Standing high above the San Francisco Bay, perched on an I-beam outside the Golden Gate Bridge railing, the man dressed neatly in khakis and a button-down shirt hesitated.
Kevin Briggs stood a few feet away, imploring him not to jump. In nearly 20 years as a California Highway Patrol officer policing the famous span, Briggs had more success than failure in talking troubled souls back from the ledge.
He and two other officers persisted for nearly an hour on this day in 2007, and the man, perhaps 35 years old, seemed touched by their earnestness. He reached over three separate times to shake Briggs' hand.
Then it was suddenly over. "He said, 'Kevin, thank you very much,' " Briggs recalls quietly, "and he left."
The man plummeted to his death in the waters below.
There's a suicide in the USA every 13 minutes.
A short ride from the Golden Gate Bridge where about 1,600 of these deaths have occurred over the years, actor-comedian Robin Williams took his life at his Tiburon home in August.
Americans are far more likely to kill themselves than each other. Homicides have fallen by half since 1991, but the U.S. suicide rate keeps climbing. The nearly 40,000 American lives lost each year make suicide the nation's 10th-leading cause of death, and the second-leading killer for those ages 15-34. Each suicide costs society about $1 million in medical and lost-work expenses and emotionally victimizes an average of 10 other people.
Yet a national effort to stem this raging river of self-destruction — 90% of which occurs among Americans suffering mental illness — is in disarray.
In a series of stories this year, USA TODAY explores the human cost of allowing 10 million Americans with mental illness to languish without care. On the dark edge of that spectrum is a consuming urge to die, and those committed to understanding suicide say there are potential solutions if there is a national will to seize on them.
Retired California Highway Patrol officer Kevin Briggs spent 20 years patrolling the Golden Gate Bridge, which has been the site of about 1,600 suicides since it opened. Martin E. Klimek, for USA TODAY
The country seems almost complacent with this staggering death toll. America's health care community remains mired in confusion over how to tackle suicide mostly because the public — and with it, the federal government — never gets serious about finding crucial answers.
Basic questions about whether suicide is a public health problem, whether it can be prevented on a broad scale, whether suicidal thoughts and actions are a disorder or a symptom of other disorders, remain widely debated.
Perhaps as a result of this scattered approach to what is clearly a health crisis, greater sums of money and research are devoted to curing diseases and social ills that kill far fewer Americans despite clear historical evidence that more investment translates into more lives saved.
"Is there the kind of concerted effort (for suicide) that's been made with HIV, with breast cancer, with Alzheimer's disease, with prostate cancer?" asks Christine Moutier, chief medical officer for theAmerican Foundation for Suicide Prevention. "There's never been that kind of concerted front."
"When we invested in HIV/AIDS and breast cancer, we dramatically reduced the rates of death," says Jill Harkavy-Friedman, vice president of research for the foundation. "If we invest in suicide prevention — really invest in it — then we have a good shot at bringing it down."
The National Institutes of Health — the largest source of research money — spends a small fraction on suicide compared with diseases such as breast and prostate cancer that result in as many or fewer American lives lost. The suicide research budget for the National Institute of Mental Health (NIMH) has actually been shrinking since 2011.
The Centers for Disease Control and Prevention promotes several "winnable" priorities, among them motor vehicle injuries and HIV. Suicide, though more costly in lives than either of those categories, is not on the list.
Lawmakers' agendas are heavily influenced by public disinterest and a persistent view in the USA that anyone bent on killing themselves cannot be saved. Briggs saw the worst of this during suicide crises on the bridge when drivers passing by would yell out, "Go ahead and jump."
"If the public doesn't think you can do anything about it, they won't support it," says Alex Crosby, a CDC epidemiologist who focuses on suicide prevention.
"Can you really stop somebody who wants to kill themselves? I still hear that," says Jane Pearson, chair of the NIMH research consortium. "Changing that perspective is really critical."
“If we invest in suicide prevention — really invest in it — then we have a good shot at bringing it down.”
Jill Harkavy-Friedman, American Foundation for Suicide Prevention
Only in one area did Americans react to suicide. When soldiers started killing themselves in record numbers during two arguably unpopular wars in Iraq and Afghanistan, a groundswell from the public and Congress drove the military to respond.
The Army suicide rate tripled from 2004 and 2012 as more than 2,000 GIs took their lives. A new RAND study says that since 2005, about $230 million was poured into suicide research, more than two-thirds of it from the military.
"All the military research is likely to benefit civilians as well," says Michelle Cornette, executive director of the American Association of Suicidology.
A centerpiece effort is a $65 million study — the cost split between the Army and NIH — analyzing soldier suicides and tracking tens of thousands of troops over a period of years to understand self-destructive urges.
"The level of detail we are getting ... nobody has ever done anything on that scale in any population relating to suicide risk," says NIMH study scientist Michael Schoenbaum. "We have an enormous amount to learn."
Briggs, who retired from the CHP last year, says answers are long overdue. Promoting crisis management and suicide prevention, he says the nation must find a way to treat despair before the only resort is a police officer begging someone not to jump.
"Get them before they're up on the bridge," Briggs says, "because when you're up on that bridge, it's almost game over."
This video animation gives a perspective of the rate at which people are taking their own lives globally.USA TODAY
When Matthew Milam smiled, dimples on his broad face ran deep, and his cheekbones grew round and high — the infectious look of someone who could light up a room.
"As a little kid, I used to always tell him he had heart," says his mother, Debbie.
Medication was the key after he grew up. Without it, Matthew toggled emotionally between a sweet, compassionate 24-year-old who loved to cook and was terribly shy around strangers — to someone consumed with paranoia who dug his own grave in the backyard and stood outside in a lightning storm, begging God to strike him down.
