The Way Some Young People Perish How we struggle with the subject of suicide and the young.

“Humans must surely be the only animals who contemplate doom, and as long as we do so, we are still human–and paradoxically not doomed.”

—Virginia Heffernan in “The Beautiful Benefits of Contemplating Doom” (2019)

In early June 2017, in the throes of navigating first-time motherhood, a disordered house, and an unkempt lawn, I chose to do something about the latter, perhaps the easiest task to tackle first. I logged onto Nextdoor, a social media site for neighbors, and contacted Samuel L. Heisel, a 15-year-old Brentwood, Missouri high school student and a football star who lived one street over and also just so happened to be willing to mow my lawn for $25.

Perhaps mowing lawns for money does not sound like an inherently benevolent act, but when Sam arrived, I was relieved that at least one visible to-do would be gone. It is an act of grace to help new parents, even if payment is exchanged for such work.

Sam was relatively short in stature yet lithe, and you could see how he would make an agile running back. “He was amazingly fast and deceptive when carrying the ball,” Ted Heisel, Sam’s father, remembered. “The coaches really didn’t know what to do with him until about the 8^th grade, at which point they let him carry the ball a few times and he started scoring touchdowns on long runs. It was both funny and impressive, considering that he didn’t get much playing time before that.”

I never got to see Sam play football. I did, however, watch in awe as he pushed his mower up and down our almost 90-degree-angle hills with no trouble and was incredibly quick in getting the job done. I offered Sam a glass of lemonade with a three-month-old baby in my arms, but Sam politely waved off the drink and just kept mowing.

I think I gave Sam a $5 tip. I want to believe that I did that, that I would have recognized his hard work with a bit more money because I remembered my own life as a broke adolescent 20 years prior: babysitting, announcing blue-light specials after school, and carting videos from the collection box in a lightning storm because somebody had to see Seven or Braveheart or Clueless right now, in the pouring rain.

That one mowing job was the only time I met Sam. When I texted him to see if he could return, he was camping or traveling or doing something with friends that summer.

It was not until early September of that year that I encountered Sam again, this time in the news as a missing teenager, whose father Ted, older brother Jonas, extended family and friends went searching for him in O’Fallon, Missouri, about 30 miles from where the Heisels lived.

First, they found Sam’s 2008 Honda Accord in the woods. Then, they found his suicide notes and his cell phone in the crashed car. Later, they found his body in Peruque Creek, a tributary of the Mississippi River.

The reasons why someone so young would take his life are many and complex. As experts will tell me again and again as I try to piece together what happened to the kind young man who mowed my lawn, there is rarely, if ever, just one reason why someone takes his or her life.

This story, like many stories, centers on a brief and chance encounter. Meeting Sam and then reading about his demise made me wonder how communities like mine could better support and care for young people who may be struggling, who may sometimes make the devastating choice to end their life. What could we do to better to support teens, and each other, before they came to such a sad and terrifying decision?

And let me be honest: Part of this question’s motives are selfish. My 3-month-old baby is now a feisty and curious 2-year-old girl. The lawn is now routinely mowed by a service I hired. Laundry is mostly folded, though there are still baskets full of the stuff from time to time.

While I have learned how to get my child to sleep, how to kiss a skinned knee, and how to better balance family, work, and home, I still do not, however, know how to talk with her about suicide. I like to tell myself that this conversation is down the road, but then meeting Sam made me question how much time I really have.

I think a lot of parents may be in a similar boat.

•  •  •

The especially hard practice of trying to understand suicide, especially suicide among those who are only beginning their lives, is that even when you have the reasons, those reasons are, quite often, the coldest of comfort.

Reasons cannot live in the world. Reasons do not graduate or show up at family holidays or have children of their own. Reasons do not return your text or your hug or help you understand the void one feels when you lose your child to suicide.

Sam’s father, Ted Heisel, a St. Louis-based attorney and a farmer who loved, still loves, to fish and canoe with his family and remaining son, recounts that Sam’s beginnings were not easy: his start was “a little more difficult than most kids’ upbringing.”

