The face of David Reeher is ageless. And like the man behind the face, it is marked with a history of savage grief and unspeakable pain.
But a closer look reveals hope, acceptance and newfound joy. David Reeher's face, in spite of its scars, reflects the newness of life this Widefield man has just begun to experience after a lifetime of profound depression and severe mood swings.
Reeher, 33, suffers from bipolar disorder, a fact he just began to understand a month after the March, 2000 day when he placed a 30.06 rifle under his chin, aimed it at his brain and fired.
"When I pulled the trigger that day," said Reeher, "I had 32 years of preparation. That morning, the only thing that I felt was total and complete pain. Total despair. When I pulled the trigger, waking up was not at all in my plans."
The bullet shattered his jaw and eviscerated most of the inside of his mouth, then ricocheted off the side of his nose to his eye socket, which also shattered. It did not enter his brain, as planned.
A month later, Reeher woke up in Penrose hospital where, finally, with the help of a therapist, he came face to face with the monster that had plagued him since early childhood -- depression and bipolar disorder. He was put on Effexor, a drug used to treat severe depression, and began to put his life back together with the help of family and personal therapy, a concerted effort to gather knowledge of his disease and a commitment to remaining on medication.
Over the last month, the Independent conducted a series of interviews with Reeher, by e-mail initially because he recently underwent another bout of reconstructive surgery rendering him unable to speak, then, face to face. (Reeher has undergone more than 60 hours of reconstructive surgery since his suicide attempt.)
In those interviews, Reeher described the burden of a life lived in secrecy and isolation and the tremendous relief of finally knowing what's wrong with him. His story, dramatic as it may seem, echoes the despair of millions of Americans with bipolar disorder, many of whom, like Reeher, were not diagnosed until adulthood even though they endured obvious symptoms throughout childhood and adolescence.
Unfortunately, many have not lived to tell the story.
The hidden diagnosis
The Surgeon General's Report on Mental Health, released in December, 1999 by U.S. Surgeon General David Satcher, indicated that approximately 9 percent to 13 percent of children ages 9 to 17 have a serious emotional disturbance with substantial functional impairment, and 5 percent to 9 percent have a serious emotional disturbance with extreme functional impairment due to a mental illness.
The report further concluded that while about one in five Americans has a mental disorder, and while a range of effective, well-documented treatments exist for most mental disorders, more than half of Americans affected never seek treatment.
Many health care professionals cite both childhood depression and suicide as epidemics in the United States, and most believe that too many cases of childhood and adolescent mental illness go undiagnosed and thereby untreated.
And some untreated depressed children, like David Reeher, act out suicide attempts secretly throughout childhood.
"There is no doubt that I was depressed as a child," said Reeher. "I can trace memories of wanting to die all the way back to the age of 6 or 7 years old. I used to put fake guns to my head wishing that I was never born."
Reeher describes his childhood, during which he moved from Pennsylvania to Arizona and, finally, to Colorado, suffering unnoticed with depression, as "a very dark existence."
"Growing up this way, I figured it was just me, " he said. "I thought that life was the same for everyone, only I just couldn't handle it. The older I got, the more serious I got about suicide. I started putting real guns to my head around the age of 8 or 9. I would sit there with the gun to my head with my eyes closed, squeezing them, wanting to pull the trigger but I just didn't have the courage to do it."
"I was a very moody child, but I was also very introverted," Reeher said. "People say I was shy, but that is a major understatement. My mind was constantly running like a train at high speed that would not stop. I was always thinking 'what is wrong with me?'"
While childhood depression is far more frequently acknowledged now than when Reeher was a child, many factors complicate and obscure the picture of childhood depression and diagnosis of bipolar disorder in children, even now. For instance, a diagnosis of ADHD (Attention Defecit with Hyperactivity Disorder) or depression might mask or foreshadow the presence of bipolar disorder.
ADHD, commonly treated with the stimulant Ritalin, is sometimes a precursor to early-onset bipolar disorder. And according to the Child and Adolescent Bipolar Foundation, parents should be alert to signals of depression or bipolar disorder in their ADHD kids since taking a stimulant can send such a child into a manic state, the severe upward mood swing that counters depression.
Additionally, the American Academy of Child and Adolescent Psychiatry reports that up to one-third of the 3.4 million children and adolescents with depression in the United States may actually be experiencing the early onset of bipolar disorder, and that prescribing a common antidepressant may also exacerbate the onset of mania in children.