"It'd be like a light bulb going off," says his father, Pat, vice president of sales for an oil field service company in New Orleans.
Those with severe mental illness such as Matthew, diagnosed with paranoid schizophrenia at 24, illustrate the gaping challenges researchers face in finding solutions to suicide. Half of those with schizophrenia, an illness marked by delusions and hearing voices, attempt suicide. One in 10 succeed.
Debbie Milam places a card she found on the bed of her son, Matthew Milam, on Sept. 1, 2014, in Harahan, La. His parents say that his room hasn't changed since he took his life there in 2011.
(Photo: Edmund D. Fountain, for USA TODAY)
(Photo: Edmund D. Fountain, for USA TODAY)
Matthew's parents said his emotional state began to grow worse after he found his younger brother Michael dead at 18 of a heroin overdose in the family home in Harahan, La., in 2007.
Within a few years, Matthew was diagnosed with bipolar disorder and later with schizophrenia as more severe symptoms emerged.
He was institutionalized for brief periods four times in 2011, once after cutting his throat with a steak knife, according to his medical files. Each time, Matthew improved with medication and promised to stay on it. Each time after coming home, he would stop — a problem common to those suffering from bipolar disorder who believe the drugs dull their manic periods of elation.
Matthew's parents said they felt helpless to prevent their worst fears from coming true.
Equally frustrating, they said, was an inability to collaborate more closely with Matthew's doctors because of their son's privacy rights under the federal Health Insurance Portability and Accountability Act, or HIPAA. The law restricts release of personal medical information for anyone 18 and older.
"As a parent, you really don't know what else to do. You try to go to doctors and talk to them and ask them what in the hell is going on?" Pat Milam says. "The first thing they always say is 'Oh, we can't talk about it. HIPAA. HIPAA.' "
In 2011, the year Matthew's life was in crisis, suicides across America had been on a steady rise for 12 years despite modest investments in research. A private-public partnership formed in 2010 called theNational Action Alliance for Suicide Prevention decided to go back to basics.
The alliance formed a task force of leading experts and published a way forward on research this year. It asked fundamental questions: Why do people commit suicide? How can they be identified? What works? Where is most research necessary?
Some of the ideas could have been drawn right from Matthew Milam's short life story — how to prevent a second suicide attempt after a first try, how to continue needed care.
Pat and Debbie Milam’s son, Matthew, committed suicide three years ago after struggling with bipolar disorder and schizophrenia. Edmund D. Fountain, for USA TODAY
The challenge in cases like Matthew's is when potential answers clash with individual rights, says Eric Caine, who assisted the alliance task force and directs the Injury Control Research Center for Suicide Prevention at the University of Rochester Medical Center.
Pat Milam says his son would be alive today if there had been a way to keep him medicated.
Some states allow for court-ordered treatment plans. No studies have been done on whether this could prevent suicides, another example of gaps in knowledge, Caine says. Such ideas, he says, lie "at the edge of what we know and what we don't know."
HIPAA restrictions, though frustrating to parent/caregivers of troubled adult children, enshrine coveted American principals of individual privacy protection, Caine says. Changing this would require substantial social debate.
The net result, he says, are many "fracture points or cracks or chasms that people can fall through." The despairing Matthews of the world "push away many, block those who would intervene and challenge our notions of individual autonomy," he says.
On Oct. 21, 2011, Matthew went into his closet and killed himself with a small homemade explosive. He fashioned it in secret. His parents were downstairs, waiting to take him to his next therapy session.
Sarah Clingan says severe depression feels like drowning, "where I can look up and see the bubbles from my nose rising toward the water's surface and am aware of every breath I can't take."
There is a profound sense of being alone, she says.
"One of the hardest things about mental illness is you can't walk into a hospital and show them you're broken," says Clingan, 30, a former preschool and kindergarten teacher who lives in Seattle.
The oldest child of a pediatrician father and a mother who is a speech therapist, Clingan grew up in Port Orchard, Wash., outside Seattle and was first diagnosed with depression during college.
“One of the hardest things about mental illness is you can't walk into a hospital and show them you're broken.”
Sarah Clingan
The illness grew more severe after graduation when she began contemplating ways of overriding feelings of oppressive gloom whether it was through eating disorders, cutting herself or even suicide, Clingan says.
"It's wanting to escape," she says, "feeling like I had worked really hard and tried everything and knowing that my depression and mental illness was affecting the people around me that I cared about and not wanting to be a burden on them anymore."
Twice she tried to kill herself at age 26 with a medication overdose. During this period, she was finally introduced to one of the few tools validated in curbing suicides.
Sarah Clingan contemplated suicide before getting the treatment she needed. She now is on the other side, offering advice and counsel to people haunted by suicidal thoughts.
(Photo: Scott Eklund, for USA TODAY)
(Photo: Scott Eklund, for USA TODAY)
Known as Dialectical Behavioral Therapy or DBT, it is an intense, team-therapy treatment. In the beginning, Clingan had access to a therapist round-the-clock. During therapy, she learned ways to avoid falling into familiar patterns of anxiety and developed tools to better tolerate feelings of sadness and hopelessness.
Last month, an American Journal of Preventive Medicine edition devoted to suicide identified five other promising therapies for curbing suicide attempts or self-harm. A small number of medications have shown promise as well.
"That's how early we are in the science around the interventions for suicide," says Moutier of the American Foundation of Suicide Prevention. "People are now turning toward it. Have they turned fully? No. Are they in the process? Yes."
Clingan says her therapy continues. She's enrolled in a master's program in social work at the University of Washington and began to blog about her life this year.
"I am alive," she wrote in a moment of exhilaration last May, "and it is a grand thing."