Sam was adopted from northeast China at four years of age by Ted’s then-girlfriend (later wife), Susan (Harris) Heisel. Sam, Ted speculates, was likely placed into adoption days after his birth because of a birth defect, a dysmorphic right hand that did not stop Sam from mowing hilly lawns or excelling at high school football or driving his Honda Accord.

Susan, who led the Missouri chapter of The Nature Conservancy after working in Missouri government serving Governor Mel Carnahan and Senator Jean Carnahan,  adopted Sam and his older brother Jonas before marrying Ted in 2006.

Ted knows that his son’s start in life involved trauma and loss, potential risk factors to keep in mind for youth who may contemplate suicide, but Ted also thought Sam had weathered the storm and was coming out on top.

“What is interesting and confusing to me about it was Sam seemed to be getting better over time,” Heisel said. “He had a large group of friends at school. He was pretty darn good at football and took a lot of pride at being good despite his disability. He hung out with a lot friends that summer and was doing fairly well in school. It’s confusing how you can have a support network and lots of friends and be in a position where you feel like that’s the only alternative.”

“As any parent, you’re sort of left with a lot of regrets and second-guessing as to what happened and what you might have done differently.”

•  •  •

Almost two years since Sam’s death, I think of him often. I think of him when my daughter and I walk past the street he once lived on en route to grab coffee and a pink cake pop or when we visit the long jumper’s sand pit near the high school track he would have crossed to get to football practice.

I also think about the neighborhood’s response after Sam’s death: the overlapping notes affixed with blue painter’s tape on a pole posted outside his home, a white orchid in bloom, grocery-store bouquets fanning the makeshift memorial like spokes on a wheel, the words “We love you Sam / Brentwood High #28” etched in blue chalk with a pink heart in the place of the word “love,” and a purple box of opened tissues placed amid the tokens of grief, many of which were likely left there by friends from Brentwood High School, just down the street.

I also think of Sam when I read the news reports in late April. A comprehensive study published in the Journal of the American Academy of Child & Adolescent Psychiatry had gone viral and revealed that “caution regarding the exposure of children and adolescents to the [Netflix] series [13 Reasons Why] is warranted,” especially with the first season of the series, which debuted at the end of March 2017, six months before Sam killed himself.

In April 2017, a month following the series’ release, researchers at Nationwide Children’s Hospital in Columbus, Ohio measured the suicide rate of 0.57 per 100,000 for 10- to 17-year-olds. This figure registered as the highest suicide rate of the five-year study period (2013-2017) for the age group. In fact, in the nine months following the 13 Reasons Why debut, an additional 195 deaths by suicide were recorded for this age group than would have been anticipated from seasonal patterns alone. This increase was primarly driven by boys, “whose rate of suicide went up by 28.9 percent in the month after the premiere of the show.”

I ask Ted if Sam had ever watched 13 Reasons Why.

“I went through all of his backpacks, his notes, his folders, and, you know, I can’t really say there was evidence in there that would have caused me to lead my life differently if had I been snooping around before,” Ted said. “The one thing I did notice, after the fact, that when I went through my Netflix account and, you know how it pulls up what people have watched, I did notice that was on there. Undoubtedly, at some point, he had watched 13 Reasons Why.”

Of course, children or teenagers who watch this particular Netflix series, by and large, will not commit suicide or even consider it; nor can it be argued that Sam’s death was directly correlated or even associated with or influenced by watching the show, but what researchers are finding is that fictionalized depictions of suicide, as well as insensitive, oversimplified, and unethical news reporting, do have an impact on young audiences.

“In some ways 13 Reasons Why and Netflix are victims of their own success,”said Dr. John P. Ackerman, PhD, one of the authors of the April 2019 JAACAP study. “The actors were very relatable and the show’s focus on critical teen problems and traumas was very appealing to young viewers. Unfortunately, what we know is when characters are much more relatable that can increase risk for [suicide] contagion. We also know that depicting suicide method in a graphic way is problematic.”

Ackerman, who serves as the suicide prevention coordinator for the Center for Suicide Prevention and Research, noted that when writers and producers script and shoot detailed suicide scenes, such as the one at the end of 13RW, that type of graphic depiction can serve as a “blueprint for reducing the uncertainty that we actually want to remain intact.”

