Joshua. By Jennifer Gonnerman
On January 30, He Nearly Killed Himself. On April 16, He Did. A 17-Year-Old's Suicide and the Questions Left Behind
Phoenix, New York—Debra Graham sat at her dining room table on a recent Wednesday morning and riffled through a stack of loose-leaf notebook paper, each page covered with the tortured scrawl of her 17-year-old son, Joshua. "Today's just another day/where I don’t feel good/and if I could find another way/you know that I would." In recent months, Debra has spent dozens of hours studying Josh's writings—his poems, prose, song lyrics. She put aside one page, then glanced at another. "Lately I've been hanging around/tired of life in this dead end town/It feels like I'm stuck/and I can't get out/I pick myself up/but I'm thrown back down . . ."
To Debra, these worn sheets of lined paper offer a chance to feel close to Josh for a few extra minutes. Maybe, if she just reads and re-reads his words one more time, she'll find the answer she so desperately craves. Her question, however, may be an unanswerable one: Why did her son decide to loop a rope around a tree in the backyard of his father's house, construct a noose, and slip his head inside? Six months ago, on the morning of April 16, she got the call from her ex-husband, who lives nearby. Their son Josh was dead.
Every year, 30,000 people in the United States die by their own hands. While murders receive more attention in the media, a far greater number of people take their own lives than end somebody else's. Some years, there are three suicides for every two homicides. The vast majority of suicide's victims are male, and among 15- to 24-year-olds, suicide is the third leading cause of death. Often suicides happen in spurts. One pocket of the country will experience a rash of suicides, and then a spate of them will occur elsewhere.
In the last six weeks, three students at New York University have jumped to their deaths. Across the Hudson River, three people died by standing before oncoming trains on the tracks of New Jersey Transit. In central New York State—in Syracuse and neighboring towns—the number of teenagers and children who are killing themselves is alarming. Since the start of 2002, 17 young people there have committed suicide, compared with eight in all of 2000 and 2001.
News accounts of suicides often leave out the details of deeply troubled lives, implying that the individuals' decision to kill themselves was spontaneous and unexpected. In fact, suicide is an end point, usually, to a long and tortured struggle, albeit one that is hidden from public view. People battle the impulse to kill themselves, searching for a reason to keep living; friends try to convince them not to give up; and in many cases, family members fight to obtain mental health care for their loved ones—the proper diagnosis, the right medication—before it is too late.
The Grahams' pale blue ranch house looks like any other on County Route 6 in Phoenix, a rural village 22 miles northwest of Syracuse. There is a swimming pool in the backyard; plastic decals of pumpkins decorate the back door. Josh Graham used to live here, but now the house has only three full-time residents: his mother, Debra; her boyfriend, Dave; and Zeus, Josh's oversize golden retriever. Josh used to drive to school every day; now his car remains in the driveway. It's a battered Dodge Lancer, which everyone calls the "Kissmobile," since the driver's door sports a sticker for the band Kiss.
The house is almost always silent, though it never was when Josh was alive. He would bang around his room, stomp down the stairs, trudge across the floors. Howard Stern's voice blared from his bedroom every morning. Many evenings, when Debra returned from her job at a financial services firm, she would discover both the television and the radio turned on, and Josh hunched in front of the computer, wearing a pair of headphones and IM'ing his friends.
From nearly the moment he was born, Debra worried about Josh. When he was two, he used to bang his head against the wall and tear out his hair. A doctor diagnosed him with attention-deficit/hyperactivity disorder, known as ADHD. Josh seemed to get better as he grew older, but then, when he was 14, Debra thought he was very depressed, and so she took him to a counselor. To people outside the family, his depression remained a secret.
In school, he was known as the kid who could make anyone laugh. Every time there was a chance to get dressed up, he went all out. Pajama Day, Toga Day, Hawaiian Day—he enjoyed them all, shopping at Salvation Army to pick out his outfits. On Pajama Day, he showed up at school in a pink bathrobe. He was a member of the Teen Spirit Club, too, which does volunteer work, including attending events at the local senior citizens' center. Josh would dance with the elderly women in their wheelchairs, wearing a top hat and bow tie and carrying a cane.
At the start of his senior year, in September 2002, his classmates voted him "Most Optimistic." At home, however, Debra began to suspect something was seriously wrong. Josh's depression seemed to be getting much worse. He spent less time with his friends and more time in his bedroom. His mood swings became frequent and extreme. He complained of headaches. He barely slept.
Debra bought a copy of His Bright Light: The Story of Nick Traina. The book, by Danielle Steel, chronicles her son's battle with bipolar disorder, also known as manic-depressive illness. Debra saw similarities between Steel's son and her own, and she felt better knowing that another mother had been through all she was now enduring. The end of Nick's story brought little comfort, however. He took his own life at age 19.
