An interview with Congresswoman Eddie Bernice Johnson about the tenth leading killer of Americans — suicide

Johnson cosponsored the National Suicide Hotline Designation Act, to make 9–8–8 a national crisis hotline. Amidst a pandemic and historic job losses, could it mitigate a deepening crisis?

We are the stories we tell. But, because ignoring something doesn’t make it go away, we are also the stories we don’t tell.

There’s no story Americans don’t tell, in proportion to lives taken, more than suicide. It’s the tenth leading killer of Americans, the tenth leading cause of death worldwide.

I lost my brother Kyle to suicide in 2008, one of an extraordinary increase of about 10,000 suicides linked to the Great Recession of 2007–2009. I think we need to talk much more openly about suicides.

Sadly, if history’s any guide, the United States may soon be seeing a new wave of suicides linked to the loss of 40 million jobs during the current pandemic.

Enter Congresswoman Eddie Bernice Johnson. The 84-year-old Texas Democrat, who I interviewed May 29, is not just an historic black female legislator and leader, the first registered nurse in Congress, or the first African-American female Chief Psychiatric Nurse at the V.A. Hospital in Dallas. She also thinks we need to talk—and do—more about suicides.

Johnson isn’t on the committees that usually address this, but the former psychiatric chief “kept an eye out,” and became cosponsor of the National Suicide Hotline Designation Act, which is attached to the HEROES Act in the House. (The act was passed in a separate bill, S.2661, by the Senate.) It would designate a new three-digit mental health crisis number, 988, and allow state and local authorities to collect fees or impose taxes to pay for it.

It could help head off unnecessary deaths in the wake of the significant social and economic upheaval caused by the current pandemic. People subject to life-or-death stress levels can’t remember 1–800–273–8255 even in the best of times, Congresswoman Johnson says.

This isn’t one of them.

“All of a sudden, one day, their job is gone, they can’t pay their bills, their kids can’t go to school, and you can’t get away from the house,” Johnson says. “That’s a real big change. And we have not dealt with that aspect of it.”

Johnson was the first registered nurse elected to Congress and for years was chief psychiatric nurse at the Dallas V.A. She’s lost patients to suicide.

Johnson speaks about suicide within the context of decades of disinvestment in mental health, Medicaid and social services. She says that for many years, “there was no such thing” as mental illness, much less suicide. “Many of the people that were pushing that [idea], to me, had mental problems that could have done better with a little treatment.”

Her interest in helping people with mental illness, she says, originated from simply trying to understand people, and prejudice.

Congresswoman Johnson says law enforcement professionals who respond to 911 calls “don’t always have the people that answer that number prepared to deal with emotional situations of that sort. That’s strictly law enforcement, and we’ve seen lots of lives lost when the police go to give remedy to a family that is dealing with a mentally ill person.”

When cops kill a suicidal family member, “that whole family is destroyed emotionally for the rest of their lives.”

About 70 percent of Americans who die by suicide are white males, but we’re also seeing a rise in suicides among black youth. Johnson is on the Congressional Black Caucus’ Youth Suicide Task Force, and seeking to fund additional research into that trend. Suicide disproportionately affects the LGBT community, younger people, and military veterans.

These are all vulnerable communities this country should be standing up for, but it doesn’t always happen.

“People are uncomfortable dealing with mental health,” Johnson says. “I think primarily [that’s] because there’s probably a little sense in everyone’s head of whether or not they’re quite all right mentally.”

In other words, mental illness, and stress, isn’t something that’s just the burden of a small group of people we can dismiss with the word “crazy.” It’s as normal as any other health problem; Johnson compares it to appendicitis.

We all have to be ready for those moments when, as Johnson puts it, “the stress hits.” And we all need to do what we can to help those most affected.

Below is my transcription of a recorded phone interview with the congresswoman.

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Interview with Congresswoman Eddie Bernice Johnson, May 29, 2020

I want to ask you about the National Suicide Designation Act, the 9–8–8 hotline bill, which you co-sponsored. You’ve been fighting for this issue for a long time, can you tell me about that?

Well, actually, it has not been so much a fight as it has been trying to get some scheduling. I am a psychiatric nurse; that was my profession before I ran for office. Being around people who are suffering with all kinds of mental and emotional problems, I was quite aware that when the stress hits, it is not a time to complicate it with some type of remedy or relief for them. So trying to remember a number that’s a lot of digits, it’s not going to service people that well under stress.

So I was trying to get a shorter number, and trying to make it so common, like 911 or 411, that it would not be that difficult for them to get the telephone and dial three digits. When you talk about dialing seven and eight digits, just trying to remember that number at a time when someone is under stress, it is just not going to be that successful.

