teen depression – Words by Black Butterfly

To Bryce…

“…he was acting strange, talking a mile a minute, and kept asking his mom large questions about life. He wanted to know if she and his brothers would be OK in his absence.” ~South Florida Sun-Sentinel

In my brand new Amazon bestselling book, A Teen’s Life, I discuss teen suicide to the best of my ability. One of the teens in that book is Damiko, a football player who finds himself on the wrong side of the law, after making some tough decisions to help him deal with life’s curveballs, mainly to help his family. He naturally begins to doubt himself and ends up on the suicide spectrum. This is a not too uncommon thought-process and mindset for most of us when we are feeling overwhelmed, anguished and trapped amongst other things, as life continues to deal (as it likes) with us.

I begin with Damiko’s story because it is what I am calling “real” fiction. Just this week, we saw my fiction imitate real life in none other than Bryce Gowdy, a football star on his way to the top, with a full ride to Georgia Tech. A life cut short by train tracks. A life cut short by suicide.

While reading his story in the news outside the post office a few days ago, I kept yelling “he left signs!” “He left signs!”…repeatedly, as I cried my eyes out.

Yes, that poor kid, my son, our son, left signs all over the place, but unfortunately, those around him did not know them, or did not recognize them, and thus did not act.

Several weeks ago, another Florida teen walked into another pair of train tracks to his death. (“His death contributes to the roughly two teens in Florida who take their lives each week, and is the second in about a month to do so by train”.)

While most news often connect mental illness to majority of suicides, it is unclear if our latest victim of suicide contagion (defined as the process by which the exposure to suicide or suicidal behaviors within one’s family, one’s peer group, or through media reports of suicide can result in an increase in suicidal behaviors and suicide in persons at risk, usually adolescents), had any issues with mental illness in his past (no diagnosis is stated), what we do see though, is that he suffered from severe mental anguish (aka emotional distress) and despair in his last days. (Despair is defined as a profound and existential hopelessness, helplessness, powerlessness and pessimism about life and the future. Despair is a deep discouragement and loss of faith about one’s ability to find meaning, fulfillment, and happiness.)

This article is not meant to argue about mental illness, and its contribution to suicide, it is, however, meant to showcase the fact that most suicide victims DO suffer severe mental anguish with severe reactive depression (aka situational depression) following significant life’s trauma, which in Bryce’s case was extreme poverty and homelessness. These factors confounded the natural anxiety he was already experiencing about leaving his suffering family and going off to college (college jitters), and the helplessness he felt about his inability to “save his family”.

If you are reading this, then you would agree that it was all a bit much for anyone, let alone a young adolescent.

So why does anyone kill themselves?

Why did a young gifted and talented athlete do this? The truth is that ultimately, we may never know his real reasons. However, a psychological postmortem would definitely bring in all the above factors and maybe even unearth more.

What role does resiliency (or the lack thereof) play in suicides? Are suicide victims truly weak? Are they truly “quitters”? Like a friend mentioned on a Facebook comment recently. Is it truly easy to end one’s life?

As one who has struggled in my past with suicidal ideations (SI), I know just how hard, overwhelming and lonely that street is. I know that the world looks at you with tinted lenses when you mention that “S” word. I know all the stigma, shame and silence that accompany it. I know no one wants to talk about it. Ironically though, talking about it is just what this doctor orders. The American Foundation for Suicide Prevention (AFSP) has the #silencekills and #talksaveslives hashtags for this particular reason. We MUST talk about these issues. We must call its name, SUICIDE, so as to take its sting and strength away, or at least diminish them.

*In teens specifically, adolescence brings unique challenges that often confound life’s experiences, so they have a tendency to succumb easier to SI.

IS PATH WARM is a mnemonic used to list the signs of suicidal behavior, but, I am quick to state that in youth like in our young teen, Bryce, signs might not be as organized or as obvious. Simply acting differently from the norm; becoming more agitated, giving away their stuff, asking and verbalizing about death, losing sleep, becoming more reckless, buying a gun, writing a suicide note, becoming suddenly happier, calmer, or simply saying goodbye, etc, could be signs of suicidal behavior. We as parents and as adults around them must be vigilant. The list below is of factors that lead to suicidality in youth, an excerpt from A Teen’s Life.

