Deaths in the family 

Four teen suicides rocked Missoula high schools last year. Have we finished asking why?

A lone teenage boy cried openly. A band student stopped playing mid-song. A teacher began class by saying, “I know you’re going through a hard time.”

Nothing seemed right at Sentinel High School on the afternoon of Thursday, December 5. Nothing was.

As students and teachers began piecing together the something’s-wrong-here scenes, news of a popular sophomore’s suicide emerged—Ray Madril, the second student to take his own life in two weeks. By day’s end, the kids had spent hours embracing in the hallways, or had left early to gather at friends’ homes. The girls’ basketball team learned of the death as players boarded the bus for a game in Kalispell. The boys’ home game that night created a space for students to exchange hugs, distribute blue-ribbon tributes to pin on shirts or backpacks, and talk.

Talking seemed to help, and the next several days brought more conversations, both off campus and inside classrooms, and in voluntary counseling sessions arranged by the school.

Six months later, that discussion seems to be waning, despite the fact that the issue of suicide has become more acute. During the school year, three Sentinel students and one Hellgate student killed themselves—all boys, all between 15 and 17 years old. Suicide is already the second-leading cause of death for people between the ages of 10 and 32 in Montana.

“We’re in the midst, have been in the midst, of a real epidemic,” says Michael Marks, a psychologist with 29 years in his Missoula practice.

Missoula County saw no teen suicides in 1999 or 2000, one in 2001, three in 2002, and two thus far in 2003, according to the Sheriff’s Department. That puts the county’s rate at three times the national average. More than other demographic groups, adolescents and young adults commit suicide in clusters—groups of suicides or attempted suicides occurring closer together in time and space than is normally found in a community. When one child commits suicide, the odds that another child in the community will follow suit increase 300 percent.

Behind the numbers are the families and friends forced to cope with sudden losses and unanswered questions. What accounts for the rising numbers of teens taking their own lives? Do these suicides represent something more sinister than isolated tragedy? What should be done to prevent more children from going down the same path? As alarming as the suicides is the lack of clear answers to those questions.

Shannon Holmgren wears a button picturing her adopted son Hildinge. With deep brown eyes, the 17-year-old looks remarkably like Holmgren, who raised him since he was two. Hildinge’s smile radiates from the button—thanks to hours of dental work, his mother says—but the smile hides a pain that she never tapped into. Hildinge committed suicide on April 9.

“He was a private person,” she says. “He’d keep a lot of things bottled up inside him. You didn’t really know. If you tried to dig in, he’d clam up even tighter.”

Hildinge played football at Hellgate and loved weightlifting, fishing and hunting. He helped his mother take care of his younger sister and brothers, one of whom suffers from diabetes. Holmgren remembers him spending entire Saturdays at the end of the couch making sure his brother was comfortable.

Two years ago, Hildinge learned that he himself had epilepsy, a diagnosis that ruined his hopes of joining the military. He had many friends and a few girlfriends, but he never liked the fact that girls had to pick him up for dates because his illness kept him from driving. Holmgren feared her son might have been suicidal in the past, but his talk about attending college convinced her that he was out of danger. Just weeks before his death, she took him to Seattle for 10 days of evaluations for his epilepsy. Doctors recommended trying one more medication. If it failed to help, they suggested brain surgery. He tried the medicine. Hildinge, who died from a self-inflicted gunshot wound, did not leave a suicide note, but his mother suspects that the seizures had returned.

“I think going to Seattle scared him, knowing what the brain surgery would entail,” she says. “He mentioned one time, when we came home, ‘I don’t want to do the surgery if that’s what it comes to.’ The way he said it, [it] came down to a vanity thing, because he didn’t want to have his hair gone. I kind of laughed that off, and I guess you think back and you say, ‘well, maybe I shouldn’t have taken that so lightly.’”

As Holmgren grieves her son’s loss, she “puts on a brave face” for her other children, who have birthday parties to attend and summer lawn-mowing jobs to complete. Her 13-year-old, Brennan, recently wrote a poem about his brother’s suicide. He titled the poem “Why?”

Bruce Buchman’s 15-year-old son, Sam, committed suicide last May. Buchman already is imagining what it will feel like when football season rolls around without his 6-foot-4-inch defensive lineman on the field. Owner of Mr. Mini-Blind, he keeps working because if he doesn’t, “we don’t buy groceries or pay for funerals or buy gas or cover utilities.”