“We want some level of uncertainty and fear around suicide,” Ackerman said, continuing. “We do not want shame and stigma, but we do want barriers in place. We know from research–for instance, Thomas Joiner’s interpersonal theory of suicide–that an ‘acquired capability,’ is one of the necessary ingredients for a suicide. That theory suggests that when we break down barriers to suicide, or provide models for what a person can do to end their life, this has ramifications. We want the idea of suicide to remain uncomfortable, but we need those who are struggling to become more comfortable with the idea that getting help is critical to healing. All of this needs more research.”

What experts like Ackerman underscore is that discussing suicide does not encourage it. In fact, discussing suicide openly with children after the age of 8 years of age, per the American Academy of Pediatrics and the American Psychiatric Association, can actively prevent it. Talking about suicide helps youth know they are not alone, suicide can often be prevented, the signs of youth in distress are usually identifiable, and that the subject of suicide is not taboo.

Where, perhaps, the confusion rests for parents, the media, and the general public is openly discussing what suicide is and how it affects communities does not need to include graphic or sensationalized descriptions of the methods of how a child or teenager die by suicide. In fact, when the media publicize the step-by-step details of a young person or celebrity’s suicide or portray suicide as “mysterious,” we contribute to the risk for suicide contagion, or copycat suicides, for some of the most vulnerable people in society.

It might feel like a delicate tightrope to walk, but discussing suicide without fixating on how someone dies is perhaps one of the single most proactive public health measures parents and educators can take to prevent yet another death.

•  •  •

Here is what we do know: From 1996 to 2016, the Centers for Disease Control and Prevention reported that suicide rates in the United States have risen consistently in every state across the board, except Nevada, which has managed to decrease that rate by one percent in the past decade. In 2017, over 47,000 Americans lost their lives to suicide, nearly twice that of homicides in the United States according to the National Institute of Mental Health.

In a cross-sectional study published in the Journal of the American Medical Association in mid-May of this year, over 85,000 young people between the ages of 10 and 19 died of suicide between the years 1975 through 2016. Keep in mind such a figure does not, of course, factor in attempts. Annually, more teenagers and young adults die from suicide than from cancer, heart disease, AIDS, birth defects, stroke, pneumonia, influenza, and chronic lung disease combined.

Suicide is consistently a leading cause of death, second only after fatal accidents, of youth 10 to 19 years of age. Suicide does not discriminate, Ackerman said, a fact many in the suicide prevention community will reiterate and say louder and louder for the people in the back.

“We are losing thousands of people each year because the conversation is often too painful or too difficult to have,” said Dr. Sean Joe, associate dean for faculty and research at the Brown School of Social Work at Washington University in St. Louis and a nationally recognized authority on suicidal behavior among African Americans.

Joe also pointed out the alarming trend that among children aged 12 and under, more black children are killing themselves than whites. That, in fact, according to research from Dr. Jeffrey A. Bridge and other preeminent suicide researchers, suicide is a leading cause of death among all school-aged children younger than 12.

“Engaging the public to consider why young people are discussing or contemplating suicide is an important conversation, and it is also not a new phenomenon,” Joe reminded me. “We should pay attention to not glorifying, promoting, or suggesting that this is a typical response during painful life experiences, and we should also be paying attention to our young people’s desire to have this conversation. I’m okay with having the conversation as opposed to the silence and neglect of not discussing teen suicide.”

Someone else who also wants to have this difficult conversation is Tina Meier, mother of Megan Meier, who died by suicide three weeks shy of her 14th birthday in the fall of 2006.

Megan’s story gained national attention because Lori Drew, a mother of one of Megan’s friends, posed as a young boy on MySpace who cyberbullied and taunted Megan before her death. While Tina is quick to point out that the cause of her daughter’s death, or almost any suicide for that matter, is multifaceted, she now speaks to youth around the nation about the dangers of bullying and cyberbullying on behalf of the foundation she started in her first-born daughter’s name, the Megan Meier Foundation.

“I don’t sugarcoat presentations, of course, things are always age-appropriate, but the more open we are in providing the right dialogue, you will then start seeing that children do care,” Meier said by phone shortly after speaking with a major news outlet about the suicide prevention work she does. “They will open up and they will talk about it.”

