Latina teen suicide: opening parents’ eyes

By Claudia Kolker

Candelaria Castillo had seen misery close up − trudging through Honduran streets selling rice and beans, piecing fabric scraps together to earn money for her parents.  But four years ago, when her teen daughter walked into their Houston living room with wrists bundled in bandages, the 49-year-old mother didn't understand what she was seeing.

"I said, 'What's happened to your hands?' " recalled Castillo, whose name has been changed here for confidentiality. "She told me she scraped them playing basketball. I knew that wasn't true. But I didn't think − I don't know if I think so now − that she wanted to kill herself."

School counselors who saw the girl's wrists had no such doubts. They sent her for medical evaluation, where doctors determined she was seriously ill: with bipolar disease. Not every suicidal girl suffers from such serious, chronic disorder. Yet Castillo's bewilderment and lack of education about her daughter's behavior echoes in many Hispanic families, Latino mental health workers say.

This bewilderment is particularly dangerous because Latina girls are about 30% more likely than their peers to try to end their lives. Researchers don't know why this is, and the first major study on the topic is in only its second year. But a few clues suggest the factors at work. 

First -- and regardless of ethnicity -- suicide attempts reflect a certain measure of mental Illness that requires help beyond the scope of the family, says Dr. Sylvia Muzquiz, a Houston psychiatrist who has worked closely with Latinas. 

For decades, doctors also have noted a pattern of "ataques de nervios" including palpitations, fainting, even convulsions, among some Hispanic women.  Research suggests there is a genetic component to these anxiety attacks, Muzquiz says. Depressed Latina girls, she thinks, may be experiencing another form of the same symptoms. "Anxiety and depression are two different disorders, but their symptoms overlap," Muzquiz says.

Hispanic family structure can aggravate these girls' fragility. Parents often don't recognize suicidal behavior -- or even the significance of attempted suicide. In English-speaking culture, the topic of suicide launches medical conferences, surgeon generals' advisories and TV specials. But for non-English, little-educated parents such as Castillo, these sources might as well not exist.

"They're very isolated," says Norma Westurn, the Brazilian-born director of a Latino health clinic in Dallas. "The unit for Latinos is the nuclear family. They don't search for help outside that border. We think, as parents, if our child doesn’t fit the norm, that's our fault. We don't share with anybody, don't get guidance. By the time you look for help, it's too late."

Until Castillo came to this country 16 years ago, she says, she never felt depression or knew anyone who tried suicide. True, she had faced terrible adversity: a sexual predator of a stepfather, a mother so crushed by spousal violence that she rarely left home. But Castillo responded by fighting to survive.

Fleeing alone to the United States, she married, had children, started her own, tiny business.

"I gather old clothes, little trinkets and toys, and wash and resell them," she said. Then, four years ago, everything fell apart. Her husband abandoned the family, vandals burned the garage where she stored her wares. Castillo's then-12-year-old daughter Sarita -- a pseudonym because the girl is a minor -- began to run away or spend her days crying.

Her mother did all she knew to help. "She blamed her father for her depression," Castillo said, jumbling her words in her haste to explain her efforts. "I told her, 'Don't blame your father. It's up to you to overcome it.' " But Sarita got more and more uncontrollable.

Alone, in a crumbling bungalow on Houston's east side, Castillo felt overwhelmed. She sold clothes on sidewalks; at home, she struggled to manage a toddler son and her middle daughter, who is blind and developmentally delayed.

Then there was Sarita. Only 12 years old, the girl kept demanding freedom to be with her friends. When it was denied, she said she wanted to die.

"She said it several times," Candelaria Castillo recalled. "I told her, ‘Don't tell me you're going to kill yourself, it hurts me too.’” Of course, Castillo was terrified. She didn't sleep, slipping into the girl's room to remove knives she found there, taking Sarita's pulse while she slept.

But it never occurred to Castillo to get professional help. It didn't occur to her that even for someone as poor as she, there was help to be had.

That isolation -- not just from services, but even from mainstream understanding about suicide -- is widespread among Latino parents, says Westurn, the Dallas clinic director. "They don't have education, for example from the media. There is no effort to reach them in a way that's sensitive to their language and culture."

The result, she said, is that Latino parents, especially mothers, dismiss the pain that every suicide attempt shows. Only last month, Westurn says, she counseled a Hispanic family whose daughter had hacked at the veins on both arms. The girl's mother insisted it wasn't a suicide bid. "She said, 'Oh, she doesn't want to kill herself. She wants attention.' "

On a certain level, that's true. One of the most mysterious aspects of Latina suicide attempts is their low completion rate. While a high percentage of girls try to take their lives, far fewer of them, relative to their white and African American peers, succeed.

Attacks on their bodies may seem the only avenue for rebellion, says Cecilia Gutierrez, a Dallas therapist who works closely with suicidal girls and their families. Consistently, Gutierrez says, the girls say they rebelled against unequal treatment.

"Typically, I think, boys are more doted on," Gutierrez says of the families she's treated. "There's definitely a sense that the boy can do no wrong. And that is definitely not true for the girls. The girls are a lot more sheltered and protected. They're much more restricted."

For Candelaria Castillo and her daughter, the circle of misunderstanding grew even more binding because it only included the two of them. Working incessantly to support relatives here in the U.S. and in their home countries, Latino fathers are often emotionally absent from their families, therapist Muzquiz says. Sometimes, they're physically absent too. Women head about 21% of Hispanic households, as opposed to 12% of non-Hispanic white households, the 2000 census reported.

Often, these mothers find themselves having to deal with frightening new challenges alone. Language differences tear children away from Spanish-speaking mothers who came here to give their girls schooling they themselves didn't have. Westurn, the Dallas clinic director, remembers treating one adolescent so bent on Americanizing he refused to speak Spanish -- his native tongue -- even during therapy.

Cracking the parents' isolation is even more crucial, and harder, than reaching daughters, Westurn said. 

When Sarita Castillo finally got professional help, it was in 2005 -- three years after she first threatened suicide. That’s when doctors diagnosed the 16-year-old’s condition as bipolar. Finally, Sarita began to receive treatment, including medicine, at the nonprofit Ripley House community center. The treatment, so far, has worked partially.

Sarita still rages at her mother over the teenager's friends and dating habits. Routinely, she runs away. The most recent time Sarita disappeared was November. Her mother has planted herself in the house waiting for the girl's return.

How she wishes, Castillo says, she'd known to look for outside help years earlier. Now she pins her hopes on the professionals at Ripley House. "If only I had been more alert," Castillo said. "If only my chamaquita comes home for her next appointment."

Tu Conexión*

National Hopeline Network: 1-800-784-2433 or www.hopeline.com/

National Suicide Prevention Lifeline: 1-800-273-TALK (8255) or www.suicidepreventionlifeline.org/

American Association of Suicidology’s Fact Sheets in English and Spanish: www.suicidology.org/displaycommon.cfm?an=1&subarticlenbr=185

Centro de Mi Salud (bilingual behavioral healthcare services in Dallas): www.centromisalud.com/

San Francisco Suicide Prevention: www.sfsuicide.org/html/about.html

* All links are provided for informational reasons only; inclusion on this list does not imply endorsement of these organizations, their philosophies or their sponsors.