● A history of bullying ● Relationship issues like breakups ● Previous suicide attempt* ● LGBTQ+ sexual orientation ● Access to lethal weapons in the home ● Behavior problems like ADHD/ADD ● Poverty ● Socioeconomic/sociocultural oppression ● Institutional racism ● Lack of access to treatment and support for mental illness ● Substance Abuse ● Microaggressions like police brutality and racial profiling ● Social Media ● Lack of Support at home and at school ● Suicide in peers and in the community (suicide contagion) *A prior suicide attempt is the strongest risk factor for a suicide death*

Reading the article, it was quite obvious that he was faced with what appeared to be “unsurmountable” life’s challenges to him. If he had only waited a few more days. If he hadn’t had that train track beckoning. If he only knew the future…if, if, if. But, he had no way of seeing the future, he had no way of knowing the outpouring of love from the world to his family following his ultimate sacrifice. He had no way of knowing how much I cried when I read his story. He had no way of knowing that much like his mother, I also have three sons, and I am a Black woman in America, and I care. For him, at that moment, he felt he had used up all his options, and death was the only choice he had…and then there was a means: a train, and a history of a recent teen death by another train.

A brave child who carried the weight of his family’s troubles on his young shoulders. A brave soul who wanted the best for his family. A boy, a teen who actually reached out, but not quite far enough to save him. A young man seeking answers, but finding death in its stead. We preach reach out all the time, the question then becomes, “what if folks reach out and no one responds?”

Apparent unsurmountable life’s challenges, feelings of entrapment, overwhelmedness, helplessness, and hopelessness…these are the ingredients for suicide.

RIP Bryce, you fought the good fight.

“Parents, please, know the signs of suicidal behavior. Our kids DO leave signs”

~ Dr. Lulu®

Is Your Child THE BULLY? 5 things every parent must do NOW!

Dear Blog,

Happy New Year…I only wish my heart was happy as I write these words this morning. The title of this blog literally pulled me up from bed, begging to be written, so here goes.

We see them on the news every day, we see them on social media every time we look at our handheld devices. Headlines: “X-year-old boy hangs himself, X year old girl found hanging in her closet” “X-year-old teen dies from self-inflicted injuries”. The headlines are not the problem though, read a few lines down and you will see them, the unmistakable words “after years or months or even weeks of being bullied” BEING BULLIED? by whom you ask yourself, then it never fails, the words, by his or her peers follows every time, and I am sick of it!

I am sick of the fact that small children are now more pre-occupied with bullying each other than playing in the sandbox or with their X-Box. Even when they do play in said sandbox or on the X-Box, they are bullying each other. They are teasing each other, they are making fun of each other, and not in a nice way, in the worst possible ways, saying the worst possible things to themselves. I often speak of how another 12-year-old child once told my then 12-year-old son “when God made you, He left you too long in the oven and you got burned” referring to his skin color. How does a 12-year-old come up with those words? Sadly, the vocabulary is now even worse, they have now progressed to calling names like “bitch” and “slut” and phrases like “go kill yourself”, and “die now” as in the case of McKenzie Adams, a 9-year-old child from Alabama who hung herself in her closet last December after months of bullying by other 9-year-olds. 9-year-olds? What do they know? How did they come up with so much meanness and hatred in their hearts and mouths and fingers? Where will a 9-year-old child find such racist statements as those that were repeatedly uttered to this poor little girl? Where are their parents when all of this is happening? Who are these people?