“Letting parents and anybody who knows someone who talks or thinks about suicide that we may think if we talk about it or indulge them in a conversation that we then, in fact, are triggering these thoughts of suicide, and that is not the case,” Meier said.

“If we all would understand how to be able to perform CPR or to dial 911, we need to have those same steps in place for anyone when we are talking about the signs of suicide.”

•  •  •

When Ted Heisel shares that Sam had met a girl at camp the summer before his death, and that Sam had also been in love for likely the first time, it is hard not to think of other star-crossed couples in art and literature.

Ovid’s Pyramus and Thisbē. Shakespeare’s Romeo and Juliet. Brontë’s Heathcliff and Catherine. Toomer’s Louisa and Tom Burwell. The list goes on and on.

Life imitates art, Oscar Wilde argued in his dialogic essay, “The Decay of Lying,” not the other way around. Wilde disagreed with Aristotle’s philosophy of mimesis, which states that art is created in reaction to the physical world. Art was “imitation” of life, Aristotle argued, and should be understood as a symbolic representation of beauty, truth, and good. Wilde not so much.

Despite their differences on what influences art, Wilde’s stance does not negate Aristotle’s belief that art imitates life. Ekphrasis shows us that art inspires poems, songs, and novels. Life, undoubtedly, influences artists and, of course, the rest of us as well.

American short-story writer and memoirist Pam Houston famously once said both her fiction and nonfiction were “82 percent true.” Houston’s reflection not only speaks to how life influences art and the arbitrary genre divide, but also serves as a clever commentary on how fiction may get at truths nonfiction may not yet touch.

This ability for a fictionalized account to reverberate with our lived experiences is nothing new. Studies have shown that those who read literary fiction are often more empathetic than their nonfiction-reading counterparts because those fiction readers are more able to imagine putting themselves into another character’s shoes.

There is also, however, a potential risk for how art might negatively influence, or be perceived to influence, human behavior.

For those who came of age in the 1990s like me, it is easy to remember the criticism of political rap ballads such as N.W.A.’s 1988 song, “Fuck tha Police” and Ice-T’s 1992 hit, “Cop Killer.” At the time, critics worried that such songs would result in increased law enforcement deaths. They did not.

“I’m singing in the first person as a character who is fed up with police brutality,” Ice-T told reporters. “I ain’t never killed no cop. I felt like it a lot of times. But I never did it. If you believe that I’m a cop killer, you believe David Bowie is an astronaut.”

The problem, however, is that songs protesting police brutality are not remotely on par with the documented suggestibility of suicide, a phenomenon we have witnessed for hundreds of years. Perhaps the first noted instance of suicide contagion followed the publication of Johann Wolfgang von Goethe’s first novel, The Sorrows of Young Werther.

In 1774, young men all over Europe reportedly began wearing Werther’s trademark yellow pants and blue jackets and, in some rare instances, killed themselves as the character Werther does after being rejected by his true love Charlotte.

“Our understanding of the interaction between pop culture and real-world consequences is fraught with lazy assumptions and fearmongering, and the best research is never utterly conclusive, but suicide is mostly an exception to this state of confusion,” Stephen Marche wrote in The New Yorker. “Suicide contagion has been observed for centuries.”

The Werther effect is so named, in fact, on the reputed reactions of some of Goethe’s readers. The effect, first coined by suicide researcher Dr. David P. Phillips in 1974, explores the media’s role in promoting copycat suicides.

The media’s role in the Werther effect matters, especially to Katherine Reed, an associate professor of journalism and the health care and public safety editor at the Missourian, a community news organization managed by professional editors and staffed by j-school students who live, breathe, and produce the daily news of Columbia, Missouri.

Reed, who teaches a standalone trauma-informed reporting class to undergraduate and graduate students at the Missouri School of Journalism, began teaching “Covering Traumatic Events” in 2014 and is one of the few educators in her field to do so.

“I think there’s only maybe two or three people who are doing this in the country,” Reed said by phone.

The need for the course, however, is so obviously dire.