There is a sense for some that time is short and too many are at risk. A new World Health Organizationstudy estimates that globally, there is a suicide every 40 seconds.
Urgency is all Army Capt. Justin Fitch thinks about. Time is running out for him personally, and he says there is too much left to do to stop suicides.
The 32-year-old commander of a headquarters unit at the Army's Soldier, Research, Development and Engineering Center in Natick, Mass., nearly succumbed to suicidal urges during his first combat deployment to Iraq seven years ago.
Army Capt. Justin Fitch, center, embraces Paul Carew, a veteran's advocate and trauma counselor, during a stop on a benefit march led by Fitch.
(Photo: Josh T. Reynolds, for USA TODAY)
(Photo: Josh T. Reynolds, for USA TODAY)
A combination of depression, loss of sleep and combat stress left him alone one day with his M-4 rifle in his shipping-container sleeping quarters.
"It was at the point where you have a gun up to your head, you can taste the carbon of a barrel in your mouth, and the only thing that stands between me and being a statistic is 4.5 pounds of trigger pressure," he remembers.
Fitch hesitated. He later reached out to a counselor on the base, and with the help of medication and therapy, he began coping with his depression. "It took time," he says.
Today, he cannot recover from colon cancer diagnosed in 2012 that doctors declared terminal last year. In June, they said he had only months left. Faced with his own mortality, Fitch consulted his wife, Samantha Wolk, and reflected on the 22 veteran suicides occurring each day. He chose to devote his remaining time to prevent others from committing suicide.
"I've always wanted to focus on trying to leave the world a better place," he says.
This sentiment, shared by others, has fueled modest victories in the war against suicide. "In pockets, there's been progress," says Rochester University researcher Caine.
Biological research led scientists in recent years to assert that suicidal behavior is a disorder that deserves to be included in the bible on mental health illnesses — the Diagnostic and Statistical Manual of Mental Disorder — so doctors could better diagnose, identify and move into treatment those who are suicidal.
“I've always wanted to focus on trying to leave the world a better place.”
Army Capt. Justin Fitch
American Psychiatric Association officials who periodically revise the manual want more study.
"It's really a shift to consider it a disorder unto itself," says Maria Oquendo, a psychiatry professor at Columbia University who urged that suicidal behavior be recognized as a disorder in the manual. "They (the authors) said it's an idea that obviously needs to be considered but is not quite ready for inclusion."
One fact about suicide that research has firmly established is that reducing access to lethal means reduces suicide. The result has been a national initiative to erect barriers at sites where suicides occur, most prominently a $76 million project to build steel nets along the Golden Gate Bridge. A record 46 suicides occurred there last year.
Prevention advocates say the death of Robin Williams shocked the public and led to a national discussion about suicide.
Army Capt. Justin Fitch, who’s facing terminal cancer, wants to help other veterans facing depression and suicidal thoughts. Josh T. Reynolds, for USA TODAY
In what time he has left, Fitch is intent on tapping into this growing awareness to raise funds for his dream: completion of a retreat for at-risk veterans and their families on a 144-acre parcel of land in Shepherdsville, Ky. Despite chemotherapy that has drained him of strength and weight, Fitch has immersed himself in fundraising through the Active Heroes organization devoted to reducing suicides in the military.
To raise money, he's led "ruck marches," in which participants carry weighted backpacks or military rucksacks on long hikes. The most recent one weeks ago left him "physically destroyed, spiritually strengthened."
"Maybe I can inspire other people," he says. "It's OK to seek help. And when they raise their hand, everything humanly possible should be done to take care of that person. Because suicide is completely preventable."
National Suicide Prevention Lifeline: 1-800-273-TALK (8255)
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INDIANAPOLIS | U.S. Sen. Joe Donnelly, D-Ind., expressed frustration Wednesday his legislation aimed at preventing military suicides likely won't get a final vote until after Election Day.
"There is no reason why this bipartisan legislation should not be passed, and passed quickly," Donnelly said. "We need to get this legislation signed into law."
Donnelly's proposal, dubbed the Jacob Sexton Military Suicide Prevention Act for a Hoosier soldier who took his own life in 2009, would require annual, confidential, face-to-face mental health assessments for all active duty, reserve and National Guard service members.
Only deploying or returning service members currently receive that level of mental health screening, even though most military suicides involve troops who never deploy, Donnelly said.
A Pentagon report released this month found that between January and March, 120 service members took their own lives -- 74 on active duty, 24 in the reserves and 22 in the National Guard.
At that rate, military suicides this year will exceed the 475 recorded in 2013. In 2012, 522 service members took their own lives.
In both years, more members of the military killed themselves than died in combat in Afghanistan.
Speaking in the U.S. Senate chamber, Donnelly said the recent suicide of actor Robin Williams is an important reminder that often we do not know when people around us are living lives of unbearable pain. September is National Suicide Prevention Month.
"Even the strongest among us sometimes need a helping hand, including the brave men and women in uniform who protect our country each and every day," Donnelly said.
The Senate is expected to recess later this week and not return until mid-November, after the Nov. 4 elections.
Donnelly's proposal is included in the 2015 National Defense Authorization Act, typically considered "must pass" legislation since it funds the U.S. military.
Neurologic pain signature, a standard map that can be applied to individual people who may be experiencing pain.(Photo: Tor Wager, AP)
While the military has poured more money into suicide research than any other sector of American society in recent years, certain targets in dire need of study remain under-funded, according to a RAND Corp. report released Monday.
Researchers sampled opinions of leading suicide experts within the military and on the RAND Corp. staff about the most important areas needing research. They found the those areas — improving ways of identifying those who are suicidal; and developing better methods for the ongoing care of those with self-destructive tendencies — receive little or moderate focus in either funding or number of studies.
