Friend in Need

It was a Sunday morning in May and I was wedged into the cab of a pickup with my roommate, Jessica Ellison, and her younger brother, Matthew. We were on our way to Tyler to attend the funeral of Jason Dion Cutting, Jessica’s best friend, dead by his own hand at the age of 33.

It was a gray, oppressive day with clouds weighting the horizon like sandbags. Jessica and Matt had been chain-smoking since we left Austin. We blew down the highway at 80 mph past the green fields of East Texas while Jessica looked up funeral details on her phone.

That’s when she found Jason’s obituary in the Tyler Morning Telegraph. It wasn’t long. Aside from the usual bits about the deceased’s family—survived by, preceded in death by—there was just one line of ostensibly personal information: “He worked in sales for Nordstrom in Austin and was a Baptist.”

Jessica stared at her phone. “You’ve got to be kidding me,” she said. “A fucking Baptist.” She started laughing, and then we were all laughing almost hysterically.

Funerals are for burying, not exposing, and obituaries are rarely models of muckraking journalism, but this one was in an obscuring league of its own. Jason had been baptized, yes, and he had grown up in the bosom of Dogwood Baptist Church of Athens, Texas, at least until he was 15, when his parents realized he was gay and kicked him out of their home, at which point he’d stopped going to their church. And he had worked at a Nordstrom makeup counter, where he exhibited, according to colleagues, a preternatural ability to treat faces as canvasses. He’d applied that talent to paper as well, creating charcoal and pastel drawings of frightening beauty: Biblical scenes, humans turned into animals, and Sunday-morning aftermaths of Saturday-night orgies.

But the fact that was least exposed at Jason’s funeral, and afterward, was his mental illness. Jason had long before been diagnosed with bipolar disorder. He was prone to alternating periods of mania and terrifying blackness. For most of his life he struggled to keep himself afloat. One Friday night in May 2014, Jason kicked his boyfriend out of his East Austin studio apartment, turned his phone to silent, and hanged himself with a belt.

When a person commits suicide, the act imbues the rest of his or her life with uneasy significance. Friends can’t help trying to figure out what happened, what might have been done. The questions are as irresistible as they are unanswerable. Driving to Tyler, angry and grieving, we blamed his family, we blamed the Baptist Church, we blamed the people of East Texas. In more forgiving moments we blamed the chemistry of his brain.

But I’ve since come to think we had it wrong. In the months since Jason died I’ve kept coming back to that obituary, a life of struggle and torment and little sparks of resilience reduced to one bland line: “He worked in sales for Nordstrom in Austin and was a Baptist.”

I read that line as a near perfect distillation of the confusion and obfuscation with which American society deals with depression and other forms of mental illness, reinforcing the isolation that is one of the most painful symptoms of mental illness.

The tragedy of Jason’s life and death was not a matter of mental illness or trauma or bad relationships, though all of that was in the mix. The tragedy is that he lived in a society that left him to deal with it alone.

Silence and Shame

There is a shameful paradox to depression: It is common and it is treatable, and yet many depressed people will never get treatment.

In any given year, more than one in six Americans will suffer from an anxiety disorder, and one in 10 will suffer from major depression. And it isn’t just Americans. According to the World Health Organization, depression is the foremost cause of disability worldwide, afflicting some 350 million people and contributing to an unknown percentage of almost 1 million suicides a year.

It’s clear, too, that effective interventions exist. According to the Centers for Disease Control, “Most adults see an improvement in their symptoms when treated with antidepressant drugs, psychotherapy, or a combination of both. Unfortunately, many never seek treatment.” A 2009 Johns Hopkins study found that about one-third of people who experience depression simply don’t get help.

It’s become a tired trope to note the stigma attached to mental illness, or to describe depression as a hidden ailment, but it’s tired because it’s true. About the only time there’s a public conversation about depression or mental health is when a famous person, like Robin Williams, kills himself or a disturbed gunman unleashes mass murder on a school. Then we can expect a brief national stock-taking by which we’re all reminded of the issue’s prevalence and the limited scope of mental health coverage in this country. And then everything goes back to normal.