What did you learn about suicide from being the chief psychiatric nurse at the Dallas V.A.?

I guess my interest has been trying to understand people, and understand stressors. I grew up in Waco, Texas, and I’m black. It was not that easy to understand why there was so much prejudice. I grew up in a mixed neighborhood where neighbors got along very well, but there was also a sense that you had a place, and you were not to get out of that place. As I was graduating from high school and wanted to go into nursing, there was not a nationally accredited [nursing] program in the state. Which was a surprise to me, and my father was the one that encouraged me not to let that get in my way, to find a good school and just go to it.

Well, I learned of St. Mary’s at the University of Notre Dame, contacted that program, took a test and was admitted there. Well, traveling during that time, taking the train back and forth, you have a lot of time to think about things. And I became more and more curious about what really made people tick in terms of developing attitudes about various things, because it was such an overt racist attitude, especially in the South. When I got to college I had white roommates, and one was from South Carolina and was very different from the one that was from Illinois.

As the first registered nurse in Congress, have you been affected by suicide personally?

I have not been affected by anyone that I knew close. I did have a couple of patients, while I was practicing, that committed suicide, but I never had anybody as close as a family member.

What did that teach you, seeing those patients that committed suicide?

Well, it let me know that there are stresses, which people sadly become inadequate in their own mind to continue to bear. So they seek a way away from it.

The one that I remember, he was a man who had been married forty-some years and his wife died. He’d been a businessman and he ran his own business, and he closed his business and just did not know how to commit or occupy his time. His life was so changed, that closing a business and losing his wife, he had no children. And we thought, and he was a veteran, that was at the veteran’s hospital. And he went home for the weekend, and after being in therapy for three or four weeks, and we were expecting him back, and he went home and committed suicide, at a time when we thought he was actually getting better.

Wow. That must have been hard. Did that take a toll on you as well?

Well, yes. It is not anything that can be taken lightly. It is certainly a time when people feel that there must be a better way to deal with something emotionally, and sometimes, you always feel that if you can just keep them positive for the next five minutes, you can probably get a little bit of a change in how they feel. And sometimes that’s true and sometimes, of course, it isn’t.

The important thing is that the people around the person cannot take the responsibility for that person’s behavior, and sometimes that is very difficult for families and loved ones. After that [suicide] happens, many of them feel guilty or try to figure out what they could have done, but a person has control over their own behavior most of the time. And you can intercept that behavior and redirect it just so much. It just depends on whether or not you are touching that spot, where they feel the most stress. But it’s always that person’s decision, and not anybody else’s.

But it’s harder on family. And we see that all the time, because you always think, what could I have done? What did I miss? And what we try to discourage is taking on the responsibility of somebody’s feelings, and somebody’s decisions.

I see suicide as having a veil of secrecy, stigma or shame around it, and I wonder if you’ve experienced that on Capitol Hill?

Well, I have not been around anyone that I thought was close to it [suicide]. What I have used my background [for] is having somewhat of an ability to allow people to take the responsibility for their own actions. That is, not be so affected by their decisions, to be whatever they are, whether it’s racism, sexism, whatever, that’s their behavior; it is not yours. And so doing, you allow that person to be themselves, and then you be yourself. So that’s one reason why I am not really as upset when people act out of what is considered proper protocol in our society as I see others get. Because I make sure that they take their own responsibility and not give it to me.

Dena Craig, your communications director, says you don’t candy-coat. Have you talked to others in Congress that do candy-coat this issue?

Well, I don’t know if I’ve even had a conversation on suicide with anyone in Congress. But I’m talking about general behavior. I’ve seen some very ugly behavior with people. I don’t start disliking the person because of that, because I don’t take on the responsibility for their behavior. If I have an opportunity, I might say something to them directly. Or just give them the impression that I don’t dislike or hate them because of it.

How did you become involved with this, choose to cosponsor this National Suicide Designation Act? Did you come up with the idea?

Well, we have talked about it for years, because we’ve had a hotline, but the numbers are so long, that it really would take a patient carrying the number around in their pocket to be able to remember that number. When you get under a stress of choosing life or death, you are not under the normal circumstances of stress. You are at a point where you feel defeated, that you can’t deal with whatever you’re facing. If you can’t deal with that, you can’t remember no ten or twelve numbers at all.

So I have always felt that that was too much of a burden for people dealing with that percentage of stress. Whether it’s them or people just around them. If you got to fumble, and call and look for a number, you’ll probably miss the mark. But everybody knows 911. And 988 or any three numbers can be programmed in the minds of people.

We’re accustomed to programming shorter numbers. But hardly anyone is going to sit around and practice all their lives to remember a number in case someone near them that they love, or they get to the point where they’re stressed enough to think about ending their life.