In November, a friend showed Debra an article in Time magazine about young people who are bipolar. The story explained that some bipolar teenagers are misdiagnosed as having ADHD when they are children. At the end of the article was a list of 40 warning signs: "withdraws or isolates self," "has irritable mood states," "is easily distracted by extraneous stimuli," "sleeps fitfully." Nearly every sign applied to Josh.
On December 17, Debra took Josh to a psychiatrist, who diagnosed him as bipolar and prescribed Depakote, an anticonvulsant that acts as a mood stabilizer. Josh was irate—at the diagnosis and at his mother. "Why can't you just leave me alone?" he railed. "Why do you keep insisting something is wrong?" He claimed the pills made him feel nauseous and made his hair fall out—side effects the doctor had warned him about. Debra didn't know if he was telling the truth, but she did know he stopped the pills within a week. "I'm not taking them," he said. "I'm not bipolar."
Six weeks later, on January 30, Debra's boyfriend, Dave, came home from work shortly before 4 p.m. and found Josh staggering around, rambling incoherently, slurring his words. Dave called Debra, Debra called 911, and Josh spent the next 72 hours in intensive care. That morning, before going to school, he had drunk a poisonous liquid he'd read about on the Internet. It contained the chemical ethylene glycol, and it nearly killed him. A psychologist interviewed Josh while he lay in his hospital bed, and afterward told Debra the boy was upset his suicide attempt had failed.
For more than 40 years, suicide has been part of Debra Graham's family. Suicide claimed the life of her ex-husband's aunt and also killed the boyfriend of one of her own aunts. It nearly took her mother's life, too. When Debra was five, she watched her mother leave home in an ambulance. She had overdosed on aspirin. In Debra's childhood years, depression and suicide were taboo topics, never to be discussed.
After Josh's suicide attempt, he spent six days at the hospital and was then sent to Four Winds, a private mental hospital in Syracuse. Debra decided to clean his bedroom, so he could feel like he was getting a fresh start when he returned home. It took her nearly a week to remove all the food wrappers, soda cans, and empty Hershey's syrup bottles. Evidently, Josh had acquired a new habit: drinking Hershey's syrup.
Josh was released from Four Winds on February 11. The poison had damaged his kidneys, so he could no longer take Depakote. Instead, a doctor gave him Lexapro, an antidepressant. Debra stopped going to her job and began working at home, so she could be there in case Josh made another attempt.
Four Winds had set Josh up with a social worker who belonged to a practice with psychologists. But Josh needed someone who could prescribe medication for him, and so Debra began looking for a psychiatrist. Her search stretched on for weeks. Some doctors never called back. Some said they did not accept her insurance. Some said they were too busy to take on a new patient who required intensive therapy.
Debra wondered if the health insurance system was part of the problem too. In New York State, some insurance companies limit one's access to mental health services, covering only a certain number of visits a year. "Psychiatrists know the insurance business," Debra says. "I think if they knew they weren't limited, I would have stood a much better chance of securing a psychiatrist."
A more likely explanation is that her difficulties stemmed from the acute shortage of psychiatrists who treat adolescents. Waiting lists in central New York can be three or four months long.
Every few days, Debra called Purnima Vyavaharkar, the pediatrician who had treated Josh since he was a baby. Dr. Purnima, as she is known, was not qualified to prescribe his medication. But she understood the gravity of the situation—she had already lost two patients to suicide—and so she tried to help. She visited Josh in the hospital, and she had previously met with him in her office. "I was depressed once, but now I'm fine," he had told her. She was not convinced. "He had a sweet smile," she says, "but he had pain in his eyes."
In late February, a guidance counselor at Josh's school heard from a student that Josh had been cutting his forearms. The counselor brought Josh into her office, inspected his inner arms, and saw cuts from his wrists to his elbows. She called Debra, who took Josh to the one hospital in Syracuse with a psychiatric emergency room. He stayed overnight.
Two weeks later, the son of Debra's boyfriend noticed a paper next to the computer in the living room. The page was blank, except for the bottom, where it had a Web address and a date—March 9. Visiting the site, he discovered instructions on how to make a hangman's noose. He showed the site to Debra. She called her older son, who drove up from Connecticut and conducted a suicide watch, monitoring Josh around the clock for the next several days.
By mid April, Debra thought Josh was a little better. She had found a psychiatrist-psychologist team willing to treat him, and he had agreed to go. He went to one appointment, then returned a week later. That same day, Monday, April 15, was the start of spring break. After the appointment, he and Debra went to see the movie Phone Booth together. About 12 hours later, around 2 a.m., Josh hanged himself. He did not leave a note, but afterward, when his older brother searched his bedroom at his father's house, he found a receipt for the rope. It was from Home Depot, dated March 9—the same day Josh had been surfing the Web.