As if that were not bad enough, just yesterday, the news broke about little Seven Bridges, a 10-year-old boy who not only had a medical condition that required him to wear a colostomy bag (and need multiple surgeries to live) about which he was repeatedly teased, he was allegedly called the N-word and “choked” on the bus by his “bus-buddy” for simply being himself. Where do I start? Who are these 10-year-olds and who are their parents and family members? What examples are we setting for them? How are we handling our home environments? Where are they learning this hatred from? What exactly is going on in our homes, in their heads, in their hearts?

It is easy to blame the teachers and counselors and the school system for not “checking the bullying at school”, but what about at home? What is happening there? Are we as parents now simply having children and leaving them to be raised by others? As a part of the village it takes to raise children, I must say, it is not my primary responsibility to raise yours for you, just as it is not yours to raise mine. We MUST as parents, stop and retrace our steps. We MUST accept our own responsibilities and accept the roles we are playing or not playing when it comes to raising our kids right. We MUST accept our own fair share of blame and then, maybe, we can seek to rectify. We MUST as a matter of urgency resist the urge to play the blame game. Enough already.

Earlier this week, the news broke about the suicide streak in Australian teen girls, a total of 5 girls aged 12-15 years have taken their lives since the beginning of this year, 2019. Blaming everything from child abuse and neglect, to sexual abuse, to poverty and even poor governance, nowhere does this article mention bullying, however, Rochelle Pryor’s last Facebook post clearly stated: “once I’m gone, the bullying and racism will stop”. This shows that even when reported, the news can sometimes be skewed, further compounding the problem and delaying any solutions.

As a pediatrician, child advocate and teen expert, the least I can do is join my voice with others trying to make a difference, to put an end to bullying by our children, at school, at home, at work, and wherever else it might be. Here are five (5) things every parent must do, today, now, in order to help in the fight to end suicide from bullying.

TALK to yourself. Start at home. Check your life. It is the mirror through which your children look at life. How are you living it? What kind of language are you using when you refer to people of other races, or other convictions different from yours? Is there some domestic violence or abuse going on in the home? Is there name calling? Are you putting yourselves down in front of your children? Do you argue a lot? Should you be in counseling? Do you speak to your children about what they should not be doing or saying in school? Do you even know your children and who they hang out with at school or at play? We must realize that if our kids are the bullies, it might not all be their faults. They might be needing some love, we might be needing to change the way we are doing things at home. They might need counseling or therapy. I recommend we watch this 2006 movie about 5th graders called “how to eat fried worms“, it touches on bullying at home and some of its consequences.

TALK to your children. We are going to have to tackle these questions head-on. Ask them the question directly, “are you a bully at school, on the bus, at the playground, on the internet, in your group chat?” Explain in the simplest terms what you mean by those words. My youngest son was a member of a group chat where some name-calling was going on one time, I saw it when I looked through his phone. I addressed it, made him report it to the school authorities, and he lost his phone privileges. He had not participated in the name-calling, but he had said nothing in the child’s defense either. 70% of children are bystanders when bullying is going on. The child being picked on in the group chat has Tourette’s syndrome, a disability he cannot help. And my child’s behavior was not good enough for me. Ask your child if he or she is bullied, or if they are bystanders when bullying is going on. Ask them what they do if or when they observe bullying going on. Now, if your child is neither the victim nor the bystander, maybe he or she is the bully. Go through your child’s room and their things, see if they happen to have stuff that does not belong to them. This might be a sign.

TALK to their friends. This means we have to know their friends, and better yet, their friends’ parents. When my youngest son David, 14, had some issues with bullying at school, (he was having a hard time transitioning after his two brothers went off to college) one of his friends’ had told his mom, who in turn told me. He had taken someone else’s lunch and eaten it, and lied about it, among other things. Ask their friends directly if they are bullies, or if they know any bullies in the neighborhood, or if they themselves are bullies. We must be seen as part of the community when it comes to raising our children. I had to have a chit-chat with David’s friends a few weeks ago after I overheard him say to David, “if you don’t come out and play ball with me, then you are gay”. I was like, “what?” Apparently, the kid had wanted to play ball with him but David had made an excuse about having to finish up his homework and needed a rain check. After a little tet-a-tet with the young lad, we fist-bumped and I went along my way, content that at least for that moment, I had stopped that line of thinking.