"There is no apparent relationship between what is being funded and what (Defense) representatives perceive as important," RAND researchers concluded.
RAND researchers found that the largest sums of money and the greatest numbers of studies were devoted to finding better treatment methods and improving care, each ranked ninth and fifth, respectively, on a list of most important research areas.
Army Maj. James Bindle, a Pentagon spokesman, responded that the Defense Department, "takes suicide prevention very seriously and considers any measure that saves a life as one worth taking. We appreciate RAND's assistance and are currently studying their recommendations."
Since 2005, about $230 million has gone into understanding why service members or civilians choose to end their lives. More than two-thirds of that funding has come from the military, which redoubled study efforts when suicide rates, particularly in the Army, rose dramatically during wars in Iraq and Afghanistan, RAND found.
The Army rate surpassed the pace of civilian suicides to reach nearly 30 per 100,000 in 2012.
As the public and Congress took notice, military investment in research expanded. The second largest source of money in recent years was he National Institutes of Health, followed by the Department of Veterans Affairs and the American Foundation for Suicide Prevention.
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FBI director lays out worries
10/9/2014
By RICK ROTHACKER
McClatchy-Tribune
CHARLOTTE, N.C. -- On a visit Wednesday to Charlotte, FBI director James Comey urged Americans to report suspicious activities by possible homegrown jihadists, who are increasingly lured by "slick" and "seductive" propaganda online.
Research on homegrown extremists by the FBI's behavioral analysis unit, made famous by the movie "The Silence of the Lambs," shows in almost every case, someone saw a change in the person's behavior but didn't report it, Comey said.
"If you see something that makes the hair stand up on the back of your neck, there is a reason that the hair is standing up," Comey said at a news conference at the FBI's gated office complex in Charlotte. "Tell one of us."
On Tuesday, the FBI asked the public for help identifying an English-speaking militant seen in a propaganda video released last month by the terrorist group known as ISIL. Comey said the FBI has received plenty of responses, but he wasn't prepared to disclose details.
Sworn in as the seventh FBI director 13 months ago, Comey was in Charlotte as part of an effort to visit all 56 of the agency's field offices. Stop No. 50 was Charlotte, where he met with local law enforcement representatives, whom he praised as strong partners.
He is a former U.S. attorney and Justice Department official who worked in the private sector from 2005 until being nominated by President Barack Obama to become director.
In his new post, his top priority is counter-terrorism, but he also has law enforcement responsibilities that range from pursuing violent crimes to investigating cyberattacks on banks.
In a big change from the 9/11 era, he said, the terrorism threat facing the United States has "metastasized" beyond al-Qaida, fueled by Internet recruiting tactics that teach people to do "terrible things" from their basement.
"These are dangerous groups that are flourishing in spaces that are not governed," Comey said. "That safe haven allows them to attract people from all around the world to their particular brand of savagery."
As director, he is worried about people flowing to these regions and even more concerned about their inevitable return. Reiterating comments he made in an interview broadcast Sunday by CBS' "60 Minutes," he said he knows of about a dozen Americans fighting with extremist groups in Syria.
If they try to return, the FBI will lock them up, he said.
Charlotte has had experience with homegrown extremists. The FBI recently released hundreds of pages of documents on blogger-turned-al Qaida propagandist Samir Khan.
Khan, 25, along with radical cleric Anwar al Awlaki, was killed three years ago in Yemen by a U.S. drone strike. Both were U.S. citizens. Comey declined to comment on the case.
On other crime fronts, Comey declined to say whether hackers who infiltrated systems this summer at New York-based JPMorgan Chase penetrated other financial institutions. The cyberattack compromised the accounts of 76 million households and 7 million small businesses, the bank has acknowledged.
"The financial industry in general, but as part of a larger problem, is constantly probed by hackers, whether they're nation-states or criminals, thugs of different sorts," he said.
Comey said he has added staff overseas to bring the fight to hackers who believe they are safe outside U.S. borders.
"We need to reach out and bang those people, to make sure they understand that you're not far from us," he said.
Read the whole story
· · ·
Series concludes with a study that provides a new perspective on serial murder investigations.
10/10/14
Mention the term serial killer and what comes to mind for many people are murderers like Ted Bundy and John Wayne Gacy, whose grisly deeds seem to haunt our collective imagination.
But when Bob Morton considers serial killers—which he has spent much of his professional life doing—the recently retired special agent formerly with our Behavioral Analysis Unit thinks mostly about statistics.
The National Center for the Analysis of Violent Crime (NCAVC) was established to provide behavioral-based investigative support to the FBI, national security agencies, and other federal, state, local, and international law enforcement involved in the investigation of unusual or repetitive violent crimes, threats, and terrorism, cyber crime, white-collar crime, public corruption, and other matters.
Our Behavioral Analysis Unit 4 (BAU-4), one component of the NCAVC, focuses on serial murders, sexual assaults, kidnappings, and other criminal acts targeting adult victims. BAU-4 members are experts on the subject of serial murder and regularly provide operational assistance, conduct research, and offer training on issues related to serial murder.
BAU-4 also runs the FBI’s Violent Criminal Apprehension Program (ViCAP), which maintains the largest investigative repository of major violent crime cases in the U.S. ViCAP collects and analyzes information about homicides, sexual assaults, missing persons, and other violent crimes and is used by state and local law enforcement nationwide to help discover links between seemingly unconnected crimes.
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Morton, the author of a new study on serial murder for the FBI’s National Center for the Analysis of Violent Crime, spent the last eight years gathering and analyzing details from hundreds of serial murder cases to help investigators better understand these terrible crimes—and be better equipped to solve them.