When a longtime friend approaches him at a restaurant, Buchman asks about the Little League team’s progress and answers the inevitable how-are-you: “It’s kind of day-to-day. I get up, start breathing. It’s learning how you go on with a new perspective,” Buchman tells the man, who says his son will stop by to visit the Buchmans.

Sam had a roller-coaster freshman year at Sentinel. An athlete, he was a star on the football field and loved playing baseball and skateboarding. His grades wavered between average and poor, but building friendships was more important to Sam than grades, his father says.

Known for his sense of humor, Sam loved to entertain. His routine often consisted of narrating the interior monologues of dogs he saw in cars or on the street, and teaching tricks to his own dogs, Lulu and Bailey. His father, who has an undergraduate degree in drama, wanted Sam to try acting, and Sam had recently told his mother that he would.

Sam had been close friends with Ray Madril, the outgoing boy whose suicide by gunshot stunned the Sentinel community in early December. Later that month, Sam attempted to take his own life. He was admitted for in-patient treatment at St. Patrick Hospital and released on Christmas Eve. His parents came to believe that suicide was no longer an imminent concern.

On the day Sam died, he and his father said they loved one another, as they routinely did. His parents don’t know why he hanged himself, but they suspect he was concerned about not achieving in school.

“Well, as I say, Sam wasn’t really into the humanities, so I knew he wouldn’t have written an essay about such things, as some kids might,” Buchman says. “But I also think he wanted to make sure that he didn’t waste time once he made his decision. He did leave a note that didn’t explain anything but simply [said] where he was and that he was sorry.”

Sam’s death unearthed rumors that he had been involved in a “suicide pact” with his friend Madril. Buchman dismisses that talk because he feels it takes the focus off of solutions. But he does think that Madril’s death may have made suicide a more imaginable option in Sam’s mind.

“If people believe this was a pact, then they may be pursuing the wrong kinds of answers to solving this for every kid,” says Buchman. “It makes sense to me that the more you seem like somebody else who has done something like this, the more you would draw the same kind of parallel in your life. As sad and as devastated as he was by Raymond’s death, and as much as we talked about it and went through the process of grieving about it, it apparently didn’t have enough impact to have overridden his choice.”

Parked cars lined the streets for blocks around First Presbyterian Church on a Monday evening in early June. Washed in warm sun and exploding with green spring growth, Missoula seemed like Eden—except for the fact that the parked cars represented people attending a meeting called to address “Suicide in Our Town.”

More than 120 adults and teenagers filled the church’s fellowship hall for the second installment in the series launched in March by the Missoula Coalition for Suicide Prevention. Buchman had died just a week before, and the attendees arrived with a sense of urgency, raw emotion and a desire to talk.

Marianne Moon, Director of Safe Schools for Missoula County Public Schools, explained district protocol after a teen commits suicide: First-period teachers read an announcement informing students of the death and offering counseling, teachers hold class but do not cover new material or give tests, counselors speak to the dead student’s closest friends, and the school calls the parent of every absent student to make sure the child is safe.

Psychologist Marks contended that mental illness lies at the heart of most suicides. Ninety percent of adolescent suicide victims carry at least one diagnosable psychiatric illness—often depression—according to the American Foundation for Suicide Prevention. Nearly everyone with depression, however, responds favorably to treatment.

Marks stressed the importance of recognizing that children and adolescents as well as adults suffer from mental illnesses, and warned against dismissing teens’ depressions as phases or ploys to get attention. People with depression feel a literal, physical pain, Marks explained, and those who commit suicide do so not because they want to be dead, but because they want the pain to end.

A single stressful situation or setback does not typically prompt suicide, Marks assured the group. Those who decide to kill themselves usually have a combination of risk factors including depression, a history of substance abuse, family violence, availability of firearms or exposure to suicidal behavior.

Attendees divided into small groups, each with a professional counselor to facilitate discussion. As the community spoke, leaders wrote their comments on giant white tablets. Parents wondered about the truth of rumors they’d heard. They asked their teenagers why the suicides were happening, and how to stop them. The students shifted uncomfortably and tried to explain something that they couldn’t understand.

Pinpointing the factors that contributed to the teen suicides is a complex process that turns up endless possibilities.

Jessica Cox, who graduated from Sentinel this spring, says that many teens feel like they have no control over their lives, which contributes to despair. “[Teens are asking], ‘How can I affect the world? How can I change it?’ The world, the country, the school, the family situation,” she says. “Just powerlessness. I know more about it on the global scale. You can say, ‘I really want to change something, I can do everything in my power to change something,’ and nothing changes, then where are you?”

