It's been 12 years, but Taryn Aiken still hurts. On Oct. 5, 2002, her father Terry Aiken killed himself, ending his agony brought on by chronic pain, prescription-drug addiction, three failed marriages and a lost career, followed by theft, jail and shame. Despite his family confronting him in a desperate intervention, he took his own life at 54 with the prescription drugs that had begun his downhill tumble. It was Terry’s second suicide attempt and his last.

His pain ended, but his family’s anguish had just begun.

“You replay it over and over,” Taryn says of her father’s suicide. “You never get over it.”

Taryn, a lanky brunette, still second guesses herself on having done more for her father. “The only thing I could have done at that point was report him for a parole violation [drug abuse]. But I was his daughter. I couldn’t do it.”

Tears well up in her eyes. “Yep,” she whispers. “I should have done it.”

Taryn herself faces her father’s same demons, but she has grown to recognize it is a hereditary predisposition to depression and addiction. As a teen, she did her own dance with darkness. “I tried to kill myself twice,” she says. “The second time, I was hospitalized and when I woke up, I was pissed because I had lived.”

The Aiken family’s struggle is one tragedy in a growing plague in the American West, where suicide rates have been soaring. In Utah, 2012, 545 Utahns committed suicide, up from 456 in 2011. At 18 suicides per 100,000 over the last decade, Utah jockeys for position with other mountain states but is always in the top 10 for suicides, consistently triple the U.S. average. Yet, in what researchers call the Utah paradox, the state gets high marks for livability and “happiness.” 

Last year, the Utah Department of Health Services belatedly launched a suicide-prevention initiative that included appointing a suicide-prevention “czar,” Kimberly Myers. In her role as suicide prevention coordinator for the DHS, Myers has to change entrenched attitudes about suicide, ignorance and a spectrum of cultural and religious factors that play a role in the high self-inflicted death rate. 

“Everyone is recognizing it’s an interaction of risks,” Myers says. Among the top problems in the rural West is the distances to mental illness facilities and a reluctance to admit weakness. “In small towns, people don’t want to be seen going into mental health clinics to get help.”

Add into the mix abundant firearms ownership. “Guns are very lethal when it comes to suicide,” Myers says. “In Utah, more than half of suicides involve firearms.”

But over and over, the one thing that stands out culturally is the deep shame attached to suicide or even admitting to a struggle with depression.

Taryn Aiken

“My father saw depression as a character flaw. It was a moral issue in our community—’You’re weak,’” Aiken says. “Religion gives people hope, but unfortunately it can be part of the problem. Our culture here is not forgiving and accepting. It’s very judgmental. You’re expected to be perfect and if you aren’t there’s not a lot of tolerance.”

Suicide prevention also runs up against the Legend of the West, recounted in thousands of Western movies. The hero is strong and stoic in the face of personal anguish. To commit suicide is to take “the coward’s way out” or, worse—to punish loved ones. On the flip side, some see suicide as the ultimate libertarian example of personal choice: It’s nobody else’s business how you end your life.

Taryn Aiken says that doesn’t hold true with a person suffering chronic depression. “It’s not that my father wanted to die—he just didn’t know how to live.”

She recalls the loneliness of her own depression within an otherwise close-knit Mormon community. “If I were physically sick, I would be getting casseroles and green jello. But when I’m at home, paralyzed with depression—where’s the casseroles?”

Taryn’s depression wasn’t entirely a genetic predisposition. She was sexually assaulted by a family friend when she was 8, shortly after she was baptized into the LDS Church. “They told me baptism washed me clean of sins. Then I was molested,” she recalls. “I felt so dirty. By age 12, I hated myself.”

After her suicide attempts, Aiken was assigned a counselor. “I needed to learn how to talk. No healthy person sees killing themselves as a solution. I know now that when I have those thoughts—I find help.”

A plan to end the pain 

To change attitudes and throw lifelines to potential suicides, Myers and activists are trying to stitch together a state-wide safety net. The state developed a comprehensive suicide-prevention plan in 2013. “We have had dedicated pockets of prevention throughout the state, but it’s really only been in the last two years that we have come together for a coordinated state effort,” Myers says.

The plan will involve educating the public, with a special emphasis on teens, on how to overcome attitudes about suicide and effectively deal with chronic depression that could lead to suicide. Advocates are also pushing for “a healthcare system that is better able to screen and assist,” potential suicides, Myers says.

Kimberly Myers

But she acknowledges, “It’s one of the tricks of prevention that it’s difficult to measure its effectiveness. There isn’t any one approach to get us there. But we really do think it is going to make a difference.”

In 2013, the state’s ever-climbing suicide rate leveled off a bit at 575, Myers says. “But it’s still more than one a day and that’s really troubling.”

And Taryn Aiken says that the numbers for the fall of 2014 appeared better than the same period in 2013. “We are seeing change, but it’s going to take time,” she says. “I have to keep reminding myself of that.”