TALK to the school. Yes, of course, the school is the extension of the home. After taking care of the home front, we must engage the school. Most of the parents of these children we read about had frequent engagements with their kids’ schools. We have to ensure that the school sees us as a present parent. You must be all about your child’s business. Get to know your child’s teachers, get to know the counselors. Get to know their coaches, their dance instructors, their tutors. Anyone who imparts any kind of knowledge on your child you should get to know. Believe me, that will make a huge difference in the end. Imagine your child was about to bully someone, the fact that they know – you know their teachers so well will put a bit of a hindrance on that tendency. Furthermore, the teachers will be your second set of eyes and ears when it comes to guidance and assistance with your child. Having an alliance with your child’s teacher can only be a good thing. Unfortunately, we hear lots of stories of how the schools in some cases claim they had no idea any bullying was going on. Like the case of 8-year-old Gabriel who was knocked out in the school bathroom by bullies a few days before he hung himself.

TALK to a healthcare provider. If you do find out that your child is the bully (and believe me, this happened to me) Talk to someone. Talk to someone right away. Get them counseling. That made a huge difference in my child. It helped us realize and understand the reasons behind his actions. There are licensed therapists, psychologists, psychiatrists and pediatricians like me waiting to help you and your child. I understand that we never want to believe our children are capable of such horrific acts we read about in the news, but, they are. We have to change our mindset about that. We must do the needful and help them because the bully often resorts to that behavior as a result of their own inside pain and stress and trauma and insecurities. They too sometimes may have been a victim and as such, need some love and understanding and care. Let us remember that babies are born, innocent, then life happens. We do not of all things want to be the parent of the child who was in any way responsible for the death of another. So, pick up the phone, make that appointment and speak to a healthcare provider about your child, the bully, you’d be glad you did.

An edited and truncated version of this blog was accepted as a guest blog post on Successful Black Parenting Magazine, check it out here.

10th day of September 2018…

Dear Blog,

In this special month dedicated to suicide prevention awareness, and on this day particularly assigned for it’s commemoration, I wanted to take a moment to share a brief insight into teen depression and teen suicide from my perspective.

Let’s face it, teens have stressors just like we adults, sometimes more. I know most of us parents think teenage years are full of fun and games and carefree living–I am here to tell you that it is often not as we think. Not only do they have to deal with issues relating to adolescence, like the hormonal and physical body changes that accompany it, they also have to deal with school work big time. This may include dealing with AP classes, preparing for SATs and other standardized tests, taking college prep courses, as well as picking colleges and interviewing. They also may deal with dating and the drama that comes along with that, nuances of peer pressure from classmates, and pressure from coaches and teammates for those that participate in sports and other extracurricular activities like band, cheer-leading, and orchestra. I won’t even begin to mention how we parents have our own unique requirements for teens to either “be grown” or act grown, or how their siblings and other family members all have different opinions on whether the teens are grown or still children.

Phew! That can make for tough teen years!!

So, now that we all agree that teens do have it rough, the onus is on us as family members and the community (the entire village it takes to raise them) to be more cognizant of that fact and act accordingly.

Amidst all of these teen issues listed above, it is easy for us to miss true signs of depression and or suicidal thoughts in our teens. I, for one, missed the depressive signs in my son who was then 12-year old son, and was bullied in middle school. That sadness that has persisted for longer than 2 weeks now, might not be as a result of his or her school workload. It might not be as a result of the recent breakup from a dating partner; it might not be stress from their overscheduled life, nor pressure from their teachers or band director.

It might be depression and your teen might be suicidal as well.