High schools can leave students feeling isolated. Although Cox says she didn’t witness much overt cruelty, she guesses that some students feel alone in school because of the way people act toward one another: “It’s a sense that I’m walking down the hall and those people don’t know me and they don’t care about me. School in general should be a place that fosters that care.”

Buchman fears that everyone from families to social groups is giving kids the wrong message about what’s important. Too often, he says, the focus is on providing kids with material comfort rather than imbuing them with a fundamental sense of value. “Where have we evolved as families?” he asks. “How does our culture deal with kids? Educate them? Counsel them? Recreate them? Sell them stuff? My fear is that too many people are growing up without the perspective that human beings are for nurturing, cherishing, encouraging. My suspicion is that that’s where an awful lot of the answers will lie in trying to solve this sort of problem in our culture.”

Sheriff Mike McMeekin attended the second town hall meeting and has sent officers to the scenes of the suicides. He theorizes that violence in the media makes young people, who may not understand the permanence of death, more vulnerable. Seeing characters in films or TV shows die on screen and then appear elsewhere may confuse kids, he says. “Especially younger people are almost inured to violence and death because of just constant exposure through the entertainment media, which my personal feeling is makes death less of a significant event.”

Despite increased understanding of why suicide occurs and how to treat those at risk, it’s what remains unknown that haunts those who have lost loved ones.

“For those of us that don’t choose to commit suicide, I think there’s an awful lot we’ll never know, because that’s not our frame of mind,” Buchman says. “I think that may be the greater mystery about suicide—why do things get so desperate and so hopeless that you would pick that as a solution? Why are the things that bother us, especially at age 15, so important that we can’t see the greater value of survival of life, and the horror and pain that such a choice would inflict on everyone that knows you? Living with no answers is part of the rest of our life.”

Suicide clusters are rare; they comprise only five percent of suicides. They don’t usually occur among middle-age or elderly populations, even though those groups have higher overall suicide rates than adolescents, and they typically plague suburban and rural areas, according to Alex Crosby of the Center for Disease Control in Atlanta. Explanations of how they work have eluded researchers for centuries.

In the 1770s, authorities tried to ban Johann Wolfgang von Goethe’s novel The Sorrows of Young Werther, because they believed it was contributing to a spate of suicides. Young men across Europe had begun dressing like the protagonist, who wears yellow pants, blue jackets and open shirts. Some also imitated the novel’s ending, in which Werther shoots himself after being rejected by a woman.

Two centuries later, sociologist David Phillips began publishing a series of studies showing that suicide rates increase in the days following highly publicized suicides. The suicides serve as permission-givers for those who are already considering the option, Phillips argues.

In Missoula County, the recent teen suicides received scant media attention: obituaries with the journalistic euphemism “died at home,” and references to the deaths in articles announcing community meetings. News of the deaths spread fast among teens anyway.

“If children go to the same school, they are likely to know the person who suicided before,” says Nels Sanddal, president of the Bozeman-based Critical Illness and Trauma Foundation. “They are likely to know the tension and sorrow and grief associated with the person.”

The Providence Center at St. Patrick Hospital treats suicidal adolescents from all over Montana through both in- and out-patient programs. Susan Honsky, a nurse and the coordinator of the programs, has worked with more Missoula teens this year than last, and she notes seeing more middle school students over the past few years. She describes a “trickle-down” effect of the older boys’ deaths on younger patients. She attributes the increase in part to a contagion effect, by which suicide “spreads out just like a cold would spread across the community.”

Many of the patients Honsky has treated this year mentioned having connections with at least one of the teens who committed suicide. Their associations underline the way contagion works.

Contagion affects those already at risk because they see suicide as their “15-minute opportunity for fame,” psychologist Marks says. And when people grieve for someone who commits suicide, they often idealize that person, which can increase the incidence of contagion.

Ashley McKee, 18, graduated from Sentinel in June. This fall she will enroll at the University of Montana, where she plans to study photojournalism. Two years ago, however, she didn’t feel so hopeful about her future. A break-up that “tore her apart” triggered a severe depression, and she began considering suicide. With her mother’s support and professional treatment, McKee says she healed over time. But she imagines a different outcome had other teens at the time chosen the hard way out.