Depression is the foremost cause of disability worldwide, afflicting some 350 million people and contributing  to an unknown percentage of almost 1 million suicides a year.

But aside from such infamous incidents, the suicides of ordinary people are still too often regarded as cause for silence and shame. In November, a University of Houston student killed himself in the dorm where a professor, Temple Northup, was living. Northup found out by way of rumor. The university made no public acknowledgement of the death. The local news was silent. In an article in the Houston Chronicle, Northup noted that suicide is the second-leading cause of death among college students and that one in 10 students reported having considered it. “The question, then,” he asks, “is what can be done. The answer is complex, yet contains what should be an easy first step: Talk about it.”

Silence comes at a price. Taboos about depression and suicide can isolate sufferers further, and that’s a big deal, because much of the pain of depression comes from isolation. In the 1990s, psychologist Roy Baumeister laid out a map of the progression of suicidal thoughts that looks like a road passing through many gates, with death at the end. In his Psychological Review article “Suicide as Escape from Self,” Baumeister describes how depressed people can arrive at the idea of suicide without even being aware they were considering it, how their thinking can change incrementally until they arrive at a point at which their very self has become loathsome to them. Once you get to that point, psychologist Jesse Bering wrote in Scientific American, “keeping a suicidal person from completing the act may be as futile as encouraging someone at the very peak of sexual excitement to please kindly refrain from having an orgasm.”

Baumeister’s theory is one of progressive isolation, in which the depressed person feels more and more cut off from society. First comes the feeling that one has fallen short of one’s standards. After that feeling of failure comes its corollary: fault. Bering describes this stage as the suicidal person’s belief that he or she is “enduringly undesirable; there is no hope for change and the core self is perceived as being rotten.” And then the torture starts, a “ceaseless and unforgiving comparison with a preferred self—perhaps an irrecoverable self from a happier past or a goal self that is now seen as impossible to achieve in light of recent events.”

Next come long periods of anxiety or depression. Time seems to telescope; temporary unhappiness and emotional pain seem eternal. Finally comes the “disinhibition” required to do the hard work of killing oneself.

One of the insidious things about depression is that it robs sufferers of the ability to view their lives rationally—it just seems like everything is awful. One of Baumeister’s key points is that the suicidal person is often unaware that her thinking has become progressively distorted, that she has in fact become “suicidal.”

What they don’t say is that if you aren’t already teetering on the verge of killing yourself, you’ll have to buy your way out with expensive medication and therapy. That’s a problem, because depression is disproportionately a disease of the poor.

All of this happens in the context of a culture focused on keeping up appearances, keeping it together. A culture in which, as Northup found, it’s not acceptable to talk about suicide or suicidal feelings.

“Depression is a disease of loneliness,” writes Andrew Solomon, author of The Noonday Demon: An Atlas of Depression, the landmark popular work on the subject. Depression, Solomon writes, “saps the vitality that friendship requires and immures its victims in an impenetrable sheath.” When we don’t talk about the clinical depression that millions of Americans feel, we make that isolation worse.

Our reluctance to talk about mental illness and suicide reflects another aspect of the problem: money.

The loneliness that Solomon describes can sometimes be broken, progress down Baumeister’s road halted. One of the most effective strategies, not surprisingly, is access to community, starting with the tiny societies represented by support groups and therapy sessions.

We know this, of course. Every article about suicide and every public-service TV spot reminds the depressed and suicidal that help is available.

What they don’t say is that if you aren’t already teetering on the verge of killing yourself, you’ll have to buy your way out with expensive medication and therapy. That’s a problem, because depression is disproportionately a disease of the poor, who are twice as likely as the well-off to report it. Quality mental health care is simply out of reach for most of America’s working poor and even much of the middle class.

Mental health care can’t save everyone, and it is by no means clear that treatment could have saved Jason. What is clear is that it’s an option he could never have afforded.

A Youth of Escalating Crises

It is difficult to write Jason’s early history now because almost everyone who experienced it firsthand—Jason, his parents, grandfather—is dead. All that’s left is the testimony of friends. And that testimony reveals someone who struggled with mental illness all his life and was never adequately treated for it. Incidents that would have been problems for other people were crises for Jason.