“In the past,” Morton said, “research tended to focus on known offenders and what led them to become serial murderers.” That information, while useful, provided little help to investigators trying to apprehend an unknown offender in an active, unsolved case.
The new study—Serial Murder: Pathways for Investigations—focuses on a key aspect of serial murder cases: how and where the victims’ bodies are discovered and what that says about the killers.
“What we tried to do was give investigators working these cases a common place to start, which is the body,” Morton said. “You work your way back from there to discern offender characteristics and narrow the suspect pool. The body is the only constant in the crime,” he explained. “Lots of other things can change, but how you find that victim is not going to change.”
If the victim was a prostitute, for example, and the body was left where the murder occurred, that may offer certain clues about the killer. If the body was hidden at a distance from the murder site, that may offer different clues. The study’s statistical data was drawn from 480 U.S. serial murder cases involving 92 offenders over a period of nearly five decades. Morton believes the study’s findings could be a “game changer” for investigators working unsolved cases.
The research project Serial Murder: Pathways for Investigations provides empirical information based on actual cases to help law enforcement personnel working active, unsolved serial murder investigations.
 The research focuses on how and where victims’ bodies were discovered, and what that says about the killers. The body disposal scenarios used by offenders were separated into four pathways:
- Transported from the murder site and concealed;
- Transported from the murder site and dumped; - Left “as is” at the murder site; and - Left at the murder site and concealed.
The reasons for focusing on body disposal scenarios, according to the study, include a number of factors:
- The body disposal site is usually the initial scene law enforcement professionals are exposed to in their investigation.
- The manner and circumstances of the body disposal can lead to logical conclusions concerning the nature of the crime. - The different body disposal scenarios can reflect the varied criminal experience levels of offenders. - The manner of body disposal may show a potential relationship between the offender and the victim. |
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“Many of the things we have learned over the years through experience we are trying to prove through empirical research,” he said. “The main goal is to provide law enforcement with relevant data that helps them focus on the most likely suspects.”
Serial murder in the United States is surprisingly rare. Although it’s impossible to quantify the number of active serial murderers nationwide or how many murders they commit, academic and law enforcement research suggests that the numbers of homicides carried out by serial offenders in a given year are a fraction of the total number of murders that occur in the U.S. “But when it does occur,” said Morton, who has worked dozens of these cases during his 25-year Bureau career, “it can be overwhelming to a community and its law enforcement agencies.”
“There is a lot of pressure on the police to solve these crimes,” he added, and most local police departments haven’t had a serial homicide in their jurisdiction. That’s where the FBI can provide behavioral-based investigative support to our state and local partners. The National Center for the Analysis of Violent Crime and members of our Behavioral Analysis Unit have extensive experience with serial murder investigations and offer their expertise on request.
“The FBI has become a clearinghouse for these crimes,” Morton said, “and we stand ready to assist local law enforcement when they are faced with an active serial murder case. This new research is one more tool to help investigators.”
Resources:
- Part 1: The FBI’s Role Takes Shape- Part 2: Birth of Behavioral Analysis in the FBI
- Part 3: Ted Bundy’s Campaign of Terror- Part 4: White Supremacist Joseph Franklin
- Part 5: Wayne Williams and the Atlanta Child Murders
- Part 6: Andrew Cunanan Murders a Fashion Icon
- Part 7: The FBI and Jeffrey Dahmer
- Part 1: The FBI’s Role Takes Shape- Part 2: Birth of Behavioral Analysis in the FBI
- Part 3: Ted Bundy’s Campaign of Terror- Part 4: White Supremacist Joseph Franklin
- Part 5: Wayne Williams and the Atlanta Child Murders
- Part 6: Andrew Cunanan Murders a Fashion Icon
- Part 7: The FBI and Jeffrey Dahmer
Read the whole story
· · · · ·
Debbie Milam places a card she found on the bed of her son, Matthew Milam, on Sept. 1, 2014, in Harahan, La. His parents say that his room hasn't changed since he took his life there in 2011. (Photo: Edmund D. Fountain (for USA TODAY) )
Standing high above the San Francisco Bay, perched on an I-beam outside the Golden Gate Bridge railing, the man dressed neatly in khakis and a button-down shirt hesitated.
Kevin Briggs stood a few feet away, imploring him not to jump. In nearly 20 years as a California Highway Patrol officer policing the famous span, Briggs had more success than failure in talking troubled souls back from the ledge.
He and two other officers persisted for nearly an hour on this day in 2007, and the man, perhaps 35 years old, seemed touched by their earnestness. He reached over three separate times to shake Briggs' hand.
Then it was suddenly over. "He said, 'Kevin, thank you very much,' " Briggs recalls quietly, "and he left."
The man plummeted to his death in the waters below.
There's a suicide in the USA every 13 minutes.
A short ride from the Golden Gate Bridge where about 1,600 of these deaths have occurred over the years, actor-comedian Robin Williams took his life at his Tiburon home in August.
Americans are far more likely to kill themselves than each other. Homicides have fallen by half since 1991, but the U.S. suicide rate keeps climbing. The nearly 40,000 American lives lost each year make suicide the nation's 10th-leading cause of death, and the second-leading killer for those ages 15-34. Each suicide costs society about $1 million in medical and lost-work expenses and emotionally victimizes an average of 10 other people.
Yet a national effort to stem this raging river of self-destruction — 90% of which occurs among Americans suffering mental illness — is in disarray.
In a series of stories this year, USA TODAY explores the human cost of allowing 10 million Americans with mental illness to languish without care. On the dark edge of that spectrum is a consuming urge to die, and those committed to understanding suicide say there are potential solutions if there is a national will to seize on them.
