Gastonia is a satellite city of Charlotte, North Carolina, and though it is contained within the official Charlotte Metropolitan Area, you have to drive thirty minutes west on an interstate (85) to reach it. Its old neighborhoods favor expansive shade trees and quiet streets, which give Gastonia an easygoing Southern vibe. Its hip downtown scatters gastropubs, BBQ joints, and live music among bookstores and consignment shops. Gastonia is less cosmopolitan and more relaxed than Charlotte, and that’s why North Carolinians like it.
Fonda Bryant grew up in a number of places, but a quiet street at the intersection of Winget Street and Memory Lane in a mostly black neighborhood holds memories of a childhood spent running free with her cousins. An athletic woman in her fifties, Fonda strolls beside her towering son, six-feet-four Wesley, and smilingly tries to make him feel the magic of her home. In his early thirties and a sports broadcaster, Wes was an offensive lineman at Wake Forest University a dozen years ago. While he’s lost some of the three hundred pounds he carried on the gridiron, he’s no less imposing.
Fonda finds the house she’s looking for, a simple wood-sided cottage in a line of cottages, all in need of fresh paint, with an ample yard and a sampling of trees. She tells Wes, “This is where many a day that me and Spankie and Tut would come when we were just little kids. And we’d come up here and hang out with Great-Grandma. That was your great-great-grandmother.”
In an old black-and-white photograph Fonda produced from her purse, she, Spankie, and Tut beam with mischief. At six, Fonda hugs a cat while Spankie, about eight with wild hair, holds on to Fonda’s brother, Tut, a toddler whose suspenders keep his short pants up. Just three years older, Spankie is Fonda’s aunt, but they look like sisters. I’m reminded of To Kill a Mockingbird’s Scout, Jem, and Dill adventuring through an endless summer. Fonda’s gang had milder escapades but enduring bonds nonetheless.
“Which grandmother?” Wesley said, trying to place the house’s owner. “Nanny Cooper?”
“No, she was your great-grandmother,” said Fonda. “This would be your great-great-grandmother. And we’d come up and sit on the porch and talk. But we would just run around and play a lot of times. Grandma would still chop wood. And she did something that you would’ve loved—she fixed biscuits every day.” Her voice is full of emphasis and punctuation, her phrases never resting on one octave when three will do.
“Yeah? Why’d she make biscuits every day, though?”
“Because back in the day, that’s what they made,” Fonda laughed. “She still had a wood stove. And I never will forget one time she tried to put a TV dinner in a wood stove and burned it slap up!” Fonda smacked her hip and laughed. “Her name was Lizzie. But we called her Great-Grandma.”
The pair follow a path made of paving stones to a backyard in need of a gardener.
Wesley said, “I’ve never been back here.”
“This yard needs a fix-up.”
Fonda rounded the house cautiously, like an explorer. She had already warned Wes about snakes.
“Great-Grandma had a well back here which she didn’t allow us to play around cause they were worried one of us would fall in.” Fonda’s voice was hushed, as if the old matriarch still stood vigil on the back porch. “And when we used to hang around up here, they didn’t even have indoor plumbing.”
“Hm.”
“You had to go outside.”
Fonda closed in on the well. It was covered by a weather-beaten wooden box held shut with an ancient padlock.
“But that well water was really good. Better than any store-bought water.”
“Water is water,” said Wes. “Unless it’s dirty.”
A shake of her head and a tolerant smile. “You are always knocking it but I’m telling you it was totally different. I miss my childhood. You know, being able to just come up here and play and be kids, and nobody was bothering you, and your great-grandma would give you food to eat. And if you got a quarter, you were really something. Because you could buy bubble gum, a cookie, chips, and a soda, and still have some money left. Can’t do that with a quarter now.”
“What’s that?” said Wes, pointing at the well cover. Below the lock hung a metal sign with an engraving.
Fonda moved nearer and read it aloud. “Be happy. For every minute you are sad, you lose sixty seconds of happiness.” She took out her phone and opened the camera app. “Man, I didn’t know that was back here. I’m gonna take a picture of that. That is really something. It will remind me of doing better when I’m not having a good day.”
Fonda’s mother had four children, two while married and two while single. She had Fonda when she was just seventeen and not married. Fonda’s brother Tut followed, then two more girls years later. She worked at a Wix Filters factory, which made oil and air filters, but money was tight. Fonda’s father was the late Blues Hall of Fame singer Johnnie Taylor, dubbed the Philosopher of Soul, and best known for the 1976 hit “Disco Lady.” Taylor fathered nine children with three women and never acknowledged Fonda’s existence or contributed a dime to her upbringing. Recently in court, Fonda and her half siblings forced a royalties payment out of Sony Records. But that money hadn’t been there when Fonda needed it.
Fonda began a story with a smile. I imagined like many of her tales of childhood it would be funny or whimsical, but it wasn’t. “When I was growing up in Gastonia one of my classmates, Lisa, never will forget her, I had on some shoes that had holes in the soles. And I had put some cardboard in them to keep the dirt out.
“So Lisa thought it would be funny to make fun of my shoes. She asked me to walk in front of her. Well, you know, when you walk, your whole shoe comes up and kids could see the holes in my shoes. And I could hear them behind me laughing and that really, really hurt me. It hurt me for the fact that I had to go to school like that and it hurt me because I felt like my mom was doing the best that she could. Because I was very attached to my mother. And the fact that Lisa, who lived on my street, would even act that way, you know? She thought it was funny.
“I tell people now, be careful how you treat each other. Because when you’re in elementary school, middle school, high school, you think it’s no big deal. You think that what you say is not going to affect the person as they get older.” Fonda’s smile slipped, then was gone. “But it does.”