Meanwhile, child and adolescent psychopharmacology lags behind approved treatments for depression and bipolar disorder in adults. Although the FDA has not approved commonly used adult antidepressants for children, doctors can prescribe them and must, because there are no alternatives. Antidepressants designed specifically to meet the neurological needs of children have yet to be developed.
Family involvement is key
The vigilance of family is the key ingredient to finding help for depressed and bipolar children, the surgeon general's report asserts. But often, the report continues, lack of insurance coverage and fear of the stigma attached to mental illness impede their involvement.
In David Reeher's case, his family was simply unaware and too wrapped up in their own problems to pay attention to his depression, a fact that his father, Harry, openly admits today.
Reeher's parents were enmeshed in marital turmoil, and father and son agree that David's symptoms were basically ignored and went unrecognized by his family until his suicide attempt last year. Still, there were plenty of signs.
At around age 10, Reeher developed a chronic neck spasm that eventually set his entire head shaking, which he believes was a result of pent-up stress. His parents took him to a chiropractor eventually, to get his neck cracked, but they did not connect the physical symptom with the possibility of depression.
"My family history played a very big role in my failure to deal with depression," said Reeher. "There was a lot of hate and anger growing up, and a lot of isolation."
Often, the onset of depression or bi- polar disorder in kids can be triggered by traumatic events such as the loss of a parent or abuse in the family. David Reeher cannot remember the initial onset of his disease, but he remembers many instances of wishing to escape the volatile conditions of his family life.
Harry admits his ignorance of what was going on with David.
"Out of the three kids from my first marriage, I thought, 'This kid's got it made,'" said Harry, referring to David's hard work and early working success as a truck driver and heavy machine operator after dropping out of high school. On a more somber note, he added, "I was one of those dumb, blind parents, going through life trying to make a living to support my family.
"It's very sad. There's never once I sat down and said, 'How's things going? Is everything OK?'" Harry was oblivious to the possibility of childhood depression or bipolar disorder. "I never heard anything about [bipolar disorder] until this happened to Dave," he said.
During the years of David Reeher's childhood and adolescence, depression in children was rarely if ever acknowledged. And as recently as 10 years ago, childhood diagnoses of bipolar disorder and depression were rare. Teachers, parents and children alike were in the dark when symptoms cropped up that couldn't be explained except as "bad" or "weird" behavior.
Mental health professionals disagreed on whether children could actually be depressed or bipolar until recently, but that outlook has changed significantly in the last decade.
The surgeon general and a majority of mental health professionals agree that top and urgent priority needs to be given to early diagnosis of depression and bipolar disorder, but resources, including the number of doctors trained to treat the disorders, are scarce. Insurance plans sometimes will not cover the diagnosis or treatment of mood disturbances, and childhood mental illness still carries a powerful stigma.
Parents fear being honest with school teachers and administrators, and children are often labeled as troublemakers because their condition is not known or understood.
"When people understand that mental disorders are not the result of moral failings or limited will power, but are legitimate illnesses that are responsive to specific treatments, much of the negative stereotyping may dissipate," said Surgeon General Satcher in his Report on Mental Health.
The teenage years
Childhood depression and bipolar disorder eventually carry over to the teenage years where the conditions do not go away but are exacerbated by the physical and emotional complications of puberty.
And in the teenage years, the risk of suicide increases.
A comprehensive study of child fatality conducted by the El Paso County Department of Public Health (Child Fatality Review Committee Report, 1990-1994) reports that during the time period under study, 110 kids 10 to 16 years of age committed suicide, 74.5 percent of them males. By age 15 to 16, the study showed, the number of suicides was three times higher than at age ten. Of firearms-related fatalities in El Paso County at that time, 12.4 percent were accidental, 38 percent were homicidal, and 47.4 percent were the result of suicide. Of those who succeeded at taking their lives, 82.5 percent were males.
When he was 15, like many kids who do not know the reason they are so miserable and maladjusted in school, David Reeher dropped out.
"When I was 15, I stole $50 out of my brother's wallet and drove to Castle Rock to run away," said Reeher. "My parents didn't even know until I called. The night before, I was home all alone and I had two shotguns that my grandfather had passed down to us. I was sticking those guns to my head almost every day, and the sad thing was my parents didn't have a single clue about it. I dropped out of school that same year."
