Hi. It’s been quite a while since I’ve written, and I apologize . . . honestly, I haven’t exactly been taking a break.
My previous pieces for Mad In America caught friendly eyes at Indian Country Today Media (ICTM), and they’ve recruited me to write a forthcoming multipart series on oppression in mental health in Indian Country. I only have so much time and feel I need to make getting the word out more widely a priority.
I’m very grateful for this opportunity, especially to you, dear reader, and all the folks at Mad In America. I’ll be linking ICTM readers to my blog site here and will hope it causes them to investigate the MIA website more deeply. I’ll also be letting MIA know when my pieces appear in ICTM.
Before I back away for a while, however, let me offer a few words about the current epidemic of youth suicide at Pine Ridge Reservation, and a recent story for the New York Times penned by Julie Bosman. In her story, Ms. Bosman suggests that a factor in this calamity is having only “six mental health professionals” which “many people agree is not enough.” I’m not sure if her remarks are based on a particular local survey, the pleas of desperate people suffering profound loss, or the opinions of ‘mental health professionals’ at the Indian Health Service (IHS).
I’d like to make it abundantly clear, however, that IHS behavioral health services haven’t ever done anything to successfully lower the suicide rate of American Indian youth. At a budget of $266 million per year, we all might wish for much more, but it’s an entirely false hope that IHS could ever succeed. We need to be careful about which superheroes we believe in.
According to the Center for Disease Control (CDC) and several other official sources, the suicide rate in the U.S. for youth aged 15 to 24 nearly tripled from 1958 to 1982 (from 4.5 per 100,000 to 12.1 per 100,000). Since 1999, this rate has remained stable at between 10 and 11 per 100,000. For example, in 2013, the suicide rate for youth in the U.S. was 11.1 per 100,000.
With respect to this overall rise, thousands of superhero ‘mental health professionals’ have brought their best thoughts to bear upon the scary issue of youth suicide, and this includes me. We’ve studied the ‘factors,’ designed crisis programs, developed screening tools, and sought to ‘intervene’ in whatever manner might prevent young people from giving up and destroying themselves.
Our superhero wish to please has led to an occasional tyranny of benevolence. I’ve even witnessed young people jumped upon by multiple attendants, then tied into four-point restraints, and shot up with haloperidol, solely because they were trying to remain out of the view of peeping superhero ‘mental health professionals’ determined to remain certain they didn’t hurt or harm themselves. My revulsion at these sorts of suicide ‘interventions’ led me to depict just such a scene in my first novel, Tessa’s Dance.
I’m not suggesting that nothing works to help suicidal kids – I truly believe compassion, lovingkindness, and a respectful, caring dialogue about life and its many problems can be very affirming and even lifesaving. Some people need professional training in order to learn to do this.
I also don’t subscribe to the naïve, minority view that suicide should be an individual choice. Few of us live in such a vacuum that a self-destructive decision won’t create terrible tragedy for other people. I can’t accept that there’s some sort of inalienable right to inflict that kind of hurt, having experienced it and sat with others who have felt it too. But this doesn’t mean I don’t believe in the right to terminate one’s own life due to intractable physical pain or its inevitability. I just don’t think we should call that kind of undertaking ‘suicide.’
So I do believe we have a moral and social responsibility to try to help prevent suicide and especially so among those of us not yet fully grown. Thus far across many years in the ‘mental health profession,’ I haven’t witnessed anything less effective in suicide prevention than the proliferation of psychiatric medications and labels.
I had a minor confrontation during a Q&A with a presenter on suicide prevention not too long ago who tried to get me to believe that the FDA’s black box warning on SSRI antidepressants was responsible for a slight uptick in the youth and young adult suicide rate in recent years. I nearly felt badly pointing out to him that most U.S. soldiers committing suicide were in this particular age range, and after all, the two wars so many of them had been compelled to take multiple tours within likely had more influence than the FDA finally accepting to undertake its fiduciary duties.
I do believe that the ‘mental health profession’ does exceedingly poorly with suicide crisis intervention. We might as well send the police to deal with it, which we usually do. Our hotline call centers fail to have any impact on suicide rates, and our screening measures tell us as much as noticing that a bird appears to be flying toward a window – we say what might happen, but we don’t really know if the bird truly intends to hit the window. A history of flying into windows is a much better predictor that the bird’s going to do it than the ‘mental health professionals’ ability to notice they’re heading in that general direction.
So what really troubles me about the NYT piece by Ms. Bosman is the implication that having more ‘mental health professionals’ around – particularly those who practice within the bio-medically-dominated Indian Health Service – will have some noticeable impact on the problem of epidemic youth suicide at Pine Ridge.
In 1982, similar ‘mental health professionals’ in Indian Country surely knew that the suicide rate for American Indian youth was about two and a half times greater than that of the general U.S. youth population (28.6 per 100,000). In 1989, similar ‘mental health professionals’ studied 291 American Indian youth aged 14 to 18 years old attending a Pacific Northwest boarding school and learned that nearly forty percent had seriously contemplated suicide, while twenty-five percent of boys and thirty-six percent of girls had made already at least one attempt.
This kind of information was already over a decade old by the time I began my own consulting work with a tribal school. On the occasion of my very first visit, the school counselor reached in the back of her file drawer to pull out a summary of a youth survey conducted by the local Bureau of Indian Affairs office pertaining to her students. Twenty percent of them had attempted suicide in the year just prior to my arrival.
So when you visit the CDC and plumb through the most updated plethora of data only to discover that the current suicide rate for American Indian youth now stands at a high of 31 per 100,000, or three times that of the rest of U.S. youth, you can bear witness to how effective the emphasis on psychiatric medications and labels by Indian Health Service ‘mental health professionals’ has proven over the years.
Then consider how well their ‘interventions’ could ever work in addressing an internalized intergenerational experience of genocide, displacement, boarding schools, loss of language, and cultural destruction alongside day-to-day abject poverty, educational obstacles, institutionalized and overt racism, and a four time greater chance of ending up in foster care than white kids.
Lastly, consider the pieces on this blog to date, particularly in how these ‘interventions’ might emanate from the same social movement responsible for creating the stereotypes of dumb, drunk, or crazy Indian with which these youth must contend everyday.
I do believe ‘mental health professionals’ should be able to contribute thoughtfully to a community collaboration aimed at suicide prevention. But we cannot rescue native youth, even if we wish we could.
Native youth have always been the superheroes rescuing themselves. Every single day. And it’s a wonder we haven’t lost even more of them given all they’ve had to fight.
We all as a nation need to come together, stand with them, and help.
Mad in America hosts blogs by a diverse group of writers. These posts are designed to serve as a public forum for a discussion—broadly speaking—of psychiatry and its treatments. The opinions expressed are the writers’ own.