It is unlikely that there is a direct line between Lisa’s cruelty and Fonda’s later suicide attempts, but the bullying she suffered probably played a contributing role. Bullying is more dangerous than it was previously thought and far more dangerous now than it has ever been before.
Dr. Madelyn Gould, professor of epidemiology in psychology at Columbia University, studies youth suicide. About bullying, she told me, “Thirty years ago, we did not recognize how devastating bullying could be. People thought, well, kids get bullied, right? And then the research started coming out that showed that being bullied increases the risk of dying by suicide. Now, the vast majority of young people who are bullied will not engage in suicidal behavior. But if you have underlying vulnerabilities, whether it is a family history of suicide or the propensity to be depressed, or you’re coming from a family who may not have as many resources as other families, that’s already putting stresses on you. And then when you’re bullied in school, that can become devastating.”
Bullying takes many forms, none of them good. Physical bullying can cause immediate injury and result in long-term effects such as headaches, poor sleep, and physical symptoms related to stress. If bullying persists, young people can develop feelings of insecurity and hypervigilance. They can become angry and isolated. They can also suffer lifelong health problems associated with chronic inflammation caused by stress. For reasons that are not yet clear, girls who are bullied report more anxiety and health problems than boys.
As Gould said, bullying is particularly harmful to those who already suffer from underlying mental health conditions. People suffering from depression and suicidal thoughts—as noted by John Mann—react more strongly to criticism of all kinds, including criticism from teachers and authority figures.
Angelo Bavetta was an acquaintance of mine, a business owner who worked with his hands. He killed himself at age fifty-three. Angelo had always struggled with his weight. In elementary school, he suffered an unconscionable amount of bullying in what should have been a safe environment. His sister Christina told me, “We went to this little Catholic school first to eighth grade. Angelo was tortured in school because he was heavy. For years they tortured him, the same mean kids grade after grade. Even the nuns were mean to Angelo. Tease the fat kid!”
Angelo suffered from a number of risk factors, including alcohol abuse disorder and a recent divorce. But according to his family, the bullying he endured in elementary school was never far from his thoughts.
No amount of bullying should be tolerated in school or any environment; besides being cruel and emotionally grueling, it has the epigenetic power to switch genes on or off to increase the probability of suicide and other maladies. One mechanism involves the chemical cortisol, one of the “fight-or-flight” hormones. The natural daily production of cortisol in the body increases during times of stress. Cortisol elevates blood sugar, suppresses the immune system, and speeds the conversion of food into energy. But preparing to fight or flee over a long period of time can switch off the gene that inhibits cortisol production, resulting in surplus cortisol. This abnormality has been found in the brains of people who have died by suicide.
Fonda suffered more than one episode of bullying due to poverty. But the torment she suffered might have been much worse for her had she been a child today. That’s because Fonda didn’t have social media to contend with. Social media is a bullying multiplier. Because of the vast networks of users on Facebook, Snapchat, Instagram, and other platforms, incidents that begin as petty insults balloon overnight into overwhelming assaults. And the assaults are magnified and perpetuated.
On February 1, 2023, fourteen-year-old Adriana Kuch was attacked by a group of her New Jersey high school classmates. They kicked, punched, and pulled her by her hair in the school hallway. A video of the assault circulated over Twitter and TikTok. To continue their harassment, classmates mailed the video and screen grabs to Adriana, along with ugly comments. Two days later, Adriana killed herself. Forensic psychologist Tristin Engels, PsyD, commented, “When [a video] is circulated in uncontrolled and unregulated environments like social media, it opens up the victims, families, teachers, and communities to more forms of cyberbullying. That’s traumatizing.”
“Online bullying is so quick and it’s so big,” says SAVE’s Dan Reidenberg. “So whereas twenty or thirty years ago when bullying occurred in a school or on a playground, that was one against one or maybe three against one. Now it’s three hundred against one or three thousand against one. And because it’s so broad and so diffused, it can happen across the state or across the country, whereas instead it used to happen in a parking lot.”
Not only are the bullying numbers magnified but their intensity is also magnified because of the anonymity granted by the internet. Reidenberg says, “People feel far more emboldened to say things that are far more hurtful than they would in person. So there is this connection between what happens with bullying and social media that we didn’t have twenty or thirty years ago.”
“Social media can be used for good as well,” counters Christine Moutier, chief medical officer of the American Foundation for Suicide Prevention. “Social media can provide connections for people when they don’t feel connected, it can provide support for people when they don’t feel supported. Social media can provide resources and good information for people when they need it.”
Clearly, social media is a double-edged sword, but aspects of it are indisputably harmful, making it hard to gauge whether its benefits outweigh its risks. One negative phenomenon is called FOMO, short for “fear of missing out.” Those who post on sites like Instagram and Facebook typically share images and stories that portray a life crammed full of vacations, family gatherings, new homes, cars, clothes. Social media consumers experience feelings of social anxiety based on the conviction that other people are having better, more rewarding lives.
Moutier says, “There is a large body of evidence that shows that for many, many people, let alone youth, there can be a negative impact on their mental health from using social media—really just endless scrolling and feeling like you’re missing out. For kids who have any level of preexisting anxiety or family history of mood disorders, there needs to be a lot of caution and guardrails around social media use, and particularly the age at which kids get access to a smartphone.”
Between 2000 and 2007, suicide rates were almost stagnant for young people between the ages of ten and twenty-four. Then they began moving steadily upward. By 2018, suicides in this age group had increased 57.4 percent from 2007 levels. An economic crisis darkened that period, and according to online posts, some seventeen- and eighteen-year-olds felt like a burden because their families were overwhelmed by household expenses and had too many mouths to feed.
But something else was happening in the background. Social media was gaining a real foothold.