Retired California Highway Patrol officer Kevin Briggs spent 20 years patrolling the Golden Gate Bridge, which has been the site of about 1,600 suicides since it opened. Martin E. Klimek, for USA TODAY
The country seems almost complacent with this staggering death toll. America's health care community remains mired in confusion over how to tackle suicide mostly because the public — and with it, the federal government — never gets serious about finding crucial answers.
Basic questions about whether suicide is a public health problem, whether it can be prevented on a broad scale, whether suicidal thoughts and actions are a disorder or a symptom of other disorders, remain widely debated.
Perhaps as a result of this scattered approach to what is clearly a health crisis, greater sums of money and research are devoted to curing diseases and social ills that kill far fewer Americans despite clear historical evidence that more investment translates into more lives saved.
"Is there the kind of concerted effort (for suicide) that's been made with HIV, with breast cancer, with Alzheimer's disease, with prostate cancer?" asks Christine Moutier, chief medical officer for theAmerican Foundation for Suicide Prevention. "There's never been that kind of concerted front."
"When we invested in HIV/AIDS and breast cancer, we dramatically reduced the rates of death," says Jill Harkavy-Friedman, vice president of research for the foundation. "If we invest in suicide prevention — really invest in it — then we have a good shot at bringing it down."
The National Institutes of Health — the largest source of research money — spends a small fraction on suicide compared with diseases such as breast and prostate cancer that result in as many or fewer American lives lost. The suicide research budget for the National Institute of Mental Health (NIMH) has actually been shrinking since 2011.
The Centers for Disease Control and Prevention promotes several "winnable" priorities, among them motor vehicle injuries and HIV. Suicide, though more costly in lives than either of those categories, is not on the list.
Lawmakers' agendas are heavily influenced by public disinterest and a persistent view in the USA that anyone bent on killing themselves cannot be saved. Briggs saw the worst of this during suicide crises on the bridge when drivers passing by would yell out, "Go ahead and jump."
"If the public doesn't think you can do anything about it, they won't support it," says Alex Crosby, a CDC epidemiologist who focuses on suicide prevention.
"Can you really stop somebody who wants to kill themselves? I still hear that," says Jane Pearson, chair of the NIMH research consortium. "Changing that perspective is really critical."
Only in one area did Americans react to suicide. When soldiers started killing themselves in record numbers during two arguably unpopular wars in Iraq and Afghanistan, a groundswell from the public and Congress drove the military to respond.
The Army suicide rate tripled from 2004 and 2012 as more than 2,000 GIs took their lives. A new RAND study says that since 2005, about $230 million was poured into suicide research, more than two-thirds of it from the military.
"All the military research is likely to benefit civilians as well," says Michelle Cornette, executive director of the American Association of Suicidology.
A centerpiece effort is a $65 million study — the cost split between the Army and NIH — analyzing soldier suicides and tracking tens of thousands of troops over a period of years to understand self-destructive urges.
"The level of detail we are getting ... nobody has ever done anything on that scale in any population relating to suicide risk," says NIMH study scientist Michael Schoenbaum. "We have an enormous amount to learn."
Briggs, who retired from the CHP last year, says answers are long overdue. Promoting crisis management and suicide prevention, he says the nation must find a way to treat despair before the only resort is a police officer begging someone not to jump.
"Get them before they're up on the bridge," Briggs says, "because when you're up on that bridge, it's almost game over."
Matthew Milam's short life story': As a parent, you really don't know what else to do'
When Matthew Milam smiled, dimples on his broad face ran deep, and his cheekbones grew round and high — the infectious look of someone who could light up a room.
"As a little kid, I used to always tell him he had heart," says his mother, Debbie.
Medication was the key after he grew up. Without it, Matthew toggled emotionally between a sweet, compassionate 24-year-old who loved to cook and was terribly shy around strangers — to someone consumed with paranoia who dug his own grave in the backyard and stood outside in a lightning storm, begging God to strike him down.
"It'd be like a light bulb going off," says his father, Pat, vice president of sales for an oil field service company in New Orleans.
Those with severe mental illness such as Matthew, diagnosed with paranoid schizophrenia at 24, illustrate the gaping challenges researchers face in finding solutions to suicide. Half of those with schizophrenia, an illness marked by delusions and hearing voices, attempt suicide. One in 10 succeed.
Matthew's parents said his emotional state began to grow worse after he found his younger brother Michael dead at 18 of a heroin overdose in the family home in Harahan, La., in 2007.
Within a few years, Matthew was diagnosed with bipolar disorder and later with schizophrenia as more severe symptoms emerged.
He was institutionalized for brief periods four times in 2011, once after cutting his throat with a steak knife, according to his medical files. Each time, Matthew improved with medication and promised to stay on it. Each time after coming home, he would stop — a problem common to those suffering from bipolar disorder who believe the drugs dull their manic periods of elation.
Matthew's parents said they felt helpless to prevent their worst fears from coming true.
Equally frustrating, they said, was an inability to collaborate more closely with Matthew's doctors because of their son's privacy rights under the federal Health Insurance Portability and Accountability Act, or HIPAA. The law restricts release of personal medical information for anyone 18 and older.
"As a parent, you really don't know what else to do. You try to go to doctors and talk to them and ask them what in the hell is going on?" Pat Milam says. "The first thing they always say is 'Oh, we can't talk about it. HIPAA. HIPAA.' "
In 2011, the year Matthew's life was in crisis, suicides across America had been on a steady rise for 12 years despite modest investments in research. A private-public partnership formed in 2010 called theNational Action Alliance for Suicide Prevention decided to go back to basics.
