was death caused by a heart attack, cancer – it’s a loss.”

spollak@washingtonjewishweek.com

Editor-in-Chief Geoffrey W. Melada contributed to this report.

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