In the past ten years, social network platforms have more than quadrupled their number of users—from 970 million in 2010 to 4.48 billion in 2021.
“Youth suicide rates turned upward at a time when social media were becoming more available,” psychiatrist Eric Caine, MD, of the University of Rochester Medical Center told me. In 2018 an academic review of literature supported this alarming correlation, stating that the “increase in suicide rates paralleled the increase in social media use.” In 2019 the American Academy of Pediatrics reported the astounding fact that mental health disorders have surpassed physical conditions as the most common complaints causing “impairment and limitation” among adolescents. That same year the United States Surgeon General expressed alarm about the devastating mental health epidemic affecting American teens.
But was social media to blame? At least in part. A ten-year study of five hundred teens conducted by Brigham Young University beginning in 2009 showed that girls who used social media for two to three hours a day and increased their use over time developed a higher risk for suicide. An independent survey of US teens in grades eight through twelve and national statistics on suicide deaths for those ages thirteen to eighteen both showed that depressive symptoms, suicide-related injuries, and suicide rates all went up between 2010 and 2015, especially among girls. Teens who spent more time on new media, like social media and electronic devices such as smartphones, were more likely to say they had mental health problems. Teens who spent more time on non-screen activities, like in-person social interaction, sports/exercise, homework, print media, and religious services, were less likely to say they had mental health problems.
How else do social media and new media contribute to suicide? The ten-year study of five hundred teens suggested that young people who harm themselves are more active on social networks than young people who don’t engage in self-harm. Self-harm generally consists of cutting, burning, or hitting oneself, often without the intent to die. However, those who engage in self-harm are at significant risk for suicide. As Moutier says, some may be seeking help online and are rewarded with supportive messages. But the opposite can also be true. Online help-seeking is often met with derision, which can fuel self-harm. And young people engaging in self-harm find messages that encourage their behavior and even copy the dangerous actions of others shared in messages or videos.
Danish suicide expert Annette Erlangsen, PhD, who studies suicide in Denmark and the United States, observed darker online connections. “We do know suicide pacts that have been established through Facebook or groups forums, where people are discussing thoughts of suicide and maybe even trying to promote or trigger others to carry out suicidal acts. So we have examples where we can clearly see that social media has had a bad impact.”
At least one social media giant has studied the life-threatening impacts its sites cause and has done nothing about them. In 2021, The Wall Street Journal reported that internal documents prepared by researchers at Facebook showed that the company had long been aware that it contributed to mental health disorders in young people. They found that Instagram, its photo-based site, made body-image problems worse for about 30 percent of female teenage users and added to depression and anxiety. Another internal report showed that among teens who reported suicidal ideas, 6 percent of American users and 13 percent of British users traced the desire to kill themselves to Instagram. These revelations came courtesy of whistleblower Frances Haugen. In May 2021, she quit her job as a product manager at Facebook and took tens of thousands of internal papers with her. The records, made public in newspaper articles, have led to a flurry of accusations and lawsuits from eight states.
Meta Platforms, the company that owns both Facebook and Instagram, is in the crosshairs of litigation that accuses it of causing eating disorders, despair, and even deaths among adolescents and teenagers. In 2021 the parents of Englyn Roberts, a Louisiana teenager, brought a case against Instagram. According to their suit, Englyn was “bombarded by harmful photos and videos,” including “violent and distressing content celebrating self-harm and death.”
As Englyn interacted with these images and videos, carefully crafted algorithms offered up more and more similar content, trapping the teenager in a dangerous cycle. Englyn began sharing films of herself and her friends committing self-harm. In August 2020, copying a video she had seen online, Englyn tried to take her life in the same manner. After days on life support, she died.
Her parents’ suit alleges her death was the direct result of psychic damage brought on by her compulsive use of social media, particularly Instagram. Englyn Roberts was just fourteen.
When Fonda Bryant turned fourteen, social media and smartphones hadn’t yet complicated the landscape for teens, but she nevertheless contended with serious sources of stress. She worked two jobs to help her mother make ends meet. After classes she filed papers in an administrative office at her high school, and on nights and weekends she waitressed. The jobs irked her, but the family had new additions. “I’d work like forty hours a week and still go to school. And I resented that because we were already struggling and my mom had two more children. I loved my brother and sister, but it fell on me to help take care of them and sign my checks over to my mother to pay the bills. I knew it wasn’t right. Being a kid and working like that. I think the onslaught of depression started when I was around fifteen or sixteen.”
But Fonda isn’t exactly sure—she thinks her depression might have begun much earlier. She attributes her lack of awareness to her culture and an enduring stigma about mental health issues, particularly in her church. “When I started feeling real depression, I didn’t know what it was. Because black people didn’t talk about mental health, we didn’t know what the signs were. The racial difference with mental health among black people, and people of color in general, is how we were raised. Pray about it. Don’t claim it. Give it to God. But I know I was probably dealing with depression all my life.”
Sean Joe, PhD, MSW, an authority on suicide among Black Americans, concurs with Fonda’s assessment of church attitudes. “For some the Black Church has not always been helpful. They say you’re not faithful enough, you’re not prayerful enough. That if you were a stronger Christian and turned your life over to God, that would heal you. But in the last fifteen to twenty years, more Black Churches and leaders are making sure they encourage people to seek mental health services.”
But while the church hasn’t always been helpful at providing counsel or advice, it has indirectly protected black women from suicide. Dr. Joe says, “A connection with the church brings social and emotional support, and that has an impact. There is the idea that black women in the United States are more orthodox in their religious views, so individuals who have a negative attitude toward suicide are less likely to engage in suicidal behavior. If your doctrine is that suicide is a sin, that’s one component of the protective factor that might be at play.”
