“They’re just crazy people; I won’t treat them,” a preeminent neurologist recently said to me regarding mentally ill patients. If a neurologist thinks that psychiatry patients are “just crazy people,” what does the rest of the population think? I don’t always agree with many of the systematic categorizations of the DSM-IV. Afterall, it wasn’t that long ago when being a “tom-boy,” or a member of the queer community was considered a diagnosable mental illness, which spurred much discrimination that continues today in the military. One thing I do understand is that “just crazy” is neither a parameter, nor is it a diagnosis anywhere in the DSM-IV. Obviously this neurologist must have been absent that day in medical school when they covered brain disease. Oh wait, doesn’t a neurologist spend a career trying to understand pathology of the brain? The comment really made me angry, having lost my younger brother to suicide just six months ago. Given that 90% of suicides are associated with a verifiable mental illness (according to American Foundation for Suicide Prevention, www.afsp.org), I wonder how a group of survivors of suicide would take it if a famous neurologist walked into their support group and announced that their loved ones were “just crazy people.” Or that their pathologies were not grounded on verifiable brain structure changes or biochemical alterations. The notion that psychiatry is somehow a pseudoscience which just treats “behavior and not discrete pathology,” especially coming from someone who is supposed to have been trained at some point in all factions of neuroscience, strikes me as incredibly ignorant. In fact, it reminds me of the level of ignorance from a nurse I once worked with who refused to treat HIV+ patients because he feared contracting the disease. Before the time of CT and MRI scans, would it have been acceptable for a doctor to tell a patient suffering an acute stroke, exhibiting slurred speech, that he was “just drunk?” Why is it somehow acceptable for a neurologist to label all psychiatric patients as “just crazy?” As a research scientist, the comments bother me because I feel very strongly that since mental illness is still very highly stigmatized, even among the medical community, research to better understand its underlying causes, prevention, and treatment is largely neglected or ignored compared to other diseases that do not affect people with the same frequency as mental illness and suicide. For example, how many people per year die of leukemia? 12,790 in 2007. How many people per year die by suicide? 32,637 in 2005, making it the 11th leading cause of death in the U.S. (8th leading cause for males). Although suicide is over two times more prevalent then Leukemia, whenever I run a road race I see a sea of people wearing the Team in Training Leukemia Society purple fundraising gear. When I go to the store or a restaurant, pamphlets about Race for the Cure for breast cancer, AIDS Ride, and of course, Team in Training wait for me in the storefronts. These are all of course very worthy causes, but who cares about raising funds to fight the suicide epidemic? Since I have been working fastidiously in the lab fighting to find treatments for other diseases, I know how much impact even one investigator can make in a field, and how much it costs to do critical research. What I don’t understand is why we aren’t tackling the suicide/mental illness problem with as much fervency, or if we are, why the suicide rate is still increasing. The fact that the overall NIH budget has been slashed for the fifth year in a row, to an effective decrease of 15% (considering inflation) compared to 5 years ago doesn’t help. However, even if the NIH budget were increased, it seems that suicide prevention research would still be on the low priority list. This stigma, this discrimination, this ignorance, even among medical doctors, must change. When my brother died, all I could think about was “what could I have done?” Now, all I can think about is “what can I do to change this.” So, I’ve decided to apply to medical school to become a doctor. I’ve decided to work to change this. I must do this for my brother and for me. Without the medical degree, my voice will not be as loud as that neurologist’s. We need answers, not restraints and stigmas. The more I can research to understand the causes of suicide, and its prevention, the more people I can help avoid that path. If I can save just one, my journey will not have been in vein. Wish me luck; thanks for reading.

I keep thinking that I see him in other people on the street. I see someone that has his walk, his hairstyle, or the stylish way that he would dress. I stare at them, and I'm sure it freaks the people out. I keep thinking, "I should call Brian and tell him about that thing I just discovered." Then I realize that I can't just call him. Sometimes I think, maybe it's more simple than that. Maybe he's with me, always, and I can just talk to him. He is, and always will be, a huge part of me. We were so much alike. He was my brother, and my best friend.