Start with his parents kicking him out of their house. According to what Jason told Jessica, his father was a drunk, “a mean, loud man” who hit him. In his mid-teens his parents took him to a psychiatrist—whether because he was gay or because he was prone to crying outbursts, or both, it’s no longer possible to know. The psychiatrist gave him antidepressants, and one day Jason took all of them. His father and stepmother found him in the shower, still breathing. It wasn’t long afterward that they kicked him out.

That exclusion was immensely painful for Jason, according to Kristen Jackson, Jason’s close friend since high school and his high school prom date, and it pretty much set the tone for his subsequent family and romantic relationships. “He was often searching for something unattainable,” Kristen told me, “pushing, wanting more from others than they could give him at the moment.” After his parents evicted him, he moved in with his grandparents in Ben Wheeler, and in 1999 he met Jessica at Tyler Junior College. The next year the two drove out to visit friends in Brownsboro, smoking joints and listening to Paul Simon’s Graceland on the way. A cop pulled them over, found a roach in the ashtray, and threw them both in jail for the weekend. For Jessica, this was the occasion for a lecture from her parents; for Jason it led to getting kicked out of his grandparents’ house.

Writing about Baumeister’s theory, the psychologist Jesse Bering notes that isolation, and the corresponding risk of suicide, is particularly high for gay men and women who, like Jason, “grow up gestating in a social womb filled with messages … that they are essentially lesser human beings.”

The tragedy of Jason’s life and death was not a matter of mental illness or trauma or bad relationships, though all of that was in the mix. The tragedy is that he lived in a society that left him to deal with it alone.

Throughout his later life it was clear to Jason that being gay played a big role in his exile. “He felt like he was fated to be unhappy because he was gay,” Jessica said. “He would joke about it all the time. He would say, ‘Oh, look at us, you can see why we’re unhappy.’” He would joke, too, that maybe in middle age he would start dating women, become a pastor. “He was always looking for a spirituality that didn’t leave him out.”

He marked his struggle on his body. Toward the end of his life he covered himself in tattoos—a cross on his neck, the chemical symbol for sulfur, the end of the Lord’s Prayer: “For the kingdom, the power, and the glory are yours forevermore.” Across the top of his ass, in big gothic letters, “FAGGOT.” And then his last tattoo: a heart with the word “Daddy” inside. His next one, according to Jessica, was going to be a dogwood tree, the symbol of his parents’ church.

All this was heavy and dark, yet Jason had a real light as well. After he died we went through his paintings, some of which were delicate and airy. Kristen told me a story about when she and Jason were in high school, sitting in an Olive Garden watching some man yelling and slamming silverware for some long-forgotten reason. “And Jason started singing, there in the middle of the restaurant, ‘what the world needs now is love, sweet love,’ and the whole restaurant just lost it laughing.”

In his mid-20s he seemed to level out. He had a boyfriend, and was accepted into art school in Austin. He stopped talking about killing himself. For four years he seemed, if not happy, at least stable.

Then, with stunning speed, it all fell apart. His boyfriend lost his job; they started fighting and finally broke up. Jason lost his loans and had to drop out of art school. Breakups and financial distress are both risk factors for major depression, and Jason dealt with the stress with drugs, partying and anonymous sex. He fell in with a new guy who talked seductively about a suicide pact. One weekend in October 2013, Jessica was in New Orleans when she got a call from this new boyfriend telling her that Jason was in Brackenridge hospital in Austin. He had cut his wrists, but not deeply enough to kill himself. A friend had taken him to the hospital.

“It took forever, but I finally got on the phone with him,” Jessica told me. “He told me that he had just woken up that morning and it had hurt so bad and he couldn’t keep going. That he tried to cut his wrists but it was too painful. He tried to hang himself but he couldn’t figure it out.

“He felt awful, like, ‘I can’t even kill myself right.’”