Teens might become gradually withdrawn or lose their appetite, they might start losing interest in their normal daily activities or extracurriculars. Suddenly, they may no longer want to participate in competitive sports or they might simply drop out of the swim team. In some of my patients, I often note the spark is gone from their eyes–their air is of melancholy, with ashen faces and poor or no eye contact. They may begin hanging out with the wrong crowd, experimenting with drugs, or worse still, they may drop out of school altogether. Self-harm usually in the form of cutting themselves may also occur, and they often find creative ways to hide the marks and scars. For instance, be wary of the teen who always wears long sleeved sweatshirts or jogging pants in the (hot) summer. If suicidal, they might start giving away their favorite stuff, asking questions about death or asking about suicide. They often wish they are better off dead, and might mention it in passing. In truth they might be trying to reach out for help, but do not know how, or who to turn to. Regardless of the presence of friends and close family members, they might not want anyone they know, to know.

The average teen who is suffering from depression is most likely not going to tell you–their parent.

rear view of a boy sitting on grassland — P

Where do you begin?

A family history of depression is sometimes the best place to start when it comes to honing in on our suspicions about our children and their prolonged moodiness. If you have a family history of mental illness, do not ignore it… it could happen to you or your child. Adolescence is often an easy period for symptoms of depression and other mental health issues to arise. Since the teens are already faced with a myriad of other stressors, depression simply slithers in, takes a seat, and gets comfortable.

When in doubt, ask their siblings, friends, or school mates about the behavior or mood of your teen. You will be surprised at the wealth of knowledge they possess. Afterall, they often spend a lot more time with your children than you do. Furthermore, these friends might not know how to approach the topic and might not know who to go to.

Your teens’ teachers and counselors will be another great resource. They are there to help and are often very willing to assist in any capacity.

Note that your child might not tell anyone at all and might even concoct stories to hide the truth. In fact, a patient’s mom recently recounted an instance when her son had told his curious sibling that the family cat had scratched him, in response to his sibling’s inquiry about the strange cuts on his forearms.

I recommend you find a nice neutral place to sit and talk, or a simple walk around the neighborhood, or a nice long drive, or even a picnic. A good ambience might help facilitate the communication on a face-to-face basis with your child. This might be a fruitful exercise if your child will cooperate, unfortunately, most teens really do not want to confide in, nor discuss these issues with their parents, however, it is still worth a try.

A short visit to the health professional, like the family pediatrician, family doctor, counselor or therapist is always a very good decision. They will ask you the proper questions and point you in the right direction to get your teen the appropriate kind of help they need. There are multiple places you can get help for your teen as well as their siblings (because there is often a need for siblings to participate in the treatment sessions in order to adequately understand exactly what is going on) and for yourself as well (especially if there is a family history of depression). These can either be online virtually, as telemedicine, or at your regular doctor’s office.

#endteendepression

#endteensuicide

#askdoctorlulu

1-800-273-TALK

PS: My website dedicated to fighting teen depression and teen suicide, teenalive.com is LIVE, click the link to check it out!

Physicians, never forget your WHY…

Dear Blog,

Last Friday, as I sat finishing up notes on the last of my almost 30 physicals (this number is never any surprise for us Pediatricians this time of the year, it’s back to school week, so every Thomason, Dickinson and Harrison is lining up for sports physicals and regular physicals and all sorts of clearance and medication forms that need to be filled out and turned in “yesterday”) I took a deep breath and exhaled, my mind filled with the events of the day. As is customary, my beloved patients often postpone their physicals all summer, in search of sandy beaches and clear blue vacation skies, so it’s usually a mad rush the first week of school.

I found myself reflecting on the patients I had seen that day as I often do at the end of my day. Most of them were mundane well baby and well child checkups, nothing really of note, a few of them had minor issues to clear up before returning to play…but one of them stood out clearly like a lily in a field of carnations…a 16year old we shall call “Maya”. I have met Maya only a couple of times in the past and I have known her to be a troubled teen, plagued with depression and anguish, never really smiling, not much eye contact, not much of an affect…just sad. I have tried to manage her depression the best I can with counseling in the office, a referral for proper psychotherapy. My good friend, and child psychiatrist sees her regularly and has placed her on an appropriate dose of antidepressants, and she reportedly goes to counseling regularly, all with little or no change in her mood(s)

