When Depression Kills

Samuel Hegel, the Marinette, Wisc., high school sophomore who held 23 students and a teacher at gunpoint, then released all of them before shooting himself, has died.

Hegel’s tragic story may, as much as anyone’s, demonstrate the fine line between psychiatric disorders and violent behavior. We don’t know whether Hegel suffered with major depression or psychotic thinking, but some of the students he held hostage noted that he seemed depressed and that he didn’t seem to have any clear goal in mind when he brandished two handguns, shot up a film projector, then refused to let them leave their classroom.

The vast, vast majority of those who suffer psychiatric symptoms never hurt anyone. Alcoholics who drive under the influence may be the most dangerous among them. Yet there are those whose darkening moods and delusional thoughts take them to places where their own destruction, or the destruction of others, or both seem to be the only way forward.
I have spoken with enough patients at the threshold of that kind of complete darkness (and more than my share of those who crossed over) to tell you a little bit about how unthinkable violence can come to feel like fate.

When depression takes hold, mood falls, sometimes dramatically, and anxiety levels often rise precipitously. More trouble for one’s state of mind comes as sleep becomes scarce (or excessive) and appetite falls off, triggering physiological changes that accelerate the disease process, making it impossible to concentrate and not infrequently convincing the depressed person that nothing will ever get better—only worse. He will never be able to work, never be able to learn, never have another friend, never have a romance, embarrass himself and his family and be a burden to everyone he once loved. Some depressed people have told me that they look at photos of their children and feel as though they are strangers. They feel utterly, completely alone, as though God has Himself forsaken them.

The subjective sense of pain has been rated on par with cancer pain, such that death seems preferable to suffering any longer. Worse, the mind can break free of rational thought, coming up with completely irrational solutions to such suffering: If I die, I am free. My legacy will not include the horrible disintegration inevitably unfolding in the weeks ahead.

Still worse: Life itself is a curse. I should and will strike out at the toxic comedy that life is by ending the farce for others, as well. Sufferers may even hear voices demanding that they kill others—and believe those voices are real, and that they must obey.

I am one psychiatrist and—even without my work in forensics—I have treated a billionaire with depression who believed he was utterly penniless and wanted to die, a depressed woman who was convinced her son had been kidnapped and replaced by a masquerading double (who she thought she might need to kill), a college student who came to believe that his arms were not his own arms and needed to be severed (which was prevented), a depressed mother who wanted to kill her new baby, and a depressed business professional who was convinced the CIA was pursuing him and would ultimately kill him—if he didn’t kill them first. They all recovered. It took the right medicines and a deep and empathetic exploration of past psychological pain.

Teenagers who become depressed may say they are sad, but they may report feeling anxious or unable to concentrate. They may become isolative. They may withdraw from activities they once found pleasurable. They may also—and here parents and teachers should be extremely worried—become suspicious of others, focused to the point of distraction on thoughts they refuse to share. They may also overtly speak about wanting to die, search the Web for painless methods of suicide or procure weapons.

No parent and no teacher and no friend should be restrained by a fear that he or she is overstepping a boundary or overreacting when concerned that depression may be taking hold of someone. No one should take shelter in the false notion that psychiatric illness cannot visit his home or his town. No one should believe the myth that people who speak of killing themselves or others are just posturing.

In my 20 years practicing psychiatry, I have never had a person suffering with mental illness hold a grudge against a person who acted out of real concern and called that person’s parents, or doctor, or an ER, or 911. Not once.

Here is the truth, as difficult as it is for survivors to read: There are always signs that someone is becoming deeply depressed. Someone close to that individual—and usually several people—know something dark is afoot, and gathering steam. The mental health care system in America is shattered, shoddy and unreliable and requires vigorous lobbying from advocates for the depressed person to get real and comprehensive care. Sadly, 24 hostages were severely traumatized yesterday and Samuel Hengel died today, probably due to a recognizable and treatable mental disorder.

Keith Ablow, MD, is a psychiatrist and member of the Fox News Medical A Team. He is a New York Times best-selling author, and the co-author, with Glenn Beck, of the upcoming book The 7: Seven Wonders That Will Change Your Life.