That is a very stressful time. Whether somebody else thinks that what you’re dealing with is that stressful or not, the person going through that thinks that.

But how did your name get to be on this bill?

I been talking about it for years, but what happened, when you’re in Congress, you get committees, and you’re concentrating on all of the activities within the committee within which you’re functioning. But you keep your eye out. Like, I didn’t get on any committee that had to do with health care, directly. Which I wanted to, but I didn’t get it. I made the best of what I did get. But you always are sensitive and looking. Like, I have sponsored legislation dealing with mental health when I was not on the committee.

But it’s a struggle. Because people are uncomfortable dealing with mental health. I think primarily because there’s probably a little sense in everyone’s head of whether or not they’re quite all right mentally. When there is a conversation, when something like that happens, you look for a remedy, or you look for an idea. If you hear somebody talk about it, and you said ‘oh, let’s do that,’ that’s how you sometimes get on bills in the committees that are not that in which you serve.

You were just kind of looking out for this one?

Yes, looking out for opportunities in that. Because it’s very difficult for people to deal with legislation dealing with mental health, it’s very difficult.

Yeah, well, maybe that’s related to the veil of secrecy, stigma, or shame?

Yes. As a matter of fact, I’m from an area where the attitude that was prevailing even in the daily paper here, there was no such thing. And I just thought it was the silliest thing I’ve ever heard of.

No such thing as mental illness?

As mental illness. And yet many of the people that were pushing that, to me, had mental problems that could have done better with a little treatment.

Wow.

So I think that that is not uncommon. It’s probably more accepted than ever before in our history, because if you just think of the history of the treatment of mental illness, it has always been off-kilter in this country. We had institutions that we would lock people up in, state institutions, and leave them, because we didn’t know how to deal with it. And we’ve just gotten to the point where, well, it took a lawsuit to stop just piling people up in state institutions. And that was back, very early in my elected career in the 1970s, and that’s what started emptying many of the state institutions. But that’s also the thing that started homelessness.

Around 40 million people have lost jobs in recent months, and we’re seeing early reports of an increase in mental illness and suicide. Does that make this issue more urgent?

Sure. And I have really been pushing lately to try to get it moved, so we can finalize it, and get it passed into law. We are almost there. And it was passed by unanimous consent [in the House]. And the Senate, I’ve tried to press to let it go, I think they’re going to take that bill and amend it.

It’s not unusual, in my experience, to see how little feeling, on something like that, it’s not seen as urgent or important. Sometimes I think that’s just because we just, in this country, have not dealt seriously with mental illness.

Mental illness is like any other illness. If you got appendicitis, you rush to the hospital. If you get a sense of an emotional episode, rarely are people rushed to the hospital. So we have never treated mental illness as a normal illness, like we have other illnesses. We have backed away from it. We have not understood it as well, we can’t fix it with just a pill, and so we have tried to act like it wasn’t there.

Do you think our culture and our capitalist system emphasizes individual choice and decision making, and sometimes in the case of mental illness, we’re uncomfortable to talk about that because we see that as that person’s personal failing, rather than a normal part of life?

I’m sure that’s a factor. The other factor is, it cannot be treated in 48 hours. It takes therapeutic sessions, sometimes it takes a number of years of fairly intensive [therapy], and we don’t want to pay for it. And that’s the reason why they had these big institutions all by themselves, where they just stored people, supposedly protecting them, but usually protecting their family from having to be bothered with them. And not a lot of treatment was going on.

Only the persons who were extremely wealthy, and had access to an individual psychiatrist, could actually get seamless treatment. It is a long-term procedure in order to impact an emotional change, and we have not dealt with it very well in this country.

I tried at least 15 years of my life in Congress trying to get mental illness have the advantage of getting Medicaid insurance coverage if their insurance runs out [so] it won’t interfere with the treatment. I have never been able to get that done.

So assuming this gets passed into law, is that what you would like to have happen next?

I pressed them to put it in there because I know this: there are a lot of emotional changes during this time. Just common sense tells us that. Number one, the change in lifestyles, and the change in money flow to people. The change in seeing mysterious death come to your families. All of that upsets anybody who is taken from their routines, that they’re accustomed to going through every day. It has to have an emotional impact on them. Sometimes it’s worse on some than it is on others. But we can’t ignore it. We can’t ignore it because we’re not a society where everybody dies at one time.

We’ve got children and young people coming along, experiencing life growing up, and so we have to think about that. We have to make sure that the parent is not just considered someone gone crazy, but someone who’s going through an illness and has access to treatment, so that that family can feel the same way, and not be ashamed of it being an illness. I don’t know that it should be a shame for people to have an emotional impact to experience.