"We lived in the foothills of Palmer Lake, right on the mountain. That was the winter that my parents divorced. I used to run up to a special place I had. I stole a saw from my father and I started to cut down trees to build my own log cabin to live in. I used to run to the same spot crying so bad that I couldn't see in the middle of winter with three or four feet of snow, just shoes and pants on. No shirt or nothing. I did it to punish myself because God obviously hated me. These were probably the worst years of my life. No one knew I existed."
Feelings of isolation and anxiety, normal and familiar to most teenagers, can be amplified to an extreme in the bipolar or depressed teenager. And normal adolescent experiences, like the development of significant relationships, can become nightmares when rejection, due to misunderstanding or just the normal course of growing up, occurs.
Kris Fronk, head of the local Parents of Bipolar Children Support Group, emphasizes the critical importance of early diagnosis of bipolar disorder.
"Unfortunately," Fronk observed, "adult criteria are often used to diagnose children and adolescents, when their symptoms are unique; their brains function differently than adults."
"If someone like David had been diagnosed at an early age, his depression may not have become so severe."
All grown up and nowhere to go
As alarming as the statistics on suicide in the teenage years are (suicide rates for kids have tripled since 1962), young adults who go undiagnosed and untreated are in even more danger.
The El Paso County child fatality study goes on to report that "suicide rates are generally twice as great among persons 20 to 24 years old as among 15 to 19 years old."
A study conducted by the Oregon Research Institute found that, out of a control group of 274 teenagers, 25 percent of those with overlooked mental illness experienced another bout of major depression as young adults. Another 25 percent experienced serious substance abuse, anxiety and eating disorders. Only one-fourth were free of illness by age 24.
David Reeher's young adulthood was marked by incredible successes during his manic phases and terrible lows when he became depressed. Reeher became a truck driver, but eventually had to leave life on the road because it aggravated his symptoms, even though he did not understand the nature of his illness.
"When I came off the road truck driving, I was experiencing a high," he explained. "I was talking so fast that I could barely understand myself. My mind was racing."
"The mania was more common in the summer months for me. If I could feel like I feel with the highs the rest of my life, that would be great."
But Reeher's manic phases, as with most bipolar disorder, were inevitably followed by depression.
"The only problem with mania is that the sudden falls into major depression always come after."
Reeher alternated between bouts of reckless, dare-devil behavior like driving down Academy Boulevard at 100 miles per hour and unsuccessful suicide attempts with drugs. Eventually, a girlfriend suggested that he seek treatment. He saw a psychiatrist who, he says, spent 10 minutes with him and prescribed Zoloft, an anti-depressant that sent him into such a manic upswing that he soon stopped taking the drug altogether.
Eventually Reeher, who had lost a house, most of his possessions and most of his friends due to depression, decided to end his life with the assistance of a gun.
But he did not succeed.
"At first, I was mad I didn't die," he said. "It was like, why am I still here?" Reeher's injuries were so severe that he lay in a hospital bed, unconscious, for four weeks. The paramedics who had found him in his apartment came back again and again to check on him, amazed at his survival.
But when he finally began to understand what was going on, with the help of a Penrose therapist, Reeher embraced the possibility of a normal life with ongoing medication and therapy. He entered therapy, and his father willingly joined him.
"[My father] and I had a lot of issues we had to work our way through," said David. "He allowed me to go through all the anger -- to get it out."
Harry Reeher says he had one prayer as he raced to the hospital when he got the call about David's suicide attempt: "Don't let him die. The rest is up to me."
"It's amazing what the truth can do," said Harry, referring to the past year with his son.
David, too, embraces the power of truth-telling, and both father and son have learned all they can about bipolar disorder.
"It made my whole life make sense," he said, referring to the many testimonies he has heard from others with bipolar disorder. "It answered so many things going on in my head.
"It's the same as coming down with heart disease or any sickness," said Harry. "[Bipolar disorder] is not a dirty thing to be kept a secret."
His son confesses that sometimes he misses his old friend and constant companion, depression, because it was "the only thing in life that was a constant." His new life is unfamiliar and frightening, but full of promise.
Regarding his injuries and his scarred face, Reeher is circumspect.
"I wish I wasn't this way," he said, "but if I had to go back ... no way. Unh-uh. No way."
"I believe that I am alive today only because that's what God wanted. If I can stop just one person from going where I've had to go, then all that I've been through is absolutely worth it."
"I look at society and it breaks my heart ... a million kids like me," he said, adding, "I often wonder how did I live 32 years of my life and never know anyone who was bi-polar?"