The alliance formed a task force of leading experts and published a way forward on research this year. It asked fundamental questions: Why do people commit suicide? How can they be identified? What works? Where is most research necessary?
Some of the ideas could have been drawn right from Matthew Milam's short life story — how to prevent a second suicide attempt after a first try, how to continue needed care.
The challenge in cases like Matthew's is when potential answers clash with individual rights, says Eric Caine, who assisted the alliance task force and directs the Injury Control Research Center for Suicide Prevention at the University of Rochester Medical Center.
Pat Milam says his son would be alive today if there had been a way to keep him medicated.
Some states allow for court-ordered treatment plans. No studies have been done on whether this could prevent suicides, another example of gaps in knowledge, Caine says. Such ideas, he says, lie "at the edge of what we know and what we don't know."
HIPAA restrictions, though frustrating to parent/caregivers of troubled adult children, enshrine coveted American principals of individual privacy protection, Caine says. Changing this would require substantial social debate.
The net result, he says, are many "fracture points or cracks or chasms that people can fall through." The despairing Matthews of the world "push away many, block those who would intervene and challenge our notions of individual autonomy," he says.
On Oct. 21, 2011, Matthew went into his closet and killed himself with a small homemade explosive. He fashioned it in secret. His parents were downstairs, waiting to take him to his next therapy session.
Sarah Clingan's journey: 'I am alive, and it is a grand thing'
Sarah Clingan says severe depression feels like drowning, "where I can look up and see the bubbles from my nose rising toward the water's surface and am aware of every breath I can't take."
There is a profound sense of being alone, she says.
"One of the hardest things about mental illness is you can't walk into a hospital and show them you're broken," says Clingan, 30, a former preschool and kindergarten teacher who lives in Seattle.
The oldest child of a pediatrician father and a mother who is a speech therapist, Clingan grew up in Port Orchard, Wash., outside Seattle and was first diagnosed with depression during college.
The illness grew more severe after graduation when she began contemplating ways of overriding feelings of oppressive gloom whether it was through eating disorders, cutting herself or even suicide, Clingan says.
"It's wanting to escape," she says, "feeling like I had worked really hard and tried everything and knowing that my depression and mental illness was affecting the people around me that I cared about and not wanting to be a burden on them anymore."
Twice she tried to kill herself at age 26 with a medication overdose. During this period, she was finally introduced to one of the few tools validated in curbing suicides.
Sarah Clingan contemplated suicide before getting the treatment she needed. She now is on the other side, offering advice and counsel to people haunted by suicidal thoughts.
Known as Dialectical Behavioral Therapy or DBT, it is an intense, team-therapy treatment. In the beginning, Clingan had access to a therapist round-the-clock. During therapy, she learned ways to avoid falling into familiar patterns of anxiety and developed tools to better tolerate feelings of sadness and hopelessness.
Last month, an American Journal of Preventive Medicine edition devoted to suicide identified five other promising therapies for curbing suicide attempts or self-harm. A small number of medications have shown promise as well.
"That's how early we are in the science around the interventions for suicide," says Moutier of the American Foundation of Suicide Prevention. "People are now turning toward it. Have they turned fully? No. Are they in the process? Yes."
Clingan says her therapy continues. She's enrolled in a master's program in social work at the University of Washington and began to blog about her life this year.
"I am alive," she wrote in a moment of exhilaration last May, "and it is a grand thing."
Justin Fitch's race': Maybe I can inspire other people'
There is a sense for some that time is short and too many are at risk. A new World Health Organizationstudy estimates that globally, there is a suicide every 40 seconds.
Urgency is all Army Capt. Justin Fitch thinks about. Time is running out for him personally, and he says there is too much left to do to stop suicides.
The 32-year-old commander of a headquarters unit at the Army's Soldier, Research, Development and Engineering Center in Natick, Mass., nearly succumbed to suicidal urges during his first combat deployment to Iraq seven years ago.
A combination of depression, loss of sleep and combat stress left him alone one day with his M-4 rifle in his shipping-container sleeping quarters.
"It was at the point where you have a gun up to your head, you can taste the carbon of a barrel in your mouth, and the only thing that stands between me and being a statistic is 4.5 pounds of trigger pressure," he remembers.
Fitch hesitated. He later reached out to a counselor on the base, and with the help of medication and therapy, he began coping with his depression. "It took time," he says.
Today, he cannot recover from colon cancer diagnosed in 2012 that doctors declared terminal last year. In June, they said he had only months left. Faced with his own mortality, Fitch consulted his wife, Samantha Wolk, and reflected on the 22 veteran suicides occurring each day. He chose to devote his remaining time to prevent others from committing suicide.
"I've always wanted to focus on trying to leave the world a better place," he says.
This sentiment, shared by others, has fueled modest victories in the war against suicide. "In pockets, there's been progress," says Rochester University researcher Caine.
Biological research led scientists in recent years to assert that suicidal behavior is a disorder that deserves to be included in the bible on mental health illnesses — the "Diagnostic and Statistical Manual of Mental Disorder" — so doctors could better diagnose, identify and move into treatment those who are suicidal.
American Psychiatric Association officials who periodically revise the manual want more study.
"It's really a shift to consider it a disorder unto itself," says Maria Oquendo, a psychiatry professor at Columbia University who urged that suicidal behavior be recognized as a disorder in the manual. "They (the authors) said it's an idea that obviously needs to be considered but is not quite ready for inclusion."
One fact about suicide that research has firmly established is that reducing access to lethal means reduces suicide. The result has been a national initiative to erect barriers at sites where suicides occur, most prominently a $76 million project to build steel nets along the Golden Gate Bridge. A record 46 suicides occurred there last year.