A suicide attempt is when society’s mental health resources are supposed to kick in. If ever there were a time for intervention, this was it. For Jason, the intervention looked like this: Brackenridge patched him up and released him with a $3,000 bill for his hospital stay, which threw him into a panic. The doctors told him he needed psychiatric drugs, but to get them he’d have to go to Austin’s Psychiatric Emergency Services clinic.

Psychiatric Emergency Services is a low-slung building tucked behind I-35 on East Avenue where Austin’s indigent and mentally ill go for treatment.

Jason didn’t want to go, but Jessica pushed him. “I said, ‘I don’t really believe in pharmaceuticals in most cases. You need therapy. But right now you need medication, too.’” So they went and they sat for six hours in a tiny waiting room, waiting for the care that she hoped would save him.

“He never had the tools to be able to try.”

There are few things more clichéd in a story about depression than a writer who writes about his own. But since Jason died I’ve been unable to help holding up a mirror to my own life. A few years before he did, I also had ended up at Psychiatric Emergency Services in crisis.

I suffered nothing like Jason’s kind of trauma. My family was supportive and loving, my childhood mostly happy. But when I was 18, soon after I got to the University of Texas, I began experiencing anxiety attacks that left me sitting on my bed gasping like a fish out of water, barely able to breathe. Everything became terrifying: the prospect of writing a paper, a new relationship with a girl who wasn’t Jewish, a summer job writing for a newspaper in Israel. The pressures were not inherently huge, but that didn’t seem to matter. I wasn’t suicidal, but if Baumeister’s road to suicide is a path punctuated by gateways, I was loitering near an early one.

Two things pulled me through. First, my parents were there, urging me to get help. There have been three suicides in my mother’s immediate family, and I think they recognized something that scared them.

Second, and equally important, my family had money. During my first year at UT, I had access to mental health services through the university health center. After my allotment of health center sessions ran out, I was able to see a very good therapist and a very good psychiatrist, thanks to my parents’ expensive health insurance plan. The cost of such care, at retail prices, would have run into the tens of thousands of dollars; for me it was basically free. When the psychiatrist prescribed antidepressants, that cost was covered as well. I stabilized. I went back off antidepressants.

The Pristiq cost $300 a month without insurance, the psychiatrist $150 for our biweekly sessions, the therapist $120 weekly. If I had not had insurance, it would have been impossible. I would not have received treatment.

Obviously, mental health is complex and care doesn’t save everyone. But quality care provided the tools I needed to survive. And I know the difference, because it was around the time that I lost my insurance that everything fell apart. I graduated in 2010, which, in that pre-Obamacare era, meant I lost my insurance. That same year I broke up with my girlfriend of four years and fell into a depression that felt like it had no bottom. I was a struggling freelance writer, just starting out, and retail mental health services were far beyond my grasp. After one particularly bad night, my parents convinced me to go to the Psychiatric Emergency Services. It was the only option I could afford.

I have never seen anything like that place, before or since. The waiting room was painted institutional beige and contained a square of chairs facing each other. Each chair was full and the clientele was edgy. I canvassed the room and found that many were recently out of jail or institutions. People yelled and wailed and talked manically. One young man with a scraggly beard and wild eyes stalked back and forth across the room demanding to know where God was so that he could shoot Him like He deserved. The place would have been tense for a Zen master, and none of us were Zen masters. In the hours I waited there—there was only one doctor on duty—I saw several fights. I would have walked out, but my mom kept calling me, pleading with me to stay. It was excruciating—and I wasn’t recovering from a suicide attempt.

I stayed for close to eight hours and finally met with a doctor who gave me a prescription for Wellbutrin and a package of over-the-counter cold medicine for my anxiety. We did not discuss therapy. I would not have been able to afford it in any case.

I spent the next few months living with anxiety and depression in something resembling the way poor people do. I was on the phone with my parents every day. I finally found a decent counselor, a student therapist at Waterloo Counseling Center in Austin, who gave me sessions at $20 apiece. But things didn’t really get better until the Affordable Care Act let me go back on my parents’ insurance. I was able to start seeing a cognitive behavioral therapist and a psychiatrist. I went on a new designer antidepressant called Pristiq.