Those who study suicide say that it is a preventable tragedy. They point to other public health issues, such as AIDS and heart disease, to make the case that concentrated attention at all levels can ameliorate these crises. And suicide in Missoula appears to be receiving some attention, which is good news. But the news is not all good.

The Missoula Coalition for Suicide Prevention hosted its third meeting in early July. If attendance is an indicator, widespread public interest in the problem of suicide seems to be fading. About 25 people, many of whom were organizers, attended the July meeting—an exponential drop from earlier ones.

At the most recent meeting, audience members directed the discussion. Their comments highlight the difficulty of battling teen suicide.

Some wondered about the role of schools, asking what could be done to prevent bullying. One noted that well-liked students also consider suicide. Others mentioned lack of access to health care, particularly during summer months when students can’t see school counselors. Some wanted to train teens in peer counseling; a teenager said she wouldn’t feel comfortable talking to her peers about being depressed.

Teen suicide puts schools in a tough bind. Because students are there seven hours a day, schools seem a logical place to begin confronting the issue. But the district has to distinguish between educating students and providing a “full mental health package,” Moon says.

The district cannot add suicide prevention programs because the district doesn’t have the money, Moon says. Already she writes grants to run the Flagship program, which provides after-school activities to head off drug and alcohol abuse. Moon has been able to fund the Project Success Program through grants that provide high schools with an additional prevention counselor. The district’s health curriculum includes units on suicide.

Sentinel Principal Tim Dennison has spent plenty of time confronting student deaths this year. In addition to the three suicides, three students have died in accidents. With each loss, he asked himself, “Why Sentinel?”

“We know that kids are in this setting, so we do have an impact,” Dennison says. “But I think it would be erroneous for us to assume that everything we do is going to change this picture, because I think it’s a societal thing, and for whatever reason, it’s a Montana thing.”

Dennison and his staff are looking to make changes that “don’t have a price tag,” but that will help students feel more connected to each other. He wants older students to lead an orientation for incoming ninth graders to build community. “I don’t accept that it’s not our problem,” he says, “because it is. But it’s more than just school. We have to work together.”

Ironically, the suicides at Sentinel have succeeded in bringing students together. “After each death we all came to a very caring place, and that’s strange in high school,” Cox says. “We cared about that person we didn’t know walking down the hall. As long as that continues it will be a good step for Sentinel.”

Elsie Weyrauch, co-founder of the Suicide Prevention Action Network, a Georgia-based group that works to develop political will to address the problem of suicide, says that it’s fear of talking about suicide that keeps people suffering in silence. “People who are suicidal keep it a big secret,” she says. “Until we release that bondage, they can’t seek help. You can’t cure it until you know that you’ve got it.”

Sheriff McMeekin wants people to know it’s OK to look someone in the eye and say, “Are you considering hurting yourself?” He says, “Everybody wants to dance around it. That’s a terribly difficult question to ask, but that’s what we need to do.”

The Missoula Coalition for Suicide Prevention plans to bring an expert to town in September to train people to ask that question. The training method, called “QPR,” teaches people of all ages how to “question,” “persuade,” and “refer” a suicidal person.

Efforts on the state level are moving slowly. In 2001, the Department of Health and Human Services convened a group to write a state suicide prevention plan. Execution of the plan, which calls for a statewide crisis hotline and the development of a grassroots network to educate citizens, has all but stalled due to lack of funds. Its authors are still committed to the task, but without resources they can’t do much, says plan co-author Sanddal. “We’ll continue to make progress on a zero-base budget, but the progress will be frustratingly slow. We realize there’s much that can be done, but not without much money.”

The media play a role in making Americans aware of the national magnitude of the problem of suicide. Each day 85 people die by suicide in the United States—more than die by homicide. “What if all those people went down in a plane crash?” Marks says. “It would be big news, but the fact that it happens individually doesn’t hurt that bad.”

If—as many have suggested—a sense of powerlessness, or recognition that society values them for the wrong reasons are factors contributing to teens’ sense of despair, adults concerned about teen suicide face an even bigger struggle: making the world a hopeful place for teens.

The pain caused by the four boys’ suicides shows that it’s a worthwhile fight.

“The fact that suicide happens is a community-of-mankind issue,” Buchman says. “Suicide rates in this state are alarmingly high. To say it’s a wake-up call is an understatement. It’s horrifying. Why? What is it about the way we have evolved as a culture that would allow this to happen?”

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