But Joe thought there had to be more protective factors. That’s because when he explored suicides among black men and women, he found a large difference in suicide rates that could only be partly explained by churchgoing. Averaging all ages, non-Hispanic black women die of suicide at one-fourth the rate of non-Hispanic black men.
Joe says, “When we started to understand that suicide was increasing among younger generations of black men—and this has been happening since the 1970s—we never saw the same increase in suicide among black women. And that posed an interesting question. If the generations of child slavery, Jim Crow, mass incarceration is impacting the black population, what is unique among black females and their experiences that they don’t engage in the same levels of suicidal behavior as black males?”
For starters, black women tend to be the primary caregivers for children, which means they cannot solely think about themselves when they’re considering the consequences of suicide. Children can also be shields against solitude and loneliness, major risk factors for suicide. And culturally, black women are able to express themselves more frequently and completely than black men. Joe says, “Black women, unlike black men, are more likely to be allowed to express their emotions and find social connections and spaces to get support. And black males and males in general are not allowed to emote or find those sorts of spaces because of the idea it’s not masculine.”
In the bigger picture, protective forces make black women less likely to kill themselves than other minority American women—Natives, Asians, Latins, and Pacific Islanders. In the United States in 2019, the last year for which data is available, non-Hispanic black women had less than half the suicide rate of non-Hispanic white women. However, in recent years the suicide rate for black girls has steadily increased, particularly among adolescents and children under thirteen. From 2003 to 2017, the suicide rate went up by an average of 6.6 percent per year for black girls.
On average, suicide rates among black youths are lower than those among white youths, but variations occur depending on age, gender, and other factors. According to the Centers for Disease Control and Prevention (CDC), between 1999 and 2018, the suicide rate for black children and adolescents from ages five to seventeen was lower than the rate for white children and adolescents. However, currently the suicide rate for black males ages fifteen to twenty-four is higher than that of white males of the same age group.
Not so fast, says Sean Joe. The rates at which black people of both genders and all ages kill themselves may be inaccurate, and greatly undercounted. Undercounting casts doubt on many conclusions we may draw from statistics about black suicides. Joe first encountered this problem when he began exploring suicides among black children.
He says, “We suffer from a lack of attention to specific ethnic groups in the United States. There’s been no real research on black children. When children are studied or treatments are developed, black children are not included in those studies.” Why not? For Joe, the problem is tied to institutional racism. “If you never develop black scientists, then you don’t get individuals who are likely to ask the question. The reason that we’re talking today is because someone invested in me, and I asked a question. And if they didn’t invest in me, who would have asked some of the questions that I’m asking?”
West Virginia University’s Ian Rockett, PhD, MPH, also studies black suicide and asked a broader question: Why is the rate of suicide among Black Americans recorded as one-third of that among whites? According to his 2010 study, Black American deaths are 2.3 times more likely than white deaths to be labeled as “indeterminate.” Dr. Rockett discovered reasons for this. Chiefly, coroners and medical examiners have less information to work with when examining black deaths. That’s because black people are less likely to acquire a mental health record due to their lack of access to medical specialists. Consequently, black people may not have a history of mental health issues or prior suicide attempts, both of which can add to a determination of suicide when they die.
“When there’s less psychological documentation,” says Rockett, “they’re more likely to be labeled as undetermined intent. This leads to suicide misclassification.”
Rockett knows a lot about suicide misclassification. His studies show that suicides among all races in the United States are underreported, and he asserts the true body count is at least 30 percent higher than its 2020 accepted number of 45,979. That would make suicide three times more common than murder. In another recent study, Rockett and coauthors showed that suicide has become the leading cause of “injury deaths,” which are those deaths such as car accidents in which people harm themselves.
A pair of black platform shoes with a glittering silver band. Huge-heeled open-toed shoes in two colors—sapphire and red. “This pair is kind of self-explanatory,” said Fonda about some elegantly decorated black pumps. She beamed at the design. “They have flowers. Thank God they were marked down.” Then her favorite, a pair of translucent green T-straps. Fonda said, “The color green for mental health stands for hope, so I had to have a pair of shoes in green.”
At her cozy apartment in Gastonia, Fonda sat on a well-padded brown sofa in the living room surrounded by a small mountain of shoeboxes. They are a fraction of her collection. She said, “Nothing makes me feel better than for somebody to look at my feet and say, ‘You got on some bad shoes,’ because I love that. And I don’t go spend a ton of money on my shoes, but I do have a lot of nice shoes. And I love for people to look at them and say, ‘Oh, where’d you get those shoes?’
“Automatically my brain goes all the way back to when I was a kid in elementary school. It all comes back to Lisa. So it really does go to show that words can hurt and being bullied can affect you for the rest of your life. It took me years to realize why I love shoes so much.”
In her teen years before her passion for shoes took hold, Fonda enjoyed one of the protective forces that benefit anyone with a large, loving extended family. During most of her childhood she was surrounded by close relatives—grandparents, aunts and uncles, and cousins. Still, her family’s warm embrace didn’t protect her from depression she seems to have been born with. Like so many of those afflicted with severe depression, she medicated her dark feelings. Her medicine of choice wasn’t alcohol, drugs, or food. It was sex.
She said, “I started being promiscuous very early, at thirteen. That’s why I tell people all the time I can understand addiction even though I’ve never done drugs, even though I’ve never done alcohol. Whether it’s eating, or working out excessively, shopping, gambling, sex. It’s not healthy, but it’s a coping skill. And if you don’t realize that and get help for it, that coping skill can spiral out of control. And it did for me. I just became a wild child. I was just wild. And I had no idea that it had anything to do with my mental health.”