The Pristiq cost $300 a month without insurance, the psychiatrist $150 for our biweekly sessions, the therapist $120 to meet weekly. If I had not had insurance, it would have been impossible. I could not have paid it and I would not have received treatment.

This is a common dilemma faced by sufferers of mental illness. Jason had tried to get help when he moved to Austin—he saw a therapist for a while—but it was too expensive and too difficult to get to without a car. So he stopped going.

Writing in The Guardian last summer, shortly after Robin Williams’ suicide, Andrew Solomon cited stats from the Royal College of Psychiatrists suggesting that two-thirds of depressed Britons will get no treatment at all, a circumstance that would “never be tolerated in response to a physical illness.”

Treating mental illness is expensive, Solomon concedes, but so is not treating it: “People who cannot function end up on the dole; parents may not be able to take care of their children; men and women too depressed to sustain their physical health could develop serious conditions that cost … a great deal.”

Jason’s is a worst-case scenario. “I don’t know if [his suicide] could have been stopped,” Jessica said, “but I know he never had the tools to be able to try. And if they were ever there they certainly weren’t easily accessible, especially in the state he was in. The system is just a labyrinth. It was difficult for me to figure out, much less someone in the throes of depression.”

“He isn’t there anymore.”

Nonetheless, Jason seemed to be getting better after he emerged from the hospital in 2013. He was pale and shaky at first, but color gradually returned to his face. I remember him coming over to the house that Jessica and I shared that Christmas for a party composed entirely of gay men, Jews and single moms. He had a new boyfriend by then, a sweet guy named Damon. On Christmas Day they ran off into the woods behind the house and cut down a wiry sapling. We propped it up in the middle of the living room and decorated it with bric-a-brac. At the end of the night, at Jason’s insistence, we took it outside and burned it. We wrote little notes about things that had happened to us the previous year, things to let go of, and dropped them into the flames. That was Jason’s idea too.

The end came as a surprise. Some suicides are premeditated and some are undertaken on the spur of the moment, like crimes of passion.

The end came as a surprise. Some suicides are premeditated and some are undertaken on the spur of the moment, like crimes of passion. One of the heartbreaking things about Jason’s death is that it is impossible to know whether he had been planning it or just had a very bad day.

His open-casket service was held at Tyler’s Burks-Walker-Tippit funeral home. A slideshow projected over the casket showed Jason as a boy playing in the dirt, Jason at his prom, Jason at Jessica’s wedding in a fire-engine-red suit. The congregation was half East Texas Baptists, half Austin freaks. Jason’s fellow makeup-counter employees from Nordstrom attended dressed to the nines, all in black like a witches’ coven. We were looking for catharsis and the shared mourning of a community united in grief.

Jason’s former youth pastor, Heath Peloquin, presided over the service. He did not talk about suicide or mental health or the importance of fellowship. He spoke instead about how his “good friend Jason” would want us to know about Jesus, as Jason had known Jesus, and how Jason was waiting for us in heaven. Then, looking out over the Austin side of the room, he said, “Now, maybe some of you out there haven’t heard this before, about this guy Jesus. Now, everyone close your eyes. If you hear all this and you think, maybe it’s time to turn my life over, just raise your hand. No one’s looking but me. Anyone? Anyone?”

The room remained silent, the hands unraised. Beside me, Jessica and her family glared at the pastor so hard their eyes seemed incandescent. At the pulpit, Peloquin nodded, more in disappointment than surprise, and said, “Well, all right, if you change your mind after the service, you can come talk to me.”

After the service there was a long interlude of contemporary country music playing over the loudspeakers. Kristen Jackson, Jason’s high school friend, came up to us in tears. “What happened to him?” she asked. “No one will tell me.”

Before we filed out, Jessica and I walked up to take a last look at Jason. He was wearing a suit. Jessica shook her head, almost in wonder. “He isn’t there anymore,” she said. “I thought he would be there, but he’s gone away.”

We collected our things and drove back to Austin, alone again to ponder the pain of his absence, or to seek such assistance as we could afford.