Losing Joshua

On January 30, He Nearly Killed Himself. On April 16, He Did. A 17-Year-Old's Suicide and the Questions Left Behind

At the start of his senior year, in September 2002, his classmates voted him "Most Optimistic." At home, however, Debra began to suspect something was seriously wrong. Josh's depression seemed to be getting much worse. He spent less time with his friends and more time in his bedroom. His mood swings became frequent and extreme. He complained of headaches. He barely slept.

Debra bought a copy of His Bright Light: The Story of Nick Traina. The book, by Danielle Steel, chronicles her son's battle with bipolar disorder, also known as manic-depressive illness. Debra saw similarities between Steel's son and her own, and she felt better knowing that another mother had been through all she was now enduring. The end of Nick's story brought little comfort, however. He took his own life at age 19.

In November, a friend showed Debra an article in Time magazine about young people who are bipolar. The story explained that some bipolar teenagers are misdiagnosed as having ADHD when they are children. At the end of the article was a list of 40 warning signs: "withdraws or isolates self," "has irritable mood states," "is easily distracted by extraneous stimuli," "sleeps fitfully." Nearly every sign applied to Josh.

Josh Graham’s bedroom in Phoenix (pop. 2,251), a rural village northwest of Syracuse.
photo: Jay Muhlin
Josh Graham’s bedroom in Phoenix (pop. 2,251), a rural village northwest of Syracuse.

On December 17, Debra took Josh to a psychiatrist, who diagnosed him as bipolar and prescribed Depakote, an anticonvulsant that acts as a mood stabilizer. Josh was irate—at the diagnosis and at his mother. "Why can't you just leave me alone?" he railed. "Why do you keep insisting something is wrong?" He claimed the pills made him feel nauseous and made his hair fall out—side effects the doctor had warned him about. Debra didn't know if he was telling the truth, but she did know he stopped the pills within a week. "I'm not taking them," he said. "I'm not bipolar."

Six weeks later, on January 30, Debra's boyfriend, Dave, came home from work shortly before 4 p.m. and found Josh staggering around, rambling incoherently, slurring his words. Dave called Debra, Debra called 911, and Josh spent the next 72 hours in intensive care. That morning, before going to school, he had drunk a poisonous liquid he'd read about on the Internet. It contained the chemical ethylene glycol, and it nearly killed him. A psychologist interviewed Josh while he lay in his hospital bed, and afterward told Debra the boy was upset his suicide attempt had failed.

For more than 40 years, suicide has been part of Debra Graham's family. Suicide claimed the life of her ex-husband's aunt and also killed the boyfriend of one of her own aunts. It nearly took her mother's life, too. When Debra was five, she watched her mother leave home in an ambulance. She had overdosed on aspirin. In Debra's childhood years, depression and suicide were taboo topics, never to be discussed.

After Josh's suicide attempt, he spent six days at the hospital and was then sent to Four Winds, a private mental hospital in Syracuse. Debra decided to clean his bedroom, so he could feel like he was getting a fresh start when he returned home. It took her nearly a week to remove all the food wrappers, soda cans, and empty Hershey's syrup bottles. Evidently, Josh had acquired a new habit: drinking Hershey's syrup.

Josh was released from Four Winds on February 11. The poison had damaged his kidneys, so he could no longer take Depakote. Instead, a doctor gave him Lexapro, an antidepressant. Debra stopped going to her job and began working at home, so she could be there in case Josh made another attempt.

Josh’s mother says her son’s drawings took on a darker tone a few years before his death.
photo: Jay Muhlin

Four Winds had set Josh up with a social worker who belonged to a practice with psychologists. But Josh needed someone who could prescribe medication for him, and so Debra began looking for a psychiatrist. Her search stretched on for weeks. Some doctors never called back. Some said they did not accept her insurance. Some said they were too busy to take on a new patient who required intensive therapy.

Debra wondered if the health insurance system was part of the problem too. In New York State, some insurance companies limit one's access to mental health services, covering only a certain number of visits a year. "Psychiatrists know the insurance business," Debra says. "I think if they knew they weren't limited, I would have stood a much better chance of securing a psychiatrist."

A more likely explanation is that her difficulties stemmed from the acute shortage of psychiatrists who treat adolescents. Waiting lists in central New York can be three or four months long.

Every few days, Debra called Purnima Vyavaharkar, the pediatrician who had treated Josh since he was a baby. Dr. Purnima, as she is known, was not qualified to prescribe his medication. But she understood the gravity of the situation—she had already lost two patients to suicide—and so she tried to help. She visited Josh in the hospital, and she had previously met with him in her office. "I was depressed once, but now I'm fine," he had told her. She was not convinced. "He had a sweet smile," she says, "but he had pain in his eyes."

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