It's only been a couple of months; I don't know if it get's worse, or better, or both from here. For the first few weeks, all I wanted to do was sleep, it was the only time I wasn't in intense pain. All I could remember of him were those last few days that we shared together. He was visiting me when it happened. He wasn't himself, but I thougth that maybe it was that cocktail of prescription meds that he was on, making him spacy. I was so happy that he was with me; I never bothered to make new friends because he would always come up for a surprise visit, and we would go out dancing, and just hang out having a great time. But, that week, he didn't really want to go out. I remember feeling frustrated that I thought the meds were damping his lively personality. I asked him if he was ok, but he would brush it off. I even broached the subject of suicide two nights before it happened by talking about a movie in which the character debates taking his life after a horrible accident. But, he didn't really say much, he also didn't seem comfortable. I wish that I had asked him if he had ever thought about it, but for some reason, I guess I didn't want to think that he ever had thought of it. He certainly had never hinted about it in any ways that were identifiable signals. I still don't know, and have to accept that I may never know, if he had thought about it before, or if it was a freak panic attack or something, or some combination of both.

I remember as if it was yesterday, the last time I saw him in this lifetime. He had spent the night at my place, crashed out on the couch as he often did. He got really worried that I was going to leave late at night when I went to get my laundry. I thought he was asleep, but he said, "I thought you were leaving." I would never have left him, especially if I knew that he was hurting. We both slept late, and when he woke up, he came to my room and said, "I'm going to get going." I asked if he wanted breakfast. He declined. Then I asked if he wanted to go to our favorite coffee shop, and he said "yeah, that sounds good. Call me when you want to hang out." I called him a couple of times at dinner time, and told him that I was with a friend, but he should join us. I didn't hear back from him, but wasn't worried because I knew he was with his good friend. My phone rang at 11:01 pm. I was in a movie with my friend. I silenced the ring tone, but it would ring again if he left a message. He didn't leave a message, so I figured it wasn't urgent. That was the last call he made. He died a little over a half hour later. I will always regret not picking up my phone. I never would have left him in the cold, in pain, or afraid if I knew that he was there. I am so sorry. That night, after the movie I checked my messages just to make sure, and there were no new messages. I walked my friend to her car and thought, wow, what a beautiful night. The stars were so crisp and bright, the air was so calm. But, for some reason I didn't sleep well.

I woke up the next morning to my phone ringing long before I prefer to get up on a sunday. It was my parents. They were both on the line and said they had something important to tell me. I thougth perhaps my grandfather had passed. Then my mom said, "Brian died." She was crying, but I thought it was a cruel hoax, or bad dream. I couldn't believe it. He had just called me that night. Suddenly, the dark cold realization began to sink in. I was his last lifeline. If only I had realized that his life was that fragile. I felt like someone hit me in the head and the stomach with a baseball bat. It was surreal. I thought about my other brother, who was getting married five days from that day. Then the horror of it all continued when I checked my call history. He had tried to call me seven times starting 10 minutes after I called him for dinner. The only one that rang was the last one in the movie theater. My phone must not have gotten the signal, and didn't ring. For many weeks I couldn't miss a call. I would answer every call from every telemarketer, and wouldn't put my phone down, even when talking to large audiences. I kept hearing my phone ringing over and over in my mind. But, it was too late. I can't stand to think what Brian might have been thinking when I didn't answer any of his calls. But, he never left any messages.

It's been a couple months. I'm still very numb much of the time. I think that might be a good thing perhaps, because I am functional when I need to be. I've been told that most people would not have answered a phone in a movie theater, but I still can't help but wonder what if I had taken the call? How would things be different? I miss him so much in the physical, even though I feel like he's still with me much of the time in subtle beautiful little ways. I'll always love him, and know that he's a part of me on this journey until it's my time to cross the river. It's up to me now to pick up where he left off, to honor him by helping others in any way I can.