A slow thaw

It’s time for the community to get past the taboo of discussing suicide, Aiken says. “Suicide is a choice made by a sick mind. Healthy people never think ending their lives is a solution. Suicides just want the pain to stop. And it’s devastating for a family. It’s a mind fuck. But the person thinks they’re doing their family a favor by dying.”

Taryn recently has been lifted by signs of change in the Mormon culture’s understanding of depression and suicide. At an LDS Conference in 2013, Elder Jeffry R. Holland spoke from the pulpit about his personal struggle with depression. Holland said mental illnesses or emotional disorders “are some of the realities of mortal life, and there should be no more shame in acknowledging them than in acknowledging a battle with high blood pressure or the sudden appearance of a malignant tumor.”

As the mother of two teenagers, hairstylist instructor and a student in social work at Utah Valley University, Aiken accepts her own struggle against depression is ongoing. She finds relief in leading the Utah County chapter of the American Foundation for Suicide Prevention, though the work is a constant reminder of suicide and her father’s death.

“It’s hard to hear about all the death, especially of young people. But I have to live in a solution,” Aiken says. “It’s the only thing that helps.” 

I'm OK; you're at high altitude

Perry Renshaw

What if the West’s high rates of depression and suicide were caused by forces that are as intrinsic to our environment as, well—the mountains?

Utah mental-health workers are finding hope in ground-breaking research being done at the University of Utah’s Brain Institute that connects depression and suicide to living at high altitude. The research, still in its early phases, indicates that a significant factor in the high rates of depression in the West is directly tied to decreased oxygen at higher altitudes. 

In a mind-boggling irony, the mountains and canyons, to which we attribute our vaunted “quality of life,” appear responsible for many of the suicides that plague the West. Researchers are finding that for genetically predisposed people, the higher altitude, the deeper their depression spirals, increasing their risk for suicide.

Researchers are finding even mild oxygen deprivation causes serotonin levels, critical in stabilizing mood, to plummet in many individuals, resulting in higher rates of clinical depression and suicide.

Perry Renshaw, a psychiatrist at the University of Utah’s Brain Center, spreads out two maps. One shows the elevations of counties across the United States—with dark red indicating the highest altitudes. The other map shows the rates of suicide across the nation; again the highest rates are in dark red. The almost perfect overlap of high altitudes and high suicide rates is uncanny. On both maps, the Mountain West and West Virginia are in red. “The effect [of serotonin reduction] increases the risk of suicide by a third beginning at 2,000 feet above sea level,” Renshaw says. “Twenty-five percent of the variation of suicide rates could be explained by altitude alone.”

All the Wasatch Front’s cities are above 4,000 feet. Utah has the third-highest average altitude in the nation at 6,364 feet above sea level and a suicide rate of 18 per 100,000, three times the national average. About 23 million Westerners are in the danger zone, Renshaw says.

The onset of the effect can occur in as little as 24 hours.“Neuro-chemical change can happen quickly. When you’re visiting the mountains, keep in mind your mood may shift,” he says. “At 10,000 feet, for instance, a bi-polar person would be at extreme risk for suicide.”

Research has yet to find out exactly why altitude has this effect on mood, Renshaw says, but “the relationship between altitude and suicide is well established.”

Kimberly Myers, Taryn Aiken and other suicide-prevention activists are following the research closely. “Obviously, you can’t tell people to move to a lower altitude,” Myers says. “But there’s obviously something going on between altitude and depression.” Myers and Renshaw caution that other important factors in suicide, particularly widespread gun ownership, remain.

Fortunately, the research may lead to solutions less drastic than uprooting and moving to the coast. It could change how depression is treated. “It’s a big answer for the Intermountain West,” Renshaw says. “The most prescribed anti-depressant in Utah is the fluoxetine (Prosac) family of drugs. But at altitude it just doesn’t work.” Renshaw hypothesizes that fluoxetine fails because, at altitudes above 2,000 feet, at-risk individuals simply aren’t producing enough serotonin for the fluoxetine to act on. “It might be that doctors should be prescribing a different kind of anti-depressant that isn’t altitude dependent.”

On the other hand, some very preliminary research done by the Brain Institute in conjunction with universities in South Korea has found that serotonin levels can be increased through the use of a common over-the-counter amino acid supplement, L-5-Hydroxytryptophan. Researchers have found that 5-HTP could increase serotonin levels enough for fluoxetine to have a positive effect. “We need money for more research,” Renshaw says. “There’s a lot of exciting work to be done.”

10 warning signs you need to know

1. Talks about wanting to die or being a burden

2. Preoccupation with death or dying

3. Loss of interest in usual activities

4. Extreme mood swings

5. Giving away prized possessions and making arrangements for unfinished business

6. Difficulty with appetite and sleeping too little or too much

7. Taking excessive risks

8. Increased drug use

9. Acting anxious or agitated

10. Withdrawn–isolated

To reduce suicides, Utahns need to change attitudes about chronic depression, learn suicide warning signs, reach out to those who are struggling and when necessary call the prevention hotlines. Utah Crisis Line: 801-587-3000. National Suicide Prevention LifeLine: 800-273-TALK. Counseling is confidential.

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