All of a sudden, one day, their job is gone, they can’t pay their bills, their kids can’t go to school, and you can’t get away from the house. That’s a real big change. And we have not dealt with that aspect of it. And that’s probably one of the most prevalent changes that we’re going through facing this pandemic.

Before my brother Kyle’s suicide in 2008, he was diagnosed with Crohn’s Disease, and we didn’t really realize what we were seeing as we started to see the early symptoms; we were not as able to understand it as mental illness. Can you share a story or anecdote about suicide?

Well, I worked in psychiatric nursing about 15 years. I have to say that I have been fortunate enough not to have any emotional problems that I have not been able to get through. Everyone has some challenges, and it just depends on how your emotional strength might be going through it. I feel very sure that many of the times, as I reflect on my life, my training, and going through the psychoanalytic training, certainly helped me to cope with some problems that I’ve had, that probably would have changed the course of my life, if I had not had access to knowing that emotional problems can be overcome as well.

It might be a little more difficult, and it might take a little bit longer than getting surgery for a problem. You can predict that so much better than you can predict going through an emotional time. Even people who go through drug addiction, which is an emotional problem, with treatment, you can see the end to that problem. Even though for the rest of your life you know you’ve got to be careful about not flipping into that as a remedy at a later time. You don’t think about that when you go for an appendectomy. You do the surgery, you heal, and it’s over.

There are reasons, and stresses, why people try certain things for a remedy. We’ve always looked upon drug addiction as more of a crime than an illness. Now, we’ve given more attention to the opioid crisis, in this country, primarily about where it hit, and who it hit. And that seems to take more of a priority in our country than anything else. The opioid crisis hit middle class white people that lost jobs, because of technology, primarily. And so it became a crisis. But there were people all over this country that were going through that that were just losing jobs.

I want to touch on the work with Congressional Black Caucus’ Youth Suicide Task Force. It seems like the numbers are growing for black youth with suicides or suicide attempts, but we also see statistically that white males have high suicide rates. Can you talk about the work you’re doing in that group, and how that relates to the statistics?

Most of us, are mothers, the women that are serving in Congress, and you notice when a mother loses a child. The statistics will show that with more and more frequency are we experiencing young black kids committing suicide. So we’ve had several talks. I have introduced in past legislation in my committee to research it, but we need some more in-depth research.

In [the committee on] Science, Space and Technology, we do the scientific research, but I also wanted something to come out of National Institute of Health, where they actually work more directly with people that are affected by that degree of emotions.

So we’re still working on that. So, as a group, I think it’s three or four of us working on trying to get some legislation ready for more in-depth research on why is this a new phenomenon? What is influencing this new phenomenon in this country?

It has never been nearly as common, for especially young African-Americans, to seek suicide as a remedy. We can look at certain societal changes and guess it, but we have not done any in-depth research to determine and factor what’s going on, and we think it’s important to do that, because most mental and emotional problems can be improved with the proper approaches.

I’m intrigued that you use the term “emotional problems” as often as you do, because sometimes emotions are not seen the same as psychiatric, and you’re a psychiatric practitioner?

Well, I think that’s just a matter of semantics, and I think that you take advantage of semantical descriptions to weave yourself through the environment that you’re in.

Assuming this gets signed, and gets implemented, there’s something like 163 crisis centers across the U.S. Is there anything specific you would like to see in how this gets implemented, this 988 process?

Well, I don’t think it will take a lot of effort to implement it, because people who are involved in community health centers and mental health clinics, any facility where you’re having a lot of contact with people, they need it. They see the need for it. So I think it’ll go pretty rapidly, once we get it done, I think that that number will pick up a lot more traffic than the number now, and I think that people will receive it as a very welcome thing.

It might not be nearly as much emotion expressed, because we’re still dealing with a taboo, something we don’t admit to, that there are emotional and mental illnesses. But I think people who are on those lines, in those clinics, in that social work dealing with people on a daily basis, coming to either pick up food, or pick up children, or going to [unintelligible] meals. Those are the people that pick up [on] emotional illnesses: teachers, those are the people that can detect a change in behavior quicker than anyone else.

In theory, 911 covers all emergencies, so I guess it’s unclear to some why we need a different number for mental health emergencies specifically. Is it that people are afraid of police response?

I think to a large degree that’s true as well, because I can think of several incidences that I’ve been personally aware of where, when the families got in distress and called the police, the person suffering the mental illness ended up being killed. And then that whole family is destroyed emotionally for the rest of their lives.

So 911 has not been a remedy, because you don’t always have the people that answer that number prepared to deal with emotional situations of that sort. That’s strictly law enforcement, and we’ve seen lots of lives lost when the police go to give remedy to a family that is dealing with a mentally ill person.

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