A rough definition of sexual addiction, or compulsive sexual behavior, is an impulse control condition that persists despite unfavorable consequences. Studies about compulsive sexual activities indicate shortages of serotonin, norepinephrine, and particularly dopamine, all neurotransmitters. Sexual addiction begins, on average, at eighteen years of age. Some 88 percent of sexual addicts have a history of other mental health conditions, including severe depression, like Fonda. In addition to depression and compulsive behavior, Fonda probably had another brain abnormality, the one that John Mann claims causes suicidal ideation and which, combined with depression, increases chances for suicide. Fonda’s future behavior would seem to bear this out.
Fonda’s mental health threw a monkey wrench into her adolescent years. She had her first child as a single mother at age sixteen. After just thirty days the infant died in the hospital from undiagnosed medical conditions. The event traumatized Fonda and worsened her relationship with her mother, who was angry her daughter had become an unwed mother, as she had twice been herself. Fonda finished high school and a year of college, then began a series of retail and secretarial jobs, one, significantly, as a pharmacy technician. At age twenty-three she had a second child, Wesley. But throughout, besieged by mental health issues, her life spun out of control.
“To be honest I attempted suicide four times. Two times where I just thought this would be the best way for me and two times where I actually had a plan.”
The first time, in the middle of an argument with her mother, Fonda swallowed a handful of painkillers she’d taken from the pharmacy where she worked. Instead of going to the hospital immediately, as she should have, she went to bed. “I thought I was gonna die. But I woke up the next morning, I was scared and I was like, ‘Oh my God, am I gonna die?’ So I called the paramedics, they came, they asked me did I need to go to the hospital and I told them no. And after that, I went back to work and just kept working. But I knew I needed help and I remember my mom did take me to a behavioral health clinic.” She spent a few hours at the clinic, had a perfunctory therapy session, then was sent home. There was no follow-up.
Fonda’s experience with thwarted suicide is not unusual. In the United States, women attempt suicide three times more often than men, but men succeed more often, about 70 percent of the time.
Why? Men more often use firearms.
Dr. Sean Joe observes, “The thing that we understand is that a suicidal crisis is usually one to ten minutes. One to ten minutes.” It may come back, to be sure, within hours, days, or months. But the crisis itself has a short duration. “In a suicidal crisis, if you have a lethal means, it’s more likely to result in death, so if you have a firearm, you have a ninety-five percent chance of dying. If you don’t have a firearm and you use some other means, right? You only have about a five to ten percent chance of dying. So the means matter.”
Men, compared with women, appear to be less fearful of death and more able to endure physical pain. As a result, they may be more likely to use more violent means of suicide, such as shooting themselves, hanging, or jumping from a high place. About 60 percent of men use a gun, compared to over 30 percent of women, whose most favored means of attempt include overdose, suffocation, hanging, self-piercing, and burning. Less than 10 percent of these cases result in death.
The means of death men choose also impacts how many attempts they make compared to women. Around 62 percent of men die from their first suicide attempt, whereas about 38 percent of women die after their first attempt. While more than 50 percent of women who die by suicide have previously attempted, less than half of men who die by suicide have a history of one or more prior attempts. Dr. Thomas Joiner’s interpersonal theory of suicide, which offers precise ideas about how the desire and capacity for suicide develops, is based in part on the notion that suicide is difficult and painful and therefore more often completed by men. We’ll discuss the interpersonal theory of suicide ahead.
As we’ve seen, the common denominator in almost all suicides is an excruciating amount of mental and physical pain that is almost indescribable. Of the people I’ve spoken with who have attempted suicide, Fonda did the best job of putting that pain into words. She described it as we drove across Gastonia to visit her aunt Spankie, who figures prominently in Fonda’s closest brush with death.
Fonda said, “The best way for people to visualize the pain, it’s from the top of your head to the bottoms of your feet. I’ve had wisdom teeth removed, an abscessed tooth, open-heart surgery, given birth twice, hysterectomy, knee surgery. You could put all the pain together and it would not touch the pain that I felt on February fourteenth, 1995.”
At the time, Fonda was thirty-five years old and living in Gastonia with Wesley, then twelve.
“I had just had it. And my mind was telling me, you know, if you just take these pills, if you just go to sleep, everything will be over with. It’s amazing how strong our mind is. It guides everything. But when it’s sick, it can make you do stuff you never thought you would do. And so my mind was telling me, you know, kill yourself. Your son would be better off. Nobody’s going to care. And that’s how I felt.” Fonda looked down at her hands. Then she looked at me.
“In my heart, I still knew I was a good mom. I was doing the best that I could, but in my mind, it was telling me, you know, just chunk it in. It’ll be better for you. So I had that plan that I was just gonna take some pills, almost like Sleeping Beauty, where your house is immaculate and you’re just gonna lay down. I had it planned out to look a certain way. I didn’t want them to find me like some people who shoot themselves. Some people hang themselves. That’s traumatic on top of it being traumatic. I didn’t want that. I just wanted to go to sleep.”
We turned into Spankie’s neighborhood, a middle-class suburb on Gastonia’s outskirts with midsize brick homes surrounded by neatly kept yards and chain-link fences.
“But before I took the pills I said man, somebody’s got to know about my pain. And I called my aunt Spankie. We grew up three years apart, always been close, she was always getting us out of trouble. I reached out to her and I simply said, you can have my shoes. That’s all I told her. And I think we talked a little bit more, but I don’t really remember what I said.”
At Spankie’s door a flurry of cheerful greetings as Fonda and Spankie embrace. Spankie is a head shorter and more soft-spoken compared with Fonda’s forceful, expressive self. Spankie’s husband had recently died and she was renovating their home. Fonda didn’t miss a detail. “I knew you were gonna do that, I knew it!” Their smiles and laughter said loud and clear that the man who was gone might not be missed all that much and these two weren’t mere relations but closer than sisters. Aunt Spankie fussed over the flowers Fonda had brought and ushered us into the screened back porch. Just outside, a huge purple and orange buddleia bush attracted a kaleidoscope of colorful butterflies.