Prevention advocates say the death of Robin Williams shocked the public and led to a national discussion about suicide.
In what time he has left, Fitch is intent on tapping into this growing awareness to raise funds for his dream: completion of a retreat for at-risk veterans and their families on a 144-acre parcel of land in Shepherdsville, Ky. Despite chemotherapy that has drained him of strength and weight, Fitch has immersed himself in fundraising through the Active Heroes organization devoted to reducing suicides in the military.
To raise money, he's led "ruck marches," in which participants carry weighted backpacks or military rucksacks on long hikes. The most recent one weeks ago left him "physically destroyed, spiritually strengthened."
"Maybe I can inspire other people," he says. "It's OK to seek help. And when they raise their hand, everything humanly possible should be done to take care of that person. Because suicide is completely preventable."
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The announcement by Dinesh Bhugra, president of the World Psychiatric Association, that an independent commission will investigate what psychiatrists of the future will look like signals what all mental health researchers have known for the past 50 years: that the profession is in crisis.
The challenges the profession faces are legion and can be divided into two types. The first relate to whether those in our midst who are miserable, unintelligible or egocentrically incorrigible should be met with a form of presumed pre-eminent medical expertise. This is a tribal issue – and some professionals, such as clinical psychologists and nurses, are making bids to legitimacy to compromise, share or even fully displace medical authority. In other words, non-medical professions are trying to undermine medical dominance in the field and assert their own autonomous theory and practice.
The second set of challenges relate to whether the mental health industry as a whole can respond in an effective and compassionate way to people who are deemed by their fellows (or themselves) to be psychologically abnormal.
The tribal challenges
Medical authority over psychological abnormality in society was only consolidated at the end of the 19th century in Western Europe and North America. Prior to that “lay managers” of asylums had implemented forms of “moral treatment,” mixing strict daily routines and compassionate fortitude, which brought lunacy back into the moral fold of society from an alienated state out of touch with shared expectations of daily life. As insanity defied a moral order, the insane had to be challenged to re-integrate into normal expectations of contemporary society.
Once psychiatrists won the battle and each asylum had its own “medical superintendent,” then an increasingly biological approach became evident. This biomedical emphasis went hand in glove with a dominant political philosophy of the time: eugenics. The eugenic consensus of the time assumed that a range of deviance, like lunacy, idiocy, epilepsy, prostitution, inebriation, was the product of a tainted gene pool of the fecund lower social orders.
In Britain, where eugenics started, the main focus was on social class, but this shifted to a racial emphasis elsewhere. Today’s psychiatry has strong eugenic roots in this 19th-century political philosophy. Its current obsession with genetics maintains that tradition.
However, during World War I this eugenic approach came into crisis in Britain, as officers and gentlemen and working-class volunteers broke down with predictable regularity in the trenches, with the first group actually having higher rates of “shell shock”. These were “England’s finest blood”, so eugenic claims about genetic inferiority were tantamount to treason. In 1926 when the Royal Commission on Lunacy and Mental Disorder was set up to review the organisation and content of services for the mentally ill, not a single asylum doctor was appointed to its inquiry team.
Suddenly non-biological theories and interventions were let into the trade. For example, prior to the war, psychoanalysis was derided and rejected in the medical profession, but by 1920 in Britain there emerged the Tavistock Clinic, the British Psychoanalytical Society and the Medical Section of the British Psychological Society (with the latter being dominated by psychotherapy-orientated “shell-shock doctors”). These two factions (biological psychiatrists and medical psychotherapists) were joined by another: social psychiatrists. And during the Great Depression, this inter-war period, like the war before it, made it very evident that mental stability was precarious in the face of environmental stressors.
The industrial challenges
The above three-way factionalism still remains today, with drug companies now a key player in shaping biomedical knowledge and offering corrective interventions with putative magic bullets for the conditions defined by diagnostic psychiatry. But this matter of internal fracturing in the psychiatric profession and the bids for legitimacy from nearby professions – like psychologists seeking to lead new forms of psychological therapy and be responsible for the discharge of detained patients – is only part of the picture.
Whoever runs the show, the central question remains: what is the point of the mental health industry? Is it to ameliorate distress? Is it to remove madness forcibly from society? Is it to contain those who others find offensive or chronically burdensome – those deemed to be “personality disordered”? In other words, is the industry in the business of healing or social control, or both?
If it is both then the crisis that Bhugra and his commission will struggle with will be about squaring a circle in society. Not only has the psychiatric profession not squared this circle but neither have its professional competitors. While we still retain “mental health law”, in the form of the Mental Health Act and other legislation, the tension between offering treatments – which are anxiously sought and gratefully received – and imposed and resented forms of control like sectioning, will be integral to the mental health industry.
Over the years various groups have kept reconsidering the same malaise: the “anti-psychiatrists” of the 1960s, the New Social Movement of user critics of the 1980s – such as Survivors Speak Out and the Campaign Against Psychiatric Oppression, which sought to abolish psychiatry or reform its oppressive aspects – and more recently, those attacking diagnostic psychiatry and failed medicinal solutions.
These matters of coercive social control, of the necessity or otherwise of “mental health law”, of ineffective and iatrogenic drug treatments (ones that actual cause illness or disease), of the shaping role of big pharma and of the choice between unique psycho-social formulations and creating categories of diagnosis, are unresolved and maybe irresolvable.
These incorrigible features of the mental health industry will be there for the foreseeable future, whether or not the psychiatric profession succeeds in retaining its medical dominance. Even if it loses the battle to its user and professional critics, the industrial challenges just noted will still haunt all parties new and old.
You can read Peter Woodruff’s response, Psychiatrists alleviate mental illness – don’t attack them,here.
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