The college countdown had begun for John Ciarmella. By the fall of 1984, Canisius College had emerged as the top choice, and orientation had gone smoothly, the school counselor said later, with John appearing as optimistic as any other incoming student.
In early November, Ciarmella -- like many of his classmates at Lancaster High School -- took his SATs. On Election Day, he took his life.
"He gave us no warnings; there was no note," recalled Marian Ciarmella, about the death of her youngest son. "But now that I look back, there were signs. He was bored. He decided he didn't want to play football anymore. No wrestling. No skiing. He changed. It was after he died that I found buckets in his closet. I guess he was bulimic, and I did not know that."
Suicide is the third leading cause of death among people ages 15 to 24, claiming more than 5,000 young people each year, according to the National Mental Health Awareness Campaign. About 80 percent of young people facing mental health-care issues do not seek help or even talk about their problems, according to the American Journal of Psychiatry.
To help address this concern, the Mental Health Association of Erie County on Thursday will present a daylong conference, "Uncommon Wisdom for Today's Youth, Parents & Professionals." Featured will be presentations by Ron Taffel, author and family therapist, and Ross Szabo, youth spokesman for National Mental Health Awareness Campaign.
"The teens are a difficult time of life," said Anne Lockwood, psychologist and clinical supervisor of the Outpatient Psychiatry Clinic at Women's and Children's Hospital. "It's very hard to be a teenager, and it certainly hasn't gotten any easier in recent years, when you think about the different stresses, the ways that teens can come to feel that life is not worth struggling with."
The outpatient psychiatry clinic serves children ages 2 to 18 with mental health concerns. Depression, she noted, is a "substantial problem," one that can be difficult to diagnose depending on the age of the child.
"I don't want to say suicide is a mystery," Lockwood said. "But there are many many young people who feel really bad about things in life who do not kill themselves. Most people who are depressed don't kill themselves."
Lockwood said there are not specific signs all parents can look for when it comes to depression and suicide.
"It's good to be aware that people aren't doing very well and that they are feeling pretty down," she said, "but those same signs don't necessarily mean they will kill themselves."
Ross Szabo was 16 when he was diagnosed with bipolar disorder. On some days, the teenager from Nazareth, Pa., was very energetic, wanting to get involved in everything, not feeling the need to even sleep. When Szabo was depressed, he just wanted to lay around. As a senior in high school, he started to feel very lonely.
"I felt like there was no one to talk to, that no one would understand me," Szabo said. "I always thought I could deal with my problems on my own, and if I couldn't, I was weak. I never told anyone what I was thinking."
In November of his senior year, Szabo started thinking about suicide.
"I started thinking about suicide and death 24 hours a day, seven days a week," he recalled. "I was thinking about everyone in my family dying, all my friends dying. I was thinking about taking my life in multiple ways. It built up and I broke down. I wanted to take my own life."
It happened one day in January, as Szabo was going about the business of being a high school senior. During the day, he did not miss a class. At night, he played on the varsity basketball team, even scoring a few points in a winning effort. After the game, he and his friends celebrated at a local restaurant. But on the way home, Szabo decided he didn't want to live anymore.
"When I came home, I walked upstairs to the bathroom, and before anything major happened, my Dad walked by and asked me to come downstairs," Szabo recalled. "We sat in the kitchen and I told him if he didn't take me to the hospital right away, I was going to kill myself. I was admitted to the psychiatric ward that night."
Szabo would be hospitalized for 10 days, and when he returned to school, he recalled being treated like an outcast. One of the largest obstacles to seeking help for emotional struggles, he soon discovered, is the stigma surrounding mental illness.
"Kids were looking at me differently, and a lot of people stopped talking to me," he said. "About two months later, a psychologist came in to talk about mental illness. As he told his stories, everyone started laughing, and I got really angry, stood up and spoke out."
Suffers a relapse
Szabo was 17 when he started speaking on the issues of mental health and stigma. Now 25, the director of youth outreach for the National Mental Health Awareness Campaign figures he has talked to about 70,000 young people across the country. His road has not been an easy one. Szabo admits he has suffered some relapses, one during his freshman year at American University.
"Two months into my freshman year, everything was going great -- B average, playing intramural sports. I was in treatment, and I relapsed," he said, during a phone interview from Denver, where he was speaking at a mental health conference. "I started having manic highs, depressive lows and anger control problems. It got to the point where I had to leave school for one year. I finally graduated with a degree in psychology in May 2002. I never accepted the word 'no' to anything. I just don't respond to it. Life is all about ups and downs. It's when those ups and downs keep you from doing what you normally do that causes concern."
The inability to cope with the "downs" can lead to chronic depression, said one University at Buffalo scholar who is considered an expert on teen suicide.
"It's not the severity of a kid's problem that leads them to kill themselves," said Thomas Frantz, associate professor of counseling psychology at UB. "It's the inability to cope with painful events -- break-ups, divorce, getting cut from the soccer team. As kids grow up, they suffer a lot of losses. They build up ways of coping. If they don't grieve successfully, the pain stays inside and leads to depression.
"Most people who attempt suicide will tell you they didn't want to die, that they wanted the pain to go away," Frantz explained. "They wanted to stop hurting, and they didn't know how. When some last straw comes along -- we call it the trigger -- they can't take it anymore, and they tell themselves they are finally going to do it."
Like many parents who have suffered the loss of a child from suicide, Marian Ciarmella has become involved in a mental health support network. For 17 years, the certified counselor has volunteered for Crisis Services. She also leads a suicide bereavement group at the Life Transitions Center on Harlem Road in Cheektowaga.
"I tell my survivors at the beginning of the meeting they are not responsible for their loved one's death because their sibling or child or spouse would have taken their life no matter what," Ciarmella said. "Something was in them, something you had no control over, and it happens.
"You make it through," she stressed. "But you always have the scar. Your loved one is the first thing you think of in the morning and the last thing at night, and in between you make yourself so darn busy that you don't have time to dwell."