Fonda caught Spankie up on what we were talking about.
“During the course of the conversation,” said Spankie, “she said, ‘You can have my shoes.’ That was an instant indication that there was something wrong. ’Cause we are serious about shoes.” She gave me a look. “And I eventually asked her was she planning to hurt herself and she said yes.”
Fonda said, “She called me back and she asked me, ‘Are you going to kill yourself?’ And I said yes. And then she went into action like a superhero. She took out the papers for me to be involuntarily committed.”
The same day a policeman came calling.
Fonda said, “There was a knock at the door and there was this big black Charlotte-Mecklenburg police officer. He said, ‘Are you Fonda Bryant?’ And I said yes. And he said, ‘I came to take you to a mental health facility.’ And I’m like, oh no you’re not!
“And I got scared,” said Fonda. “And I went up the stairs to the bedroom thinking if I went up there, he’d just go away. Which they don’t do if you’re being committed. They come after you. And he came upstairs and things started escalating. And he put his hands on me. And I scratched him. And when I scratched him, he grabbed me by the back of my neck. He shook me extremely hard and he put me in handcuffs.”
Even cuffed, Fonda fought on. But twelve-year-old Wesley, who had followed the policeman up the stairs, pleaded with her. “Momma, you need help!”
As Fonda tells it, she was saved twice that day. Once by Spankie, who had had her committed, and again by her son, Wesley, whose plea worked magic. Fonda surrendered. “My son kept me from getting seriously injured by a police officer because we hear all the time where people who have mental health issues have been killed by police officers. So it was very fortunate that my son was up there that day because I could have gotten seriously injured or killed.”
An expert on black suicide, Sean Joe puts the scene into context. “There used to be two service providers Black Americans did not want showing up to their doors. One was a psychiatrist, the other one was a police officer. And the concern was, they can both lock you up. Then you have the history of violence among Black Americans in police custody, where police suggested they hung themselves, they killed themselves. So, this sort of history plays out into the common experience of Black Americans and has an impact on their perceptions about mental health services.”
For Joe, Fonda’s confrontation combines two elements that are important to consider—stigma about mental health issues, and violence against black and mentally ill people by law enforcement. First, the stigma. As we saw earlier, black people tend not to have mental health records because they don’t seek out services, and that’s owed chiefly to cultural stigma and therapy’s steep price tag. Another disincentive—people of different races and cultures are often driven to suicide by different risk factors. Mental health services don’t often make adjustments for cultural differences. One size doesn’t fit all.
Joe says, “If the services do not work for the population, were never designed for the population, that also impacts the stigma related to mental health services. So if we never invested in making sure that the treatments work for Black Americans, which we did not, and on top of that, it can lead to some level of involuntary incarceration, naturally people developed concerns around mental health and mental health services.”
If these services fail black and underserved communities, who do they serve? Psychological therapy is challenging to obtain in the United States unless you are financially well-off and white. Money alone won’t cut it. White culture brings with it familiarity and acceptance of psychiatrists, therapists, and medicines that treat depression. Joe parses the demographic even further. “Our mental health services, our efficacious treatments, were designed for middle-aged, middle-class white women.” That’s because, according to Joe, men of all races have traditionally frowned upon mental health services. “It was primarily middle-aged white women who can afford therapy and have the time to go to therapy. So our system of mental health services was really designed around them.”
I’ve heard more than one expert assert that the popular and effective therapy modality cognitive behavioral therapy (CBT) was designed for white women. I thought this was hyperbole until I read that CBT trials included primarily white populations.
Joe agrees that access and cultural sensitivity have improved, but not much. “I’d say in the last fifteen to twenty years, some of that has changed. There are now more intentional efforts to design services for specific populations because we know the risk factors vary.”
Next there’s the police violence component of Fonda’s commitment. In the United States, there is a long and well-documented record of police killing black people and others with mental health disorders. Black people are killed by police at more than twice the rate of white people, even though they make up only 13 percent of the US population. A vast majority of the black people who are killed are male, and half are younger than thirty-five years. But age is no protection—police are five times more likely to shoot and kill unarmed black men over age fifty-four than unarmed white men in the same age range. Regarding black men with a mental health disorder, police are more apt to shoot and kill unarmed black men who exhibit signs of mental illness compared with white men with similar behaviors.
In fact, people with mental disorders of any race have much to fear from police contact.
A 2022 Washington Post investigation reported that at least 25 percent of those who are killed by police officers in the United States have a severe mental health disorder at the time of their death. According to a study by the national nonprofit Treatment Advocacy Center the same year, people with untreated mental illness are sixteen times more likely to be killed during a police encounter than other civilians.
Most shockingly, from 2019 to 2021, law enforcement officers shot and killed 178 mentally ill people they were called upon to help. Many of the callers—worried family members, friends, or neighbors—told authorities that someone was having a mental health crisis, or someone was planning to kill themselves. None of these callers expressed concerns about anyone else’s safety.
“It should horrify but not surprise us that people with untreated mental illness are overrepresented in deadly encounters with law enforcement,” said John Snook, lawyer and coauthor of the Treatment Advocacy Center study. “Individuals with untreated mental illness are vastly overrepresented in every corner of the criminal justice system. Until we reform the public policies that have abandoned them there, these tragic outcomes will continue.”
Police understand that they don’t have many good ways to deal with people who are mentally ill. A recent survey by the Police Executive Research Forum found that new recruits spend about sixty hours learning how to use a gun, but only eight hours learning how to de-escalate tense situations and eight more learning how to deal with people with psychological disorders.