“A lot of journalists became so wary of covering suicides that they stopped doing anything on suicide,” Reed said of a recent conversation that came up at a conference held by the Association of Health Care Journalists. “In other words, there is awareness of the idea of suicide contagion, but people were so worried about not contributing to that harm that we missed some very big stories related to suicide in the United States.”

And that is, perhaps, part of the larger problem: Many in entertainment and the news either sensationalize teen suicide or become so scared or flummoxed by the topic that we do not broach it at all.

The chilling effect that Reed speaks of also does very little in helping parents and communities understand that there are discernible signs of someone in distress that can help communities prevent suicide: discussing the desire to die or kill oneself, researching ways to kill oneself, talking about feeling hopeless or unmoored, feeling unbearable pain or that the individual feels like a burden, increased use of substances, erratic behavior, sleeping too little or too much, and more.

The more we are able to discuss what to do to prevent suicide versus glorifying the way in which someone died, the better.

•  •  •

So, how do artists and the media-at-large potentially increase the risk for suicide contagion among the young?

“I have no axe to grind with Netflix,” Ackerman wanted to make clear. “But I do have an axe to grind with people who disregard the science of what increases risk of suicide for an already vulnerable group of young people. In suicide, there’s a weird phenomenon where we think it’s okay to increase the risk to vulnerable people if we get this conversation going.”

“I don’t think everyone is convinced that how we depict suicide matters in a meaningful way,” Ackerman said, “which is a shame because there are dozens of studies that show how the media depicts suicide can influence population rates of suicide, especially among youth.”

Reed, the professor working with the next generation of journalists to think critically and ethically about how they cover not just teen suicides but also mass shootings, sexual assault, natural disasters, war, and communities unduly affected by violence and trauma, among other trauma-related topics, agrees.

“I have been somewhat stunned by the fact that news organizations wouldn’t want to err on the side of caution,” Reed said. “If, in fact, there are some that are unconvinced by the research, and, by the way, I am convinced by it and a whole bunch of other people are convinced by it, why wouldn’t you err on the side of caution anyway?”

Unfortunately, Reed said, she knows why the media do not play it safe.

“Because of clicks, because of attention,” Reed said. “There’s no question these stories drag eyeballs to your site, but it is not good journalism to go into meaningless detail.”

•  •  •

On the evening before Sam went missing—Monday, September 4, 2017—the father and son had stayed up late talking through some “troubling texts” Sam had sent to his ex-girlfriend, who had broken off the relationship before the start of school.

“Part of what I wish I would have done differently was that specific night before he disappeared because I didn’t have any background in worrying about him in that regard, the mother of the girl called me,” Ted said. “We had gone on a canoe trip that day, the three of us, my two kids and my older son’s girlfriend, so we got home and my girlfriend and I just crashed in front of the TV and around 9 p.m. that night, the mom of Sam’s ex-girlfriend called and said Sam’s sending some troubling texts.”

“Can you forward them to me?” Ted asked the girl’s mother, who did so immediately. After reviewing the messages, Ted went downstairs to Sam’s room to talk about it.

“We talked for quite a while about what was going on, and I could tell he was sad and hurt,” Ted said. “I went back upstairs, but I didn’t feel right about the situation, so I went back down, and we talked some more. I then I decided at some point that it was serious enough that I decided to stay with him, and I slept on the extra bed in his room that night. What I didn’t do, not having any background in suicide, is I didn’t look him in the eye and say, ‘Are you really considering suicide? Are you really going to try to kill yourself?’”

At some point after midnight Tuesday morning, Sam snuck out past his sleeping father, got into the Honda Accord he was learning to drive in, and left. Ted woke up around 6:30 a.m. to an empty room.

I try to imagine Ted’s moment of discovery. Panic and bewilderment flood me. A parent’s worst nightmare. Talking with Ted is like visiting a land where only those who have experienced the unforgiving terrain of suicide can actually map the magnitude and grief of such a terrible loss.

“We’re all little rats or sheep in our own little universe interested in doing our own thing,” Ted said before we said goodbye and hung up. “But yes, in particular with your own kids, try to maintain some connection where you can understand what they’re going through.”