She came in that day in the company of her mother and her older 17yr old sister. I sensed something wrong right away, but I continued my usual intros and salutations and other little talk. Her mom could not stop fidgeting, with the characteristic continuous knee shaking. Her sister’s face was buried in her mobile device for pretty much the duration of the visit, except when I inquired about her. It turned out her sister was also to be seen that day. Both mother and child proceeded to explain to me that her sister needed to be seen for “stomach problems” that only happen at her high school, stemming from her “unique eating habits”, and her lunch time not being fixed at a particular time of the school day. This apparently never happens at home or during the holidays or vacation, when she reportedly “has her own eating schedule”. She wanted a note from me to the school nurse authorizing her to eat her lunch at the exact time she wanted, or she would develop abdominal cramps, nausea and headaches and “get so sick” she would end up being sent home from school. This story line and request stuck me as bizarre, I recognized a familiar thread of possible anxiety in her sister, and maybe some co-dependency in her mom, but I digress…

Maya on the other hand, wore a thick black sweat shirt and jogging pants…mind you, it is 105F outdoors in San Antonio Texas in July! As I indicated in my first two Kevinmd articles https://www.kevinmd.com/blog/2018/07/a-pediatricians-healing-spirit-treating-depressed-anxious-and-suicidal-teens.html, and https://www.kevinmd.com/blog/2018/08/why-this-physician-quit-her-job.html

I somehow am a magnet for depressed and suicidal teens, and Maya, was no different. She made absolutely no attempt to engage with me, no eye contact, shoulders drooped over, melancholic and flat affected. She appeared pale, ashen and sullen, with dark circles around her eyes, she simply looked like she could use a looooong-warm-heart-filled-hug. During the physical exam, she hesitated to take off her sweat shirt, but I insisted, eventually, her mother ordered her to do so. She did so veeerrry-reluctantly, and immediately pronated both forearms…I gently supinated them, and to my horror, revealed numerous, clearly visible, freshly carved cuts all over her forearms, extending from her wrists all the way to her elbows, on her left and right forearms respectively. I said nothing, gently turned them back to her preferred position, completed her examination, and walked back to my seat. I then calmly asked her mom about Maya’s depression and how her cutting behavior was fairing. She hurriedly replied “oh, a lot better, she is receiving counseling, and has not cut in 2years. 2yrears?? I thought to myself, more like 2days!!… Her response immediately made me stop typing on my laptop EMR, I looked up at her, made sure my words came out clearly and as gently as my rapidly beating heart could muster, as I said, “No ma’am, I am afraid but I have to tell you that Maya has fresh cuts on her forearms and wrists, that are probably not more than 2 days old…”

The rest of the visit was a bit awkward. Her mom asked to see the cuts, Maya vehemently refused, and an uneasy silence set in after I explained to mom that, she would probably do better waiting until they got home to approach her alone in her bedroom. Meanwhile, we should probably revisit her counseling sessions, and explore the possibility of an in-house facility if possible, especially since her self-completed PHQ-9 score that day was a total of zero.

I write this story today to remind myself of my why. To urge each one of us doctors to remember our why(s) Never lose sight of the reason you went into medicine, no matter what. We are a special breed, a unique set of like-minded individuals who choose service to humanity above all. We choose to make a difference in our patients’ lives regardless of all the administrative, legislative, personal and sometimes insurmountable difficulties we face daily in the field. I was reminded that day of my reason for leaving my beloved 9-5 job to follow a passion of fighting to end teen depression and teen suicide. I was reminded to follow my heart and believe in my dream. I was reminded to stay the course, because, for every Maya in my office, there are a hundred or even a thousand more out there, so, I must go forth. “The harvest is plenty, the laborers, few…”, Luke 10:2

#endteendepression

#endteensuicide

#askdocotorlulu

PS: My website dedicated to fighting teen depression and teen suicide, teenalive.com is LIVE, click the link to check it out!

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