In interviews, current and former police chiefs said that these deadly encounters will keep happening if police aren’t retrained on a large scale and mental health services aren’t expanded across the country. But in recent years, some states have cut their budgets for psychiatric services by as much as 30 percent, leaving a gap that local police aren’t willing or qualified to fill.
In response to the United States’ growing need for suicide and mental health crisis support, SAMHSA (the Substance Abuse and Mental Health Services Administration) set up the new 988 Lifeline for voice and text to make it easier for people to get appropriate help in a crisis. The 988 Suicide and Crisis Lifeline is modeled after 911. It’s intended to be a rapid and memorable number that links people who are experiencing suicidal thoughts or any other type of mental health crisis with a qualified mental health practitioner. The 988 initiative aims to eventually decrease run-ins between the law and mentally ill people, and to connect those in need of immediate assistance. At the federal, state, and local levels, considerable capacity investments have made it possible for the 988 Lifeline to assist a lot more people in need. August 2022 showed a 45 percent increase in the volume of calls compared with August 2021. September calls increased by about 32 percent over calls from a year before.
Tipped off by Fonda’s remark that she would leave Aunt Spankie her shoes, Spankie took an impressive step: she filled out court papers to have her niece Fonda committed to a behavioral health center. Spankie told me, “I just did what I did, I didn’t stop to think about who would be affected or who would be mad, I guess I didn’t care.”
State laws vary greatly, but generally speaking, a person must have a mental disorder to be forced into psychiatric hospitalization by a probate court. Probate courts handle cases involving wills and estate administration. In a majority of states, but not all, they demand that an individual be committed if they pose a clear and present risk to themselves or others. In some cases, whether or not a person is deemed dangerous, involuntary hospitalization may take place if they refuse necessary care.
There’s no doubt Spankie deserves credit for acting quickly and decisively. It’s no small feat to have anyone involuntarily committed to psychiatric care, much less someone to whom you are related and emotionally close. But what exactly did Spankie do right?
First of all, Spankie saw one of the signs of impending suicide: giving away prized possessions. Giving things away isn’t the most common sign by far, but a meaningful one nevertheless. SAVE’s Dan Reidenberg says, “We know anecdotally there are a lot of people, especially young people, that will give away prized possessions. They’ll leave a book that they borrowed from somebody in a locker or they’ll give a trophy that they earned to somebody else as a goodbye present. But if you look across the span of those who died by suicide, not everybody gives things away.”
The stories of Greg Whitesell and Chris Dykshorn show more common signs we should all look out for: isolating oneself, pushing loved ones away, giving up treasured pastimes, feeling like a burden, and talking about dying. Reidenberg further describes the impression people who are suicidal make upon others. “They have a sense of being hopeless, like there’s no future for them, or that there’s no reason for them to be alive, no sense of purpose for them—they don’t have anything left to contribute to their family, to their friends, to society, or to the world.”
In many ways, people on the verge of killing themselves are pulling back from everything that attaches them to life. The changes in their demeanor and what they talk about should be easy to detect, but often they are not. Some people display no signs before dying by suicide. And recall that most people who die by their own hand don’t tell anyone about it, nor do they seek professional help. Some deliberately hide their intentions so their plans won’t be interrupted. But if you know what to look out for, you have a better chance to save a life.
The American Foundation for Suicide Prevention points out additional signs of suicidal thinking, which we can organize into three categories—talk, behavior, and mood. Does the individual talk about killing themselves, or say they feel trapped? Do they complain of unbearable pain? Are they visiting people to say goodbye, or increasing their use of drugs or alcohol? Do they search online for methods to kill themselves? Have they bought a gun or are they stockpiling pills? Do they display unusual anger, anxiety, irritability, feelings of shame, and sudden improvements in mood? Sometimes when people who are suicidal have conclusively decided to kill themselves, they become almost euphoric; they’ve made up their minds, their pain will soon be over.
Dr. Sean Joe frames a concise portrait of someone on the brink. “We see people start to change their behavior. They start to not eat. They don’t sleep right. They start to express thoughts like ‘I don’t want to be here,’ or they might even say, ‘I want to die’ or ‘Life is too difficult for me, I can’t go on.’ It’s important that we pay attention to these sorts of expressions. In addition, we can see those individuals who are suicidal really start to close themselves off. All the things that used to bring them joy don’t bring them the same level of joy and at all times, they might begin to express, and this is important, ‘I’m fine. I’m fine.’ ”
One theme I’ve often heard is that people in an emotional crisis have a strong desire to talk about it but at the same time are afraid or ashamed, so they may have their guard up. You do not need special training to have an open conversation about mental health; you just need patience and a few guidelines. The American Foundation for Suicide Prevention suggests that you let the person know that you are open to a conversation about how they are really doing by casually initiating a discussion. You may say, simply, “Are you feeling okay?” Or “I care about you. Can we have a conversation about how you’ve been feeling?” Or “You seem stressed lately. Is there something going on in your life that’s making you feel a little overwhelmed?” If it’s appropriate, you could even share your own experiences with emotional issues as an introduction to the subject. You may say something like “I’ve had challenging times in my life and I’ve found that talking to someone really helped me.”
If the person isn’t comfortable talking with you, don’t be insulted. Ask if there’s someone else they’d feel at ease talking with. This gentle approach accomplishes a few things. It lets the other person know you care and that you are open to talking about mental health issues. It tells them you’re not judging; again, you’re coming from a position of caring. Make sure you make time to really listen. You might be surprised at how productive and rich the conversation you prompt becomes.
If you have reason to believe that the person is a danger to themselves, ask this specific question: “Are you thinking about killing yourself?”