Debra leads a visitor through the living room and up the stairs to Josh's bedroom. Britney Spears poses in a photo pinned to the door. A Metallica flag is above the bed. A ribbon from a school science fair hangs on one wall, and an autobiography by Mankind, the pro wrestler, sits atop the desk. The room is neat and clean. No Hershey's syrup bottles or Coke cans or Taco Bell wrappers.
For three months after Josh's death, Debra could not bring herself to walk into this room. More recently she has started coming here whenever she wants to feel close to him. She lies down on his water bed and listens to a CD he made of his favorite songs, by bands like Radiohead and Limp Bizkit.
Sometimes she sits on the edge of his bed and studies the drawings tacked to one wall. "This one shows a broken person," she says, pointing to a simple drawing of a figure with all the body parts disconnected. Other drawings reveal an obsession with death—a tombstone, a crucifix, a noose. "I was so upset when I saw this work," she says. "He had drawn cartoon characters all his life, but when he turned 14, his drawings took on a darker tone. They clearly depicted my son was in pain."
She pulls out a portfolio and opens it on the bed. Josh had focused on art classes in high school. After his death, his friends had cleaned out his locker and brought the contents over to the house. "I had never seen any of the drawings in here," she says, pulling out a sketch of a young man seated on the end of a coffin. "He did this in his junior year, but I never knew of its existence until after he died." A minute or two later, she closes the portfolio and puts it away.
After Josh's death, Debra discovered a stash of videotapes in a drawer in his bedroom. One was a brief home movie dated March 27, 2002, a year before his death. Downstairs in the living room, she slides the tape into the VCR. Josh appears on the screen. He is thin, with piercing blue eyes and messy blond hair. He wears a hat made of tinfoil with two horns.
He is alone in his bedroom. "A room with a view," he jokes, since all he can see from the window is the driveway. The camera jerks toward the floor, then focuses on a porn magazine, zooming in on a photo of a naked woman. Next is a shot of his blue lava lamp, then the bed. "This is the master bedroom, where nothing at all really happens," he says.
Debra lights a Marlboro Light and settles back into the sofa, facing the television. She has seen this video maybe 20 times in recent months. Studying Josh's pen and pencil drawings usually depresses her, but watching this video always lifts her spirits.
Josh removes his tinfoil hat and puts on a Shriner's hat. He sits down in a chair, faces the camera, picks up a ukulele, strums a couple times, and sticks a cigarette between his lips. Soon he is coughing. He tries to blow a smoke ring. Debra laughs. The sight of her son pretending he's a smoker amuses her, especially since he spent years berating her for her pack-a-day habit.
He lifts a condom to his mouth and blows into it, creating a balloon. "OK," he says. "That's enough of that." His next prop is a pair of leopard-print girls' underwear. He places it on his head, then grins at the camera. Soon he's back to the cigarettes. He jams six or seven in his mouth at once. He picks up a lighter and tries to ignite them all, without much luck. "He didn't get a single one lit," Debra says, with a smile.
"I'll be right back," Josh says, and then the camera shuts off.
After Josh's death, Debra noticed that some people in town treated her differently. Last spring, she went to a few graduation parties for Josh's friends. Some people stiffened when they saw her. Nobody knew what to say. She stopped going to the parties, and tried to make herself feel better by attending a support group for suicide survivors. That didn't work either. Her grief was so raw that she could not relate to anyone. One of the other women there was talking about her son's suicide, which had happened 17 years earlier.
Not long after Josh's death, Debra herself felt suicidal for the first time in her life. She had never battled depression in the past, but now she felt sad all the time. "Oh my God," she said to herself. "This is what Josh lived with for such a good portion of his life." It seemed a horrible irony that his death had somehow given her new insight into his mind, a new understanding of the demons against which he had long struggled.
For Debra, guilt has become a constant companion. "I know in my mind that I did everything that I could do," she says. "I tried to get him help. But in my heart I still feel as if I failed him somehow, as if I didn't do the right thing. I just knew he was so troubled, and I just knew I was racing against the clock." The same few questions hound her every day. "What could I have said different? What could I have done differently? Why couldn't I save my son?"
In early August, Debra discovered an outlet for all her rage and frustration when she learned about the statewide campaign for "Timothy's Law." Timothy was 12-year-old Timothy O'Clair, who hanged himself in Schenectady in 2001. The bill that bears his name would require health insurance companies to provide the same coverage for mental illnesses as for physical ailments. In September, Debra recruited 150 people, including many of Josh's friends, to attend a rally in Albany. Now, everywhere she goes, she carries a cardboard box with letters to legislators about Timothy's Law, and she solicits signatures from whomever she meets.
When people ask why she is so passionate, she says, "Josh's death cannot be for nothing. His death has to have purpose and meaning." There is another reason, too, why she is devoting so much energy to trying to stop future suicides. Debra heard that in August, four months after Josh's death, a 17-year-old boy who lived in a nearby town had also ended his own life.