There’s a long-standing hesitation to ask this because of fears it will plant ideas in the distressed person’s mind or spark suicidal behavior. Studies have shown that it won’t. Researcher and clinician Jane Pearson, PhD, of the National Institute of Mental Health wants to put this myth to rest. “We’ve learned over time it’s okay to ask somebody if they’re suicidal. People are often concerned you’ll put that idea in their head, and for adolescents and adults we know that that is not the case. So, people will tell you if they’re suicidal or not, but you’re not creating a problem that way.”
Not only are you likely to get a straight answer, but offering an opportunity to talk about suicidal feelings may reduce the risk of acting on them. Combined with a gentle introduction to a conversation about mental health, the question will increase the individual’s sense of connectedness. Isolation or lack of connectedness is a major risk factor for suicide. Your question might illicit a simple yes or no, but it may also begin an outpouring of information about the individual’s state of mind and intentions.
Remember that asking the question is effective only if you actively listen. Take their answers seriously, especially if they say they are thinking about killing themselves. Take care to learn why they are in such emotional pain. Listen for reasons why they may want to keep on living. Encourage them to think about why they want to live.
Aunt Spankie instinctively did the right thing and asked Fonda, “Are you thinking about killing yourself?” Fonda answered yes. Aunt Spankie completed the process to have Fonda committed to a psychiatric hospital. Between their phone call and when the policeman arrived, Fonda was alone with her twelve-year-old son for a few hours at most. The policeman’s arrival must have seemed dizzyingly fast, which prompted Fonda to call Spankie a superhero.
The American Foundation for Suicide Prevention advises you to quickly get to the person and stay with them. Never leave someone in a crisis alone. If you are nearby, go and be prepared to spend time. Help them remove lethal means from their home, such as firearms; medicines, including over-the-counter painkillers; household poisons; and sharp knives or tools. As we’ve discussed, the best option for firearms is to make sure they are unloaded and then taken somewhere else—the home of a friend, for example—for safekeeping. Some police departments will hold on to guns if they present a danger to a citizen. The second-best option—lock the guns in a gun safe and lock up ammunition separately. It’s best of course if the suicidal person does not have the combination or key to the safe.
Restricting access to lethal means accomplishes a couple of things. First, it prevents the person in crisis from immediately using those means to harm themselves. Second, if people who are suicidal cannot access their primary means of self-harm, they may not look further. They may give up their suicide attempt for that day, or forever. For this reason, barriers on bridges and high buildings have been particularly effective in stopping or dramatically reducing suicides at those locations.
Next, if the individual has a mental health counselor or therapist, contact them to see if they are available to meet with their patient. If the individual does not have a counselor, or if theirs is unavailable, escort the person in crisis to mental health services or a hospital emergency department. Again, do not leave them alone until they are under the care of a medical or mental health professional.
If you are not nearby and cannot take these actions with the individual in crisis, your job will be more complicated. Find out if the person can depend on someone close by to visit them. Ask the individual to call or text the 988 Suicide and Crisis Lifeline. There they’ll be connected to trained counselors at one of over two hundred crisis centers nationwide. Studies have shown that talking to a Lifeline counselor makes people feel less suicidal, less depressed, less overwhelmed, and more hopeful. At any time, whether or not you are nearby and you would like information about how to handle someone in crisis, you may also call or text 988.
Finally, follow up. Though you’ll want to do something more than send a postcard, studies have shown that hospitals that sent a regular postcard expressing concern improved patients’ mental health and decreased later suicide attempts. This shows the efficacy of even the simplest follow-up steps. Once you are involved in the suicidal crisis of a friend, loved one, or colleague, following up should come naturally. Check and make sure their crisis is over. Make sure they have a plan for continuing care. And keep checking up. Getting quality care is challenging in the United States, especially for people of limited means. Perhaps your friend, colleague, or loved one could use your help penetrating the often dense bureaucracies.
After Fonda was taken from her home, she spent a week at Cedar Spring Hospital in Pineville, North Carolina, where she received inpatient psychiatric care. At first she was angry and resistant to help. But during group therapy she turned a corner. “I first learned about self-care when the therapist asked me, ‘Who do you put first, Fonda?’ And I said, ‘My son, Wesley.’ And she told me that was the wrong answer. She said, when that oxygen bag drops in an airplane, what are you supposed to do? Put it on your face first, so you can help someone else. And that’s self-care because if we don’t put ourselves first, we can’t help anyone. I couldn’t help myself that day. I couldn’t help anyone that day.”
Fonda followed up with regular therapy and eventually a regimen of self-care. She told me, “We have so many things that can help us now. Exercise—I hit the gym three to four times a week. That gets my serotonin going no different than if I was taking medication. You also have walking in nature, being among trees, vitamin D from the sun, that’s a great help. Adult coloring books are great because they’re very intricate. And when I color, I can feel the anxiety leaving. You have to eat right. Who would’ve thought that eating has anything to do with our mental health, but it does. Eating blueberries, strawberries, raspberries, they contain antioxidants. Getting enough sleep and music therapy helped me. So we have all these great things now that can help us. It’s not just about medication and talk therapy.”
But medication and talk therapy are important tools for those suffering from mental health conditions. Fonda has received behavioral therapy since 1995. Insurance through her employers paid for some of it. Later a benefit offered by her son Wesley’s employer called the Employee Assistance Program (EAP) helped with the cost. Many employers offer EAP, which supports the wellness of employees and family members as they navigate life stressors, including mental health issues, divorce, recovery from substance abuse, job transitions, and more. Fonda also got involved in Mental Health America (MHA) and the National Alliance on Mental Illness (NAMI). MHA is a community-based nonprofit founded to address the needs of those living with mental health issues through services, education, research, and advocacy.
NAMI is a nonprofit that provides access to support groups and educational programs that help individuals and families living with mental health conditions. NAMI is active in every state in America, as well as Puerto Rico and the District of Columbia.